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:
  • Narrow-complex tachycardias
  • Wide-complex tachycardias
  • AV blocks
    • Second Degree AV Block Type I (Wenckeback)
    • Second Degree AV Block Type II
    • Third Degree AV Block
  • Premature atrial contraction
  • Premature junctional contraction
  • Premature ventricular contraction
  • Sick sinus syndrome
  • Wandering atrial pacemaker
• Non-arrhythmic cardiac causes:
  • Acute coronary syndrome
  • Cardiomyopathy
  • Congenital heart disease
  • Congestive heart failure (CHF)
  • Mitral valve prolapse
  • Pacemaker complication
  • Pericarditis
  • Myocarditis
  • Valvular disease
• Psychiatric causes:
  • Panic attack
  • Anxiety
  • Somatic Symptom Disorder
• Drugs and Medications:
  • Alcohol
  • Caffeine
  • Drugs of abuse (e.g. cocaine)
  • Medications (e.g. digoxin, theophylline)
  • Tobacco
• Misc
  • Anemia
  • Hyperthyroidism
    • Thyroid storm
  • Pulmonary embolism
  • Dehydration
  • Sepsis
  • Pheochromocytoma

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 β-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)