The prognosis on extra heartbeat is usually normal
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I’m an 83-year-old woman in very good health who takes no medications. My doctor informed me that I have an “extra” heartbeat, but I have no noticeable symptoms. What is my prognosis? Will my heart wear out sooner? — R.P.
ANSWER: Based on what you’ve told me, I’m going to guess that you have an irregular heart rate due to some premature beats. These beats may come from the upper chambers of the heart or from the lower chambers. “Premature atrial contractions” or “supraventricular premature beats” are both terms used frequently to describe upper-chamber originators, and “premature ventricular contractions” describes those from the lower. In people with otherwise normal hearts, these are common and benign.
Some people have so many premature beats that the beats may either cause symptoms or cause the heart rate to be faster than optimal. A too-fast heart rate is an uncommon cause of heart failure. In such cases, medication can be used to regulate the heart rate. Even more rarely, the source of the abnormal premature beat can be removed via radiofrequency waves.
Physicians need to be cautious about the words we use, especially in reference to the heart, and do a better job explaining that some conditions of the heart — such as many murmurs, valvular leakages and rhythm changes — are not necessarily a cause for alarm.
DEAR DR. ROACH: My grandson is 27 years old and a second-year medical student. He was recently diagnosed with Wilson disease. I have never heard of this disease, and I wonder if you have information on it or any group I could reach out to for him. — M.S.
ANSWER: Your grandson has probably read a lot about Wilson disease already, as I’m sure he will want to know as much as he can.
Wilson disease is a malfunction of copper transport within the cell. Many people don’t realize that copper has important roles in cellular metabolism.
It is an uncommon disease, seen in about 1 person in 30,000, and because it prevents excretion of copper, it causes copper to build up and damage organs, especially the eye, liver and brain. Different people may develop different symptoms. Wilson disease runs in families, so his siblings and parents should be considered for screening. The diagnosis is made by a combination of blood and urine tests, and often in combination with genetic testing.
In the liver, copper can build up to cause symptoms such as pain or jaundice. Without treatment, liver cirrhosis and failure can occur in some people. Neurological symptoms are varied, but often start with movement difficulties. The copper itself can be seen in the eye (called Kayser-Fleischer rings) in advanced cases.
Treatment is to get rid of excess copper, usually with a drug that binds the copper and is then excreted, such as penicillamine (as its name suggests, it’s related to penicillin but is not an antibiotic). Unfortunately, penicillamine has quite a few side effects that limit its use, and there are alternatives now. Zinc prevents absorption of copper so it can be used to maintain normal copper levels once they are back to normal.
Once treatment is started, most people return quickly to normal, as long as the disease has not become too advanced. This is why it’s so important to make the diagnosis early.