Premature Ventricular Complexes (PVC's) - Summary Framework Why PVCs? Can be the first manifestation of cardiac disease, including: • Coronary artery disease • Cardiomyopathy • Inherited arrhythmia syndromes (e.g., long QT syndrome, ARVC) • Hypertension, LV hypertrophy • Other forms of structural heart disease Causes: • Hypertension • Myocardial ischemia • Sympathomimetics • Hypomagnesemia • Hypokalemia • Bundle branch block • Underlying ischemic heart disease • Stimulants, ETOH, Substances • Digoxin toxicity Symptoms: • Fluttering • Pounding or jumping • Skipped beats or missed beats • Increased awareness of the heartbeat • Palpitations, Presyncope PVC burden is classified as: • Low: <1 percent or 1000 PVCs/day • Intermediate burden: >1 to <15 percent PVCs/day • High: >15 percent or 15,000 PVCs/day • >3 Consecutive PVC's up to 300 = NSVT EKG Findings: • Broad QRS complex (≥ 0.12s) with abnormal morphology • Premature – i.e., occurs earlier than would be expected for the next sinus impulse • No associated P-wave, and the T-wave records in the opposite direction from the QRS • Usually followed by a full compensatory pause • Retrograde capture of the atria may or may not occur Differential Diagnosis: • PAC – Often have a very similar sensation to PVCs but are benign. A PAC also has a shorter compensatory pause than a PVC. • Non-sustained ventricular tachycardia (NSVT) – Three or more consecutive PVCs are defined as NSVT until a time length of 30 seconds. • Sustained ventricular tachycardia • Bigeminy, Trigeminy, Quadrigeminy • Supraventricular tachycardia • Sinus arrhythmia • Atrial fibrillation Complications: • Cardiomyopathy (PVC-induced cardiomyopathy may result from frequent PVCs – generally >10%-15% of beats) • Heart failure • Exacerbation of ventricular tachyarrhythmias High-risk features will indicate more intensive treatment and monitoring. #Premature #Ventricular #Complexes #PVCs #PVC #diagnosis #differential #cardiology
