Premature Atrial Contraction (PAC)

Premature Atrial Contraction (PAC)

Premature atrial contraction is a kind of irregular heartbeat (arrhythmia). It happens when the heart beats too early and then pauses before beating again.

The heart has four areas, or chambers. Normally, electrical signals spread across the heart and make all the chambers beat together. During a PAC, the upper chambers of the heart (atria) beat too early, before they have had time to fill with blood. The heartbeat pauses afterward so the heart can fill with blood for the next beat.

Sometimes PAC can be a warning sign of another type of arrhythmia called atrial fibrillation. Atrial fibrillation may allow blood to pool in the atria and form clots. If a clot travels to the brain, it can cause a stroke.

What are the causes?

The cause of this condition is often unknown. Sometimes it is caused by heart disease or injury to the heart.

What increases the risk?

This condition is more likely to develop in children and in adults who are 50 years of age or older. Episodes may be triggered by:

  • Caffeine.
  • Alcohol.
  • Tobacco use.
  • Stimulant drugs.
  • Some medicines or supplements.
  • Stress.
  • Heart disease.

What are the signs or symptoms?

Symptoms of this condition include:

  • A feeling that your heart skipped a beat. The first heartbeat after the “skipped” beat may feel more forceful.
  • A feeling that your heart is fluttering.

How is this diagnosed?

This condition is diagnosed based on:

  • Your symptoms.
  • A physical exam. Your health care provider may listen to your heart.
  • Electrocardiogram (ECG). This is a test that records the electrical impulses of the heart.
  • Ambulatory cardiac monitor. This device records your heartbeats for 24 hours or more.

You may also have:

  • An echocardiogram to check for any heart conditions. This is a type of imaging test that uses sound waves (ultrasound) to make images of your heart.
  • Blood tests.

How is this treated?

Treatment depends on the frequency of your symptoms and other risk factors. Treatments may include:

  • Medicines (beta-blockers).
  • Catheter ablation. This is done to destroy the part of the heart tissue that sends abnormal signals.

In some cases, treatment may not be needed for this condition.

Follow these instructions at home:

Alcohol use

  • Do not drink alcohol if:
    • Your health care provider tells you not to drink.
    • You are pregnant, may be pregnant, or are planning to become pregnant.
    • Alcohol triggers your episodes.
  • If you drink alcohol, limit how much you have. You may drink:
    • 0–1 drink a day for women.
    • 0–2 drinks a day for men.
  • Be aware of how much alcohol is in your drink. In the U.S., one drink equals one typical bottle of beer (12 oz), one-half glass of wine (5 oz), or one shot of hard liquor (1½ oz).

General instructions

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • If caffeine triggers episodes, do not eat, drink, or use anything with caffeine in it.
  • Exercise regularly. Ask your health care provider what type of exercise is safe for you.
  • Find healthy ways to manage stress.
  • Try to get at least 7–9 hours of sleep each night, or as much as recommended by your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You feel your heart skipping beats.
  • Your heart skips beats and you feel dizzy, light-headed, or very tired.

Get help right away if you have:

  • Chest pain.
  • Trouble breathing.
  • Any symptoms of stroke. “BE FAST” is an easy way to remember the main warning signs of a stroke.
    • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
    • E – Eyes. Signs are trouble seeing or a sudden change in vision.
    • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
    • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
    • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
    • T – Time. Time to call emergency services. Write down what time symptoms started.
  • Other signs of stroke, such as:
    • A sudden, severe headache with no known cause.
    • Nausea or vomiting.
    • Seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • A premature atrial contraction (PAC) is a kind of irregular heartbeat (arrhythmia). It happens when the heart beats too early and then pauses before beating again.
  • Treatment depends on your symptoms and whether you have other underlying heart conditions.
  • Contact a health care provider if your heart skips beats and you feel dizzy, light-headed, or very tired.
  • In some cases, this condition may lead to a stroke. “BE FAST” is an easy way to remember the warning signs of stroke. Get help right away if you have any of the “BE FAST” signs.
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