Premature Ventricular Contractions: Causes and Further Testing

Q: Premature Ventricular Contractions: Causes and Further Testing

Hello： Premature ventricular contractions (PVCs) are a common type of arrhythmia that can be triggered by emotional stress, physical stress (such as infections), the use of tobacco, alcohol, and caffeine, or even changes in temperature. <br>Isolated PVCs usually do not indicate a

Evaluation of Premature Contractions (Premature Beats)

Hello Doctor, I have been experiencing premature ventricular contractions (PVCs) for the past six months, and I can feel almost every single one of them, accompanied by palpitations and brief episodes of dizziness.
I wore a 24-hour Holter monitor and recorded about 80 occurrences in a day.
I noticed that the frequency increases as the day goes on; for example, during the day, I might have one every 30 minutes, while at night, it could be every 5 minutes or even every 2 minutes.
I have had tests for autonomic nervous function and thyroid hyperactivity, both of which came back normal.
Currently, I still cannot find the cause.
Are there any other areas I should investigate? (Additionally, I have been dealing with a thyroid cyst and recurrent Candida infections over the past six months.)

Lico, 20~29 year old female. Ask Date: 2023/05/18

Dr. Huang Yinghe reply Cardiology

Hello: Premature ventricular contractions (PVCs) are a common type of arrhythmia that can be triggered by emotional stress, physical stress (such as infections), the use of tobacco, alcohol, and caffeine, or even changes in temperature.
Isolated PVCs usually do not indicate any significant heart disease and do not require specific treatment.
If you have already seen a physician and no issues were found, it is recommended to start with lifestyle adjustments, such as managing and alleviating stress, maintaining a regular sleep schedule combined with exercise, and avoiding stimulants like tobacco, alcohol, and caffeine.
In your case, where symptoms are frequent, the physician may consider prescribing medication to alleviate them.
It is advisable to return for a follow-up appointment to discuss further treatment options with your doctor.

Reply Date: 2023/05/18

More Info

Premature Ventricular Contractions (PVCs) are common cardiac arrhythmias characterized by early heartbeats originating from the ventricles. They can be benign in nature, especially in individuals without underlying heart disease, but they can also be symptomatic and warrant further investigation, particularly when accompanied by symptoms such as palpitations, dizziness, or syncope.

In your case, the presence of PVCs, especially with the frequency you described (approximately 80 occurrences in a 24-hour period), along with sensations of heart palpitations and occasional dizziness, suggests that further evaluation may be necessary. While you have already undergone a 24-hour Holter monitor, which is a valuable tool for capturing the frequency and timing of PVCs, there are additional steps you can consider to further investigate the underlying causes.

1. Electrocardiogram (ECG) Analysis: A standard ECG can provide immediate information about the heart's rhythm and electrical activity. It can help identify any other arrhythmias or underlying conditions that may be contributing to your symptoms.

2. Echocardiogram: An echocardiogram is an ultrasound of the heart that can assess the structure and function of the heart chambers and valves. It can help rule out any structural heart disease that may be causing the PVCs.

3. Exercise Stress Test: This test evaluates how your heart responds to physical stress. It can help determine if the PVCs are exercise-induced or if they occur at rest, which may provide insight into their significance.

4. Thyroid Function Tests: Given your history of thyroid cysts and previous concerns about thyroid function, comprehensive thyroid testing (including TSH, Free T4, and Free T3) can help rule out hyperthyroidism or other thyroid-related issues that could contribute to arrhythmias.

5. Electrophysiological Study (EPS): If PVCs are frequent and symptomatic, an electrophysiological study may be considered. This invasive procedure allows for detailed mapping of the heart's electrical system and can help identify the origin of the PVCs.

6. Holter Monitor Follow-Up: If your PVCs are increasing in frequency, a longer-term Holter monitor (more than 24 hours) may be beneficial to capture any changes over time, especially during different activities or sleep.

7. Lifestyle and Dietary Assessment: Sometimes, PVCs can be exacerbated by lifestyle factors such as caffeine intake, alcohol consumption, stress, or lack of sleep. Keeping a diary of your symptoms in relation to these factors may help identify triggers.

8. Consultation with a Cardiologist: Given the complexity of your symptoms and the potential for underlying issues, a consultation with a cardiologist specializing in arrhythmias may provide additional insights and management options.

In summary, while PVCs can be benign, your symptoms and the frequency of occurrences warrant a thorough evaluation to rule out any significant underlying conditions. It is essential to work closely with your healthcare provider to determine the most appropriate next steps based on your specific situation. Regular follow-up and monitoring can help manage your symptoms and ensure that any potential issues are addressed promptly.

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