MD REVIEW

Premature Ventricular Contractions

Too Many Heartbeats

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Have you ever felt a ‘skipped’ or ‘extra’ heart­beat? An odd sensa­tion that feels like a pal­pita­tion or pound­ing in the chest can follow it. You could be experiencing a pre­mature ventri­cular contrac­tion (PVC). Most people have PVCs at some point in their lives. Don’t let an isolated inci­dent alarm you. A better under­stand­ing of what they are provides clues to when further inves­tiga­tion is necessary.

What Are Premature Ventricular Contractions?

PVCs are premature extra beats from the lower chambers of the heart. Their electrical activity does not originate in the normal heart­beat. This leads to disrup­tion of your regular cardiac rhythm. Excessive PVCs are indicative of an under­lying heart condition. Frequency impairs ventricular relaxation and increases the risk of atrial fibrillation (AFib).

When amounting to 10–15% of total heart­beats, PVCs can be dangerous. If you experience more than 5 PVCs per minute, consult a cardiologist or electro­physio­logist. After treat­ment of causative factors, premature ventri­cular contrac­tions often subside.

Why Do I Feel Extra Heartbeats?

Chronic PVC Danger

Understanding the mechanism of a regular heart­beat is helpful. The human heart consists of four chambers: two atria, and two ventricles. Atria delivers the blood to the ventricle, which further pumps it to the rest of the body. The sinoatrial node (SA) is the electrical pace­maker of the heart. It creates electrical impulses that travel from atria to ventricles. These impulses contract atria and ventricles to supply blood to the rest of the body. The heartbeat that you feel is due to the contraction of the ventricle.

A PVC is a too-early heart­beat that does not originates from the sinoatrial node. It initiates from Purkinje fibers of ventricles. Therefore, PVCs occur before the regular heart­beat. The stronger heart­beat that follows creates the feeling of an extra beat.

What Are Risk Factors of PVCs?

Though more common in elderly men, PVCs can occur in any person at any age. Some drugs and medical condi­tions can induce pre­mature contrac­tions. Caffeine, alcohol, nicotine, and cocaine can cause too-early heartbeats (PVCs). Medications like anti­histamines and deconges­tants may produce similar contrac­tions. High levels of adrenaline in the body can also disrupt cardiac rhythm. Anxiety and nicotine help in the release of adrenaline in the body. Congenital heart diseases, myo­cardial infrac­tions (heart attacks), and hyper­tension also produce pre­mature ven­tricu­lar contractions.

How PVCs Are Diagnosed?

Electrocardiogram (ECG) is the primary means of identifying premature ventricular contractions. The discovery of PVCs often occurs during a routine ECG for other medical conditions. You can experience mild to no symptoms during a PVC. The feeling may heighten during times of stress. Doctors do not consider isolated PVCs to be dangerous. The burden of continuous PVCs can pose grave health concerns.

PVC electrocardiograph
ECGs demonstrat­ing narrow and wide PVCs. A: Patient with a narrow left bundle branch/inferior axis PVC. The patient had normal left ventri­cular (LV) function with persis­tent palpita­tions despite trials of metoprolol and flecainide. Ablation was performed success­fully in the right parahisian region. B: A right bundle branch/superior axis PVC. This PVC is wider, and the patient had developed a cardio­myopathy with an ejection fraction of 42%. PVC ablation on the postero­medial papillary muscle resulted in compete restora­tion of normal LV function.

Frequent premature ventricular contrac­tions after heart attacks require remote cardiology monitoring. One customer notes that Apple Watch Series 4 detected a benign PVC. (You can enable irregu­lar rhythm notifica­tions for Apple Watch with no claims regarding diagnosis. This feature is not constantly looking for, and therefore cannot detect all, instances of AFib.) Fatigue or hyper­ventila­tion is common after strenuous activity. Symptoms of palpitation, light­headed­ness, and chest pains can require prompt medical assistance.

⚠️ Apple iPhone 12 Safety Alert

Medical device interference. iPhone contains magnets as well as components and radios that emit electromagnetic fields. These magnets and electromagnetic fields may interfere with medical devices, such as pacemakers and defibrillators. Placing an iPhone 12 on or near chest, as in shirt or jacket pocket, can deactivate an implantable device.

PVC Complications and Outlook

You may experience an unevent­ful PVC in your life­time. When the incidence of PVCs is high, you should consult a cardiology professional. Frequent pre­mature ventri­cular contrac­tions can weaken your heart muscles. Further escalation can develop cardiac arrhythmias or atrial fibrillation. Minimally invasive catheter ablation of chronic PVCs can restore normal heart function.

Premature ventricular contrac­tions are manage­able with proper care and treatment. Positive life­style changes like limiting your alcohol and caffeine intake can improve your heart health and lower risks of PVCs.

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