Premature Ventricular Contractions (PVCs, PVC)

  • Medical Author:
    Daniel Lee Kulick, MD, FACC, FSCAI

    Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

How is premature ventricular contraction diagnosed (EKG and Holter)?

There are two aspects in the diagnosis of premature ventricular contractions -- detecting them and diagnosing the underlying causes. Electrocardiograms (EKGs) and Holter monitors are used to diagnose premature ventricular contractions. EKGs, blood tests, echocardiograms, and cardiac stress tests are used to determine the underlying causes of premature ventricular contractions.

Electrocardiogram (EKG)

An electrocardiogram (EKG or ECG) is a brief recording of the heart's electrical discharges. EKGs can be performed in the doctors' offices, clinics, and hospital emergency rooms. Doctors frequently ask for a rhythm strip (a prolonged EKG recording) to be performed at the same time as an EKG to increase the chances of detecting premature ventricular contractions and other abnormal rhythms. The premature ventricular contractions are easy to recognize on EKG and rhythms strips, provided premature ventricular contractions occur during the recording. EKG may also demonstrate other problems such as heart attacks, hypokalemia, digoxin toxicity, and heart muscle thickening (hypertrophy) due to long term high blood pressure.

Holter monitor

A standard EKG and a rhythm strip performed at the time of a visit to the doctor's office may not detect the premature ventricular contractions because they may not be occurring at that moment. Holter monitoring is then necessary to detect the premature ventricular contractions in these patients with heart palpitations. A Holter monitor is a continuous recording of the heart's rhythm for 24 hours. Holter monitoring can be used diagnose premature ventricular contractions as well as other heart rhythm abnormalities such as atrial fibrillation, atrial flutter, and ventricular tachycardias.

PVCs are present in more than 6% of middle-aged adults. PVCs can be demonstrated during Holter monitoring. However, not all premature ventricular contractions found during Holter monitoring are clinically important. Doctors interpreting the Holter monitoring studies must take into account the patient's medical history in determining the importance of Holter monitor findings.

In patients with infrequent symptoms an event marker may be used in lieu of a Holter monitor as this can be worn for up to 30 days. Continue Reading

Reviewed on 3/23/2016
References
REFERENCES:

"Sudden Cardiac Arrest." Cleveland Clinic. March 2010.

Simpson, R. J. Jr., et al. "Prevalence of premature ventricular contractions in a population of African American and white men and women: the Atherosclerosis Risk in Communities (ARIC) study." American Heart Journal 143.3 (2002): 535-540.

Zipes, Douglas P. and Hein J. J. Wellens. "Sudden cardiac death." Circulation 98.21 (1998): 2334-2351.

Medically reviewed by Robert J. Bryg, board certified in internal medicine with a subspecialty in cardiovascular disease.

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