8 Common Symptoms of Premature Ventricular Contractions (PVCs) You Should Know

Premature ventricular contractions (PVCs) are extra, abnormal heartbeats that begin in one of the heart’s two lower pumping chambers, called ventricles. These extra beats disrupt your regular heart rhythm, sometimes causing a sensation of a skipped or forceful heartbeat. PVCs are among the most common types of arrhythmias and can occur in people with or without heart disease.

While many people with PVCs experience no symptoms at all, others may notice distinct sensations that range from mildly uncomfortable to concerning. Understanding these symptoms is crucial for recognizing when to seek medical attention. In this comprehensive guide, we’ll explore the eight most common symptoms of premature ventricular contractions, helping you identify what your body might be telling you.

It’s important to note that while occasional PVCs are usually harmless, frequent or persistent symptoms warrant a consultation with a healthcare provider to rule out underlying heart conditions.

1. Heart Palpitations

Heart palpitations are the most frequently reported symptom of PVCs. When you experience palpitations, you become suddenly aware of your own heartbeat, which you typically don’t notice during normal heart function.

With PVCs, palpitations may feel like:

• A fluttering sensation in your chest
• Your heart is pounding or racing
• An irregular or uneven heartbeat pattern
• A thumping feeling that seems stronger than normal

These sensations occur because the ventricles contract prematurely, before they’ve had time to fill completely with blood. The subsequent normal heartbeat may feel more forceful as the heart compensates for the weaker premature beat. Palpitations from PVCs can last for just a few seconds or may occur repeatedly over minutes or hours.

Many people notice these palpitations more when they’re resting or lying down, particularly when trying to sleep, as there are fewer external distractions and the body is quieter overall.

2. Skipped Heartbeats

The sensation of a skipped beat is another hallmark symptom of PVCs, though technically, your heart isn’t actually skipping a beat. Instead, what you’re feeling is the result of the heart’s timing being disrupted.

Here’s what actually happens:

When a PVC occurs, the premature beat may be too weak to create a pulse you can feel. The pause that follows before the next normal beat can feel like your heart has skipped a beat entirely. This compensatory pause allows the heart’s chambers to refill with blood before the next contraction, which then feels stronger than usual.

The sensation of skipped beats can be:

• Occasional and isolated
• Occurring in patterns or clusters
• More noticeable during physical activity or rest
• Accompanied by a brief moment of lightheadedness

While this symptom can be alarming, especially when first experienced, isolated skipped beats are generally not dangerous in people without underlying heart disease.

3. Chest Discomfort or Fluttering

Many people with PVCs describe a fluttering or uncomfortable sensation in their chest. This symptom differs from typical chest pain and is more accurately described as an unusual awareness of heart activity.

The chest discomfort associated with PVCs typically presents as:

• A “flip-flopping” sensation in the chest
• A brief, fleeting discomfort that comes and goes
• A bubbling or tickling feeling behind the breastbone
• A momentary tightness that quickly resolves

This fluttering sensation occurs at the moment of the premature contraction and the compensatory pause that follows. The irregular rhythm creates an unusual mechanical movement in the chest that you can perceive.

It’s crucial to distinguish this type of discomfort from cardiac chest pain, which is typically more sustained, may radiate to the arm or jaw, and could indicate a more serious condition requiring immediate medical attention.

4. Pounding Sensation in the Neck

Some people with PVCs experience a noticeable pounding or pulsing sensation in their neck, which can be both uncomfortable and concerning. This symptom is related to the irregular blood flow caused by the abnormal heart rhythm.

When a PVC occurs, it can cause:

The jugular veins in your neck to pulse more noticeably due to changes in blood pressure and flow patterns. The premature contraction may cause blood to back up temporarily into these veins, creating a visible or palpable pulsation. Some people can actually see their neck pulsing when they look in a mirror during a PVC episode.

The neck pounding may be described as:

• A throbbing sensation in one or both sides of the neck
• Visible pulsations in the jugular area
• A feeling of fullness or pressure in the neck
• Synchronous with the sensation of palpitations in the chest

This symptom is generally harmless but can be quite noticeable and sometimes socially embarrassing for those who experience it.

