Resent onset of early beat, but I'm in China!

[Lance666]

I have developed cardiac arrhythmia just in the past month (mid-December to now), so I am not up on all the acronyms used on this forum. The symptom is an early beat rather than a fast or slow over-all beat speed. My resting pulse is around 58. The early beat might be one in five beats or one in 30. It varies widely, and is more noticed by me after eating or when first going to bed, especially if I am lying on my left side. I am 63 years old working in Shanghai, China where the air quality is poor (100-400 AQi in the winter, but hit a record over 800 once in December). I have only started wearing a respirator outdoors in the past two weeks, but plan to wear it any day the AQI is high (most days!). I have never been a smoker or heavy drinker. I am 5'6", 155 lbs. My blood pressure has not been more than slightly high until a couple of months ago after I spent a week in Beijing (December 7-13). A Chinese doctor has diagnosed the arrhythmia as related to the left ventricle and suggested radiofrequency catheter ablation. He also mentioned medication (Metopropol succinate and Mexiletine hydrochloride) as an alternative, but seemed heavily in favor of ablation. He thought my condition was alarming and should be resolved A.S.A.P., based on the high frequency of the extra beat as noted by the ultrasound technician (ultrasound required my lying on my left side, so the symptom was likely exaggerated).  He cautioned that the medication has significant side effects, and that I should decide between ablation and meds, since the meds would interfere with the ablation process. I bought but have not tried the meds, since nightmares was one side effect, and also since I am not yet sure I have a life-threatening problem.

The night after my doctor visit, I turned on the TV to see an investigative report on hospital / doctor conspiracies to bilk patients with false diagnoses and unneeded treatments. I know it is just a coincidence, but I had some thought along those lines even before seeing the TV story. China is widely known for graft, corruption, cheating, and fake drugs.

Can this be a temporary condition that might be resolved by better air quality or is surgery the only long-term solution? Is radiofrequency catheter ablation a standard procedure for early beat? Does this procedure have a very high risk? I'm trying to decide if I am nuts to allow a doctor in China to do this. The whole medical experience here is a bit chaotic, crowded, rushed, and no privacy (six patients crowd into the doctor's cubicle at once to try to get the doctor's attention, and listen carefully to everything the doctor tells me). Almost all hospitals in China are dingy and ramshackle, like a M.A.S.H. unit. I could fly back to the U.S. for the procedure, but I wonder if the delay and flight stress would be worth it, not to mention the cost being at least five times as much in the U.S.

I also have kept to a rather strict low-salt diet for years, and probably have been most observant in that this past two years. Can too little salt in the diet affect cardiac rhythm? I am now altering my diet a bit to include more salt, potassium, magnesium, and zinc, but no tablets or other supplements, just almonds, halibut, pumpkin seeds, etc. I have heard it said that doctors in the U.S. are highly trained in medicine and surgery, and not much trained in diet and nutrition, but I still want to know if any studies indicate nutrient deficiencies, poor air quality, or other environmental factors can adversely affect heart rhythm.

[MichelleP_3811]

You're funny.  Pvcs are premature ventricular contractions or extra beats coming from the ventricles and Pacs are premature atrial contractions or extra beats coming from the atria.  They are what you call early beats or ectopic beats.  They can come isolated in the above terms or if you get a bunch in a row or what is called a run of them it is termed PAT premature atrial tachycardia for the pacs and NSVT Nonsustained Ventricular Tachycardia or straight Ventricular Tachycardia if the run of beats last longer than 30 seconds.  Atrial tachycardias are not deemed a health threat with the exception of Afib which I won't get into now since it doesn't seem to pertain to you.  However, VT can pose a health risk in a diseased heart from previous heart attacks or blocked arteries.  This said, if your Holter, yes you have that right and you did have the test, it said you only had 2% of your beats were ectopics then that says to me that you occasionally feel a good number of beats but you aren't having them consistently all day long which could tax the heart out in the 20% of the beats range but you aren't having that many so that is good.  Also if your Holter report didn't say anything about any runs then you are in a better position as well.  But I would still suggest that you ask for a few more tests to check the over all health of your heart, An Echocardiogram or Echo for short is the best test but if there is suspected clogged arteries an angiogram might be a good test as well but we are talking about a little more invasive test so I would at least try to get an Echo.  This said its good you aren't having any troublesome symptoms which also indicates that your issue is likely a benign one but I am not a doctor and only a doctor can really give you a clean bill of health.  Like the above poster stated, maybe see if you can have your tests results sent to your doctor here in the states to evaluate the situation.  This would give you a good second opinion and some peace of mind.  But whenever faced with a complicated decision I always try to tell people to follow your instincts.  If you are feeling very uncomfortable about the whole situation then it is good to take a step back and evaluate if it is simply fear or if your instincts are trying to warn you.  In this case your instincts may be right in warning you to slow down a bit.  Whatever you do decide I wish you health and well being.  Take care.

