How to manage premature ventricular contractions?

Question

Hello doctor,

I am an 18-year-old female with no current medications and no known medical conditions. There is a family history of various heart problems on both my maternal and paternal sides. I was seen by a cardiologist over the summer for a bigeminy and an irregular heartbeat. Although I still experience palpitations fairly often, and occasional chest and left shoulder pain, the cardiologist told me I have nothing to worry about. I have not consulted with her since then. However, yesterday I received my paperwork and test results from wearing a 24-hour Holter monitor, and I am extremely worried.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

What you have is called premature ventricular contractions (PVCs), which are extra beats coming from the bottom chamber of the heart. In some cases, these occur every other beat, a condition known as ventricular bigeminy. These extra beats can be tolerated as normal in many individuals. However, there are two important factors to consider:

What is the burden of PVCs? This refers to the amount or percentage of PVCs over 24 hours in your heart. While some people consider up to 6 PVCs per hour as normal, cardiologists become concerned when there are more than 10,000 or even 20,000 PVCs in 24 hours. This is because this threshold is associated with potential impairment of the heart’s pumping function.
What is the heart’s function, specifically the ejection fraction? The ejection fraction is a measure of the heart’s ability to pump blood. If the ejection fraction is low, we need to investigate the PVC burden, particularly if there are more than 10,000 PVCs in 24 hours, as a possible cause of reduced pumping function. This can be assessed with an ultrasound of the heart. If we find that the pumping function is low and there are more than 10,000 PVCs in 24 hours, we may need to treat this with medications, a catheter-based procedure, or both.

Finally, it is important to determine if you are experiencing significant symptoms, such as palpitations, dizziness, fainting, or chest pain on a regular basis, and whether these symptoms are affecting your daily life.

I hope this helps you.

Thank you.