Medical Physiology Online

Peer reviewed, open access journal. ISSN 1985-4811.

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

with one comment


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

Written by Elapulli S. Prakash

April 11, 2008 at 10:00 AM

One Response

Subscribe to comments with RSS.

  1. Stress is indeed bad for your heart!

    Reply to Karthik Viswanathan: What is the link between psychologic stress, caffeine, sympathetic activity and ventricular ectopics?

    Mohan Shanmugam, Anesthesia & Intensive Care, Abertawe Bro Morgannwg University NHS Trust, Swansea, UK; E-mail: mohan at intubator dot co dot uk

    Received, accepted and published 27 April 2008

    There appears to be adequate clinical, laboratory and cellular evidence that suggests that psychologic stress is arrhythmogenic. It is presumably related to the sympathetically mediated catecholamine surge [1-3]. Essentially, the mechanism is related to the activation of sodium-potassium-ATPase pump causing redistributional hypokalemia. The resulting hyperpolarisation of cardiac muscle cells predisposes to ventricular arrhythmias.

    While a relationship between caffeine intake and ventricular ectopics is anecdotally presumed, there is inconsistent evidence in this area. It seems caffeine, when consumed in moderate amounts (~200 mg/day), causes a relatively insignificant increase in catecholamines [4].

    The clinical management of ventricular ectopics and the current evidence base is very well summarised in a recent paper by Ng [5].

    Conflict of interests: none declared.

    [1]. Tisdale JE, Patel RV, Webb CR, Borzak S, Zarowitz BJ. Proarrhythmic effects of intravenous vasopressors. The Annals of Pharmacotherapy. 1995; 29: 269-281 available online at, accessed 27 April 2008

    [2]. Clausen T and Everts ME. Regulation of the Na, K pump in skeletal muscle. Kidney International 1989; 35: 1–13. Full text article at accessed 27 April 2008

    [3]. Macdonald JE and Struthers AD. What is the optimal serum potassium level in cardiovascular patients? Journal of the American College of Cardiology 2004; 43: 155-161; full text at accessed 27 April 2008

    [4]. Myers MG. Caffeine and cardiac arrhythmias. Chest 1988; 94: 4–5, full text at accessed 27 April 2008

    [5]. Ng GA. Treating patients with ventricular ectopic beats. Heart 2006; 92:1707-1712; extract at accessed 27 April 2008

    Reviewed by E.S.Prakash, Editor, Medical Physiology Online

    Mohan Shanmugam

    April 27, 2008 at 10:00 AM

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: