Premature Ventricular Contractions: Symptoms, Diagnosis, and Treatment - Cardiology

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Premature Ventricular Contractions (PVCs) are a common type of arrhythmia characterized by early heartbeats originating in the ventricles. They can be benign in many cases, but they can also be associated with underlying heart conditions, especially if they occur frequently or are symptomatic. Your experience with PVCs, particularly the sensations of "skipping" or "pausing" in your heartbeat, is consistent with how many patients describe this condition.


Symptoms of PVCs
Patients with PVCs often report a variety of symptoms, including:
- A sensation of a skipped heartbeat or a "fluttering" feeling in the chest.

- Palpitations or a feeling that the heart is racing.

- Discomfort or pain in the chest, which can sometimes radiate to the back or shoulders.

- Dizziness or lightheadedness, particularly if the PVCs are frequent or occur in bursts.

In your case, the discomfort you described, particularly the pain radiating to your left back and the sensation of blood flowing in your chest, could be related to the PVCs or other cardiac issues. It's important to differentiate between symptoms that are benign and those that may indicate a more serious condition.


Diagnosis
The diagnosis of PVCs typically involves:
- Electrocardiogram (ECG): This is the primary tool for diagnosing PVCs. It can show the characteristic early beats and help determine their frequency and pattern.

- Holter Monitor: A 24-hour Holter monitor, which you underwent, provides a more comprehensive view of your heart's rhythm over an extended period. The fact that your doctor noted 190 PVCs during this time and deemed it acceptable suggests that while you have PVCs, they may not be causing significant concern at this moment.

- Echocardiogram: This imaging test assesses the structure and function of your heart, which you have already undergone, showing normal results.


Treatment
The treatment for PVCs often depends on their frequency, symptoms, and any underlying heart conditions. Here are some common approaches:
- Lifestyle Modifications: Reducing caffeine, alcohol, and stress can help decrease the frequency of PVCs. Since you mentioned that emotional fluctuations seem to trigger your symptoms, stress management techniques such as mindfulness, yoga, or counseling may be beneficial.

- Medications: Antiarrhythmic medications like "Diltiazem" (迪心贊) and "Entresto" (恩特來錠) are sometimes prescribed to manage PVCs. Your doctor may adjust your medications based on your symptoms and the results of your Holter monitor.

- Follow-Up: Regular follow-up with your cardiologist is essential. If your symptoms persist or worsen, further evaluation may be necessary, including possible electrophysiological studies or adjustments in your medication regimen.


Next Steps
Given your ongoing symptoms and concerns, here are some recommendations:
1. Continue Monitoring: Keep track of when your PVCs occur, their duration, and any associated symptoms. This information can be valuable for your healthcare provider.

2. Discuss Medication Effects: If you feel that your medications may be affecting your symptoms or the accuracy of your Holter monitor, discuss this with your doctor. They can provide guidance on how to manage your medications around testing.

3. Seek Immediate Care for Severe Symptoms: If you experience severe chest pain, prolonged discomfort, or any new concerning symptoms, seek immediate medical attention. These could indicate a more serious condition that requires prompt evaluation.

4. Emotional and Physical Health: Since you noted that emotional states trigger your symptoms, consider engaging in relaxation techniques or speaking with a mental health professional to help manage anxiety or stress.

In conclusion, while PVCs can be concerning, they are often manageable with the right approach. Regular communication with your healthcare provider and adherence to their recommendations will be key in managing your condition effectively.