When Should I Worry About Premature Ventricular Complexes (PVCs)?

A premature ventricular complex (PVC, or premature ventricular contraction) is an extra electrical impulse arising from one of the heart's ventricles. This extra impulse happens before the next normal heartbeat has a chance to occur.

PVCs are very common and usually harmless. Most do not cause symptoms and resolve on their own without treatment. If you are experiencing symptoms, such as dizziness or fainting, tell your healthcare provider. In many cases, simply lifestyle changes like limiting caffeine are enough to manage symptoms.

This article provides an overview of the symptoms, causes, and diagnosis of PVCs. You'll also learn about when treatment for PVCs may be indicated, and what those therapy options entail.

What Are the Symptoms of PVCs?

Many people with PVCs do not feel them at all. Others describe them as a "fluttering" or "flip-flopping" feeling in the chest.

In some people, these unusual heartbeat sensations can be difficult to tolerate.

Other PVC symptoms may include:

• Shortness of breath (dyspnea)
• Lightheadedness or feeling faintish
• Tiredness
• A pounding sensation felt in the neck
  

Risk Factors

The risk of PVCs is higher in people with certain health conditions, such as:

• High blood pressure
• Previous heart attack
• Coronary heart disease
• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Congenital heart disease
• Heart failure

Certain lifestyle factors also increase the risk of PVCs, including:

• High stress levels
• Caffeine use
• Drug use
• Excessive alcohol consumption
• Nicotine use
• Lack of sleep or insomnia

People with obesity are also at an increased risk of PVCs.

When to See a Healthcare Provider

For most people, PVCs are harmless and do not cause symptoms. If the PVCs happen occasionally or do not come with other symptoms, then you do not need to see a healthcare provider.

If you have PVCs that are becoming more frequent, plan to see a healthcare provider for an evaluation.

See a healthcare provider right away if you have PVCs in addition to:

• Chest pain
• Lightheadedness
• Sudden shortness of breath
• Dizziness
• Fainting
• Nausea
  
• Sweating
• Anxiety

These can be signs of a more serious heart problem.

What Are the Potential Complications of PVCs?

PVCs usually are not dangerous in healthy people. However, in people with heart problems or a history of heart attack, PVCs can trigger more dangerous heart rhythm abnormalities, such as:

• Ventricular tachycardia (VT): A rapid heart rhythm of 100 beats per minute or more that prevents the heart from filling with enough blood
• Ventricular fibrillation (VF): An arrhythmia in which erratic electrical signals cause the ventricles of the heart to twitch, trapping blood inside the heart

Although it is rare for PVCs to trigger these types of serious heart rhythm abnormalities, they should not be ignored. Both VT and VF can be life-threatening if they are not treated promptly. In severe cases, they can result in sudden cardiac arrest and death.

High-frequency PVCs occur when 20% to 40% of heartbeats in 24 hours are PVCs. High-frequency PVCs can also be dangerous, as they can weaken the heart muscle over time. Eventually, this can lead to a heart disease called cardiomyopathy, in which the heart loses its ability to pump blood effectively.

If you think you might be having an abnormally fast or irregular heartbeat, see your healthcare provider for an evaluation.

How Are PVCs Prevented?

You may not be able to stop PVCs entirely, but you can take steps to help prevent them:

• Eat a heart-healthy diet that includes a wide variety of fruits and vegetables, legumes, nuts, fish, and minimally processed foods. Make sure to minimize salt and sugar intake, too.
• Quit tobaccoin all forms, including smoking, vaping, chewing tobacco, or any other source of nicotine.
• Eliminate triggers like drinking caffeine or alcohol in excess, or not getting enough sleep.
• Exercise to strengthen your heart muscle. Aim for at least 150 minutes of moderate physical activity per week. If exercise triggers your PVCs, consider a less intense exercise modality like yoga or weight training.
• Maintain a healthy weight for your height, sex, and body type. If you are not sure what a healthy weight is for you, consult with a healthcare provider.
• Minimize stress by practicing relaxation exercises, such as meditation or journaling, and getting adequate sleep.
• Drink electrolytesto prevent low magnesium and potassium levels, which may increase the risk of PVCs.
• Get regular health checkups, such as yearly physicals, to check your blood pressure, cholesterol, BMI, and other indicators of heart health.
  

Whether you have PVCs or not, it's important to stay on top of any medications or treatments that are prescribed to you.

What Are the Causes of PVCs?

PVCs are very common, even in completely healthy people. When normal individuals are monitored by ECG for 24 hours the majority show at least one PVC. In one study, 99.5% of individuals with an average age of 75 years had at least one PVC.

But more frequently, they occur in people with underlying heart disease. Heart conditions associated with PVCs include:

• Coronary artery disease (CAD)
• Heart failure due to dilated cardiomyopathy.
• Hypertrophic cardiomyopathy
• Heart valve disease
• Myocarditis
• Congenital heart disease
  

People with chronic high blood pressure (hypertension) may also develop structural changes in their hearts that lead to PVCs. Additionally, an injury to the heart can make the cells of the ventricles electrically unstable and cause PVCs.

