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Facts about PACs and PVCs
I'm sorry - this is not really a question - just some thought that hopefully is a relief you.
I'm new to this forum, but I've already seen a lot of questions regarding PVCs. Are they dangerous? Can they cause ventricular tachycardia? Sudden death? It's very understandable that we get afraid when our heart skips (one of our vital organs creating a "bug" - and we don't want a crash).
To the PAC/PVC "Faq":
Why do I have PACs or PVCs?
Every cell in your heart have pacemaking abilities, and can fire impulses before your sinus node (the natural pacemaker) does. Though it can be annoying, this is actually a possible life saving ability. If your sinus node for some reason fails, or the heart develops a blocking due to heart disease that makes ordinary impulses not conduct - PVCs will keep you alive until you've got a pacemaker implanted.
However, those cells can fire impulses though it's not needed. Adrenaline, due to stress, anxiety, caffeine, nicotine, etc, will increase your heart rate through the sinus node, but may also trigger activity within your other heart cells, making them more "aggressive" with increased possibility to discharge and create premature beats. The heart cells can also (but this is less common) be irritated by viruses, damages (such as heart attacks and valve diseases) or other reasons. And - in some cases, the reason is unknown. From time to time the heart cells just fires off before they should.
If the premature beat origins in your upper heart chamber, it's named a premature atrial complex (PAC). If it origins from the lower (main) heart chambers, it's named a premature ventricular complex (PVC).
How do I know if I have PACs or PVCs?
It's impossible to tell exactly without being monitored with a 12 channel ECG. Even on Holter monitors, PACs may appear as PVCs. However, if you feel a "double beat" followed by a quick pause, it's most likely a PAC. If you feel a skipped beat, it may be both, but if you feel the next beat coming about exact where you would expect it, it's more likely to be a PVC. If the pause is a little bit shorter, it's almost certainly a PAC. Irregular heart beats during exercise or during high heartrate caused by anxiety are more likely to be PACs.
Are PACs and PVCs dangerous?
PACs are almost never dangerous. However, if someone is severely bothered by PACs (several thousands a day) it's a good idea to see the doctor, to determine if something more severe is causing the PACs.
PVCs in a healthy heart are essentially benign. The same goes for PVCs as for PACs, if you are very bothered, it's a good idea to see the doctor to determine the cause. If PVCs occur in an abnormal heart (damaged from heart attacks, etc) they are usually taken care of with medications, because PVC impulses can "get lost" in the scars from heart attacks, possibly doing a "loop" creating what is called ventricular tachycardia or VT.
Anyway, people bothered with / anxious about PACs and PVCs should see a doctor, just to rule out any abnormalities and get reassured that everything is OK.
How many PACs or PVCs are normal?
My cardiologist told me that anything below 1000 PACs and 1000 PVCs a day is, in a structurally normal heart considered normal. However, 2000 or 5000 is not necessarily abnormal. Some people actually have bigeminy (half of all heartbeats are PACs or PVCs) as their normal rhythm, in other words about 50.000 PACs or PVCs/day. It all depends on the cause, and how bothered you are from them, what the doctor does.
Can PACs or PVCs be treated.
Yes. Only problem is - the treatment is usually more dangerous than PACs or PVCs. Beta blockers reduce the effect of adrenaline on your heart, and is effective especially if the premature beats are caused by anxiety or stress. However, beta blockers do have side effects such as fatigue and exercise intolerance, and in healthy people with normal blood pressure, low blood pressure and dizziness. Antiarrhythmic drugs works better, but side effects can be so severe (dangerous arrhythmias as ventricular tachycardia) they are not used unless heart disease is present, or you are so bothered that your cannot live a normal life. Anxiety management and reassurance is the best treatment. If all premature beats origin at the same location, this location can be "burned" to remove them.
How many of us have PACs or PVCs?
Everyone. In average, 50-70% have PACs, and 40-60% have PVCs during a random 24-hour interval. Many have both. And if someone have a day without them, they are likely to occur the next day, or after some stress at work, etc. Even children have them. In a test, 100 healthy boys, 14-16 years old, was monitored through 24 hours. 44 had PVCs. 38 had PACs. One kid had >22.000 PVCs.
