Premature Ventricular Contraction

Aka: Premature Ventricular Contraction, PVC

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II. Physiology

  1. PVCs have been historically thought to be benign
  2. More recently, data suggests increased risk
    1. In underlying cardiac disease, PVCs increase Arrhythmia risk
    2. In otherwise normal hearts, PVCs are still typically benign
      1. However, longstanding frequent PVCs, increase risk of Cardiomyopathy

III. Definitions

  1. Bigeminy
    1. Extrasystole follows every sinus beat
  2. Trigeminy
    1. Extrasystole follows every other sinus beat
    2. Every third beat is ectopic
  3. Couplet
    1. Extrasystole and preceding beat

IV. Causes

  1. Occasional PVCs are normal finding in healthy patient
  2. Cardiac causes
    1. Ischemic Heart Disease
    2. Cardiomyopathy
    3. Valvular heart disease
    4. Mitral Valve Prolapse
  3. Stimulants
    1. Caffeine
    2. Cocaine
    3. Alcohol
    4. Ephedrine or Pseudoephedrine
  4. Electrolyte Abnormalities
    1. Metabolic Acidosis
    2. Hypoxemia
    3. Hyperkalemia
    4. Hypokalemia
    5. Hypomagnesemia
  5. Medications
    1. Digoxin
    2. Theophylline
    3. Antipsychotic Medications
    4. Tricyclic Antidepressants
    5. Antiarrhythmics (Flecainide, Sotalol, Quinidine)

V. Signs: EKG Findings

  1. Unusual and Wide QRS with bizarre axis
  2. Large T Wave with opposite polarity as QRS
  3. Full compensatory pause
  4. No P Wave included in Extrasystole
  5. Associated with left bundle branch pattern

VI. Evaluation: Lown Criteria to distinguish pathologic PVCs

  1. Low risk of degenerating into ventricular Dysrhythmia
    1. Class 0: No PVCs
    2. Class 1: <30 PVCs per hour
  2. Intermediate risk of degeneration
    1. Class 2: 30 or more PVCs per hour
  3. High risk of degeneration
    1. Class 3: Multifocal PVCs
    2. Class 4a: Two consecutive PVCs
    3. Class 4b: Three consecutive PVCs
    4. Class 5: R on T Phenomena

VII. Management

  1. No heart disease (normal left ventricular function)
    1. Avoid provocative factors
    2. Mild asymptomatic PVCs
      1. No management required
    3. Symptomatic PVCs accounting for <20% of total beats
      1. Consider Beta Blocker for disabling symptoms
    4. PVCs account for >20% of total beats
      1. Consider Cardiac Catheter Ablation
      2. Associated with increased risk of developing a Cardiomyopathy
        1. See physiology above regarding risk
  2. Heart disease (with Left Ventricular Dysfunction)
    1. PVCs increase risk of morbidity and mortality
    2. Consider management for Lown Class 3-5
      1. Consider Cardiac Catheter Ablation

VIII. References

  1. Baman (2010) Heart Rhythm 7(7): 865-9 [PubMed]

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Related Studies

Ontology: Premature ventricular contractions (C0151636)

