Diseases and Conditions
Premature ventricular contractions (PVCs)

Updated: 2/8/2018

Overview

Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a fluttering or a skipped beat in your chest.

Premature ventricular contractions are common — they occur in many people. They're also called:

  • Premature ventricular complexes
  • Ventricular premature beats
  • Ventricular extrasystoles

If you have occasional premature ventricular contractions, but you're otherwise healthy, there's probably no reason for concern, and no need for treatment. If you have frequent premature ventricular contractions or underlying heart disease, you might need treatment.

Symptoms

Premature ventricular contractions often cause few or no symptoms. But you might feel an odd sensation in your chest, such as:

  • Fluttering
  • Pounding or jumping
  • Skipped beats or missed beats
  • Increased awareness of your heartbeat

When to see a doctor

If you feel fluttering, a sensation of skipped heartbeats or odd feelings in your chest, talk to your doctor. You'll want to identify the source of these symptoms, whether it's PVCs, other heart rhythm problems, serious heart problems, anxiety, anemia or infections.

Causes

Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by the sinoatrial (SA) node — or sinus node — an area of specialized cells in the right atrium.

This natural pacemaker produces the electrical impulses that trigger the normal heartbeat. From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood to your lungs and body.

PVCs are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat. And they often interrupt the normal order of pumping, which is the atria first, then the ventricles.

Why do extra beats occur?

The reasons aren't always clear. Certain triggers, heart diseases or changes in the body can make cells in the ventricles electrically unstable. Heart disease or scarring may also cause electrical impulses to be misrouted.

Premature ventricular contractions can be associated with:

  • Certain medications, including decongestants and antihistamines
  • Alcohol or illegal drugs
  • Increased levels of adrenaline in the body that may be caused by caffeine, tobacco, exercise or anxiety
  • Injury to the heart muscle from coronary artery disease, congenital heart disease, high blood pressure or heart failure

Risk factors

The following can increase your risk of PVCs:

  • Caffeine , tobacco, alcohol and illicit drugs
  • Exercise — if you have certain types of PVCs
  • High blood pressure (hypertension)
  • Anxiety
  • Heart disease, including congenital heart disease, coronary artery disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)

Complications

Having frequent PVCs or certain patterns of them might increase your risk of developing heart rhythm problems (arrhythmias) or weakening of the heart muscle (cardiomyopathy).

Rarely, when accompanied by heart disease, frequent premature contractions can lead to chaotic, dangerous heart rhythms and possibly sudden cardiac death.

Diagnosis

An electrocardiogram (ECG) can detect the extra beats and identify the pattern and source.

Electrocardiogram

Depending on the frequency and timing of your PVCs, different types of ECG testing options are available.

  • Standard ECG. Sensors (electrodes) are attached to your chest and limbs to create a graphical record of the electrical signals traveling through your heart. This brief test usually is done in a clinic or hospital setting.

If you have infrequent PVCs, they may not be detected during the brief time a standard ECG is being done. In such cases, you may need to use a portable monitoring device for 24 hours or more to capture any abnormal rhythms. Common types of portable ECGs include:

  • Holter monitor. You carry this device in your pocket or in a pouch on a belt or shoulder strap. It automatically records your heart's activity for 24 or 48 hours, which provides your doctor with an extended look at your heart rhythms.
  • Event recorder. This device can be carried in your pocket or worn on a belt or shoulder strap for home monitoring of your heart's activity. When you feel symptoms, you push a button, and a brief ECG strip recording is made. The recorder, which can be used for several weeks, allows your doctor to see your heart rhythm at the time of your symptoms.
  • Exercise stress ECG. This test uses electrocardiography to record your heart's electrical activity while you walk on a treadmill or pedal an exercise bike. It can help determine whether exercise triggers your PVCs.

Treatment

For most people, PVCs with an otherwise normal heart won't need treatment. However, if you have frequent PVCs, your doctor might recommend treatment.

In some cases, if you have heart disease that could lead to more-serious rhythm problems, you might need the following:

  • Lifestyle changes. Eliminating common PVC triggers — such as caffeine or tobacco — can decrease the frequency and severity of your symptoms.
  • 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 might recommend ablation therapy. This procedure uses radiofrequency energy to destroy the area of heart tissue that is causing your irregular contractions.

Lifestyle and home remedies

The following self-care strategies can help control PVCs and improve your heart health:

  • Track your triggers. If you have frequent symptoms, you might want to take note of your symptoms and your activities. This can help identify substances or actions that may trigger premature ventricular contractions.
  • Modify your substance use. Caffeine, alcohol, tobacco and other recreational drugs are known triggers of premature ventricular contractions. Reducing or avoiding these substances can reduce your symptoms.
  • Manage stress. Anxiety can trigger abnormal heartbeats. If you think anxiety is contributing to your condition, try stress-reduction techniques, such as biofeedback, meditation or exercise, or talk to your doctor about anti-anxiety medications.

Preparing for an appointment

You're likely to start by seeing your family doctor. Or you might be referred to a doctor trained in diagnosing and treating heart conditions (cardiologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, how they feel and when they began
  • Key medical information, including other recent health problems you've had and family history of heart disease
  • All medications, vitamins and other supplements you take and dosages
  • Questions to ask your doctor

Take a friend or relative with you, if possible, to help you remember the information you receive.

For premature ventricular contractions, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What tests do I need?
  • What treatment approach do you recommend, if any?
  • What lifestyle changes can I make to reduce my symptoms?
  • Do I need to eliminate alcohol and caffeine?
  • Am I at risk of long-term complications?
  • How will you monitor my health over time?
  • Do I need to adjust the medications I'm taking for other health conditions?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • Do your symptoms come and go? If so, when are they likely to occur?
  • Do you drink alcohol? If so, how much?
  • Do you use caffeine? If so, how much?
  • Do you smoke or use other nicotine products?
  • Do you use recreational drugs?
  • How often do you feel stressed or anxious? What do you do to manage these feelings?

Content from Mayo Clinic