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 [1] [2]. 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 [1] [3]. 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 [1] [3] [4] [5] [6]. 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 [1] [7]. Moreover, heart failure and cardiomyopathy can also develop, presumably due to impaired ventricular dysfunction and consequent reductions in cardiac output [1] [7].

• Inflammation

  Of course, my theory is that PVCs associate with excess inflammation. The reason I see inflammation as the link is because PVCs often occur in patients who are exposed to stress. [drjohnm.org]

  Infection, inflammation or degeneration of the heart muscle. Infections at other sites in the body. They are often worse with lack of sleep, or stress. [cardiachealth.org]

  Inflammation of the myocardium (as occurs in myocarditis) and systemic inflammation cause surges of cytokines, which can affect the electrical properties of myocytes and may be ultimately responsible for causing irritability of myocytes. [en.wikipedia.org]

• Heart Disease

  […] 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 [mayoclinic.org]

  Therefore, in patients with no evidence of heart disease on noninvasive workup, reassurance is appropriate. [emedicine.com]

• Tachycardia

  Patients with three or more consecutive premature ventricular contractions in a row have ventricular tachycardia. Ventricular tachycardia that is prolonged can result in low cardiac output, low blood pressure, and fainting (syncope). [medicinenet.com]

  Those with significant structural heart disease, ventricular tachycardia greater than 1% of rhythm at the time of premature ventricular contraction diagnosis, or family history of cardiomyopathy - except tachycardia-induced - were excluded. [ncbi.nlm.nih.gov]

  Types of supraventricular tachycardia include: Atrial fibrillation Atrial flutter Atrial tachycardia Atrioventricular nodal reentrant tachycardia Atrioventricular reentrant tachycardia, also known as Wolff-Parkinson-White syndrome Expand All Collapse [scripps.org]

• Skipped Beats

  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 [mayoclinic.org]

  The extra beat is followed by a stronger heartbeat, which creates the feeling of a skipped beat or a flutter. These extra beats are usually less effective in pumping blood throughout the body. [umcvc.org]

  This causes a feeling of a skipped beat in the chest. Common symptoms reported by people with premature ventricular contractions Reports may be affected by other conditions and/or medication side effects. [patientslikeme.com]

• Ventricular Bigeminy

  ECG Examples: Premature Ventricular Contraction (PVC) ECG (Example 1) Premature Ventricular Contraction (PVC) ECG (Example 2) Premature Ventricular Contraction (PVC) ECG (Example 3) Ventricular Bigeminy ECG (Example 1) Ventricular Bigeminy ECG (Example [healio.com]

  For your basic student, it is a good example of sinus rhythm with ventricular bigeminy. ECG Basics: Normal Sinus Rhythm With Premature Ventricular Contractions This ECG shows an underlying rhythm of normal sinus rhythm at a rate of 80 / min. [ecgguru.com]

  METHODS: Ten swine underwent implantation of ventricular pacemakers; 6 programmed to deliver a 50% PVC burden and 4 controls without pacing. Voltage maps were acquired at baseline and after 14 weeks of ventricular bigeminy. [ncbi.nlm.nih.gov]

  Shanmugam N et al. (2006) 'Frequent' ventricular bigeminy—a reversible cause of dilated cardiomyopathy. How frequent is 'frequent'. Eur J Heart Fail 8 : 869–873 7. [nature.com]

• Irregular Heart Rhythm

  Ventricular Arrhythmias Premature ventricular contractions (PVCs) are the most common cause of irregular heart rhythms. [my.clevelandclinic.org]

  If your heart feels out of rhythm or "flutters," especially when you have a lot of anxiety, it could be caused by premature ventricular contractions, or PVCs. They're the most common reason for arrhythmia, or an irregular heart rhythm. [webmd.com]

  The physical examination findings are often normal except irregular heart rhythm when PVCs are frequent. [circep.ahajournals.org]