5. Dizziness or Lightheadedness

Dizziness and lightheadedness can occur with PVCs, particularly when they happen frequently or in clusters. This symptom results from temporary changes in blood flow to the brain caused by the irregular heartbeat.

The mechanism behind this symptom involves:

When a PVC occurs, the premature contraction doesn’t pump blood as efficiently as a normal heartbeat because the ventricles haven’t fully filled with blood. If multiple PVCs happen in quick succession, the overall cardiac output can decrease temporarily, reducing blood flow to the brain and causing brief lightheadedness.

This dizziness typically:

• Lasts only a few seconds to a minute
• Occurs suddenly and resolves quickly
• May be accompanied by a brief feeling of unsteadiness
• Rarely leads to actual fainting (though this can occur with frequent PVCs)

If you experience severe dizziness, prolonged lightheadedness, or actual loss of consciousness with PVCs, it’s important to seek medical evaluation promptly, as this may indicate a more significant rhythm disturbance.

6. Shortness of Breath

Shortness of breath, or dyspnea, can accompany PVCs in some individuals, particularly those who experience frequent premature contractions or have underlying heart conditions.

This symptom may manifest as:

• A feeling that you can’t catch your breath
• The need to take deep breaths more frequently
• Breathlessness during activities that normally don’t cause it
• A sensation of air hunger or breathing difficulty

The shortness of breath associated with PVCs occurs because:

Frequent PVCs can reduce the heart’s efficiency in pumping blood, which means less oxygenated blood reaches the body’s tissues. Your body responds by increasing your breathing rate to try to compensate for the perceived oxygen deficit. Additionally, if PVCs are frequent enough, they may interfere with the heart’s ability to maintain adequate cardiac output, leading to genuine breathlessness.

In most cases, the breathlessness is mild and temporary. However, if you experience significant or worsening shortness of breath, especially with exertion or when lying flat, it’s important to consult a healthcare provider, as this could indicate decreased heart function.

7. Fatigue or Weakness

Unexplained fatigue and generalized weakness are symptoms that some people with frequent PVCs report. While not as immediately noticeable as palpitations, these symptoms can significantly impact quality of life.

The fatigue associated with PVCs may present as:

• Persistent tiredness despite adequate rest
• Reduced exercise tolerance or stamina
• Feeling drained of energy, particularly after episodes of PVCs
• General malaise or lack of vitality

Several factors contribute to this symptom:

When PVCs are frequent, the heart’s pumping efficiency decreases because the premature beats don’t contribute effectively to circulation. Over time, this reduced cardiac output can lead to fatigue. Additionally, the anxiety and stress that often accompany awareness of irregular heartbeats can be mentally and physically exhausting.

Some people also experience disrupted sleep due to PVCs that are more noticeable when lying down at night, leading to daytime fatigue. The body’s constant response to irregular heart rhythms can also be energy-depleting over time.

If fatigue is severe or accompanied by other concerning symptoms like chest pain or significant shortness of breath, medical evaluation is recommended.

8. Anxiety or Sense of Unease

Many people with PVCs experience heightened anxiety or a general sense of unease, which can be both a symptom and a consequence of the condition. The relationship between PVCs and anxiety is bidirectional and complex.

This symptom may include:

• Sudden feelings of worry or panic when PVCs occur
• Fear that something is seriously wrong with your heart
• Hyperawareness of your heartbeat and bodily sensations
• Anticipatory anxiety about when the next PVC will occur
• General nervousness or feeling “on edge”

The anxiety connection works in both directions:

Feeling your heart beat irregularly can naturally trigger anxiety, especially if you don’t understand what’s happening. This is a normal response to an unfamiliar bodily sensation. However, anxiety and stress can also trigger PVCs. When you’re anxious, your body releases stress hormones like adrenaline, which can increase the likelihood of experiencing PVCs.

