How to Explain Premature Ventricular Contractions (PVCs) to a Patient
The best way to explain PVCs to a patient is to describe them as early heartbeats that originate from the lower chambers of the heart (ventricles) rather than from the heart's normal pacemaker, causing what feels like a "skipped beat" or "extra beat" sensation. 1
What Are PVCs?
- Simple definition: PVCs are extra heartbeats that start in the ventricles (the heart's lower pumping chambers) instead of the heart's natural pacemaker
- What happens physically: The heart beats earlier than it should, followed by a pause, and then a stronger beat as the heart returns to its normal rhythm
- How common: PVCs are extremely common, occurring in 40-75% of the general population when monitored for 24-48 hours 2
- Visual explanation: You can use a simple drawing showing normal beats versus a PVC pattern (early beat followed by a pause)
What PVCs Feel Like
- Sensation: Patients often describe PVCs as:
- A "skipped beat" or "missed beat" (though the heart isn't actually skipping—it's beating early)
- A "flip-flop" feeling in the chest
- A "thud" or stronger beat after the pause
- Sometimes palpitations, chest discomfort, or dizziness
- Important point: Many people have PVCs without feeling them at all 3
Risk Factors and Causes
- Age: PVCs become more common with age, increasing from 0.6% in those under 20 years to 2.7% in those over 50 years 1
- Common triggers:
- Caffeine, alcohol, and stimulants
- Stress and anxiety
- Lack of sleep
- Certain medications
- Electrolyte imbalances
- Underlying conditions: Sometimes PVCs can be related to heart disease, but often occur in completely healthy hearts 4
When to Worry About PVCs
- Generally benign: Most PVCs, especially in people with structurally normal hearts, are harmless 5
- PVC burden: The frequency of PVCs matters:
- Less than 2,000 per day or <1% of total heartbeats: Very low risk
- 2,000-10%: Low to intermediate risk
- 10-15%: Higher risk that may require monitoring
15%: Associated with potential heart issues if persistent 1
- Warning signs that require medical attention:
- Frequent symptoms like dizziness, chest pain, or shortness of breath
- Family history of sudden cardiac death
- Known heart disease
- Very frequent PVCs (many thousands per day)
Treatment Options
- No treatment needed: For infrequent, asymptomatic PVCs in a healthy heart 1
- Lifestyle modifications:
- Reducing caffeine, alcohol, and stimulants
- Stress management techniques
- Regular sleep habits
- Moderate exercise (which can sometimes reduce PVCs)
- Medical treatment: For symptomatic or very frequent PVCs:
- Beta-blockers (first-line therapy for symptomatic PVCs)
- Calcium channel blockers
- In some cases, other heart rhythm medications
- Catheter ablation: A procedure to eliminate the source of problematic PVCs when medications don't work or aren't tolerated 3
Monitoring and Follow-up
- Holter monitoring: A 24-hour recording of heart rhythm to determine PVC frequency 1
- Follow-up testing: May include:
- Echocardiogram to check heart structure and function
- Exercise stress testing to see how PVCs respond to activity
- Longer-term monitoring for intermittent symptoms
Common Patient Questions
- "Will PVCs cause a heart attack?" No, PVCs themselves don't cause heart attacks.
- "Do I need to restrict my activities?" Usually not, unless specifically advised by your doctor.
- "Will they go away on their own?" PVCs can come and go, and may decrease with lifestyle changes.
- "Are PVCs life-threatening?" Rarely. In structurally normal hearts, they're generally benign 5.
Key Points to Emphasize
- PVCs are extremely common and often completely benign
- Many people have PVCs without ever knowing it
- Simple lifestyle changes can often reduce PVCs
- Medical treatment is available if PVCs cause significant symptoms
- Regular follow-up is important if PVCs are frequent or symptomatic
Remember to reassure patients that most PVCs are not dangerous while still acknowledging that the sensation can be uncomfortable and concerning.