Yes, Schedule a Medical Evaluation Immediately
You should schedule a medical evaluation promptly given your increasing frequency of PVCs combined with an elevated resting heart rate, as this combination warrants systematic cardiac assessment to exclude underlying structural heart disease and assess your risk profile.
Why This Matters
The combination of increasing PVCs and elevated resting pulse is clinically significant. Research demonstrates that elevated heart rate independently predicts PVC occurrence and that the combination of PVCs with increased heart rate dramatically increases mortality risk 1. The "increasing" nature of your symptoms is particularly concerning, as a rising burden of ventricular ectopy can indicate underlying cardiac pathology or progression toward PVC-induced cardiomyopathy.
What Your Evaluation Should Include
At minimum, your workup must include 2:
- Ambulatory Holter monitor (at least 24 hours) to quantify your PVC burden
- Echocardiogram to assess for structural heart disease and left ventricular function
- Exercise stress test to evaluate how your PVCs behave with exertion
This triad is non-negotiable for anyone with multiple PVCs on ECG or increasing symptoms.
Critical Risk Stratification
Your PVC burden on Holter monitoring will determine next steps 2:
- <2,000 PVCs per 24 hours: If echocardiogram is normal and PVCs suppress with exercise, no further evaluation needed
- ≥2,000 PVCs per 24 hours: Up to 30% risk of underlying structural heart disease—requires cardiac MRI and possible electrophysiology study
- >20% PVC burden: Risk threshold for PVC-induced cardiomyopathy 3
The Elevated Heart Rate Component
Your elevated resting pulse is not incidental. Heart rate >100 bpm at rest requires investigation 2 for:
- Recent exercise or anxiety (repeat ECG after rest)
- Fever, infection, dehydration
- Stimulant use (caffeine, medications, supplements)
- Anemia or hyperthyroidism
- Underlying cardiac or pulmonary disease
The documented association between elevated heart rate and PVCs suggests a hyperadrenergic state that contributes to adverse prognosis 1.
Common Pitfalls to Avoid
Do not dismiss this as benign without proper evaluation. While PVCs can be benign in structurally normal hearts, the guidelines are explicit that multiple PVCs (≥2 on ECG) are uncommon (<1% of athletes) and "may be the hallmark of underlying heart disease" 2. The increasing frequency you describe makes this even more concerning.
Do not accept reassurance based solely on a 12-lead ECG. A single ECG captures only seconds of rhythm; you need extended monitoring to quantify burden and characterize the arrhythmia 4, 5.
What Happens After Initial Testing
If your initial workup shows:
- Normal echocardiogram + PVCs suppress with exercise + low burden: Reassurance and observation
- Any LV dysfunction with PVC burden >10-15%: Consider PVC-induced cardiomyopathy; referral to electrophysiologist for possible catheter ablation 3, 5
- High PVC burden (>2,000/day) or non-sustained VT: Cardiac MRI mandatory to exclude arrhythmogenic right ventricular cardiomyopathy (ARVC), myocarditis, or other cardiomyopathies 2
Bottom Line
The increasing nature of your symptoms combined with elevated heart rate creates a clinical scenario requiring systematic evaluation to exclude life-threatening conditions. While many PVCs are ultimately benign, the only way to determine this safely is through proper cardiac assessment. Schedule the appointment—this is not something to monitor at home.