Premature Ventricular Contractions (PVCs)
Extra early heartbeats felt as a skip or flutter
Quick Facts
- Type: Heart rhythm disturbance (arrhythmia)
- Origin: Lower chambers (ventricles)
- Common feeling: Skipped beat, flutter, or thump
- Usual outlook: Harmless in healthy hearts
Overview
Premature ventricular contractions (PVCs) are extra heartbeats that start in the ventricles, the heart's lower pumping chambers, earlier than the next expected beat. This briefly disrupts the normal rhythm and is often felt as a skipped beat, a flutter, or a forceful thump in the chest.
PVCs are very common and occur in many people who have completely healthy hearts. In that setting they are usually harmless. However, when PVCs are frequent or occur alongside underlying heart disease, they may need closer evaluation. PVCs are one type of arrhythmia, the medical term for an irregular heartbeat.
Symptoms
Many people with PVCs feel nothing at all and learn about them only during a routine exam. When symptoms occur, they may include:
- A sensation of a skipped or missed beat
- A flip-flop, flutter, or pounding feeling in the chest or neck
- An awareness of the heartbeat (palpitations)
- A brief pause followed by a stronger beat
PVCs themselves are usually brief. Seek prompt medical attention if palpitations come with chest pain, severe shortness of breath, fainting, or near-fainting, as these can signal a more serious problem.
Causes
PVCs happen when an irritable spot in the ventricles fires an early electrical signal. Many factors can trigger them, even in healthy hearts:
- Stimulants: Caffeine, nicotine, and some decongestants or other medications.
- Stress and anxiety: Strong emotions and adrenaline surges.
- Fatigue and lack of sleep.
- Electrolyte imbalances: Low potassium or magnesium levels.
- Alcohol and certain drugs.
- Heart conditions: Coronary artery disease, prior heart attack, heart failure, or cardiomyopathy can make PVCs more frequent and more significant.
In many people no specific trigger is found.
Risk Factors
- High caffeine, nicotine, or alcohol intake
- Stress, anxiety, and sleep deprivation
- High blood pressure
- Underlying heart disease such as coronary artery disease or cardiomyopathy
- Electrolyte abnormalities
- Certain stimulant medications
Diagnosis
PVCs are diagnosed by recording the heart's electrical activity and looking for the extra beats.
- Electrocardiogram (ECG): A quick test that can capture PVCs if they occur during recording.
- Holter or event monitor: A portable monitor worn for a day to weeks to count PVCs and capture symptoms.
- Blood tests: To check electrolytes, thyroid function, and other contributors.
- Echocardiogram or stress test: To assess heart structure and function, especially if PVCs are frequent or symptoms are concerning.
How often PVCs occur and whether the heart is otherwise healthy guide further testing and treatment.
Treatment
Occasional PVCs in a healthy heart often need no treatment beyond reassurance and reducing triggers.
- Lifestyle changes: Cutting back on caffeine, nicotine, and alcohol, managing stress, and getting adequate sleep.
- Correcting contributors: Restoring normal electrolyte levels and reviewing medications.
- Medications: Beta-blockers or other antiarrhythmic drugs may be used when PVCs cause bothersome symptoms or are very frequent.
- Treating underlying heart disease: Managing conditions such as coronary artery disease or heart failure.
- Catheter ablation: A procedure that targets the source of frequent PVCs may be considered in selected cases.
Very frequent PVCs over a long time can occasionally weaken the heart, so monitoring is advised in those situations.
Prevention
- Limit caffeine, nicotine, and alcohol if they trigger your symptoms
- Manage stress and prioritize adequate sleep
- Stay well hydrated and maintain normal electrolyte levels
- Control blood pressure and other heart risk factors
- Review stimulant medications and supplements with your clinician
- Keep regular follow-up if you have underlying heart disease
When to See a Doctor
See a clinician if you have frequent palpitations, skipped beats that bother you, or PVCs along with known heart disease. Seek emergency care or call emergency services if palpitations occur with:
- Chest pain or pressure
- Severe shortness of breath
- Fainting or near-fainting
- A very rapid, sustained, or irregular heartbeat that does not settle
Frequently Asked Questions
Are premature ventricular contractions dangerous?
In people with healthy hearts, occasional PVCs are usually harmless and need no treatment. They become more important when they are very frequent or occur with underlying heart disease, which may require evaluation. Get prompt care if PVCs come with chest pain, fainting, or severe shortness of breath.
What does a PVC feel like?
PVCs are often felt as a skipped beat, a flutter, or a forceful thump in the chest, sometimes followed by a brief pause and a stronger beat. Many people feel nothing at all and only learn about PVCs during a heart test.
What triggers PVCs?
Common triggers include caffeine, nicotine, alcohol, stress, fatigue, and low potassium or magnesium. Certain medications and underlying heart conditions can also cause them. In many cases no specific trigger is identified.
Do PVCs need treatment?
Occasional PVCs in a healthy heart usually need only reassurance and trigger reduction. Treatment with medication or, rarely, a catheter procedure may be considered when PVCs are frequent, very bothersome, or linked to heart disease.
Can frequent PVCs harm the heart over time?
In most people PVCs are benign, but a very high burden of PVCs over a long period can occasionally weaken the heart muscle. For that reason, clinicians may monitor people with very frequent PVCs and treat them if needed.
References
- Mayo Clinic. Premature ventricular contractions (PVCs).
- American Heart Association (AHA). Premature Contractions — PACs and PVCs.
- MedlinePlus, U.S. National Library of Medicine. Heart palpitations.