Hu Dayi: Case story - early beat is not a disease, "heart disease" is a disease

Entering the clinic was an emaciated, weary young and middle-aged woman.

Patient: I've always had my heart beat prematurely.

Professor Hu Dayi: When did it find out?

Patient: In 2010, I started 4 months pregnant. It was not strong at first, but the more it got to the back, the more powerful it was, and Holter found more than 10,000 times in 24 hours.

Professor Hu Dayi: Is there any discomfort in the early beat?

Patient: It's like the heart is beating, like it's going to jump out.

Professor Hu Dayi: Are you okay after giving birth?

Patient: Immediately after giving birth, there will be no more. After a month or two of confinement, it appeared again, also more than 10,000 times a day.

Professor Hu Dayi: How did you cure it at that time?

Patient: Went to Shanghai ×× Hospital for 18 days. When she was pregnant, she ate danshen tablets and Ning Xinbao in Shanghai ×× Hospital. After giving birth, I went to the ×× hospital and ate a flat heart rhythm. After eating a week, the heartbeat slowed down to more than 40 times, and I felt very uncomfortable, so I went to the Chinese medicine hospital and used proprietary Chinese medicine, and there was no treatment for a few days. A doctor at the Chinese medicine hospital said that I had a small heart and had surgery. I went to the best hospital in Shanghai and the doctor advised me to operate.

Professor Hu Dayi: Have you always had early beats since then?

Patient: After seeing the Chinese medicine hospital, I took Chinese medicine for more than 1 month, and the effect was not very good. Later, there have always been, and now more than 30,000 times. I checked on regularly and didn't feel very comfortable.

Professor Hu Dayi: What else do you feel?

Patient: a little chest tightness, the arm has been sore. Now I occasionally stand and faint, feeling like I'm going to faint but not fainting.

Professor Hu Dayi: How is blood pressure?

Patients: high pressure of about 105mmhg, low pressure of 60~70mmhg.

Psychiatrist: Have you lost weight?

Patient: 2 to 2.5 kg thinner than before giving birth.

Psychiatrist: Is it easy to be nervous?

Patient: I feel that my guts have become smaller, and it is easy to panic when there is a little sound outside. If you can't exercise, you will jump harder if you exercise vigorously.

Psychiatrist: What kind of sports will be uncomfortable?

Patient: A little running on the treadmill is uncomfortable. It feels like people are particularly tired.

Psychiatrist: Has it become easy to get anxious?

Patient: Yes, it is easy to lose your temper when encountering unsatisfactory things, and your temper used to be very good.

Psychiatrists: What do you do?

Patient: Opened a store in Shanghai.

Psychiatrist: Have you ever had any serious illness?

Family (mother): When I was 18 years old, I had a high fever, and I was hospitalized for four or five days without falling, and the doctor said that it seemed to be myocarditis, and the final cause was not checked. I don't know if her current illness is related to myocarditis.

Psychiatrist: Are you allergic to anything?

Patients: penicillin allergy.

Psychiatrist: Menstrual regularity?

Patient: Very regular.

Psychiatrist: Is it easy to be irritable before menstruation?

Patients: There is a point, there is dysmenorrhea.

Psychiatrist: Is there still a baby after giving birth?

Patient: Yes, I had a caesarean section because the heart was not good and the doctor recommended a caesarean section.

Psychiatrist: How old is the child?

Patient: More than 3 years old.

Psychiatrist: I was born in 2010 at the age of 4.

Patient: I'm a bit confused now, and I feel like my memory is also losing.

Psychiatrist: Do you feel early beats?

Patient: When it is quiet, it feels more obvious, and when doing things, it is not felt.

Psychiatrist: Have you used arrhythmia?

Patient: After eating for a week, feeling uncomfortable, go to check for slow heartbeat.

Psychiatrist: Do family members have a similar illness?

Family members of the patient: Her father had tachycardia.

Professor Hu Dayi: Do you have feelings now?

Patient: There is a point when I sleep at night and feel that I jump more severely on my side, as if I am pressed.

Professor Hu Dayi: From ultrasound, the heart function and structure are normal, and premature beats are not a disease, nor is there a risk. You can do ultrasound every year or two. If you take medicine and feel bad, you can skip it, try to downplay this matter.

Patient: I don't dare to take Western medicine now, afraid of sudden death, so I always carry "heart-saving pills" every day.

Professor Hu Dayi: You try not to pay attention to it, it is very benign, there is no danger. Don't be a holter all the time, make 20,000, 30,000 you are more annoyed. There is also no need for radiofrequency ablation surgery. If you are willing to take medicine, you can take mexilobi. But my advice is still: the best treatment is not to treat.

Psychiatrist: What exactly do you do in your industry?

Patient: I'm in the shop during the day and doing Taobao at night.

Psychiatrist: Are you busy with business?

Patients: at night until one or two o'clock, in the morning sleep until ninety o'clock.

Psychiatrist: Isn't life very regular?

Patient: Right.

Psychiatrist: You are not a typical anxiety disorder, but you are easily annoyed, and if you are willing to use some medicine to adjust your mood, it can help you.

Patient: Can I exercise?

Professor Hu Dayi: You can exercise, if you don't believe it, you can make an activity board, it should be the more you exercise, the better.

Patient: Running on the treadmill for a while is very tiring.

Professor Hu Dayi: The more you don't move, the worse your body is, and the more you exercise, the less you beat.

Patient: Is it related to myocarditis?

Professor Hu Dayi: Now that you don't have myocarditis, the function of the heart is normal.

Psychiatrist: You can use Delixin first, and if you eat it for a while, you don't have to eat mexiletine. Eating for 1 week will show results, and it will improve significantly in 1 month. If you have been particularly uncomfortable for a while you can use a tablet of midazolam, you can relieve the symptoms.

Patient's family: Does she need to eat anything nutritious?

Professor Hu Dayi: No, she needs to live a relaxed life.

Doctor's summary

Premature beats are not diseases, there is no independent risk, there are premature beats caused by heart disease, and early beats are not treated for heart disease. In this case, the echocardiogram results were not abnormal, the doctor did not have a correct understanding of this premature beat, and advised the patient to undergo "surgical" treatment, coupled with the patient's ambiguous "myocarditis" at the age of 18, his father's "paroxysmal supraventricular tachycardia", so that the patient was overly sensitive to the symptoms of his premature beat, and was overly worried about the prognosis of the premature beat (worried about sudden death), so that the "heart-saving pill" was always carried on the body. The patient's irregular, lack of exercise life, and the pressure in the workplace have left her in an atypical anxiety for a long time. The synergy of the above factors makes patients more and more worried about their premature beats and seek medical treatment everywhere.

This symptom is not heart disease, but "heart disease", which makes the patient's quality of life poor and puts stress on the whole family.

Correct, patient, clear explanation, follow-up echocardiogram once a year, to dispel the doubts in the patient's mind, in order to make the patient return to normal life.