Definition (CSP) premature ventricular beats, the most common of all arrhythmias; in the absence of heart disease, they are not of great clinical significance, but in patients with coronary disease, they represent a constant danger of ventricular tachycardia or fibrillation and sudden death.
Definition (MSH) A type of cardiac arrhythmia with premature contractions of the HEART VENTRICLES. It is characterized by the premature QRS complex on ECG that is of abnormal shape and great duration (generally >129 msec). It is the most common form of all cardiac arrhythmias. Premature ventricular complexes have no clinical significance except in concurrence with heart diseases.
Concepts Pathologic Function (T046)
MSH D018879
ICD10 I49.3
SnomedCT 17338001, 155367002, 195096003, 195093006, 251175005
LNC LP31568-6, LP31253-5, MTHU024512, MTHU024517, LA17095-3
English EXTRASYSTOLE VENTRICULAR, Ectopic Beat, Ventricular, Ectopic Beats, Ventricular, Extrasystole, Ventricular, Premature Ventricular Beat, Premature Ventricular Beats, Premature Ventricular Complex, Premature Ventricular Contraction, Premature Ventricular Contractions, Ventricular Beat, Premature, Ventricular Beats, Premature, Ventricular Complex, Premature, Ventricular Contraction, Premature, Ventricular Contractions, Premature, Ventricular Ectopic Beat, Ventricular Ectopic Beats, Ventricular Extrasystole, Ventricular Extrasystoles, Ventricular Premature Complex, Ventricular Premature Complexes, Ventricular ectopic beats, premature ventricular contraction, Premature ventricular contractions, Ventric premature depolarisatn, Ventricular contractions premature, Ventricular ectopics, Extrasystole ventricular, Extrasystoles ventricular, Premature VEB's, PVC's, VEB's, VPC's, Ventricular Premature Complexes [Disease/Finding], ventricular ectopics, ventricular premature beat, Ectopic beat(s);ventricular, ventricular ectopic activity, ventricular ectopic beat, ventricular extrasystoles, Systoles;ventricular (extra), pvcs, ventricular ectopic complex (PVC), ventricular premature complexes, ventricular ectopic, ventricular ectopic complex (PVC) [heart disease], premature ventricular beat, premature ventricular beats, ventricular ectopy, ventricular premature beats, premature ventricular complex, premature ventricular complexes, PVC, ventricular extrasystole, Premature ventricular contraction (PVC), ventricular premature depolarization, premature depolarization ventricular, ventricular premature depolarization (diagnosis), Ventricular ectopic beats (disorder), PVC - Premature ventricular contraction, PVC - Premature ventricular complex, VPC - Ventricular premature contraction, Premature ventricular contraction, VPC - ventricular premature complex, premature ventricular contractions, premature ventricular contractions (diagnosis), Premature ventricular ectopic beats, Ventricular extrasystoles, Ventricular premature beats, Ventricular premature contractions, Ventricular premature systoles, Ventricular ectopic complex, Ventricular premature complex, Ventricular premature depolarization, Ventricular premature depolarisation, Premature ventricular complex, Ventricular premature beats (disorder), Ventricular premature complex (disorder), beats; ectopia, ventricular, contraction; premature, ventricular, ectopia; beats, ventricular, ectopia; ventricular beats, extrasystoles; ventricular, premature; contraction, ventricular, premature; ventricular systole, ventricular; ectopic beats, ventricular; extrasystoles, ventricular; premature contraction, ventricular; premature systole, Ventricular ectopic beats (finding), extra ventricular systoles, ventricular ectopic beat(s)
Spanish EXTRASISTOLE VENTRICULAR, contracciones ventriculares prematuras, Focos ectópicos ventriculares, Contracciones ventriculares prematuras, CVP, Latidos ventriculares ectópicos, CV prematuras, Extrasístole ventricular, Latidos ventriculares prematuros ectópicos, latidos ectópicos ventriculares, latidos ectópicos ventriculares (trastorno), complejos ventriculares ectópicos, complejos ventriculares prematuros (trastorno), complejos ventriculares prematuros, despolarización ventricular prematura, extrasístoles ventriculares (trastorno), extrasístoles ventriculares, Extrasístoles ventriculares, latidos ectópicos ventriculares (hallazgo), Complejos Prematuros Ventriculares, Contracciones Ventriculares Prematuras, Extrasístole Ventricular, Latidos Ectópicos Ventriculares, Latidos Ventriculares Prematuros