• Excitement

  Normal levels of these electrolytes are necessary for excitability and rhythmic contraction of muscle fibers. A shift from normal levels also alters excitability and leads to generation of PVCs. [wikihow.com]

  Contents: Overview of the circulation, blood, and hemostasis -- Excitation: the cardiac action potential -- Automaticity: natural excitation of the heart -- The cardiac pump -- Regulation of the heartbeat -- Hemodynamics -- The arterial system -- The [worldcat.org]

  Freeman, 2008 - 1158 Seiten 1 Rezension In the Fifth Edition, authors Dave Nelson and Mike Cox combine the best of the laboratory and best of the classroom, introducing exciting new developments while communicating basic principles through a variety of [books.google.com]

• Insomnia

  Theophylline In susceptible individuals, theophylline can cause nausea, diarrhea, increase in heart rate, arrhythmias, and CNS excitation with resultant headaches, insomnia, irritability, dizziness and lightheadedness. [bodyrestorationanownersmanual.com]

  The severity of heart palpitations, shortness of breath, lack of strength, insomnia, profuse dreams, dizziness, tinnitus, impaired memory, tidal heat, dry mouth, tongue, and pulse signs were assigned a number from 0 to 6. [townsendletter.com]

  Deficiency symptoms include insomnia, muscle cramps, kidney stones, osteoporosis, fear, anxiety, and confusion. Low magnesium levels are found in more than 25 percent of people with diabetes. But magnesium shines brightest in cardiovascular health. [theskepticalcardiologist.com]

  If you are struggling with getting at least seven hours of rejuvenating sleep, please read my article (Blog #16) Ten Ways to Cure Insomnia without Medications. 4. [drjohnday.com]

• Vertigo

  This can also cause additional symptoms, which include: weakness dizziness ( vertigo ) loss of consciousness These symptoms are serious and should be evaluated by a doctor as soon as possible. [healthline.com]

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 [1] [5]. Physical examination may be apparently normal apart from detection of arrhythmia on cardiac auscultation [7]. Still, syncope and associated symptoms, particularly if an arrhythmia is noted during the exam, are sufficient to raise clinical suspicion of a cardiac pathology [1] [5], 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 [1]. In fact, studies advocate the use of repeating the 24-hour or even 72-hour monitoring in order to ensure PVCs are not missed [1] [7]. 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 [1] [7]. Cardiac magnetic resonance imaging has also been mentioned as a possible method in confirming the diagnosis [1].

• Wide QRS Complex

  Wide complexes; because they come from the ventricles and do not use the normal ventricular conduction system, action potentials need to travel from myocyte to myocyte, which is much slower, creating a wide QRS complex. [healio.com]

  ECG Diagnosis of ventricular premature beats is by electrocardiography (ECG) showing a wide QRS complex without a preceding P wave, typically followed by a fully compensatory pause. [merckmanuals.com]

  A premature ventricular complex is recognized on the ECG as an abnormal and wide QRS complex occurring earlier than expected in the cardiac cycle. [ecgwaves.com]

  Mont L. et al: A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 83:1649, 1991. ‎ [books.google.de]

• Right Bundle Branch Block

  right bundle branch block (RBBB), atrial premature contraction (APC), and paced beat (PB) rhythms. [ncbi.nlm.nih.gov]

  When describing PVCs or the morphology of nonsustained ventricular tachycardia, the terms “left bundle-branch block pattern” and “right bundle-branch block pattern” refer to lead V 1. [doi.org]

  The origin of each PVC can be discerned from the QRS morphology: PVCs arising from the right ventricle have a left bundle branch block morphology (dominant S wave in V1). [lifeinthefastlane.com]

• Premature Atrial Contractions

  Premature atrial contractions ( PACs ), also known as atrial premature complexes ( APC ) or atrial premature beats ( APB ), are a common cardiac dysrhythmia characterized by premature heartbeats originating in the atria. [en.wikipedia.org]

