Avatar universal

Why are some PVCs more forceful than others?

I've been trying to find an answer for the longest time and decided to post this for those that may have wondered this as well.

In short, I'm no stranger to odd heart rhythm symptoms. Pauses, head/neck rushes, small thumps, intense thumps, and many ones where I even ask myself it was even a palpitation at all. Of course, the anxiety and hyperawareness allows us to do so. I recently had a Zio Patch test done and found nothing but PACs, PVCs, couplets and triplets of both variety.  I "bookmarked" a few occasions when pressing the button- one of each symptom (the light ones, the hard ones, the "phantom" ones).  To my surprise, they were all single PVCs.

So my question is: what is it about a PVC/PAC that causes some to feel so much more intense than others when on a recording, they all look the same?
6 Responses
Avatar universal
very good question. have wondered that myself for many years, as I sit here early Sat morning, getting some short light PVCs, and then a very strong one that I can really feel. maybe someone will jump in that has a better clue than me. but thanks for posting the question.
257552 tn?1404602554
An explanation I've read.

""...Timing of the premature ventricular contraction (PVC -- these are usually the ones that are sometimes felt as a literal kick). The more violent-seeming ones usually have happened just at the moment when the tricuspid valve is closed, which does, in fact, take one's breath away for a moment. It's harmless, but that sensation just adds to the disturbing quality of the event. When the valve is closed the blood can't be pushed out to the lungs and causes both that "stolen breath" sensation, but often also what are called cannon A-waves in the neck, as the blood then regurgitates up the jugulars, causing a sense of momentary fullness in the neck.

Premature atrial beats (which arise, as one might assume, in the atria instead of the ventricles) are sometimes perceived as less noxious, because the atria (the upper chambers of the heart) are smaller. The beat still gets conducted to the ventricles, but the sensation is often has less "punch" to it. These,however, may cause more of a "fluttery" sensation, which is also disturbing if it is new.....""

He goes on to suggesting relaxing, avoiding caffeine, and obtaining a prescription for a Beta Blocker which slows the heart rate and reduces how forcefull they feel.
257552 tn?1404602554
I wish we could edit.

I'm assuming that those with Benign PVCs and PACs have been examined by a doctor and that specific diagnosis given. If not, and you experience more than a few per hour, see your doctor to get a proper diagnosis. Most often, they don't do more than an in office EKG and exam, but at least you'll know they're benign.
Avatar universal
Very good answer. thanks.
257552 tn?1404602554
Hi Tom,

Another possibility are PVCs accompanied by a compensatory pause versus PVCs that are interpolated. See the following EKG strips.


I experience long episodes of bigeminy (12 beats or more, some people are in bigeminy much of the day) and, due to the pauses, my heart rate is only half of what it was before the bigeminy occurred. Being that it's only about 60 beats/min, during the bigeminy, it drops, effectively, to 30 beats/min. Needless to say, I feel odd when that occurs. If I weren't on a Beta Blocker, my resting pulse would be higher and I may not feel the effects of the bigeminy as much.

PVCs with a compensatory pause require two heart cycles until the next normal beat occurs. Count the lines on the EKG graph paper between the normal beats and then count from the normal through the PVC and to the next normal. Remember, the PVC, in this case, is not an effective beat, we don't feel the actual PVC, we feel the results of the pause, namely, that the heart filled with more blood than normal, and when the next normal beat occurs, the ventricles contract and force that additional volume of blood out, producing a more pronounced thud.

Interpolated PVCs don't have the pause, therefore the additional blood in the heart apparently doesn't occur, and the intensity of the perception of the event would be less.

Oddly enough, most people with premature beats don't feel them, they tend to be revealed in these individuals by other symptoms or are discovered during routine doctor's office visits or screening for employment.

Interpolated PVCs feel very disconcerting, like a rapid wobbling that lasts a second or two. You know about them compared to normal PVCs.
Avatar universal
Hi Artaud,

thanks for the Informative reply. I have never had that info explained to me before. I never knew about the pause effect and distinction with the interpolated PVCs. you really put a lot of time and effort into your post replies. thanks for another good link that I will bookmark. take care. hope your ectopics are less bothersome.
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