There are also other health factors or problems not necessarily related to the heart that may contribute to the development of PVCs.

• Electrolyte imbalances (e.g., low potassium or low magnesium levels in the blood)
• Substance use, including tobacco, alcohol, and cocaine
• Low oxygen level in the bloodstream (hypoxia)
  
• Anxiety or excess adrenaline release from exercise or from taking allergy medications, like antihistamines
• Digoxin toxicity
• Certain non-heart conditions, like thyroid disease or obstructive sleep apnea

How Are PVCs Diagnosed?

If no symptoms are present, PVCs may be suspected if a patient has an irregular heartbeat on a physical examination. PVCs can then be officially diagnosed by electrocardiogram (ECG or EKG).

With this test, flat disks that can detect electrical activity of the heart are placed on your chest. Results are graphed on a monitor.

In some cases, PVCs are diagnosed incidentally through a routine ECG—for example, during a preoperative evaluation before surgery.

When symptoms are present, PVCs are diagnosed through an ECG or a more sophisticated tool called an ambulatory ECG monitoring system.

Ambulatory ECG monitoring systems are portable devices that are worn for a long period of time to capture and record abnormal heart rhythms ( arrhythmias ) that may come and go.

A Holter monitor is one type of ambulatory ECG system that may be used to diagnose and measure the frequency of PVCs. It records the electrical activity of your heart continuously for 24 to 48 hours.

The recordings of ambulatory ECG systems are analyzed for PVCs (or another arrhythmia) by a cardiologist—a doctor who treats heart conditions.

Additional Testing

To help determine if your PVCs are benign, your healthcare provider will want to assess several things from the history and physical exam, laboratory evaluation, and cardiac imaging tests.

Depending on findings from your medical history/physical exam, various blood tests may be ordered.

For example, if an electrolyte imbalance is suspected, a basic metabolic panel and a magnesium level may be ordered. Likewise, if you are taking Digox (digoxin) for heart failure or another arrhythmia, a digoxin level will probably be ordered.

Further testing to look for previously unknown heart disease is also commonly performed.

In general, an echocardiogram, which is an ultrasound of your heart, is the main way to screen for most underlying heart conditions. In select cases, your doctor may want to perform a nuclear stress test or a cardiac magnetic resonance imaging (MRI).

Besides revealing an image of the heart's anatomy, an echocardiogram provides a measurement called the left ventricular ejection fraction, or LVEF. An LVEF reveals how well your heart is pumping blood. A reduced LVEF indicates that your heart muscle not working as well as it should. Knowing your LVEF is important, as it can affect how (or if) your doctor decides to treat your PVCs.

Around 50% of people with or without heart disease will have at least one PVC during a 24-hour Holter monitor study.

Management of PVCs

Managing PVCs is not a straightforward matter, as their impact can vary from person to person.

If your healthcare provider has demonstrated that your heart is structurally normal (typically by performing a stress-echocardiogram), reassurance that the PVCs are benign is often the only treatment that is needed.

Once it's understood exactly what is going on with the heart—and that it is common and not dangerous—you may be less likely to become anxious when PVCs occur.

PVCs can create a vicious cycle, because the anxiety they provoke can cause an increase in neurohormonal factors (catecholamines/adrenalin). These factors may increase heart rate and make the heart beat stronger, which can increase the frequency of the PVCs.

Some people find their PVCs are triggered by caffeine (e.g., tea, soda, coffee, chocolate) or stress, and reducing or eliminating those triggers helps greatly.

Regular follow-up with a primary care physician is recommended for patients with infrequent PVCs, no symptoms, and a normal LVEF.

For those with frequent PVCs but no symptoms and a normal LVEF, yearly echocardiograms and follow-up with a cardiologist are advised.

Beyond that, the following may be considered:

Potassium

Low potassium levels (hypokalemia) have been linked to PVCs. This corresponds to potassium levels less than 3.5 meQ/L. Hypokalemia can be caused by many things, including certain diuretics (such as hydrochlorothiazide or furosemide), vomiting, diarrhea, or excessive sweating.

Potassium supplementation is an effective way to manage PVCs caused by low potassium levels. An alternative to potassium supplements is ramping up how much potassium you consume in your diet.

Radiofrequency Ablation

Radiofrequency ablation is a specialized form of cardiac catheterization that is performed by a heart rhythm specialist called an electrophysiologist.

Painless radiofrequency energy is used to destroy heart tissue deemed to be the source of abnormal electrical signals.

Ablation may be warranted in certain highly symptomatic people. It may also be considered in those with a low LVEF who have frequent PVCs, regardless of whether symptoms are present or not.

Ablation carries significant risks of major cardiac events, which occur in 3%-5% of cases.

Summary

PVCs are abnormal heartbeats that begin in one of your heart's lower chambers. They are common and may cause palpitations, lightheadedness, or no symptoms at all. Once PVCs are diagnosed, an echocardiogram is typically performed to assess the heart's function and structure. The treatment of PVCs is highly variable, ranging from annual checks to taking medications or undergoing an ablation procedure. Although frequent PVCs can increase the risk of other abnormal heart rhythms, the vast majority of people who have PVCs will continue to live a long life.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.

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