Premature Ventricular Contractions: Is Your Heart Freestyling?

Ever had that strange moment when your heart seems to skip a beat or adds an extra thump, leaving you wondering if it’s just a hiccup or something more? These irregularities are known as Premature Ventricular Contractions (PVCs).

India has one of the highest burdens of cardiovascular disease (CVD) worldwide. Premature ventricular contractions are typically benign but can sometimes be a sign of heart problems. While occasional flutters aren’t usually a cause for concern, persistent or disruptive irregularities should not be ignored. Let’s explore these heart rhythm changes, understand what’s normal, and recognise when it’s time to seek medical advice.

What are premature ventricular contractions?

Premature ventricular contractions (PVCs) are extra heartbeats that start in the ventricles, the heart's lower chambers, disrupting the normal rhythm. These early beats interrupt the regular pumping pattern of the heart, causing an irregular heartbeat. PVCs happen when the ventricles contract prematurely, before getting the signal from the heart's natural pacemaker. Essentially, it's an electrical glitch in the heart’s intricate circuitry. While PVCs are often harmless, frequent occurrences could indicate underlying heart issues.

How do your heart’s ‘electrical signals’ work?

Your heart has a reliable ‘electrical system,’ with the sinoatrial (SA) node acting as its natural pacemaker. This tiny cluster of cells generates electrical impulses that travel through the heart, ensuring the chambers contract in perfect coordination. The signal moves from the atria to the ventricles, creating the familiar lub-dub sound we associate with a healthy, well-functioning heart.

• The ‘lub’ sound, also known as S1, is produced by the closing of the mitral and tricuspid valves at the beginning of systole (ventricular contraction).

• The ‘dub’ sound, also known as S2, is produced by the closing of the aortic and pulmonary valves at the end of systole (ventricular relaxation).

Who is most likely to have premature ventricular contractions?

PVCs occur in anyone, but some groups are affected more often than others. Adults over 40 years of age experience them more frequently, as well as people with high blood pressure or heart disease. Pregnant women commonly report them as a result of hormonal changes. Those with stressful lifestyles, anxiety disorders, or sleep problems tend to be at higher risk. Also, heavy caffeine and alcohol consumers, smokers, and those with electrolyte imbalances are at a greater risk. Athletes can also notice them even when they are fit.

Signs and symptoms of premature ventricular contractions

For many people, PVC are silent and discovered only during a routine heart checkup. However, others may experience noticeable sensations or symptoms. Below is a breakdown of the common signs and symptoms associated with PVCs. 

• Skipped or missed heartbeat  

This is one of the most frequently reported symptoms. The heart appears to ‘pause’ or ‘miss’ a beat because the PVC occurs prematurely, and the next normal beat may be delayed slightly. 

• Chest discomfort

Though not common, some people may feel a brief moment of discomfort or pressure in the chest when PVCs occur, particularly if they happen frequently. It’s not usually sharp pain, but rather a vague uneasiness or tightness. 

• Fluttering in the chest  

Some people describe PVCs as a fluttering or flapping sensation, usually in the upper chest or throat area. This occurs because the premature beat disrupts the smooth rhythm of the heart.

• Dizziness or light-headedness  

When PVCs are very frequent or occur in runs, they can affect the heart’s ability to pump blood efficiently. This may cause temporary drops in blood pressure, leading to feelings of dizziness.

Causes of premature ventricular contractions

While premature ventricular contractions are common and often harmless, especially in healthy individuals, they can sometimes be linked to underlying issues or lifestyle factors. Here's a detailed look at the possible causes:

• Hormonal changes

Fluctuations in hormone levels, such as during pregnancy, menopause, or thyroid disorders, can affect heart rhythm. For example, an overactive thyroid (hyperthyroidism) increases the body’s metabolism and can overstimulate the heart, potentially causing PVCs.

• Excessive exercise

While regular exercise is heart-healthy, intense or prolonged physical exertion, especially without proper hydration or electrolyte replenishment, can sometimes trigger PVCs. 

