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PREMATURE VENTRICULAR CONTRACTION (PVC)

What Is a PVC?

The heart has two upper chambers (atria) and two lower chambers (ventricles). In normal rhythm, the heartbeat begins in the sinoatrial (SA) node, which is the heart’s natural pacemaker in the right upper chamber. The SA node sends out an electrical signal that causes the atria to contract. This signal then moves throughout the heart’s electrical conduction system, later causing the ventricles to contract. With a PVC, however, the electrical signal starts earlier than it should and originates from a site in the bottom chambers of the heart.

The pattern is a normal beat followed by an extra beat (the PVC), then a slight pause (during which the electrical system of the heart resets, and the heart fills with more blood), and then a stronger-than-normal beat. People can be asymptomatic or may have symptoms related to the pause or the subsequent forceful beat after the PVC.

Who Is at Risk for PVCs?

  • Almost everyone has PVCs at some time, from childhood through adulthood.
  • In a study of healthy members of the military, the incidence of PVCs was 0.5% among those under the age of 20 and 2.2% among those over the age of 50. This study shows the rise in PVCs—as in all types of abnormal heart rhythms—that occurs with age.
  • PVCs occur more commonly in older people and individuals with underlying heart disease, including a history of heart attack and high blood pressure.
  • PVCs may also be indicative of cardiomyopathy, valvular disease, atherosclerosis, and endocarditis.
  • PVCs can predispose you to serious arrhythmias if they occur in association with a heart attack or during cardiomyopathy.
  • People with a family history of cardiac arrhythmias (abnormal heart rhythm) also have a higher risk for PVCs.
  • PVCs can also occur in healthy hearts and may simply be a response to:
    • Increased catecholamines (adrenaline excess such as at times of stress)
    • Substances like caffeine, cocaine, and alcohol
    • Hypoxia (low amounts of oxygen in the blood). For example, hypoxia occurs with lung diseases such as emphysema or chronic obstructive pulmonary disease (COPD).
    • Fever
    • Prescription pills like tricyclic antidepressants, sympathomimetics, and digoxin
    • Electrolyte disturbances like hypokalemia (low blood levels of potassium) and hypomagnesemia (low blood levels of magnesium). Hypokalemia and hypomagnesemia can occur, for example, in patients taking diuretics (water pills).
    • Sleep deprivation
    • Physical exertion
    • Exhaustion

What Are the Symptoms of PVCs?

Many people with PVCs are asymptomatic and may not even know that they have them. Others may have symptoms that range from mild to severe, depending on the individual and the frequency of the PVCs.

  • When a PVC occurs as a single premature beat, patients may describe the feeling as a “palpitation” or “skipped beat.”
  • The beat following the PVC can be strong enough to cause pain or discomfort in the chest.
  • Individuals who have frequent PVCs or a series of them may experience a fluttering sensation in the chest or neck or shortness of breath shortness of breath.
  • If PVCs are frequent enough to reduce the heart’s pumping ability, the individual may experience weakness, dizziness, or fainting. This is because frequent premature ventricular contractions can diminish the ability of the heart to pump blood to the other organs (diminished cardiac output), resulting in low blood pressure.

What Are the Risks Associated with PVCs?

  • Most PVCs occur infrequently and are benign. Frequent PVCs may increase the risk of developing other, more serious cardiac arrhythmias.
  • Individuals with frequent PVCs who have underlying heart disease, structural abnormalities in the heart, or have had a previous heart attack have a higher risk of death.
  • Over time, frequent PVCs can, in some patients, cause changes in heart function. This is called cardiomyopathy, which is a weakening of the heart muscle.

Workup for PVCs

  • PVCs can be difficult to diagnose because they occur at unpredictable intervals.
  • In most cases, PVCs are difficult to detect during a routine physical unless you have one during the exam or while getting a routine electrocardiogram (EKG).
  • In patients with known heart disease, PVCs may incidentally be detected during other diagnostic testing for that condition.

Electrocardiogram (EKG)

  • An EKG is the standard test for diagnosing PVCs.
  • An electrophysiologist, which is a cardiologist specifically trained in heart rhythms, can look at the PVC on the EKG and determine its morphology (shape). This allows your provider to better treat you since some PVCs’ morphologies are known to be benign, and some can be more sensitive to certain medications or catheter ablation

Heart Monitoring

  • A provider may order a heart monitor, with the length of the monitoring depending on the frequency of the symptoms. The information from a heart monitor is very useful in determining the frequency of the PVCs and correlating symptoms with the arrhythmia.

Echocardiogram

  • An echocardiogram is an ultrasound of the heart and is useful in assessing the overall size and function of the heart’s chambers, walls, and valves.
  • Even if you have no symptoms or only minimal symptoms, patients with a high PVC burden require follow-up with an echocardiogram because of the association between frequent PVCs and arrhythmia-induced cardiomyopathy (weakening of the heart).

Stress Testing

  • Because of the known association between PVCs and heart disease, it is common for people with PVCs—especially PVCs that occur frequently or with a certain morphology—to undergo stress testing to rule out signs of ischemia.

How Are PVCs Treated?

The reasons for treating premature ventricular contractions are to relieve symptoms of palpitations, to treat conditions that cause premature ventricular contractions since many conditions that cause premature ventricular contractions are potentially life-threatening, and to prevent ventricular tachycardia and sudden death.

  • For individuals who experience occasional PVCs with no other symptoms and no underlying heart disease or structural problems, no treatment is necessary.
  • Lifestyle changes: You can help control your PVCs by reducing or eliminating your caffeine, tobacco, and alcohol intake and reducing stress and anxiety. Stop the use of over-the-counter (OTC) nasal decongestants that may contain adrenaline such as medications containing pseudoephedrine.
  • If the medication you take routinely is causing your PVCs, we will discuss a possible change in medication.
  • When PVCs are due to some form of heart disease or structural abnormality, treating that problem often causes the PVCs to go away.
  • Medications: Beta-blockers—which are often used to treat high blood pressure and heart disease—can suppress premature contractions. Other medications, such as calcium channel blockers, or anti-arrhythmic drugs, such as amiodarone (Pacerone) or flecainide (Tambocor), also might be used if you have ventricular tachycardia or frequent PVCs that interfere with your heart’s function.
  • Radiofrequency catheter ablation. For PVCs that don’t respond to lifestyle changes or medications, your doctor may recommend ablation therapy. This procedure uses radiofrequency energy to destroy the area of heart tissue that is causing your irregular contractions.

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