Can Premature Ventricular Contractions (PVCs) cause dizziness?

From the Guidelines

Yes, premature ventricular contractions (PVCs) can cause dizziness in some people. PVCs are extra heartbeats that originate in the ventricles (lower chambers of the heart) and disrupt the normal heart rhythm. When PVCs occur, they can temporarily reduce the heart's pumping efficiency, resulting in a brief decrease in blood flow to the brain, which may cause sensations of lightheadedness or dizziness, as noted in the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1.

Some key points to consider about PVCs and their potential impact on health include:

• PVCs that occur during an exercise test are associated with a higher risk of death 1
• Very frequent PVCs, >10,000 to 20,000 a day, can be associated with depressed LV function in some patients that is reversible with control of the PVCs, and has been referred to as PVC-induced cardiomyopathy 1
• PVCs are common in trained athletes who have palpitations, in whom there does not appear to be increased risk of death based on studies of small numbers of athletes, at least in those without other cardiovascular abnormalities 1

It is essential to evaluate frequent PVCs or those causing significant symptoms like persistent dizziness by a healthcare provider, as treatment may include addressing underlying causes or medications to reduce PVC frequency and associated symptoms. The primary concern with PVCs is their potential to cause significant symptoms or indicate underlying heart disease, which can impact morbidity, mortality, and quality of life. Therefore, it is crucial to prioritize the evaluation and management of PVCs based on the most recent and highest quality evidence, such as the 2017 AHA/ACC/HRS guideline 1.

From the Research

Premature Ventricular Contractions (PVCs) and Dizziness

• PVCs are heartbeats initiated in the ventricles instead of in the sinoatrial node, and a high burden of PVCs can lead to cardiomyopathy, characterized by reduced left ventricular (LV) systolic dysfunction 2.
• A case study presented a 65-year-old male with PVC-related cardiomyopathy, who initially experienced chest pain and dizziness, suggesting a possible link between PVCs and dizziness 2.
• However, other studies suggest that PVCs are usually benign and may not always cause symptoms, but frequent PVCs can lead to ventricular dysfunction, which may improve after PVC treatment 3, 4.
• The range of symptoms associated with PVCs can vary from asymptomatic to palpitations, fatigue, or heart failure symptoms, but dizziness is not explicitly mentioned as a common symptom in most studies 5, 6.
• One study presented three cases of patients with PVCs, with varying presentations, including incidental (harmless) PVCs to frequent and potentially symptomatic PVCs, but dizziness was not reported as a symptom in these cases 4.
• Overall, while there is some evidence to suggest that PVCs may be associated with dizziness, particularly in cases of high burden PVCs, the relationship between PVCs and dizziness is not well-established and may require further research 2, 3, 5, 4, 6.

Symptoms and Clinical Profiles

• Frequent PVCs can lead to symptoms such as cardiomyopathy and increased mortality, and beta-blockers are recommended as first-line therapy to reduce PVC burden 6.
• Patients with PVCs can be divided into different groups based on their diurnal variability patterns, which may predict distinct clinical characteristics and beta-blocker responses 6.
• The clinical profiles of patients with PVCs can vary, and some patients may experience symptoms such as fatigue and exertional dyspnoea, particularly when PVCs exceed 10% of heartbeats 4.
• However, the relationship between PVCs and dizziness is not well-established, and further research is needed to determine the clinical significance of PVCs in patients with dizziness 2, 3, 5, 4, 6.

Treatment and Management

• Catheter ablation of PVCs is often the treatment of choice, considering the high success rates, particularly in patients with frequent PVCs 3, 5.
• Beta-blockers and antiarrhythmic drugs are typically part of the initial management strategy for PVCs, but the response to these treatments can be unpredictable 5, 6.
• The treatment of patients with mild ventricular dysfunction due to PVCs is still a matter of debate, and further research is needed to determine the most effective management strategies 3, 4.