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PAC without symptoms needn’t raise an alarm

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POSTED January 7, 2018 6:25 p.m.

DEAR DR. ROACH: I am a 72-year-old man in excellent health and physical condition. I ride a bicycle 60 miles a week, and I generally feel good. I have an irregular heartbeat in the form of a premature atrial contraction, which showed up years ago for the first time on a routine EKG. I have had this for many years, and I do not have any effects from it that I am consciously aware of. My family doctor is concerned and wants further tests. A cardiologist told me not to worry about it unless I start to have symptoms like chest pain or dizziness. My question is whether it is OK to just have this sort of irregular heartbeat for many years, or if I should look into it with further testing? -- M.M.B.

ANSWER: Premature beats come in two different types: those that originate in the atria, the smaller upper chambers of the heart (called premature atrial contractions, or PACs); and those from the thicker, larger ventricles (PVCs). Both of these are common, and the vast majority of people with them have no problems. My training and experience correlate to what your cardiologist says. 

Further, although there are medications and procedures to reduce them, there is no good evidence that the treatment will reduce your risk of a bad event like a heart attack, so treatment would be purely for those few people who are noticeably symptomatic from the premature beats.

   The booklet on abnormal heart rhythms explains the more common heart rhythm disturbances in greater detail. Readers can obtain a copy by writing: 

   Dr. Roach 

   Book No. 107 

   628 Virginia Dr. 

   Orlando, FL 32803 

   Enclose a check or money order (no cash) for $4.75 U.S./$6. Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

   DEAR DR. ROACH: Is there some reason penicillin and erythromycin are hard to get? The above antibiotics are what my old doctor prescribed. They cured what ails me! I have yet to find a doctor half as good as him. Has there been a shuffle in the medical profession? -- B.J.P.

   ANSWER: There has been a shift. Physicians are trying to prescribe fewer antibiotics overall in order to address the problem of antibiotic resistance. Antibiotics are effective against bacteria, and many times they have been prescribed for viral infections, for which they are ineffective.

   Penicillin is active against many types of bacteria, but it is considered the best treatment only for a relatively few infections. I seldom prescribe actual penicillin.

   Erythromycin also is effective against many types of bacteria. It is used less often now because newer antibiotics (azithromycin and clarithromycin in particular) are as effective or more effective and have fewer side effects. 

   I hope you find a physician you trust as much as your former physician. 

   DR. ROACH WRITES: A recent column on bad taste in the mouth (dysgeusia) generated some interesting letters, which I wanted to share. One person noted that her symptoms seemed to be from eating a certain type of pine nuts, and disappeared when she switched to Italian pine nuts (pignoli). I also heard from a person who said that eating a small amount of peanut butter solved the problem, while a clinician wrote to say he had good results prescribing probiotics. I don’t know if any of these suggestions will help, but I doubt they will hurt. 


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