[Bromley]

Hi Lance. The symptoms you describe dont sound like a serious issue, but here on the heart forum, like Michelle says, we are mostly just patients.  Its a little hard for people here to contradict a doctor, even one from overseas.

Could you somehow call a doctor in the united states for some advice? Honestly, you situation sounds like a typical presentation of simple extra beats which in my recollection dont raise a lot of concern as long as your heart is a structurally normal one (ie. No heart disease or genetic abnormalities, broken valves, etc).

Metaprolol is a fine beta blocker if it works.  As for a procedure though, there are some risks, and I would be inclined to use someone   that I have a high degree of trust in (i.e. US board certified MD's for instance).  The concerns of using a complete stranger in china would fraud, as well as additional medical complications.

Can you call someone in the US for advice?

Sorry to hear about your worries, and best of luck working through this...

[Lance666]

I was sleeping when you were answering, so now it is 8:55 a.m. I checked my pulse for over one minute this morning while lying on my right side–– no early beat. I also have a wrist-velcro-attachable blood pressure device that has shown a blinking heart icon when I notice early beats. This morning, no blinking heart icon. Of course, it's no substitute for a doctor.

"Are your ectopics pvcs or pacs? Are you having any runs or nsvt?"

I will have to do some research to translate what you say. I don't speak these acronym terms yet. I suppose nothing I already said about "doctor has diagnosed the arrhythmia as related to the left ventricle" and "symptom is an early beat rather than a fast or slow over-all beat speed" helps to answer your questions, eh?

I don't know what an echo is other than a reflected voice over a canyon, so I guess i haven';t had one. Am I the one who should make such a request or does the doctor know what to do? (I think this is my main concern in a nutshell, but you wouldn't know unless you had some knowledge of medical practice outside the U.S.)

I don't know what "a holter monitor" is. Could that be spelled "holster" like a G-man's gun belt? I did have a battery-operated ECG device attached for 24 hours. It showed 2% early beats. -- OK, got this from Wikipedia, yes, it seems it was a Holter (capitalized, man's name) monitor.

As for meds, the Mexiletine is a sodium channel blocker, and the Metoprolol is a beta blocker. I think you know a lot about general terms, but when I tell you the exact med, you don't know what it is. Wikipedia can be your friend, too.

I have no dizziness, fainting, or breathing problems. I feel normal, except the awareness of the early beats occasionally (usually only when I am sitting quietly or in bed).

[MichelleP_3811]

Unfortunately I don't know that anyone here can tell you whether you should or shouldn't proceed.  There is a professional forum on this site where you can post a question to a doctor though there is a fee.  When you go to the Forums menu choose Doctors Forum.  This said, without seeing you they may not be able to give you an actually recommendation but it might be worth a shot.  

What I personally know from my own research and you have to keep in mind I am just a patient and have no medical training but if your heart is structurally healthy then any amount you are having isn't necessarily a threat to your health especially if you aren't having any runs.  Are your ectopics pvcs or pacs?  Pacs are less a threat then pvcs. Are you having any runs or nsvt?  Are you having symptoms with these ectopics?  Do you have dizziness or are you passing out?  Do you have difficulty breathing?  

Essentially what I have read is the threshold is around 20,000 or 20% of your total beats a day is deemed a high load.  You average 86,400 beats a day of those if you have 1 every 5 beats all day long that would put you at 17,280 ectopics which is about 20% of your load.  This said, if you only have one every 30 beats this drops to only 2,880 ectopics in a day so quite a difference.  Have you had a holter monitor to see what you are averaging in a day?  Have you had an echo to see how healthy your heart is?  What is your oxygen saturation?  

I will firstly say it doesn't sound like they are trying to pull a fast one on you but if you are not experiencing any troubling symptoms that make it hard for you to function and you are not falling into vt then you don't necessarily need an ablation.  It would be more up to you if you feel it would help.  So maybe you might want to try meds though I think in the US they try beta blockers as a first line of defense before anything that is so strong to cause nightmares.  But I would definitely push to have an echo done to determine the health of your heart as well find out if any of this is nsvt which could put you at risk if there is any heart disease.  Best of luck sorting this out in a foreign country.  Take care and keep us posted on how you are doing.