But why did I start getting them, I've never noticed them before?
It's all about focus. You've had them before, but if you get anxious, you will put some of your mind to subconcious monitor your heart rhythm at all times. In addition, this anxiety triggers them more often.
What should I do?
If you are anxious, you should see a doctor, and get necessary tests done, just to be completely sure they are benign, so you can relax. Such tests can be a Holter monitoring (24 hours of ECG) to clearify how many you have, and if necessary, an echocardiogram to rule out structural heart diseases (though this is very rarely necessary). If you are bothered with them during exercise, your doctor would probably want to do a stress test.
Other advice:
- Quit smoking
- Cut down on coffee
- Regular exercise
- Healthy meals
- Anxiety and stress management.
I hope this is helpful if you worry about palpitations.
Kind regards,
PACs and anxiety sufferer.
I'm new to this forum, but I've already seen a lot of questions regarding PVCs. Are they dangerous? Can they cause ventricular tachycardia? Sudden death? It's very understandable that we get afraid when our heart skips (one of our vital organs creating a "bug" - and we don't want a crash).
To the PAC/PVC "Faq":
Why do I have PACs or PVCs?
Every cell in your heart have pacemaking abilities, and can fire impulses before your sinus node (the natural pacemaker) does. Though it can be annoying, this is actually a possible life saving ability. If your sinus node for some reason fails, or the heart develops a blocking due to heart disease that makes ordinary impulses not conduct - PVCs will keep you alive until you've got a pacemaker implanted.
However, those cells can fire impulses though it's not needed. Adrenaline, due to stress, anxiety, caffeine, nicotine, etc, will increase your heart rate through the sinus node, but may also trigger activity within your other heart cells, making them more "aggressive" with increased possibility to discharge and create premature beats. The heart cells can also (but this is less common) be irritated by viruses, damages (such as heart attacks and valve diseases) or other reasons. And - in some cases, the reason is unknown. From time to time the heart cells just fires off before they should.
If the premature beat origins in your upper heart chamber, it's named a premature atrial complex (PAC). If it origins from the lower (main) heart chambers, it's named a premature ventricular complex (PVC).
How do I know if I have PACs or PVCs?
It's impossible to tell exactly without being monitored with a 12 channel ECG. Even on Holter monitors, PACs may appear as PVCs. However, if you feel a "double beat" followed by a quick pause, it's most likely a PAC. If you feel a skipped beat, it may be both, but if you feel the next beat coming about exact where you would expect it, it's more likely to be a PVC. If the pause is a little bit shorter, it's almost certainly a PAC. Irregular heart beats during exercise or during high heartrate caused by anxiety are more likely to be PACs.
Are PACs and PVCs dangerous?
PACs are almost never dangerous. However, if someone is severely bothered by PACs (several thousands a day) it's a good idea to see the doctor, to determine if something more severe is causing the PACs.
PVCs in a healthy heart are essentially benign. The same goes for PVCs as for PACs, if you are very bothered, it's a good idea to see the doctor to determine the cause. If PVCs occur in an abnormal heart (damaged from heart attacks, etc) they are usually taken care of with medications, because PVC impulses can "get lost" in the scars from heart attacks, possibly doing a "loop" creating what is called ventricular tachycardia or VT.
Anyway, people bothered with / anxious about PACs and PVCs should see a doctor, just to rule out any abnormalities and get reassured that everything is OK.
How many PACs or PVCs are normal?
My cardiologist told me that anything below 1000 PACs and 1000 PVCs a day is, in a structurally normal heart considered normal. However, 2000 or 5000 is not necessarily abnormal. Some people actually have bigeminy (half of all heartbeats are PACs or PVCs) as their normal rhythm, in other words about 50.000 PACs or PVCs/day. It all depends on the cause, and how bothered you are from them, what the doctor does.
Can PACs or PVCs be treated.
Yes. Only problem is - the treatment is usually more dangerous than PACs or PVCs. Beta blockers reduce the effect of adrenaline on your heart, and is effective especially if the premature beats are caused by anxiety or stress. However, beta blockers do have side effects such as fatigue and exercise intolerance, and in healthy people with normal blood pressure, low blood pressure and dizziness. Antiarrhythmic drugs works better, but side effects can be so severe (dangerous arrhythmias as ventricular tachycardia) they are not used unless heart disease is present, or you are so bothered that your cannot live a normal life. Anxiety management and reassurance is the best treatment. If all premature beats origin at the same location, this location can be "burned" to remove them.
