Premature beats

Alternative names
PVB (premature ventricular beat); Premature contraction; Ectopic heartbeat; PVC (premature ventricular contraction); Extrasystole

Definition
Ectopic heartbeat is an irregularity of the heart rate and heart rhythm involving extra or skipped heartbeats.

Causes, incidence, and risk factors

Ectopic heartbeats are an arrhythmia involving small variations in an otherwise normal heartbeat. In many cases, they may occur without obvious cause and be benign.

Other times, however, they are associated with electrolyte abnormalities in the blood which should be corrected. They can also be associated with ischemia, or local reduction in blood supply to the heart. In addition, ectopic beats may be caused or aggravated by excessive smoking, alcohol consumption, caffeine, certain medications, and some illicit drugs.

Ectopic beats are rare in children other than those with congenital heart disease. The majority of extra heartbeats in children are PAC’s (premature atrial contractions), which are almost always benign.

In adults, ectopic beats can occur more commonly, and underlying reversible reasons should be investigated even if it turns out that no treatment is ultimately needed.

Symptoms

     
  • the sensation of feeling heart beat (palpitations)  
  • the sensation of stopped or skipped beats

Note: In many cases, the person may have no symptoms.

Signs and tests

A physical examination may show an occasional irregularity, but if the ectopic beats do not occur frequently, they may not be detectable on physical exam. Blood pressure is usually normal.

An ectopic heartbeat may be revealed on:

     
  • an ECG  
  • continuous ambulatory cardiac monitoring (Holter)

Etopic beats may also be observed during:

     
  • an echocardiogram  
  • coronary angiography

Treatment
Often ectopic heartbeats do not require treatment. The condition is treated if symptoms are severe or if extra beats are very frequent.

An underlying cause, if discovered, may also require treatment.

Expectations (prognosis)
Ectopic heartbeats are generally benign, requiring no treatment. Ocasionally, they may indicate an increased risk for other cardiac arrhythmias.

Complications

     
  • ventricular tachycardia (occasionally)  
  • other arrhythmias (occasionally)

Note: There usually are no complications.

Calling your health care provider

Call your health care provider if you feel palpitations that are persistent or are accompanied by chest pain or other symptoms.

Call your health care provider if ectopic heartbeats have been diagnosed and the symptoms worsen or do not improve with treatment.

Prevention
Moderation in caffeine, alcohol, and tobacco use may reduce the risk of ectopic heartbeats in some people. Exercise often helps persons who lead a sedentary lifestyle.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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