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People may feel a flip-flop in their chest when they're under stress, haven't slept well or even during normal activity. They may say, "I felt my heart stop for a second." But in most cases, that heart-stopping feeling is actually an extra heartbeat, called a premature ventricular contraction (PVC).

They're very common. Some people feel them, but others don't."

Dr. Sarah Hussain, cardiac electrophysiologist with Penn State Heart and Vascular Institute

PVCs most often originate in the bottom chambers of the heart. "A PVC is a wider looking heartbeat," said Barbara Bentz, a certified registered nurse practitioner with the Heart and Vascular Institute. "That extra beat is almost always followed by a pause, which occurs when the heart resets back to its normal beat."

For people who feel PVCs, they can seem frightening. "They are not always dangerous," Hussain said.

Causes of PVCs can vary. They may occur in high-adrenaline situations, triggered by stress or anxiety. Others may be side effects from certain medications. Sometimes electrolyte imbalances can cause PVCs. So can too much caffeine or alcohol.

PVCs can occur at any age, young or old. The causes of PVCs often varies depending on the age of the patient.

PVCs become more of a concern if they happen frequently. "If more than 10% to 15% of a person's heartbeats in 24 hours are PVCs, that's excessive," Bentz said. The more PVCs occur, the more they can potentially cause a condition called cardiomyopathy (a weakened heart muscle).

People who have experienced a prior heart attack-;or those already diagnosed with cardiomyopathy-;should also take PVCs seriously. So too should people who experience symptoms, which can include chest pain and shortness of breath, in addition to palpitations or skipped heartbeats.

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The first step in diagnosing PVCs-;and learning whether they need treatment-;is an electrocardiogram (ECG), performed in a primary care doctor's office. A physician may recommend a wearable cardiac (Holter) monitor that will record a person's heartbeats over a 24-hour period. "That will quantify how many PVCs someone is having and the frequency of their PVCs," Hussain said.

In some cases, doctors may order an exercise stress test to see whether PVCs become worse with exertion.

Treatment for PVCs depends upon their cause. "If people only experience them when they have a large cup of coffee, then reducing caffeine intake is likely the answer," Bentz says. Other lifestyle changes may include reducing alcohol or energy drink consumption.

For people experiencing frequent PVCs, medications such as beta blockers, which slow heart rate, or calcium channel blockers, which relax the heart, may reduce the number of extra beats. Antiarrhythmic medications may also be used. If medication isn't effective or well tolerated because of side effects, doctors may recommend a minimally invasive procedure called cardiac ablation. It cauterizes the spot in the bottom chamber of the heart that causes the PVCs.

While most PVCs are harmless, people who experience any irregular heartbeat should call their doctor's office. "It may be PVCs or another type of arrhythmia," Hussain says. "So always ask to be evaluated and get an ECG."

Source:

Penn State Health

In a study of patients with kidney failure and atrial fibrillation, racial/ethnic minorities experienced higher rates of stroke compared with non-Hispanic White patients, and they were less likely to fill prescriptions of stroke-preventive medications. The findings, which appear in an upcoming issue of JASN, indicate that equalizing the distribution of such prescriptions may help address stroke-related disparities among patients.

Because patients with kidney failure and atrial fibrillation, or an irregular heartbeat, are at risk of developing strokes, they may benefit from taking blood thinners as a preventive measure. Prior studies of patients with atrial fibrillation, with or without kidney failure, have reported that minority racial/ethnic groups face a higher risk of stroke compared with Whites.

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To investigate the potential causes of such disparities, a team led by Paul L. Kimmel, MD (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health) examined information from a national registry of patients with kidney failure.

For the study, the researchers analyzed information from the United States Renal Data System to identify patients with kidney failure who initiated hemodialysis from 2006 to 2013, and then they identified those with a subsequent atrial fibrillation diagnosis and Medicare Part A/B/D insurance coverage.

Among 56,587 patients who were followed for one year, the number of strokes per 1,000 people were 84, 94, 97, and 102 in non-Hispanic White, Black, Hispanic White, and Asian patients, respectively.

Black, Hispanic White, and Asian patients filled prescriptions of the blood-thinner warfarin less often than non-Hispanic White patients, and they were more likely to experience stroke. Specifically, Black, Hispanic White, and Asian patients were 10%, 17%, and 28% less likely than non-Hispanic Whites to fill a warfarin prescription, respectively, and they were 13%, 15%, and 16% more likely to experience stroke. (The database did not provide information on whether patients were prescribed drugs, only whether they filled prescriptions.)

Analyses suggested that equalizing the warfarin distribution to that in the non-Hispanic White patient population would prevent 7%, 10%, and 12% of the stroke disparity among Black, Hispanic White, and Asian patients, respectively.

Institutional features and medical choices may play key roles underlying differences between prescriptions received by members of different groups. Our estimates suggest equalization of prescription of warfarin, a relatively inexpensive anticoagulant medication, across all ethnic/racial groups would be associated with decreased stroke rates in Black, Asian, and Hispanic White patients on hemodialysis."

Dr. Paul L. Kimmel, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Source:

American Society of Nephrology

Journal reference:

Waddy, S.P., et al. (2020) Racial/Ethnic Disparities in Atrial Fibrillation Treatment and Outcomes among Dialysis Patients in the United States. JASN. doi.org/10.1681/ASN.2019050543.