How many of us have PACs or PVCs?
Everyone. In average, 50-70% have PACs, and 40-60% have PVCs during a random 24-hour interval. Many have both. And if someone have a day without them, they are likely to occur the next day, or after some stress at work, etc. Even children have them. In a test, 100 healthy boys, 14-16 years old, was monitored through 24 hours. 44 had PVCs. 38 had PACs. One kid had >22.000 PVCs.
But why did I start getting them, I've never noticed them before?
It's all about focus. You've had them before, but if you get anxious, you will put some of your mind to subconcious monitor your heart rhythm at all times. In addition, this anxiety triggers them more often.
What should I do?
If you are anxious, you should see a doctor, and get necessary tests done, just to be completely sure they are benign, so you can relax. Such tests can be a Holter monitoring (24 hours of ECG) to clearify how many you have, and if necessary, an echocardiogram to rule out structural heart diseases (though this is very rarely necessary). If you are bothered with them during exercise, your doctor would probably want to do a stress test.
Other advice:
- Quit smoking
- Cut down on coffee
- Regular exercise
- Healthy meals
- Anxiety and stress management.
I hope this is helpful if you worry about palpitations.
Kind regards,
PACs and anxiety sufferer.
Hi Lisa,
Sorry bad English grammar ;)
I meant "rare monomorphic" as a monomorphic PVC once in a while. Not that they are rare vs other PVCs :)
Sorry bad English grammar ;)
I meant "rare monomorphic" as a monomorphic PVC once in a while. Not that they are rare vs other PVCs :)
1 Comments
Thank you so much. Pac/Pvc' s are very scary for someone who doesn't know about it. If they are so common you would think I would've heard about it before age 25. But thanks to you I can relax and hopefully they go away.
I found the scale and a TON of information. I posted it in my journal under pvc's and cardiomyoapthy with medical info.
I wonder why your gp considers pvc's (VES) dangerous and american drs treat 99% of pvc's as benign? this is a very interesting subject, I love learning new things about something that's plagued me for awhile and treated as "nothing" but turned out to be dangerous.
Where is the Lowns scale? Im going to see if I find it and stick it in my journal - I didn't know monomorphic pvc's were rare, I thought polymorphic were the rare ones? And yes on the LV function and morphology - the article from emidicine has that in there...it's just SO much info to take in :P
Where is the Lowns scale? Im going to see if I find it and stick it in my journal - I didn't know monomorphic pvc's were rare, I thought polymorphic were the rare ones? And yes on the LV function and morphology - the article from emidicine has that in there...it's just SO much info to take in :P
Thanks for great reply and info (and thanks for nice replies and kind words to all other replies;)
First: PJCs are Premature Junctional Contractions (premature beats from AV node.) They are uncommon but may be bothersome as ventricles are activated a few milliseconds before atrias (retrograde atrial activation, Cannon A wave), thus atrias fire towards closed triscupid- and mitral valves (atrial pressure < ventricular pressure), making blood backfire causing a strange feeling in your neck. Very premature PACs and some PVCs can have a similar effect. In general, PJCs are considered and treated as PACs, or the more correct term supraventricular extrasystoles (SVES). In my language, the term for PVCs is Ventricular Extrasystoles (VES).
To determine risk from PVCs, Lowns scale may be useful (or was at least used before). Risk levels are 1-5 where 1 is rare monomorphic PVCs and 5 is R-on-T PVCs. This is a quite debated subject, though, cardiologists disagree about the meaning of this phenomenon. Anyway, it seems that LV function and PVC morphology is more important then your actual number.
First: PJCs are Premature Junctional Contractions (premature beats from AV node.) They are uncommon but may be bothersome as ventricles are activated a few milliseconds before atrias (retrograde atrial activation, Cannon A wave), thus atrias fire towards closed triscupid- and mitral valves (atrial pressure < ventricular pressure), making blood backfire causing a strange feeling in your neck. Very premature PACs and some PVCs can have a similar effect. In general, PJCs are considered and treated as PACs, or the more correct term supraventricular extrasystoles (SVES). In my language, the term for PVCs is Ventricular Extrasystoles (VES).
