Ectopics, exercise and sudden death

hi guys um my name is Sanjay Gupta I'm a consultant cardiologist and I work in York um over the past two or three days I've gotten to know a lot of new people um uh who've been sharing my videos in Facebook groups and um through that I've met a lot of new people and um I've really enjoyed meeting them and I'm grateful for all the really kind comments I've received uh and uh I also wanted to say happy birthday to Kendra who's a new friend um that I made recently anyway so one of the um interesting questions that has been raised by a few of you is the subject of having ectopic beats which come on during exercise and the reason this worries people is because it scares them about exercising further um it also makes them worry about whether they may develop ventricular tachycardia ventricular fibrillation and drop down dead and therefore a lot of people then stop exercising for fear of that happening and I therefore thought I would do a little video on the subject of ectopics uh particularly those that come on on exercise and sudden death okay so the first thing to say is that it is not uncommon for people to develop big topics it is generally uncommon for people to get a lot of their topics so what do I mean by that well there was a study in um I think it was in 19 um gosh I can't remember but it was there was a study in uh 2004 published in the circulation journal and it was um by a guy called ramachandran as the sun in in circulation okay and what they did was they looked at the Framingham uh Offspring participants so Framingham uh the Framingham study the framing of monster studies a epidemiological study and they looked at 2885 patients uh all of whom had exercise tests and they then went and started trying to work out how many of them actually developed their topics during the exercise okay these were asymptomatic patients so these patients did not have any symptoms they they simply had exercise testing as a part and parcel of the study that they were participating in and these guys then looked back and said how many of these guys actually get egg topics when they exercise and you know it was 27 percent of them had some form Factory okay so having a topics on exercise is not uncommon a quarter of asymptomatic people can have it then they said well how many people get a lot of activity and a lot of activities defined by having more than 10 percent of all Beats during the exercise test as ectopic beats okay and in young people that is vanishingly low and in fact only I think four people out of the 2885 people they studied had more than 10 percent of their beats uh worktopics now if you look at a slightly older population there was another study that was published in uh the Journal of American College of Cardiology by a guy called uh flag JL flag and this was published in 1989 and they took a slightly older population and um this population was between 21 to 96 years and they found that almost 10 almost seven percent seven percent developed free conductivity which is defined as greater than 10 percent of all Beats being ectopic beats okay and the people who get these are generally older they're generally men and they're generally people who have high blood pressure and therefore they're generally by definition more by they're generally by inference more likely to have coronary artery disease because they're older and they have high blood pressure but in young people it is very uncommon to get a lot of activity but it is common to get some entity okay so that should be a bit of reassurance that you're not alone and it isn't all that bad if you get some ectopics on exercise but if you get a lot of vector picks a lot of egg topics on exercise uh then that probably wants a bit more investigation um so there was an interesting paper where they looked at evaluation of cardiac arrhythmias amongst athletes and um basically this was done by a guy called Hugh Calkins and nazarian and basically ventricular tachycardia which is unassociated with structural heart disease so what I'm basically trying to say is that if you get ectopics on exercise it's worth getting checked them out it's getting it's worth getting them checked out it's worth having an echocardiogram and a stress test and a holster and it's worth knowing how many ectopics you get when you exercise now if you're getting infrequented topics you know some people get 10 15 ectopic don't worry about it it doesn't matter if you're getting more frequent topics it is worth knowing whether you have underlying structural heart disease or not and in particular the echo is useful because it will tell you if you have hypertrophic cardiomyopathy which can be serious and if you have arithmogenic right ventricular dysplasia although sometimes you need an MRI scan to look for that but otherwise if you have a structurally normal heart a ventricular tachycardia does sometimes occur but there is little Associated risk of sudden death from it okay if it does occur it's most likely due to be right ventricular outflow track tachycardia um and I'm just trying to find it a right ventricular track tacky card here uh and um this is because exercise for some reason increases the cycling A and P levels which lead to an increase in intracellular calcium and that causes the tachycardia and it's important when you find that particular tachycardia or right ventricular output track tachycardia to make sure that the patient doesn't have something called a rhythmogenic right ventricular dysplasia which is uh which is structural heart disease and this particular tachycardia is very amenable to ablation so even even if you get ventricular tachycardia on exercise in the absence of structural heart disease it is unlikely to cause you to drop down dead if you do have structural heart disease um sorry if you if you do get ventricular tachycardia in the absence of structural heart disease it is important and to get that defined and usually it's right ventricular outflow tract tachycardia which is amenable to ablation and can be cured okay um and that's really about it I mean if if the other thing to say is that if you are getting a lot of ectopics on exercise you are not found to have structural heart disease you don't have any family history of sudden cardiac death you're not blacking out with your ectopics and you you're a rhythmia or your topics are not significantly worsening with exercise then most people wouldn't even stop you from exercising so I hope this provides you with a little bit of reassurance that and you know the the that the um that ectopics that come on on exercise are not uh always a marker of something bad and they are common uh and it's only when you get very very frequent ectopics um which cause you to be unwell in some way which cause you to you know collapse or and particularly if you found that structural heart disease well then they're important otherwise all you need to do is if you get them get checked out make sure you don't have structural heart disease and once you um once that's been excluded get on with your life get on with your exercise and don't worry about it all right so I hope this helps um now I just wanted to tell you that uh you can contact me on www.yorkcardiology.com uh you can ring my secretary on that number um if you wanted to um have a virtual consultation or a consultation by phone I'm also available on Twitter and I'm also available on Facebook so um I wish you all the best and I'll speak to you soon bye

Channel: York Cardiology

Views: 96,133

Keywords: #hangoutsonair, Hangouts On Air, #hoa, sudden death, vtach, vfib, pvcs, pacs, ectopics, palpitations, heart palpitations, Cardiac Ectopy (Disease Or Medical Condition), Physical Exercise (Interest), Sudden Cardiac Death (Disease Or Medical Condition)

Id: ZE8xmpzgOBA

Length: 9min 26sec (566 seconds)

Published: Sun Jun 28 2015