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Premature Ventricular ContractionAka: PVC

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  1. See Also
    1. Extrasystole
  2. Physiology
    1. PVCs have been historically thought to be benign
    2. More recently, data suggests increased risk
      1. In underlying cardiac disease, PVCs increase arrhythmia risk
      2. In otherwise normal hearts, PVCs are still typically benign
        1. However, longstanding frequent PVCs, increase risk of cardiomyopathy
  3. Definitions
    1. Bigeminy
      1. Extrasystole follows every sinus beat
    2. Trigeminy
      1. Extrasystole follows every other sinus beat
      2. Every third beat is ectopic
    3. Couplet
      1. Extrasystole and preceding beat
  4. Causes
    1. Occasional PVCs are normal finding in healthy patient
    2. Cardiac causes
      1. Ischemic Heart Disease
      2. Cardiomyopathy
      3. Valvular heart disease
      4. Mitral Valve Prolapse
    3. Stimulants
      1. Caffeine
      2. Cocaine
      3. Alcohol
      4. Ephedrine or Pseudoephedrine
    4. Electrolyte Abnormalities
      1. Metabolic Acidosis
      2. Hypoxemia
      3. Hyperkalemia
      4. Hypokalemia
      5. Hypomagnesemia
    5. Medications
      1. Digoxin
      2. Theophylline
      3. Antipsychotic medications
      4. Tricyclic Antidepressants
      5. Antiarrhythmics (Flecainide, Sotalol, Quinidine)
  5. Signs: EKG Findings
    1. Unusual and wide QRS with bizarre axis
    2. Large T Wave with opposite polarity as QRS
    3. Full compensatory pause
    4. No P Wave included in Extrasystole
    5. Associated with left bundle branch pattern
  6. Evaluation: Lown Criteria to distinguish pathologic PVCs
    1. Low risk of degenerating into ventricular dysrhythmia
      1. Class 0: No PVCs
      2. Class 1: <30 PVCs per hour
    2. Intermediate risk of degeneration
      1. Class 2: 30 or more PVCs per hour
    3. High risk of degeneration
      1. Class 3: Multifocal PVCs
      2. Class 4a: Two consecutive PVCs
      3. Class 4b: Three consecutive PVCs
      4. Class 5: R on T Phenomena
  7. Management
    1. No heart disease (normal left ventricular function)
      1. Avoid provocative factors
      2. Mild asymptomatic PVCs
        1. No management required
      3. Symptomatic PVCs accounting for <20% of total beats
        1. Consider Beta Blocker for disabling symptoms
      4. PVCs account for >20% of total beats
        1. Consider Cardiac Catheter Ablation
        2. Associated with increased risk of developing a cardiomyopathy
          1. See physiology above regarding risk
    2. Heart disease (with Left Ventricular Dysfunction)
      1. PVCs increase risk of morbidity and mortality
      2. Consider management for Lown Class 3-5
        1. Consider Cardiac Catheter Ablation

Premature ventricular contractions (C0151636)

Definition (MSH)A type of cardiac arrhythmia with premature contractions of the HEART VENTRICLES. It is characterized by the premature QRS complex on ECG that is of abnormal shape and great duration (generally >129 msec). It is the most common form of all cardiac arrhythmias. Premature ventricular complexes have no clinical significance except in concurrence with heart diseases.
Definition (CSP)premature ventricular beats, the most common of all arrhythmias; in the absence of heart disease, they are not of great clinical significance, but in patients with coronary disease, they represent a constant danger of ventricular tachycardia or fibrillation and sudden death.
Definition (NCI)Ectopic impulses originating in the ventricles.
ConceptsPathologic Function (T046)
EnglishEXTRASYSTOLES VENTRICULAR, Premature Ventricular Beat, PREMATURE VENTRICULAR BEATS, Premature Ventricular Complex, PREMATURE VENTRICULAR CONTRACTION, Premature ventricular contractions, PVC, PVC'S, VENTRICULAR BEAT PREMATURE, VENTRICULAR CONTRACTIONS PREMATURE, Ventricular Ectopic Beat, Ventricular ectopic beats, Ventricular ectopic complex, Ventricular ectopics, Ventricular Extrasystole, VENTRICULAR EXTRASYSTOLES, Ventricular premature beats, Ventricular Premature Complex, Ventricular Premature Complexes, Ventricular premature contractions, Ventricular premature depolarisation, Ventricular premature depolarization, Ventricular premature systoles, VPB, VPC, VPC'S
Spanishcomplejos ventriculares ectopicos, complejos ventriculares prematuros, contracciones ventriculares prematuras, despolarizacion ventricular prematura, extrasistoles ventriculares, latidos ectopicos ventriculares
Parent Conceptscardiac arrhythmia (C0003811), Premature Cardiac Complex (C0340464), Ventricular arrhythmia (C0085612), Aberrant premature complexes (C0428987), Duplicate concept (C1274013), Ectopic rhythm (C1399226)
SourcesCOSTAR, CSP, CST, DXP, LNC, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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