Heart
Premature Ventricular Contractions
Extra heartbeats that begin in one of your heart's two lower pumping chambers, causing a skipped beat sensation.
Premature ventricular contractions (PVCs) are early beats from the ventricles causing a 'skipped beat' sensation — common and usually benign, but requiring specialist assessment when frequent, symptomatic, or associated with structural heart disease.
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Premature ventricular contractions (PVCs) disrupt your normal heart rhythm and can feel like a fluttering or skipped beat in your chest.
Symptoms
- Often asymptomatic, discovered by chance
- Palpitations described as skipped beats, chest thumping, or forceful beats following a pause
- More noticeable at rest or when lying down
- High-frequency PVCs may produce lightheadedness, chest discomfort, or breathlessness during exertion
PVC Patterns
- Bigeminy — every other beat is a PVC
- Trigeminy — every third beat is a PVC
- Couplets — two consecutive PVCs
- Non-sustained ventricular tachycardia (NSVT) — three or more consecutive PVCs lasting under 30 seconds
When PVCs Warrant Concern
- PVC burden exceeding 10–15% on 24-hour monitoring
- Exercise-induced increase rather than suppression
- Reduced ejection fraction or structural heart disease
- Family history of sudden cardiac death
Causes & Risk Factors
- Stimulant triggers: caffeine, alcohol, nicotine, stress
- Electrolyte imbalances: low potassium or magnesium
- Structural causes: coronary artery disease, prior infarction, cardiomyopathy
- Systemic conditions: hyperthyroidism, sleep apnoea
Treatment Options
- Observation for asymptomatic, low-burden cases in structurally normal hearts
- Trigger modification: reduce caffeine, correct electrolytes, treat thyroid disease
- Beta-blockers (first-line pharmacological treatment)
- Calcium channel blockers (alternative: verapamil, diltiazem)
- Catheter ablation for drug-resistant cases or PVC-induced cardiomyopathy
Concerned About Premature Ventricular Contractions?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.