What is the link between psychologic stress, caffeine, sympathetic activity and ventricular ectopics?

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Karthik Viswanathan, Coronary Artery Disease Clinical Research Network Group, Leeds Institute for Genetic, Health & Therapeutics, Leeds, United Kingdom. E-mail: drkarthikv at gmail dot com

I see a lot of patients referred to us in the cardiology department with palpitations due to ventricular ectopics, and if there is no evidence of structural heart disease or coronary artery disease, we usually reassure and discharge these patients. Some of them have unifocal ventricular ectopics, some have multifocal ventricular ectopics, others have bigeminy or trigeminy. Few have pauses with compensatory tachycardia thereafter. Very often we get asked: Is there anything we can do to stop these symptoms? We usually say that reducing caffeine, alcohol, stress may help but I don't really know if there is any physiological basis for this recommendation. Is there any evidence that physiological ventricular ectopics are driven by increased sympathetic activity or by increased levels of stress, caffeine in susceptible people?

Conflict of interests: none declared

Read the response by Mohan Shanmugam