Ventricular Arrhythmias

Premature Ventricular Contractions (PVCs)  &  Nonsustained Ventricular Tachycardia (NSVT) 

So, you have been diagnosed with PVCs or NSVT, what does that mean?

PVCs are extra heartbeats that come from the lower chambers of the heart.  NSVT is 3 or more PVCs in a row lasting less than 30 seconds.  

 Why do people get PVCs or NSVT?

Smoking, caffeine, alcohol, illicit drugs, structural heart abnormalities, infiltrative and inflammatory heart conditions, coronary heart disease, heart valve disease, electrolyte imbalances, low oxygen levels, scarring of the heart muscle, and non-cardiac conditions (ex: thyroid disease).  Sometimes people get PVCs and NSVT for no known reason.   

 Are these Dangerous?

PVCs typically are not dangerous but can potentially cause damage to the heart over time if you are having a lot.  NSVT is not dangerous but is a potential marker for the development of sustained ventricular arrhythmias, which are dangerous. 

 Signs & Symptoms of PVCs or NSVT 

• Feeling overtired or having little to no energy (most common) 
• Trouble with everyday exercises or activity  
• Palpitations (feelings of having fast-beating, fluttering, or pounding heart) 
• Shortness of breath 
• Chest pain, pressure, tightness, or discomfort 
• Dizziness or lightheadedness 

 What should I do if I am experiencing an episode of PVCs or NSVT?

If you’ve had this problem before and it feels similar to past ones, and you feel okay, you can do your normal activities.  Pay attention to how your body feels and rest if you need to. You can try some relaxing exercises like meditation or deep breathing. Take note of how long the problem lasts, how you feel during the episode(s), and if you’re having episodes more or less often than before. Tell your doctor about all these things when you see them next. 

 Symptoms of NSVT or PVCs that you should call your provider about: 

• Dizziness 
• Lightheaded 
• Changes in your shortness of breath that worry you 
• Mild discomfort in your chest  
• Symptoms feel worse than usual, or you start feeling worse 
• A loss of stamina that is out of proportion to how you have felt previously 

 Symptoms of NSVT to go to the ER for: 

• Moderate-to-severe chest pain 
• Fainting or feeling like you might faint  
• New-onset shortness of breath or difficulty breathing at rest 

How is it diagnosed? 

• Ambulatory Rhythm Monitoring (event monitors, holter monitors, loop recorders) 
• ECG (also called EKG): a non-invasive test that records the heart’s electrical impulses for a few seconds 
• Wearable Devices: (Link from, Heart Rhythm Society) Personal devices and Smart Devices that you can use at home to capture a simple ECG such as the Apple Watch or Kardia App.   
• Electrophysiology (EP) study (PDF)

How is it Treated? 

 Medications: 

• Magnesium supplements 
• Beta Blockers: metoprolol, carvedilol, atenolol, propranolol 
• Calcium Channel Blockers: diltiazem, verapamil 
• Antiarrhythmics: amiodarone, flecainide, propafenone, Betapace (sotalol), Tikosyn (dofetilide) 

Invasive procedure: Cardiac ablation 

 Control other health conditions that impact PVCs and NSVT:  moderating/quitting alcohol and caffeine, quitting drugs, quitting smoking, treating sleep apnea, and controlling chronic diseases such as sarcoidosis, amyloidosis, hypertension, coronary disease, heart failure, thyroid disease, and lung disease can impact how many PVCs and how much NSVT you have.