Premature Ventricular Complexes (PVC's) - Summary Framework



Why PVCs?  Can be the first manifestation of cardiac disease, including:

• Coronary artery disease

• Cardiomyopathy

• Inherited arrhythmia syndromes (e.g., long QT syndrome, ARVC)

• Hypertension, LV hypertrophy

• Other forms of structural heart disease



Causes:

• Hypertension

• Myocardial ischemia

• Sympathomimetics

• Hypomagnesemia

• Hypokalemia

• Bundle branch block

• Underlying ischemic heart disease

• Stimulants, ETOH, Substances

• Digoxin toxicity



Symptoms:

• Fluttering

• Pounding or jumping

• Skipped beats or missed beats

• Increased awareness of the heartbeat

• Palpitations, Presyncope



PVC burden is classified as:

• Low: <1 percent or 1000 PVCs/day

• Intermediate burden: >1 to <15 percent PVCs/day

• High: >15 percent or 15,000 PVCs/day

• >3 Consecutive PVC's up to 300 = NSVT



EKG Findings:

• Broad QRS complex (≥ 0.12s) with abnormal morphology

• Premature – i.e., occurs earlier than would be expected for the next sinus impulse

• No associated P-wave, and the T-wave records in the opposite direction from the QRS

• Usually followed by a full compensatory pause

• Retrograde capture of the atria may or may not occur



Differential Diagnosis:

• PAC – Often have a very similar sensation to PVCs but are benign. A PAC also has a shorter compensatory pause than a PVC.

• Non-sustained ventricular tachycardia (NSVT) – Three or more consecutive PVCs are defined as NSVT until a time length of 30 seconds.

• Sustained ventricular tachycardia

• Bigeminy, Trigeminy, Quadrigeminy

• Supraventricular tachycardia

• Sinus arrhythmia

• Atrial fibrillation



Complications:

• Cardiomyopathy (PVC-induced cardiomyopathy may result from frequent PVCs – generally >10%-15% of beats)

• Heart failure

• Exacerbation of ventricular tachyarrhythmias



High-risk features will indicate more intensive treatment and monitoring.



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