Premature ventricular contractions are early beats that start in the ventricles, producing a wide QRS complex followed by a pause. They are common and usually benign in a healthy heart, but frequent PVCs or PVCs with structural heart disease need further evaluation.
Key symptoms
- Skipped beats or a flip-flop feeling in the chest
- A strong thump after a pause
- Often no symptoms
- Fatigue or breathlessness when very frequent
What you find on exam
- Irregular pulse with early beats and pauses
- Heart exam for murmurs or signs of heart failure
- Thyroid exam and signs of stimulant use
Tests
- 12-lead ECG: wide early QRS without a P wave before it
- Ambulatory monitor to measure the PVC burden
- Echocardiogram to look for structural heart disease
- Potassium, magnesium and thyroid tests
Treatment basics
- Reassurance if the heart is normal and the burden is low
- Cut down on caffeine, alcohol, stimulants and stress
- Beta blocker or a nondihydropyridine calcium channel blocker for symptoms
- Catheter ablation for a high burden or PVC-related cardiomyopathy
Red flags
- Fainting or near fainting
- Runs of ventricular tachycardia
- PVCs with chest pain or known heart disease
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.