  METHODS AND RESULTS: Using our premature pacing algorithm, pentageminal PVCs at coupling intervals of 200 to 375 ms were delivered from the epicardial right ventricular apex, RV outflow tract, and LV free wall, as well as premature atrial contractions [ncbi.nlm.nih.gov]

  PVB (premature ventricular beat); Premature beats; PVC (premature ventricular complex/contraction); Extrasystole; Premature supraventricular contractions; PAC; Premature atrial contraction; Abnormal heartbeat Fang JC, O'Gara PT. [medlineplus.gov]

  Extra or early beats arising in the atria are called premature atrial contractions (PACs), atrial premature beats, atrial ectopic beats, or atrial extrasystoles. Such extra beats often occur in normal hearts and are usually harmless. [healthcentral.com]

• Ventricular Bigeminy

  ECG Examples: Premature Ventricular Contraction (PVC) ECG (Example 1) Premature Ventricular Contraction (PVC) ECG (Example 2) Premature Ventricular Contraction (PVC) ECG (Example 3) Ventricular Bigeminy ECG (Example 1) Ventricular Bigeminy ECG (Example [healio.com]

  For your basic student, it is a good example of sinus rhythm with ventricular bigeminy. ECG Basics: Normal Sinus Rhythm With Premature Ventricular Contractions This ECG shows an underlying rhythm of normal sinus rhythm at a rate of 80 / min. [ecgguru.com]

  METHODS: Ten swine underwent implantation of ventricular pacemakers; 6 programmed to deliver a 50% PVC burden and 4 controls without pacing. Voltage maps were acquired at baseline and after 14 weeks of ventricular bigeminy. [ncbi.nlm.nih.gov]

  Shanmugam N et al. (2006) 'Frequent' ventricular bigeminy—a reversible cause of dilated cardiomyopathy. How frequent is 'frequent'. Eur J Heart Fail 8 : 869–873 7. [nature.com]

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. [mayoclinic.org]

Patients' symptoms were calculated before and after treatment. The number after treatment was subtracted from the number before treatment. That was then divided by the number before treatment, and the result was multiplied by 100. [townsendletter.com]

In addition, catheter ablation has emerged as an effective treatment modality that has compared favorably to pharmacological antiarrhythmic therapy. [ncbi.nlm.nih.gov]

[…] common, occur in 1 ⁄ 2 of normal adults monitored by EKG for 24 hrs, and are of no significance Etiology Anxiety, fever, stimulants, associated with drug toxicity–digitalis, quinidine, tricyclic antidepressants and an indication for discontinuing therapy Treatment [medical-dictionary.thefreedictionary.com]

[…] who was the master in pulse palpation and diagnosis. 1 He noted that these irregularities did not interfere with normal lifespan when they were occasional but an ominous prognosis was implied if they were frequent. [doi.org]

We conclude that the long-term prognosis in asymptomatic healthy subjects with frequent and complex ventricular ectopy is similar to that of the healthy U.S. population and suggests no increased risk of death. [ncbi.nlm.nih.gov]

which occurs before the usual sinuatrial beat, characterized by premature, widened, bizarre QRS complexes, not preceded by a P wave; PVCs are extremely common, occur in 1 ⁄ 2 of normal adults monitored by EKG for 24 hrs, and are of no significance Etiology [medical-dictionary.thefreedictionary.com]

[…] latest insights into the treatment of ventricular tachyarrhythmia, especially with the advent of catheter ablation, there has been renewed interest in premature ventricular contractions, not only as a predictor of arrhythmia, but also for their potential etiological [ncbi.nlm.nih.gov]

Etiology Although in a great majority of patients, PVCs are not a sign of an underlying heart disease, following conditions can trigger PVCs in some people: Hematologic disease Acute MI or angina Hypertrophic or dilated cardiomyopathy Myocarditis Mitral [xpertdox.com]

LBBB is an indicator of cardiac disease, but not specific to one etiology. [ecgguru.com]

