Premature Ventricular Contractions

Premature ventricular contractions or PVC is a condition wherein your heart experiences abnormal heart heartbeats that originate from the ventricles or the lower chambers of the heart.

Normally, the heart contraction starts at the atrium (the two upper chambers of the heart) and then proceed to the ventricles. The abnormal heartbeat from the ventricles causes extra heartbeats disrupt normal heart beat rhythm and causes rapid and bounding heart rate.

Premature ventricular contractions are very common and occasionally occur in most people, especially in older individuals, but most cases do not cause symptoms and are not a cause for concern.

Frequent or long-standing premature ventricular contractions may be a symptom of underlying heart disease, which requires treatment.

Premature ventricular contractions are also known as:

• Extrasystoles
• Ventricular premature beats
• PVCs
• Premature ventricular complexes

You may not feel the symptoms of premature ventricular contractions. If you do, you may feel that your heartbeat is fluttering and/or irregular.

Most patients describe that they feel that their heartbeats are pounding, jumping, skipping or missing a beat.

You can see a doctor if you feel that these abnormal heartbeats occur too often or stay that way for long periods.

Premature ventricular contractions may be a symptom of underlying heart disorder, or other non-heart conditions such as anemia, infections or anxiety disorders.

The exact cause of premature ventricular contractions usually isn't known.

To fully understand what happens in premature ventricular contractions, you must know some information on how your heart works.

Your heart has two upper chambers (left and right atrium) and two lower chambers (left and right ventricles). Electrical signals cause the heart muscles contract and be able to pump blood.

These electrical signals originate from specialized cells in the right atrium called sinoatrial (SA) node, which also regulates it and acts as a pacemaker. From the SA node, electrical signals travel from the atrium to the ventricles, stimulating muscle contractions along the way causing whole heart to beat rhythmically and pump blood.

In premature ventricular contraction scenario, contractions start in the ventricle rather than the atrium. These extra contractions tend to start earlier than normal contractions, hence the term ‘premature’. After the abnormal contraction, the heart tends to fill up with more blood resulting in irregular beats and bounding heart rate.

The extra beats in premature ventricular contractions occur for various reasons. It can be associated with:

• Infection, anemia and electrolyte imbalances in the body
• Use of certain medicines, like medications for asthma 
• Use of alcohol or illegal substances
• Sensitivity to caffeine, nicotine
• Adrenaline rush
• Effect of anxiety or exercise
• Injury to the heart caused by heart failure coronary artery disease, congenital heart disease or high blood pressure

Diagnosis of premature ventricular contractions will be made by your cardiologist upon recommendation from your general physician.

Most people with premature ventricular contractions start treatment by seeing a family doctor. The family doctor will check your symptoms, and if a heart condition such as PVC is suspected, will refer you to a specialist called a cardiologist.

To help improve care, you can do the following before you go to the doctor:

• Write down a detailed description of your symptoms and how long did you have it. Describe your heartbeat in particular. Is it fluttering? Pounding? It can really help your doctor if you can describe those symptoms.
• List important information like taken medicines and vitamins. Write things like stresses and major life changes as well. 

Have a list of questions to ask your doctor

Write them down so you will not forget them. Here are some questions you might want to ask:

• What could have caused the symptoms?
• What are the required tests to diagnose the condition?
• What are the treatment options for premature ventricular contractions? Which one is best for my case?
• Would lifestyle changes able to reduce the symptoms?
• Do I really have to eliminate alcohol and caffeine?
• Is the condition caused or worsened by stress? 
• Would stress-management exercise useful in treating my condition?
• What are the long-term side effects of treatment?
• Do you think stress-management practices is good for the condition?
• What are the long-term complicaitons?
• Is there a need for constant monitoring for my case?
• Is there a need for me to adjust or stop medicines I am taking for other health conditions?

During appointments, expect your doctor to ask you questions

• When did the symptoms first appeared?
• Do your symptoms tend to come and go, or does it occur continuously?
• Can you point or remember if your symptom has triggers?
• Can you share information about the history of heart disease, heart defects or palpitations in your family?
• Do you feel that your symptoms have triggers?
• Do you drink alcohol? Caffeine? 
• Do you smoke or use tobacco products?
• Have you used recreational drugs before?
• How many times you felt too much stress and became burdened with anxiety?

In the meantime, you can try to check the history of heart diseases in your family tree. Find if any one of them was treated for heart problems.

Although harmless, premature ventricular contractions can be an underlying sign of heart diseases.

Many cases of premature ventricular contractions are not harmful and do not require treatment.

In case you experience severe symptoms, your doctor may recommend the following:

• Healthy lifestyle and avoiding caffeine and tobacco may work to eliminate triggers for premature ventricular contractions.
• You may be prescribed with beta blockers normally used to control blood pressure. Beta blockers slow down heart rate and suppress premature ventricular contractions. Other medications are prescribed in case of problems like very frequent PVC and ventricular tachycardia. These medicines include calcium channel blockers or anti-arrhythmic drugs such as amiodarone.
• In case the mentioned therapies do not work, the doctor may recommend Radiofrequency Catheter Ablation. This procedure inserts catheters threaded into the heart, right onto the area causing irregular contractions. Electrical energy is sent to the catheters to destroy the area to relieve premature ventricular contractions.

Lifestyle modifications are necessary in order to cope with premature ventricular contractions.

In the meantime, there are strategies you can do to monitor your health and control palpitations caused by premature ventricular contractions.

You need to identify triggers, like caffeine or nicotine and stay away from them. Seek help for abuse of recreational drugs, alcohol, and tobacco. In case you have frequent palpitations, try to note the activities could be triggering the condition.

You also need to be good at managing stress, which can cause palpitations. Anxiety is known to trigger premature ventricular contractions. Search for stress relief through measures such as exercise, massage, meditation and biofeedback. In case you have an anxiety disorder, talk to your doctor about available anti-anxiety medicines.

The following stimulants, conditions and triggers may increase your risk of premature ventricular contractions:

• Elevated or abnormally high blood pressure
• Anxiety
• Exercise
• Use of caffeine, tobacco, and alcohol

Premature ventricular contractions can also be a symptom of heart diseases such as heart failure, problems with heart muscles (cardiomyopathy), heart attack or coronary artery disease.