Dutch VPC's, premature ventriculaire ectopische hartslagen, premature ventrikelcontracties, ventriculaire extrasystolen, ventriculaire ectopische hartslagen, extrasystole ventriculair, premature ventriculaire extrasystolen, PVC's, premature ventriculaire contracties, ventriculaire extrasystole, ventriculaire ectopics, contractie; prematuur, ventriculair, ectopie; slagen, ventriculair, ectopie; ventriculaire slagen, extrasystole; ventriculair, prematuur; contractie, ventriculair, prematuur; ventriculaire systole, slagen; ectopie, ventriculair, ventriculair; ectopische slagen, ventriculair; extrasystole, ventriculair; premature contractie, ventriculair; premature systole, ventriculaire extrasystoles, Depolarisatie, ventriculaire premature, Extrasystole, ventriculaire, Premature ventriculaire hartslag, Premature ventriculaire systole, Ventriculaire ectopische hartslag, Ventriculaire premature depolarisatie
French ESV, CVP, Contractions ventriculaires prématurées, ESV prématurées, Battements ventriculaires ectopiques prématurés, Battements ventriculaires ectopiques, EXTRSYSTOLES VENTRICULAIRES, Complexe ventriculaire prématuré, Contraction ventriculaire prématurée, Extrasystole ventriculaire, Extrasystoles ventriculaires
German Extrasystolen extraventrikulaer, vorzeitige ventrikulaere Kontraktionen, Extrasystole extraventrikulaer, VEB, ventrikulaere Kontraktionen vorzeitig, vorzeitige VEB, PVC, VPC, ventrikulaere Ektopien, verfruehte ventrikulaere Extrasystolen, EXTRASYSTOLEN VENTRIKULAER, Ventrikulaere Extrasystolie, ventrikulaere Extrasystolen, Kammerextrasystolen, Vorzeitige Kammerkontraktionen, Extrasystolie, ventrikuläre, Ventrikuläre ektopische Systolen, Ventrikuläre Extrasystolie
Italian Contrazioni ventricolari premature, Battiti ectopici ventricolari prematuri, Contrazioni ventricolari, Battiti prematuri ventricolari, Contrazioni premature ventricolari, Battiti ectopici ventricolari, Extrasistole ventricolare, Extrasistoli ventricolari
Portuguese Contracções ventriculares ectópicas, Batimentos ectópicos ventriculares, Contracção ventricular orematura, Extra-sístole ventricular, Batimentos ectópicos ventriculares prematuros, Complexos ventriculares prematuros, EXTRASISTOLE VENTRICULAR, Extrassístole Ventricular, Extra-sístoles ventriculares, Batimentos Ectópicos Ventriculares, Batimentos Ventriculares Prematuros, Complexos Ventriculares Prematuros, Contrações Ventriculares Prematuras
Japanese 異所性心室期外収縮, ｼﾝｼﾂｾｲｷｶﾞｲｼｭｳｼｭｸ, ｲｼｮｾｲｼﾝｼﾂｷｶﾞｲｼｭｳｼｭｸ, 期外収縮-心室, 期外収縮-心室性, 心室性早期収縮, 心室性期外収縮, 心室性異所性収縮, 心室期外収縮
Swedish Hjärtkammarprematurslag
Finnish Kammiolisälyönnit
Russian RANNIE ZHELUDOCHKOVYE EKSTRASISTOLY, ZHELUDOCHKOV EKTOPICHESKIE SISTOLY, ZHELUDOCHKOV EKSTRASISTOLY, EKSTRASISTOLA ZHELUDOCHKOVAIA, ЖЕЛУДОЧКОВ ЭКСТРАСИСТОЛЫ, ЖЕЛУДОЧКОВ ЭКТОПИЧЕСКИЕ СИСТОЛЫ, РАННИЕ ЖЕЛУДОЧКОВЫЕ ЭКСТРАСИСТОЛЫ, ЭКСТРАСИСТОЛА ЖЕЛУДОЧКОВАЯ
Czech Komorová extrasystola, Předčasné komorové stahy, Komorové extrasystoly, Komorové ektopické stahy, KES, Komorová ektopie, Předčasné komorové ektopické stahy, předčasné komorové kontrakce, komorové extrasystoly, předčasné ventrikulární kontrakce
Korean 심실 조기 탈분극
Polish Pobudzenia komorowe przedwczesne, Ekstrasystolia komorowa, Skurcz komór przedwczesny, Skurcz komór ektopowy
Hungarian VEB-ek, Ventricularis ectopiás ütések, Ventricularis korai contractiók, PVC-k, Korai ventricularis ectopiás ütések, Ventricularis extrasystolék, Kamrai extrasystole, Korai VEB-ek, VPC-k, Extrasystolék, ventricularis, Korai ventricularis contractiók
Norwegian Premature ventrikulære kontraksjoner, Ventrikulær ekstrasystole, Ventrikulære ektopiske slag, Premature ventrikulære ekstrasystoler
Derived from the NIH UMLS (Unified Medical Language System)

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