To determine risk from PVCs, Lowns scale may be useful (or was at least used before). Risk levels are 1-5 where 1 is rare monomorphic PVCs and 5 is R-on-T PVCs. This is a quite debated subject, though, cardiologists disagree about the meaning of this phenomenon. Anyway, it seems that LV function and PVC morphology is more important then your actual number.
What are PJC's? never heard that term before; but it could be another term that's abbreviated and not common here - I think this may be PAC's?
Extra systole is also known as premature beat, premature contraction, premature systole, premature ventricular beat or PVB, premature ventricular contraction or complex or simply "PVC".
It refers to when the left ventricle of the heart contracts first, which means that circulation is inefficient. This is frequently perceived as palpitations or a skipped beat, somtimes a flip flopping or fluttering may be felt, but rarely. It's then followed by a pause where the heart's electrical system resets itself and the contraction following the pause is usually more forceful than normal.
I've never heard or read that all PVC's are dangerous - single beat PVC's do not usually pose a danger and can be asymptomatic in healthy individuals and do not require any treatment. They can occur in a healthy person of any age, but become more frequent as we age, and is more commonly found in men. They can often be resolved by restoring the balance of magnesium, calcium and potassium within the body as well as eliminating any offending "triggers".
There's a LONG list of possible causes and triggers from many different sources, some genetic, some enviornmental and some are idiopathic.
PVC's in frequent continuous episodes can become a form of ventricular tachycardia (VT) and can become dangerous (VFib). Typically, if 3 or more PVCs occur in a row it is indicative of ventricular tachycardia. There's patterns of "pvc's" - Bigeminy; Trigeminy; Quadrigeminy; Salvo's and can be seen also as couplets & triplets.
I was told by my EP that only 1% of pvc's are considered dangerous, although I've read 1%-5%. Dr's here typically treat between 6,000 - 8,000 pvc's with meds and anything above 15% - 20% of a total 24 HR they treat with surgery. At higher continuous amounts, it can damage the heart and lead to cardiomyopathy. Although, follow up research has shown this can happen at much lower thresholds of continous pvc's - http://emedicine.medscape.com/article/761148-followup
Supraventricular extrasystole and pvc's are 2 separate things, because they originate in different areas. A supraventricular extrasystole is generated above the level of the ventricle. This can be either a premature atrial contraction or a premature impulse from the atrioventricular node. SVES is the opposite of premature ventricular contraction.
Alot of my information comes from the American Heart Association, so I hope I explained this the right way. http://www.americanheart.org/presenter.jhtml?identifier=8 They have a ton of info on their website and some great illustrations and animations that may explain more.
This is one cool one: http://www.americanheart.org/presenter.jhtml?identifier=15
Here's a fun fact from the AHA: "During a 24-hour period, about one-fifth of healthy adults are likely to have frequent or multiple types of premature ventricular heartbeats."
Here's another link from AHA - it's a media player of arrythmia's and NSR - it's amazing to watch the videos - http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=719
now, if someone can just point me to concrete evidence of how many pvc's become malignant, I'll be estatic :)
Extra systole is also known as premature beat, premature contraction, premature systole, premature ventricular beat or PVB, premature ventricular contraction or complex or simply "PVC".
It refers to when the left ventricle of the heart contracts first, which means that circulation is inefficient. This is frequently perceived as palpitations or a skipped beat, somtimes a flip flopping or fluttering may be felt, but rarely. It's then followed by a pause where the heart's electrical system resets itself and the contraction following the pause is usually more forceful than normal.
I've never heard or read that all PVC's are dangerous - single beat PVC's do not usually pose a danger and can be asymptomatic in healthy individuals and do not require any treatment. They can occur in a healthy person of any age, but become more frequent as we age, and is more commonly found in men. They can often be resolved by restoring the balance of magnesium, calcium and potassium within the body as well as eliminating any offending "triggers".
There's a LONG list of possible causes and triggers from many different sources, some genetic, some enviornmental and some are idiopathic.
