When the heart beats in the wrong place, why do some people get chest pain?
When someone has ectopic beats, chest pain is one of the most common symptoms. Patients frequently report feeling of pain when an extra beat occurs. Most doctors will be able to diagnose it as extra contractions of the heart, but this is rarely enough for patients just to know this. In this article, I’m going to try to explain it in a simple way.
Mechanics of a heartbeat
First, let’s understand how your heart beats. First, picture the heart getting smaller, like a spring. Spring is a flexible object that changes shape when a force is put on it and then goes back to its original shape when the force is taken away. Think of a heat pump as a spring to understand how it works. In physics, you do work and use energy when you push on a spring to make it shorter. Energy is used to do this, and the spring takes in that energy. Then letting go of the spring releases that energy. Next, imagine the electric currents of the heart set by a pacemaker. Imagine someone hitting a gong to help you understand how a pacemaker works. A pacemaker is like a musician who hits a gong. After each hit, he waits until the sound dies down and the echo goes away before hitting again. When the pacemaker hits the gong and the heart fills with blood, the spring loosens and lets out energy to push the blood out of the heart. Now, if you wait longer between gongs, the heart will have more time to fill with blood, and the “spring” will tighten and be filled with more energy stored.
Ectopic heartbeat and why it causes symptom
Now, let’s talk about extra beats. The same musician had just hit the gong and was waiting for it to reverberate. But suddenly out of nowhere, someone else rang the gong. The pacemaker then has to wait for the echo of the second hit to go away before it can hit the gong again. This extra beat happens when the heart isn’t full of blood and someone hits a gong before the heart has a chance to fill with blood. So, when it beats, it feels empty because there isn’t much blood flowing out due to the spring not being fully compressed. After that, there is a delay while the pacemaker waits for the echo of the gong to go away. This gives the heart more time to fill with blood and “spring stretch.” The longer the spring waits, the more energy it stores. When the next pacemaker fires, the spring loosens and pushes more blood through the heart. Because the heart is pumping out much more blood, you experience a forceful beat. I think this is why some people experience a symptom of pain from ectopic beats. If these ectopic beats happen often, the symptoms can be very bad and keep coming back.
What can you do
When this happens, the first thing you can do is an exercise to speed up the pacemaker and make it more regular. This will make it less likely that the gong can be struck again by somebody else. Also, avoid things like alcohol or caffeine that are known to cause arrhythmias and “gongs” that don’t sound right. To control the patient’s arrhythmias, doctors may give them drugs like beta-blockers, which slow the heart rate, or antiarrhythmic drugs, which stop the heart from beating too fast. Also, early heartbeats can be caused by stress, lack of sleep, or diseases like hyperthyroidism. Depending on rhythm control with medications, your cardiologist may seek more definitive therapy such as radiofrequency ablation.
I hope this simple comparison helps you understand how chest pain can be caused by an ectopic heartbeat.