Ectopic heart beats which happen on exercise

One of the biggest anxieties in people with ectopic heart beats is if they notice them on exercise and this is because everywhere you read on the internet it says that if your ectopics go away on exercise then they are benign and therefore people worry that if their ectopics are actually noticeable on exercise then that is in some way more sinister and it is not uncommon for me to get people contacting me and saying look i have had ectopics for many years and they were only at rest and now i notice them on exercise and i am panicking and i have stopped exercising

So i thought id reassure you

it is true that ectopic heart beats generally get less with exercise and this is because when you increase your heart rate you are reducing the amount of time between each heart beat and therefore there is less chance of the ectopics creeping in but that doesn’t mean you can’t have ectopic heart beats on exercise as well. In fact in my job i often have to supervise treadmill tests and i see one or two ectopic heart beatss creep in during exercise in the majority of patients.

it is also true to say that most heart conditions become more noticeable on exercise because you are increasing the demands on the heart so if you have heart artery narrowings then the first time the heart will have a problem receiving the blood it needs is when it is working really hard and therefore needs a lot more of it. Similarly if the heart is anyway damaged or a heart valve is narrowed then the first time you will notice it is when the heart is working really hard and so if the heart is struggling because it is not able to keep up it could become more irritable and therefore misfire with more ectopics

So how do you know whether it is just the kind of incidental ectopics you are noticing or whether they really do reflect that the heart is more distressed and the answer is that there are two things to look for:

consistency
progression

Consistency means that if there is major heart problem you would usually expect the ectopics to happen everytime you do the same level of exercise. If you get them one day when you are walking briskly but then you can go and do a fast run without a problem then it makes it highly unlikely that the ectopics are sinister

Progression means that if your ectopics are happening because the heart is distressed and therefore more sinister then you will find that they will increase with increased exertion which means that if you continue to exercise your ectopics will continue to get worse and worse.

It is always good to have some baseline investigations if you haven’t had any and i would always recommend a stress echocardiogram because with a stress echocardiogram you can study the heart at rest, look for consistency and progression and also work out if all the heart muscle is getting all the blood at maximal physical stress.

If you have a normal stress echo then it is highly unlikely that you need to worry about your ectopics on exercise.

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