From the Guidelines
You are likely experiencing a premature ventricular contraction (PVC), which is a common and usually benign heart rhythm disturbance. This occurs when an early heartbeat originates from an area outside the heart's normal pacemaker, causing the sensation of a skipped beat followed by a stronger "compensatory" beat 1. PVCs are most commonly benign, but their appearance requires at least a minimal level of evaluation before clearance, including a 12-lead ECG and exercise stress test 1.
Some key points to consider about PVCs include:
- They can be triggered by stress, caffeine, alcohol, lack of sleep, or certain medications
- Most PVCs are harmless, especially in people with healthy hearts
- If these episodes are occasional and not accompanied by other symptoms like dizziness, chest pain, or shortness of breath, they typically don't require treatment
- However, if you experience frequent palpitations, feel lightheaded, have chest discomfort, or have a history of heart disease, you should consult a healthcare provider 1
- PVCs recorded at a frequency of >2000 per 24 hours have a higher likelihood of association with underlying cardiac disease, estimated at 30% in this subgroup 1
It is essential to note that PVCs that become more frequent or convert to runs of nonsustained VT (NSVT) during exercise should lead to further evaluation, depending on findings on the initial noninvasive testing 1. Additionally, athletes with persisting frequent PVCs should remain under surveillance over time for early evidence of development of PVC-induced cardiomyopathy, with annual cardiological evaluation required in athletes with PVCs >2000 per 24 hours 1.
From the Research
Description of the Symptom
- The feeling of a heart skip and a subsequent hard beat is a common symptom described by patients as palpitations, which can be characterized by a racing or fluttering heart, a pounding chest, irregular or skipped heartbeats, or a pounding sensation in the neck 2.
- Palpitations are a symptom of many cardiac and noncardiac conditions, and their cause can be difficult to diagnose due to their intermittent and sometimes infrequent nature 3, 4.
Possible Causes
- Cardiac disorders, such as arrhythmias or structural heart disease, can cause palpitations 2.
- Noncardiac conditions, such as endocrine and metabolic disorders, medication or illicit drug use, or psychosomatic disorders, can also contribute to palpitations 2.
- In some cases, palpitations may be triggered by a premature ventricular contraction (PVC), which is a type of abnormal heartbeat 5.
Evaluation and Diagnosis
- A detailed history, physical examination, and electrocardiogram (ECG) are essential in evaluating palpitations and may be sufficient to identify the etiology of the symptom 3, 4, 2.
- Additional testing, such as ambulatory ECG monitoring, echocardiography, or cardiac stress testing, may be indicated to distinguish whether symptoms correlate with cardiac arrhythmia or structural heart disease 3, 6, 2.
- Wearable smart devices with ambulatory electrocardiogram monitoring technologies can also be used to detect arrhythmias and allow patients to participate in their healthcare 2.