Chris Iliades, MD is a regular contributor to Bottom Line Health. He was an ear, nose, throat, head, and neck surgeon before becoming a full-time medical writer.
“My heart just skipped a beat.” You have probably heard it or said it. It’s called a premature ventricular contraction (PVC) or heart palpitation. According to the National Library of Medicine, PVCs are very common. They turn up in 1 to 4 percent of routine electrocardiograms (EKGs), and 75 percent of people will have a PVC over a 24- to 48-hour period. In fact, PVCs are not considered to be frequent unless you have more than 30 in one hour.
A PVC is an early beat that is out of sync with your heart’s regular rhythm. The early beat is followed by a longer pause between beats, like your heart is standing still. When your heart does beat, it beats a little stronger than usual to catch up, which causes the sensation that you feel.
The heart has four chambers: two atria on the top and two ventricles on the bottom. Normally, control of your heart’s rhythm starts in the right atrium. An electrical charge starts in the sinoatrial node (SA node) and travels down specialized heart-cell fibers to the lower chambers of your heart (ventricles). This triggers a beat that sends blood from your heart to your lungs and your body. A PVC occurs when the heartbeat is started by fibers in one of the ventricles (called the Purkinje fibers) instead.
Most PVCs occur spontaneously and aren’t even felt. They can be caused by a variety of things:
Less commonly, PVCs can be a warning sign of a medical problem. Examples include heart disease, high blood pressure, hyperthyroidism, and anemia. You need to have a lot of PVCs to cause heart damage. People who have over 1,000 PVCs per day may develop a condition called cardiomyopathy, in which the heart muscles become soft and weak. This can lead to heart failure.
Frequent PVCs usually cause other symptoms, like dizziness, shortness of breath, a pounding pulse in your chest or neck, or a sensation of almost passing out, called syncope.
Let your doctor know if you have frequent palpitations or any of the other symptoms of frequent PVCs. A health-care provider may be able to feel or hear a PVC by checking your pulse or listening to your heart, but, in most cases, an EKG is ordered to look for the delayed beat and stronger recovery beat. If an EKG shows that PVCs are very frequent or come in pairs or triplets, it is a possible sign of heart disease. A single EKG may not show any PVCs, but if you have symptoms, you may need to wear a Holter monitor to record your EKG over 24 to 48 hours. If PVCs are worrisome, further testing to find the cause may include blood tests, heart imaging studies, and cardiac stress testing.
Treatment depends on the cause of the PVCs and could include correcting triggers like stress, anxiety, or lack of sleep, avoiding caffeine or nicotine, treating high blood pressure or hyperthyroidism, correcting electrolyte abnormalities, or treating heart disease.
PVCs that are very frequent may also be treated with medications that control heart rhythm, called antiarrhythmics. People who have several thousand PVCs per day may benefit from a procedure called radiofrequency catheter ablation. During this procedure a catheter is threaded into the heart to eliminate the source of the PVCs.
There is no way to prevent PVCs, but you may be able to reduce your risk and improve your heart health by maintaining a healthy weight, getting regular exercise, eating a heart-healthy diet, getting enough sleep, and avoiding nicotine, too much caffeine or alcohol, and illicit drugs like cocaine or amphetamines. You can also work with your health-care provider to control anxiety, stress, high blood pressure, or high cholesterol.
Let your health-care provider know about frequent palpitations or other symptoms, like feeling lightheaded, dizzy, short of breath, pounding pulse, or syncope. Call 911 if you have trouble breathing or chest pain.