Diagnosis

If your doctor suspects that you have premature ventricular contractions, you may have an electrocardiogram (ECG). This test can detect the extra beats, identify their pattern and their source, and look for any underlying heart disease.

Electrocardiogram

Depending on the frequency and timing of your premature ventricular contractions, different types of ECG testing options are available.

  • Standard ECG. During a standard ECG test, sensors (electrodes) are attached to your chest and limbs to create a graphical record of the electrical signals traveling through your heart. It is usually done in a clinic or hospital setting and lasts only a few minutes.

If you experience infrequent premature ventricular contractions, they may not be detected during the brief time a standard ECG is being done. In such cases, you may need to use a portable monitoring device for 24 hours or more to capture any abnormal rhythms. Common types of portable ECGs include:

  • Holter monitor. This portable device is carried in your pocket or in a pouch on a belt or shoulder strap. It automatically records your heart's activity for an entire 24-hour period, which provides your doctor with an extended look at your heart rhythms.
  • Event recorder. This portable electrocardiogram device can also be carried in your pocket or worn on a belt or shoulder strap for home monitoring of your heart's activity.

    When you feel symptoms, you push a button, and a brief ECG strip recording is made. This allows your doctor to see your heart rhythm at the time of your symptoms.

A Holter monitor or event recorder can help identify the pattern of your premature ventricular contractions. The occurrence of more than three premature ventricular beats in a row is called ventricular tachycardia — which can cause symptoms and be a sign of serious heart disease.

  • Exercise stress ECG. This diagnostic test uses electrocardiography to record your heart's electrical activity while you walk on a treadmill or pedal an exercise bike. It can help determine the significance of your premature ventricular contractions.

    When premature beats disappear or dwindle during an exercise test, they're usually considered harmless. On the other hand, if exercise provokes extra beats, it may indicate higher risk of serious heart rhythm problems.

Treatment

Most people with premature ventricular contractions (PVCs) and an otherwise normal heart won't need treatment. Rarely, if you have frequent, bothersome symptoms, you may be offered treatment to help you feel better, but PVCs are usually not harmful.

In some cases, if you have underlying heart disease that could lead to more serious rhythm problems, you may need to make efforts to avoid triggers or perhaps take medications.

  • Lifestyle changes. Eliminating common PVC triggers — such as caffeine or tobacco — can decrease the frequency and severity of your symptoms.
  • Medications. Beta blockers — which are often used to treat high blood pressure and heart disease — can suppress premature contractions.

    Other medications, such as calcium channel blockers, or anti-arrhythmic drugs, such as amiodarone (Cordarone, Pacerone) or flecainide, also may be used if you have ventricular tachycardia or very frequent premature ventricular contractions that interfere with your heart's function, causing severe symptoms.

  • Radiofrequency catheter ablation. For premature ventricular contractions that don't respond to lifestyle changes or medications, your doctor may recommend ablation therapy. This procedure uses radiofrequency energy to destroy the area of heart tissue that is causing your irregular contractions.

Lifestyle and home remedies

The following self-care strategies can help control premature ventricular contractions and improve your heart health:

  • Track your triggers. If you have frequent symptoms, you might want to take note of your symptoms and your activities. This can help identify substances or actions that may trigger premature ventricular contractions.
  • Modify your substance use. Caffeine, alcohol, tobacco and other recreational drugs are known triggers of premature ventricular contractions. Reducing or avoiding these substances can reduce your symptoms.
  • Manage stress. Anxiety can trigger abnormal heartbeats. If you think anxiety may be contributing to your condition, try stress-reduction techniques, such as biofeedback, meditation or exercise, or talk to your doctor about anti-anxiety medications.

Preparing for your appointment

You're likely to start by seeing your family doctor. However, in some cases when you call to set up an appointment, you may be referred to a doctor trained in diagnosing and treating heart conditions (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Write down any symptoms you're experiencing, and for how long. Pay attention to your symptoms in the time leading up to your appointment so that you can describe the odd sensations in your chest as specifically as possible. Does your heart feel as if it flip-flops? As if it flutters? As if it pounds? Your description will help your doctor determine next steps in making your diagnosis.
  • Make a list of your key medical information, including other recent health problems you've had and the names of any prescription and over-the-counter medications you're taking.
  • Write down key personal information, including any major stresses or recent changes in your life.
  • Write down the questions you want to be sure to ask your doctor.

For premature ventricular contractions, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Are there any other possible causes for these symptoms?
  • What kinds of tests do I need?
  • What treatment approach do you recommend, if any?
  • What lifestyle changes can I make to reduce my symptoms?
  • Do I need to totally eliminate alcohol and caffeine?
  • Do you think stress is a factor in my symptoms?
  • What stress management techniques do you think would help me most?
  • Am I at risk of long-term complications?
  • How will you monitor my health over time?
  • Do I need to adjust the medications I'm taking for other health conditions?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions that may occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • When did you begin experiencing symptoms?
  • Do your symptoms come and go? If so, when are they likely to occur?
  • Are you aware of any history of heart problems in your family?
  • Are you being treated for any other health conditions?
  • Do you drink alcohol?
  • Do you use caffeine?
  • Do you smoke or use other nicotine products?
  • Do you use any recreational drugs?
  • How often do you feel stressed or anxious? What do you do to manage these feelings?
  • What else concerns you?

What you can do in the meantime

While you wait for your appointment, check with your family members to find out if any relatives have been diagnosed with heart problems. Although premature ventricular contractions are usually harmless, the symptoms of this condition mimic those of many other cardiac illnesses.

Knowing your family health history will help your doctor plan the right diagnostic tests and treatments, based on your individual risks. It will also help your doctor to know what triggers your symptoms.

In the time leading up to your appointment, take note of any substances or activities that seem to bring on the strange sensations in your chest.

April 26, 2014
References
  1. Manolis AS. Ventricular premature beats. http://www.uptodate.com/home. Accessed Jan. 16, 2014.
  2. Ventricular premature beats. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/cardiovascular_disorders/arrhythmias_and_conduction_disorders/ventricular_premature_beats_vpb.html. Accessed Jan. 16, 2014.
  3. Arrhythmia. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/arr/. Accessed Jan. 16, 2014.
  4. Cha YM, et al. Premature ventricular contraction-induced cardiomyopathy. Circulation: Arrhythmia and Electrophysiology. 2012;5:229.
  5. Zipes DP, et al. Cardiac Electrophysiology: From Cell to Bedside. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 16, 2014.

Premature ventricular contractions (PVCs)