Heart
Premature Ventricular Contractions
Extra heartbeats that begin in one of your heart's two lower pumping chambers, causing a skipped beat sensation.
Premature ventricular contractions (PVCs) are early beats from the ventricles causing a 'skipped beat' sensation — common and usually benign, but requiring specialist assessment when frequent, symptomatic, or associated with structural heart disease.
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Premature ventricular contractions (PVCs) disrupt your normal heart rhythm and can feel like a fluttering or skipped beat in your chest.
The Skipped Beat: What a PVC Actually Is
A premature ventricular contraction (PVC) is a single early beat that fires from one of the heart's lower pumping chambers instead of from the natural pacemaker. The early beat is weak, so you often do not feel it — what you feel is the pause that follows, and then the next normal beat landing with extra force. People describe it as a flip, a thud, a flutter, or the heart ‘turning over’.
PVCs are almost universal. Fit a monitor to a room full of healthy adults and nearly all of them will have some. On their own, in a structurally normal heart, they are benign.
PVCs are almost universal. Fit a monitor to a room full of healthy adults and nearly all of them will have some. On their own, in a structurally normal heart, they are benign.
When PVCs Matter
The question is never simply ‘do I have PVCs’ but ‘how many, and is the heart otherwise normal’.
- Reassuring — occasional PVCs, a normal echocardiogram, and a burden below about 10% of all beats on a 24-hour recording
- Worth a closer look — a burden above 10 to 15%, which over months can weaken the pumping chamber (‘PVC cardiomyopathy’), and is reversible if the PVCs are controlled
- Higher priority — PVCs that increase rather than settle with exercise, PVCs running in pairs or short bursts, an already reduced ejection fraction, or a family history of sudden death before 50
Diagnosis in Singapore
A resting ECG shows the shape of the PVC, which hints at where in the heart it is coming from. A 24 to 48-hour Holter monitor is essential because it puts a number on the burden — the percentage of beats that are PVCs — which drives every subsequent decision.
An echocardiogram checks that the heart muscle and valves are normal, and an exercise test shows whether the PVCs disappear with effort (reassuring) or multiply (a flag). Blood tests check potassium, magnesium and thyroid function. This is straightforward to arrange at Paragon Medical Centre on Orchard Road.
An echocardiogram checks that the heart muscle and valves are normal, and an exercise test shows whether the PVCs disappear with effort (reassuring) or multiply (a flag). Blood tests check potassium, magnesium and thyroid function. This is straightforward to arrange at Paragon Medical Centre on Orchard Road.
Treatment: Reassurance First, Then Options
For the common picture — a normal heart and a low burden — the most valuable treatment is a clear explanation that these beats are harmless, together with cutting back on caffeine, alcohol and nicotine, improving sleep, and addressing stress. Correcting a low potassium or magnesium, or an overactive thyroid, often helps.
If PVCs are troublesome despite that, a beta-blocker is the usual first medication. When the burden is high, or the pumping chamber has weakened, an antiarrhythmic drug or a catheter ablation of the single spot producing the beats is highly effective, and the heart function typically recovers afterwards.
If PVCs are troublesome despite that, a beta-blocker is the usual first medication. When the burden is high, or the pumping chamber has weakened, an antiarrhythmic drug or a catheter ablation of the single spot producing the beats is highly effective, and the heart function typically recovers afterwards.
Premature Ventricular Contractions: Common Questions
Concerned About Premature Ventricular Contractions?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.