PVC's in frequent continuous episodes can become a form of ventricular tachycardia (VT) and can become dangerous (VFib). Typically, if 3 or more PVCs occur in a row it is indicative of ventricular tachycardia. There's patterns of "pvc's" - Bigeminy; Trigeminy; Quadrigeminy; Salvo's and can be seen also as couplets & triplets.
I was told by my EP that only 1% of pvc's are considered dangerous, although I've read 1%-5%. Dr's here typically treat between 6,000 - 8,000 pvc's with meds and anything above 15% - 20% of a total 24 HR they treat with surgery. At higher continuous amounts, it can damage the heart and lead to cardiomyopathy. Although, follow up research has shown this can happen at much lower thresholds of continous pvc's - http://emedicine.medscape.com/article/761148-followup
Supraventricular extrasystole and pvc's are 2 separate things, because they originate in different areas. A supraventricular extrasystole is generated above the level of the ventricle. This can be either a premature atrial contraction or a premature impulse from the atrioventricular node. SVES is the opposite of premature ventricular contraction.
Alot of my information comes from the American Heart Association, so I hope I explained this the right way. http://www.americanheart.org/presenter.jhtml?identifier=8 They have a ton of info on their website and some great illustrations and animations that may explain more.
This is one cool one: http://www.americanheart.org/presenter.jhtml?identifier=15
Here's a fun fact from the AHA: "During a 24-hour period, about one-fifth of healthy adults are likely to have frequent or multiple types of premature ventricular heartbeats."
Here's another link from AHA - it's a media player of arrythmia's and NSR - it's amazing to watch the videos - http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=719
now, if someone can just point me to concrete evidence of how many pvc's become malignant, I'll be estatic :)
Thanks so much for all the wonderful information. It is very helpful and honestly, made me feel better!
Thanks so much for posting! I'm a PAC and tachy sufferer (caught on monitor and EKG) and my daughter has them as well (caught on EKG). We are very much Type A personalities and I agree that I have always had them, just never focused in on them...they do cause me much anxiety and panic. Your info. is great...something the doctors should tell you in lay terms but for whatever reason, they do not...It's not enough for them to say just try to ignore them, they won't kill you...Thanks again, you will be a great asset to this forum along with Jerry, itdood, and many others who help to calm mine and so many others' fears.
Thanks for great comments and links!
It's just something I really don't understand (after reading forums and articles). It seems you guys (in the US) almost automatic translates a "skipped beat" or "extrasystole" or "palp" with PVC. Norwegian doctors consider almost every palpitation as what we call SVES (Supraventricular extrasystole) a joint term for PACs and PJCs. My GP said one time "You cannot have PVCs because they are dangerous and your condition is not dangerous" (what a relief..)). Anyway, my cardiologist disagreed, of course, but I still wonder why this is so different..
It's just something I really don't understand (after reading forums and articles). It seems you guys (in the US) almost automatic translates a "skipped beat" or "extrasystole" or "palp" with PVC. Norwegian doctors consider almost every palpitation as what we call SVES (Supraventricular extrasystole) a joint term for PACs and PJCs. My GP said one time "You cannot have PVCs because they are dangerous and your condition is not dangerous" (what a relief..)). Anyway, my cardiologist disagreed, of course, but I still wonder why this is so different..
great info thankd for taking the time to post it. I once asked if we could have a sticky FAQ with some questions and answers from the doctors, but never received an answer, it would be a great addition similar to our dysautnomia forum that has something similar to this
in addition to this site, www [dot] skippinghearts [dot] com has some GREAT articles, tips, and is the only site I've found that has normal cardiac values like the ones we see in so many posts asking questions about
there's so much info on the front page alone and even more info in the article & glossary section with footnote of research such as: A study of 50 male med students showed 50% had PVCs, 56% had PACs, which was shocking
maybe some forum gods will see this again and set up a sticky for this forum also :)
in addition to this site, www [dot] skippinghearts [dot] com has some GREAT articles, tips, and is the only site I've found that has normal cardiac values like the ones we see in so many posts asking questions about
there's so much info on the front page alone and even more info in the article & glossary section with footnote of research such as: A study of 50 male med students showed 50% had PVCs, 56% had PACs, which was shocking
maybe some forum gods will see this again and set up a sticky for this forum also :)
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