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].

• Increased Energy

  Ask specifically about any supplements taken to help with weight loss or increase energy levels. Almost all of them contain caffeine or other “natural” sympathomimetic agents. Also ask specifically about illicit drug use. [doi.org]

• Movement Disorder

  Copyright 2005 Movement Disorder Society. [ncbi.nlm.nih.gov]

• 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]

  A PVC may be perceived as a “skipped beat” or felt as palpitations in the chest. [ncheartvascular.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]

  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]

  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]

  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. [doi.org]

• Ventricular Trigeminy

  2) Ventricular Bigeminy ECG (Example 3) Ventricular Trigeminy ECG (Example 1) Ventricular Trigeminy ECG (Example 2) Ventricular Trigeminy ECG (Example 3) References: 1. [healio.com]

  A PVC that occurs after every normal beat is called ventricular bigeminy. If it occurs after every second normal beat, it is called ventricular trigeminy and if it occurs after every third beat, it is called ventricular quadrigeminy. [cardiorhythm.co.za]

• Palpitations with Skipped Beats

  When a PVC occurs as a single premature beat, patients may describe the feeling as a "palpitation" or "skipped beat." The beat following the PVC can be strong enough to cause pain or discomfort in the chest. [my.clevelandclinic.org]

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].

• Ejection Fraction Decreased

  RESULTS: In the PVC group, left ventricular ejection fraction decreased from 67% ± 7% to 44% ± 15% (P < .05) with no change in controls (71% ± 6% to 73% ± 4%; P = .56). [ncbi.nlm.nih.gov]

• 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. [msdmanuals.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]

• 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]

  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]

  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]

  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]

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]

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]

Treatment for symptomatic patients includes medications such as beta blockers or calcium blockers. [umcvc.org]

Treatment In general, if the patient is asymptomatic and has no associated cardiac disease, no therapy is indicated. If they are frequent or symptomatic, medication and other treatment will be recommended. [healthcentral.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]

Presence of heart disease should be sought and, if absent, indicates good prognosis in patients with PVCs. [escardio.org]

[…] 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]

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]

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]

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]

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]

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]

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

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]

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]

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

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]

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2. Noheria A, Deshmukh A, Asirvatham SJ. Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes. Methodist Debakey Cardiovasc J. 2015;11(2):109-120.
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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.
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