This creates a cycle where PVCs cause anxiety, which in turn triggers more PVCs. Breaking this cycle often involves both medical reassurance that the PVCs are not dangerous and stress-reduction techniques.

For some people, simply understanding that PVCs are usually benign can significantly reduce the anxiety associated with them.

What Causes Premature Ventricular Contractions?

Understanding the causes of PVCs can help you identify potential triggers and take steps to minimize their occurrence. PVCs can develop from various factors, ranging from lifestyle habits to underlying medical conditions.

Lifestyle and Environmental Triggers

• Caffeine: Coffee, tea, energy drinks, and some sodas can stimulate the heart and trigger PVCs in sensitive individuals
• Alcohol: Both excessive drinking and alcohol withdrawal can precipitate PVCs
• Nicotine and tobacco: Smoking and other tobacco products are common triggers
• Stress and anxiety: Emotional stress releases adrenaline, which can cause PVCs
• Lack of sleep: Fatigue and sleep deprivation can increase PVC frequency
• Dehydration: Inadequate fluid intake can affect heart rhythm
• Intense exercise: Particularly in people not accustomed to vigorous physical activity

Medical Conditions and Physical Factors

• Electrolyte imbalances: Low levels of potassium, magnesium, or calcium can trigger PVCs
• Heart disease: Including coronary artery disease, cardiomyopathy, and previous heart attacks
• High blood pressure: Hypertension can strain the heart and lead to PVCs
• Heart valve problems: Structural abnormalities can cause irregular rhythms
• Hyperthyroidism: Overactive thyroid increases metabolism and can affect heart rhythm
• Certain medications: Including asthma inhalers, decongestants, and some prescription drugs
• Stimulant drugs: Cocaine, amphetamines, and similar substances

Idiopathic PVCs

In many cases, particularly in young, healthy individuals, no specific cause can be identified. These are called idiopathic PVCs and are generally considered benign. Even extensive cardiac testing may reveal no underlying abnormality, and the PVCs occur without any identifiable trigger.

Prevention Strategies for PVCs

While not all PVCs can be prevented, especially those related to underlying heart conditions, many lifestyle modifications can help reduce their frequency and severity.

Dietary and Lifestyle Modifications

• Limit caffeine intake: Reduce or eliminate coffee, energy drinks, and other caffeinated beverages if you notice they trigger PVCs
• Moderate alcohol consumption: Limit alcohol intake or avoid it entirely if it worsens your symptoms
• Quit smoking: Eliminate tobacco products, which are known triggers for cardiac arrhythmias
• Stay hydrated: Drink adequate water throughout the day to maintain proper electrolyte balance
• Eat a balanced diet: Include foods rich in potassium (bananas, spinach) and magnesium (nuts, whole grains)
• Maintain healthy weight: Obesity can strain the heart and increase PVC risk

Stress Management and Sleep

• Practice stress-reduction techniques: Try meditation, deep breathing exercises, or yoga
• Get adequate sleep: Aim for 7-9 hours of quality sleep per night
• Regular exercise: Engage in moderate physical activity most days, but avoid overexertion
• Establish a relaxing bedtime routine: Create habits that promote restful sleep

Medical Management

• Monitor electrolyte levels: Work with your healthcare provider to ensure proper mineral balance
• Manage underlying conditions: Keep conditions like high blood pressure, diabetes, and thyroid disorders well-controlled
• Review medications: Discuss with your doctor whether any medications might be contributing to PVCs
• Regular check-ups: Maintain routine cardiac evaluations if you have frequent PVCs

Tracking and Awareness

• Keep a symptom diary: Note when PVCs occur and what you were doing, eating, or feeling at the time
• Identify personal triggers: Use your diary to recognize patterns and avoid specific triggers
• Monitor your heart rate: Consider using a fitness tracker or smartwatch to track heart rhythm patterns

Remember that while these prevention strategies can be helpful, you should always consult with a healthcare provider before making significant changes to your diet, exercise routine, or medications.

Frequently Asked Questions

Are PVCs dangerous?

