Premature Ventricular Contractions (PVCs) on ECG

Introduction

Premature Ventricular Contractions (PVCs) are early heartbeats originating from the ventricles. They are commonly found on an electrocardiogram (ECG) and can occur in both healthy individuals and those with heart conditions.

Causes of PVCs

PVCs can be caused by various factors, including: - Electrolyte imbalances (such as low potassium or magnesium) - Heart disease (such as coronary artery disease, heart failure, or cardiomyopathy) - Stress or anxiety - Stimulants (such as caffeine, alcohol, or nicotine) - Medications (such as certain decongestants or asthma drugs)

ECG Features of PVCs

On an ECG, PVCs appear as: - A wide QRS complex (>120 ms) - Absence of a preceding P wave - A compensatory pause following the PVC - Different morphologies depending on the site of origin in the ventricles

Clinical Significance

PVCs are usually benign in healthy individuals but can indicate underlying heart diseases when: - They are frequent (>10% of total heartbeats) - They occur as couplets or triplets (two or three consecutive PVCs) - They appear as ventricular tachycardia (a run of three or more PVCs in a row) - They are symptomatic (causing palpitations, dizziness, or syncope)

Diagnosis and Management

Diagnosis:

• ECG or Holter Monitoring (24-48 hours) to assess frequency and patterns
• Echocardiography to evaluate heart structure
• Cardiac MRI or Stress Test if underlying heart disease is suspected

Treatment:

• Lifestyle modifications (reducing caffeine, stress, and alcohol intake)
• Electrolyte correction if imbalances are found
• Beta-blockers or calcium channel blockers if PVCs are symptomatic
• Catheter ablation for frequent or symptomatic PVCs that originate from a focal area

Conclusion

PVCs are often benign but should be evaluated if frequent, symptomatic, or associated with heart disease. If you experience symptoms, consult a cardiologist for proper diagnosis and management.

Source recommendations

1. American Heart Association Guidelines for Ventricular Arrhythmias

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
2. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia--fast-heart-rate
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
4. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
5. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/ventricular-fibrillation

2. European Society of Cardiology Guidelines for Ventricular Arrhythmias and Sudden Cardiac Death

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
4. https://pubmed.ncbi.nlm.nih.gov/36017572/
5. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022