Etiology Causes of PVCs include: · ischemia · certain medicines such as Digoxin, which increases heart contraction · myocarditis · cardiomyopathy, hypertrophic or dilated · myocardial contusion · myocardial infarction · hypoxia · hypercapnia (CO2 poisoning [townsendletter.com]

Epidemiology. 1992 ; 3 : 434–440. [doi.org]

Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]

Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr. 1995; 126 :605–610. et al. [ PubMed ] [ Google Scholar ] 6. Schneider DJ, Moore JW. Patent ductus arteriosus. [ncbi.nlm.nih.gov]

Some epidemiological data exist with an association between PVCs activity with caffeine intake, but experimental human studies have not produced consistent results to establish this link. [escardio.org]

This title features pathophysiology content that serves as a bridge between normal function and disease, and Read more... Reviews User-contributed reviews [worldcat.org]

Pathophysiology of PVCs In PVCs, ventricular myocytes spontaneously depolarize to create an extra systole that creates mechanical dyssynchrony with the cardiac cycle. 2,3 Affected cells are triggered by cyclic adenosine monophosphate-mediated and calcium-dependent [thecardiologyadvisor.com]

Clinical relevance of prostaglandins and prostaglandin inhibitors in PDA pathophysiology and treatment. Clin Perinatol. 1995; 22 :457–479. [ PubMed ] [ Google Scholar ] 8. Ellison RC, Peckman GJ, Lang P. [ncbi.nlm.nih.gov]

It is not intended to be a comprehensive review of the pathophysiology, electrophysiology, or localization and ablation of PVCs. We will discuss approaches to the initial therapy of symptomatic PVCs. [doi.org]

Pathophysiology of physiologic cardiac pacing: advantages of leaving well enough alone. JAMA. 2002 ; 288 :3159–3161. Crossref Medline Google Scholar 40. Goldberger JJ, Kadish AH. Cardiac memory. Pacing Clin Electrophysiol. 1999 ; 22 :1672–1679. [circep.ahajournals.org]

Ablation of the triggering PVCs may eliminate the fatal arrhythmias and prevent the sudden death in patients with LQTS. [ncbi.nlm.nih.gov]

Some people may take medicine to prevent these heartbeats and to relieve symptoms. If you have a known heart problem, such as heart failure or heart disease, PVCs may be a sign that a dangerous heart rhythm could occur. [uwhealth.org]

Drug treatment is aimed at suppressing premature ventricular contractions (PVCs) in order to prevent serious ventricular arrhythmias and to reduce the risk of sudden death. [healthcentral.com]

1. Sheldon SH, Gard JJ, Asirvatham SJ. Premature Ventricular Contractions and Non-sustained Ventricular Tachycardia: Association with Sudden Cardiac Death, Risk Stratification, and Management Strategies. Indian Pacing Electrophysiol J. 2010;10(8):357-371.
2. Noheria A, Deshmukh A, Asirvatham SJ. Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes. Methodist Debakey Cardiovasc J. 2015;11(2):109-120.
3. Saurav A, Smer A, Abuzaid A, Bansal O, Abuissa H. Premature ventricular contraction-induced cardiomyopathy. Clin Cardiol. 2015;38(4):251-258.
4. Eugenio PL. Frequent Premature Ventricular Contractions: An Electrical Link to Cardiomyopathy. Cardiol Rev. 2015;23(4):168-172.
5. Giles K, Green MS. Workup and management of patients with frequent premature ventricular contractions. Can J Cardiol. 2013;29(11):1512-1515.
6. Ofoma U, He F, Shaffer ML, Naccarelli GV, Liao D. J Am Heart Assoc. 2012;1(5):e002519.
7. Lee GK, Klarich KW, Grogan M, Cha YM. Premature ventricular contraction-induced cardiomyopathy: a treatable condition. Circ Arrhythm Electrophysiol. 2012;5(1):229-236.