Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist.
Yasmine S. Ali, MD, MSCI, is a board-certified preventive cardiologist and lipidologist. Dr. Ali is also an award-winning writer.
A premature ventricular complex (PVC, or premature ventricular contraction) is an extra electrical impulse arising from one of the heart's ventricles. This extra impulse happens before the next normal heartbeat has a chance to occur.
PVCs are very common and often require no treatment unless they cause symptoms or occur frequently.
This article provides an overview of the symptoms, causes, and diagnosis of PVCs. You'll also learn about when treatment for PVCs may be indicated, and what those therapy options entail.
Many people with PVCs do not feel them at all, or they may only feel them during quiet times when they are not distracted, like when lying in bed at night.
Those who do experience PVC symptoms usually report palpitations, which are often described as "skipped beats" or a "pounding heart."
In some people, these unusual heartbeat sensations can be difficult to tolerate.
Other PVC symptoms may include:
PVCs are common, and the cause is not always clear. They can happen in healthy people on occasion. But more frequently, they occur in people with underlying heart disease.
For instance, people with chronic high blood pressure (hypertension) may develop structural changes to their hearts that lead to PVCs.
Similarly, an injury to the heart can make the cells of the ventricles electrically unstable and cause PVCs.
Other heart conditions associated with PVCs include:
There are also other health factors or problems not necessarily related to the heart that may contribute to the development of PVCs.
Interestingly, while caffeine is often spoken of as a cause of PVCs, studies have failed to show that a link between PVCs and the consumption of chronic caffeinated products exists.
If no symptoms are present, PVCs may be suspected if a patient has an irregular heartbeat on a physical examination. PVCs can then be officially diagnosed by electrocardiogram (ECG or EKG). With this test, flat disks that can detect electrical activity of the heart are placed on your chest. Results are graphed on a monitor.
In some cases, PVCs are diagnosed incidentally through a routine ECG—for example, during a preoperative evaluation before surgery.
When symptoms are present, PVCs are diagnosed through an ECG or a more sophisticated tool called an ambulatory ECG monitoring system.
Ambulatory ECG monitoring systems are portable devices that are worn for a long period of time to capture and record abnormal heart rhythms (arrhythmias) that may come and go.
A Holter monitor is one type of ambulatory ECG system that may be used to diagnose and measure the frequency of PVCs. It records the electrical activity of your heart continuously for 24 to 48 hours.
The recordings of ambulatory ECG systems are analyzed for PVCs (or another arrhythmia) by a cardiologist—a doctor who treats heart conditions.
PVCs are relatively common. Around 50% of people with or without heart disease will have at least one PVC during a 24-hour Holter monitor study.
Once PVCs are diagnosed, your doctor will want to try and get to the bottom of why they are occurring.
Depending on findings from your medical history/physical exam, various blood tests may be ordered.
For example, if an electrolyte imbalance is suspected, a basic metabolic panel and a magnesium level may be ordered. Likewise, if you are taking Digox (digoxin) for heart failure or another arrhythmia, a digoxin level will probably be ordered.
Further testing to look for previously unknown heart disease is also commonly performed.
In general, an echocardiogram, which is an ultrasound of your heart, is the main way to screen for most underlying heart conditions. In select cases, your doctor may want to perform a nuclear stress test or a cardiac magnetic resonance imaging (MRI).
Besides revealing an image of the heart's anatomy, an echocardiogram provides a measurement called the left ventricular ejection fraction, or LVEF.
Your LVEF reveals how well your heart is pumping blood. A reduced LVEF indicates that your heart muscle not working as well as it should.
Knowing your LVEF is important, as it can affect how (or if) your doctor decides to treat your PVCs.
Diagnosing PVCs involves detecting the abnormal rhythm on an ECG or an ambulatory ECG system. Next, an echocardiogram must be ordered to see if an underlying heart problem is present and to measure how well the heart is pumping blood.
Treating PVCs is not a straightforward matter, as their impact can vary from person to person.
The bulk of scientific evidence today suggests that PVCs usually aren't inherently dangerous. That doesn't mean, however, that PVCs are to be ignored, especially if they are interfering with the normal pumping function of the heart or are causing significant symptoms.
Frequent PVCs (more than 12 per day) can also be worrisome, as this is associated with a weakening of the heart muscle and sudden cardiac death.
Regular follow-up with a primary care physician is recommended for patients with infrequent PVCs, no symptoms, and a normal LVEF.
And in all cases of PVCs, potentially reversible causes or lifestyle factors (e.g., electrolyte imbalance or smoking) should be addressed and managed.
Beyond that, the following may be considered.
For those with frequent PVCs, but no symptoms and a normal LVEF, yearly echocardiograms and follow-up with a cardiologist are advised.
For people with symptoms and/or a reduced LVEF, medication may be considered. Doctors usually start with a beta-blocker or a calcium channel blocker.
If one of these medicines does not work, or cannot be tolerated, an antiarrhythmic drug is sometimes tried.
Antiarrhythmic drugs work to keep your heart in a regular rhythm, but some are not safe to take if you have underlying heart disease.
Also, when taken for PVCs, antiarrhythmic drugs may actually increase the risk of death in certain people.
Radiofrequency ablation is a specialized form of cardiac catheterization that is performed by a heart rhythm specialist called a electrophysiologist.
Painless radiofrequency energy is used to destroy heart tissue deemed to be the source of abnormal electrical signals.
This low-risk procedure can be effective in eliminating or greatly reducing PVCs in people who are having severe symptoms. Ablation is also offered to those with a low LVEF who have frequent PVCs, regardless of whether symptoms are present or not.
Treating PVCs always involves correcting reversible triggers or causes. While some people may only need regular follow-up with their doctor and possibly an annual echocardiogram, others may need medication or a procedure that uses energy to destroy part of the heart's tissue.
PVCs are abnormal heartbeats that begin in one of your heart's lower chambers. They are common and may cause palpitations, lightheadedness, or no symptoms at all.
Once PVCs are diagnosed, an echocardiogram is typically performed to access the heart's function and structure.
The treatment of PVCs is highly variable, ranging from annual checks to taking medications or undergoing an ablation procedure.
PVCs are very common, even among people who are perfectly healthy. Still, PVCs may cause symptoms, and they may indicate that some form of undiagnosed heart disease is present.
Finding PVCs should, at the very least, trigger a broader assessment of your heart.
UpToDate. Premature ventricular complexes: clinical presentation and diagnostic evaluation.
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By Richard N. Fogoros, MD Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.
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