For most people, especially those without underlying heart disease, PVCs are benign and not dangerous. Occasional PVCs are extremely common and occur in most people at some point. However, very frequent PVCs (more than 10,000-20,000 per day) or those accompanied by symptoms like chest pain, severe shortness of breath, or fainting should be evaluated by a cardiologist, as they may indicate underlying heart problems or could potentially lead to weakened heart muscle over time.

How many PVCs per day is normal?

Most people experience occasional PVCs, and having up to several hundred per day can be considered normal, especially if you have no underlying heart disease. Studies suggest that even healthy individuals can have up to 500 PVCs per day without concern. The significance of PVCs depends more on their frequency, pattern, associated symptoms, and whether you have underlying heart conditions rather than an absolute number.

Can stress and anxiety cause PVCs?

Yes, stress and anxiety are common triggers for PVCs. When you’re stressed or anxious, your body releases adrenaline and other stress hormones that can affect your heart’s electrical system and make PVCs more likely. Additionally, the awareness of PVCs can cause anxiety, which may trigger more PVCs, creating a cycle. Managing stress through relaxation techniques, exercise, and other methods can help reduce PVC frequency.

Do PVCs go away on their own?

PVCs often come and go, and many people experience periods where they’re more frequent followed by periods with few or no PVCs. If PVCs are triggered by specific factors like caffeine, stress, or lack of sleep, they may resolve when those triggers are eliminated. However, some people have persistent PVCs that don’t completely go away. The good news is that even persistent PVCs are usually not harmful in people without heart disease.

Should I go to the emergency room for PVCs?

Most PVCs don’t require emergency care. However, you should seek immediate medical attention if you experience PVCs along with chest pain or pressure, severe shortness of breath, loss of consciousness or fainting, very rapid heart rate that doesn’t slow down, or dizziness severe enough to prevent normal activities. If you’re experiencing PVCs for the first time and they’re causing concern, it’s reasonable to seek medical evaluation, though it may not need to be in an emergency setting.

Can exercise make PVCs worse?

The relationship between exercise and PVCs varies among individuals. In some people, exercise can trigger PVCs, particularly intense or unaccustomed physical activity. However, in others, PVCs may actually decrease during exercise and appear more frequently during rest or recovery. Regular, moderate exercise is generally beneficial for heart health and may reduce overall PVC burden in some people. If you notice PVCs during exercise, especially if accompanied by other symptoms, discuss it with your healthcare provider.

What is the difference between PVCs and PACs?

PVCs (premature ventricular contractions) originate in the heart’s lower chambers (ventricles), while PACs (premature atrial contractions) originate in the upper chambers (atria). Both are extra heartbeats that occur earlier than the normal rhythm. PVCs typically feel more forceful and create a longer pause afterward, while PACs often feel milder. On an electrocardiogram (ECG), they have distinctly different appearances. Generally, both are benign, though PVCs are monitored more closely, especially when frequent.

Can dehydration cause PVCs?

Yes, dehydration can trigger PVCs. When you’re dehydrated, it can lead to electrolyte imbalances, particularly affecting potassium, magnesium, and sodium levels, which are crucial for normal heart rhythm. Dehydration also reduces blood volume, making the heart work harder and potentially triggering irregular beats. Staying well-hydrated by drinking adequate water throughout the day can help prevent dehydration-related PVCs.

Will PVCs show up on an ECG?

PVCs will show up on an ECG (electrocardiogram) if they occur during the time you’re being monitored. However, since a standard ECG only records for about 10 seconds to a few minutes, it might not capture PVCs if they’re infrequent. For people with occasional PVCs, a Holter monitor (24-48 hour continuous ECG) or event monitor (worn for weeks) may be used to capture and document the irregular beats over a longer period.

References:

• Mayo Clinic – Premature Ventricular Contractions (PVCs)
• American Heart Association – Premature Contractions
• Johns Hopkins Medicine – Premature Ventricular Contractions
• National Center for Biotechnology Information – Premature Ventricular Contraction
• Cleveland Clinic – Premature Ventricular Contractions