A premature ventricular contraction is defined as an early ventricular depolarization that is quite commonly encountered in the general population. It is considered to be a benign finding in otherwise healthy patients without structural heart disease (SHD) of any kind, but many studies have pointed out its role in the development of many cardiovascular diseases, including myocardial infarction and stroke. The diagnosis is made after a comprehensive cardiac workup.
A premature ventricular contraction (PVC) is often regarded as a benign incidental finding, and its exact pathogenesis remains to be confirmed. It is known that PVCs arise as a result of increased automaticity (predominantly from the right ventricular outflow tract) presumably due to the effects of catecholamines, electrolyte imbalance, physical activity, cardiotoxic effects, ischemia and reperfusion changes, and menstrual cycles  . It has been reported that between 40-75% of the population exhibited PVCs on routine 24h or 48h Holter monitoring, and its frequency is significantly linked to advancing age  . Its association with ventricular dysfunction, cardiomyopathy, ischemic stroke, sudden cardiac death, and various other cardiovascular risks, however, particularly on the grounds of a pre-existing structural heart disease (SHD), has been extensively evaluated     . For this reason, its early recognition and monitoring may be of clinical importance. Signs and symptoms are nonspecific and range from mild to severely debilitating. Palpitations, presyncope, syncope and complaints of chest pain in otherwise healthy individuals with no apparent cardiac disease are the main features  . Moreover, heart failure and cardiomyopathy can also develop, presumably due to impaired ventricular dysfunction and consequent reductions in cardiac output  .
Given the fact that a nonspecific clinical presentation is seen in patients with PVCs, a detailed clinical and laboratory workup should be conducted. Firstly, a complete patient history including the onset, progression and duration of symptoms, evaluation of preexisting cardiovascular risks and comorbidities, and a thorough family history is performed  . Physical examination may be apparently normal apart from detection of arrhythmia on cardiac auscultation . Still, syncope and associated symptoms, particularly if an arrhythmia is noted during the exam, are sufficient to raise clinical suspicion of a cardiac pathology  , in which case several laboratory studies are necessary. A standard 12-lead electrocardiography (ECG), widely recognized for its ability to determine the exact type of arrhythmia and its origin, is performed first, but because PVCs are often not caught during this short testing period, 24-hour or 48-hour Holter monitoring is recommended . In fact, studies advocate the use of repeating the 24-hour or even 72-hour monitoring in order to ensure PVCs are not missed  . Echocardiography is the cornerstone in assessing the changes of the myocardium in PVC and other similar rhythm disorders, and most common findings are cardiomyopathies (in fact, the reversible form of PVC-related cardiomyopathy is described in literature), valvular disease (eg. mitral regurgitation), left ventricular dysfunction and reduced contractility, as well as increased dimensions of the left ventricle  . Cardiac magnetic resonance imaging has also been mentioned as a possible method in confirming the diagnosis .