Premature ventricular contraction

Background

• Abbreviation: PVC

Causes

• Digoxin
• CHF
• Hypokalemia
• Alkalosis
• Hypoxia
• Myocardial infarction
• Cardiomyopathy
• Drugs

PVC

PVCs

Clinical Features

• May be asymptomatic, or may have Palpitations

Differential Diagnosis

Palpitations

• Arrhythmias:
  • Atrial fibrillation
  • Grouped beats on ECG (commonly misdx as A-fib)
    • Atrial bigeminy and trigeminy
    • Mobitz I or Mobitz II
  • Atrial flutter
  • SVT
  • Ventricular Tachycardia
  • Sick sinus syndrome
  • Multifocal atrial tachycardia
  • PVCs
  • Wolff–Parkinson–White syndrome (WPW)
  • Sinus node dysfunction
  • AV Block
  • Lown-Ganong-Levine Syndrome‎
  • Accelerated idioventricular rhythm
• Non-arrhythmic cardiac causes:
  • Cardiomyopathy
  • CHF
  • Mitral valve prolapse
  • Congenital heart disease
  • Pericarditis
  • Valvular disease
  • Pacemaker malfunction
  • Acute MI
• Psychiatric causes:
  • Anxiety disorder
  • Panic attack
• Drugs and Medications:
  • Alcohol
  • Caffeine
  • Meds (i.e. digitalis, theophylline)
  • Street drugs (i.e. cocaine)
  • Tobacco
• Misc
  • Hyperthyroidism

Evaluation

Workup

• ECG
• If PVC burden is large, consider:
  • TSH
  • BMP
  • Magnesium level
  • Ionized calcium

Management

• Benign; generally does not require any treatment or additional workup
• Treat hypoxia/drug toxicity if existing
• Correct electrolyte imbalances, particularly magnesium, calcium, potassium
• Acute ischemia/infarction:
  • Complex ectopy frequently seen after patient receives thrombolytics
  • 1st line are beta blockers, options below:
    • Acute MI: Metoprolol 5mg IV q2 min for x3 doses, then PO metoprolol 50mg q6hrs for 2 days, followed by maintenance of 100mg bid
    • Post-MI: Atenolol 5mg IV over 5 min, then repeat in 10 min, then PO atenolol 50mg q12hrs for 7 days post-MI

Disposition

• Generally may be discharged (unless other indications for admission exist)

See Also

• ECG (Main)

References

Authors

Ross Donaldson