A 45 Year Old Female Presents to You with Complaints of Fluttering and Pounding Sensation in the Left Side of the Chest Since 4 – 5 Months.

Dr Saad Hussain Gillani*, Dr Saima Gillani¹

1. Associate professor Paediatrics, Ayub Medical College , Abbottabad, Pakistan.

Corresponding Author: Dr Saad Hussain Gillani, Consultant physician, Fauji Foundation Hospital, Pakistan.

Copy Right: © 2022 Dr Saad Hussain Gillani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: January 20, 2022

Published Date: February 01, 2022   

Case History:

A 45-year-old female presents to you with complaints of fluttering and pounding sensation in the left side of the chest for 4 – 5 months.

On examination, Her Blood pressure is 123/73 mmHg.

ECG is given below:

She consumes a lot amount of coffee.

 1. What are the findings in the ECG?

 2. What are the causes of this condition?

 3. How will you manage this patient?

Figure 1

1. What are the findings in the ECG?

This patient's ECG shows PVCs / Premature ventricular contractions.

Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of the ventricles of the heart.

These extra beats disrupt regular heart rhythm, sometimes causing the patient to feel a fluttering or a skipped beat in their chest.

2. What are the causes of this condition?

Certain triggers, heart diseases or changes in the body can make cells in the ventricles electrically unstable.

Heart disease or scarring may also cause electrical impulses to be misrouted.

Premature ventricular contractions can be associated with:

Certain medications, including decongestants and antihistamines alcohol or illegal drugs.

Increased levels of adrenaline in the body may be caused by caffeine, tobacco, exercise or anxiety.

Injury to the heart muscle from coronary artery disease, congenital heart disease, high blood pressure or heart failure.

3. How will you manage this patient?

For most people, PVCs with an otherwise normal heart won't need treatment.

However, if the patient has frequent PVCs, treatment may be needed.

In some cases, if a patient have heart disease that could lead to more-serious rhythm problems, the following may be needed:

Lifestyle changes. Eliminating common PVC triggers — such as caffeine or tobacco — can decrease the frequency and severity of patients' symptoms.

Medications. Beta-blockers — which are often used to treat high blood pressure and heart disease — can suppress premature contractions.

Other medications, such as calcium channel blockers, or anti-arrhythmic drugs, such as amiodarone or flecainide also might be used if ventricular tachycardia or frequent PVCs interfere with the heart's function.

Radiofrequency catheter ablation.

PVCs that don't respond to lifestyle changes or medications, might need ablation therapy. This procedure uses radiofrequency energy to destroy the area of heart tissue that is causing irregular contractions.