• Heart disease

People with underlying heart conditions, such as coronary artery disease, heart failure, or cardiomyopathy, are more prone to PVCs. These diseases affect the heart's structure or blood supply, making the ventricles more likely to misfire.

• Sleep disorders

Conditions like obstructive sleep apnoea disrupt oxygen supply during the night, placing stress on the heart. This repeated stress can lead to rhythm disturbances like PVCs, particularly during or just after sleep.

• Anxiety and stress

High levels of emotional stress or anxiety can trigger PVCs. When the body is in a heightened state, say, during a panic attack or chronic stress, it releases stress hormones like adrenaline and cortisol, which can make the heart more irritable and prone to premature beats.

How to prevent premature ventricular contractions 

Premature ventricular contractions may seem harmless at first, and often they are, but frequent flutters or thumps can sometimes point to something more serious. Instead of waiting for those irregular beats to become a regular nuisance, adopting a few simple habits now can help keep your heart in sync and your worries at bay.

• Limit stimulants: Reduce caffeine, alcohol, and nicotine intake.

• Maintain electrolyte balance: Ensure adequate magnesium and potassium levels through diet.

• Manage stress: Practise meditation, deep breathing, or yoga to keep stress levels in check.

• Prioritise sleep: Aim for 7-9 hours of quality sleep each night.

• Exercise wisely: Stay active but avoid excessive or extreme workouts.

• Stay hydrated: Drink enough water to support heart function.

• Watch your diet: Cut back on salty, processed foods and energy drinks that may trigger PVCs.

• Monitor medications: Avoid or adjust certain medications under a doctor’s guidance.

• Control blood pressure: Keep hypertension in check with lifestyle changes or medication.

• Treat underlying conditions: Manage thyroid disorders, anxiety, or sleep apnoea effectively.

• Avoid personal triggers: Identify and steer clear of foods, stressors, or activities that worsen symptoms.

Diagnosis and risk factors of premature ventricular contractions

PVCs are typically diagnosed through a combination of patient history, physical examination, and heart monitoring techniques. These may include heart check-ups or longer-term monitoring to capture irregular beats and assess their frequency and pattern. Many people discover they have PVCs incidentally, during check-ups for unrelated issues, as the condition often presents with subtle or no symptoms at all. In cases where symptoms are more pronounced, further non-invasive tests may be recommended to evaluate overall heart function and rule out any structural abnormalities.

Several factors can increase the likelihood of developing PVCs. These include lifestyle habits such as high caffeine or alcohol consumption, smoking, and poor sleep hygiene. Psychological stress and anxiety are also well-known triggers. Additionally, individuals with underlying heart conditions, high blood pressure, or metabolic imbalances may be at higher risk. Even seemingly healthy people may experience PVCs occasionally, but frequent episodes could signal the need for closer observation and lifestyle adjustments to support better heart rhythm stability.

When your beats are out of sync 

Although PVCs can feel intimidating, awareness is the first step to effective management. Most cases are harmless and can be controlled through lifestyle adjustments, such as stress reduction, proper sleep, and a balanced diet. Regular follow-ups with a doctor help track their frequency and impact, ensuring that any concerning changes are addressed.

Occasional PVCs are normal and shouldn’t cause undue worry. The key is to identify personal triggers and work with healthcare providers to develop a tailored management plan.

Frequently Asked Questions

1. How do I know if I am at risk of premature ventricular contractions?

Risk factors for PVCs include high blood pressure, obesity, anxiety disorders, excessive caffeine or alcohol intake, smoking, and sleep disorders. A family history of heart problems, being over 40 years old, previous heart conditions, or certain medications can also increase risk. Your doctor will assess your individual risk through regular check-ups.

2. Can other health conditions cause similar symptoms to PVC?

Yes, several conditions can mimic PVC symptoms. These include anxiety disorders, panic attacks, thyroid problems, and acid reflux. Other heart conditions like atrial fibrillation (AFib) and supraventricular tachycardia (SVT) can also cause similar sensations. Additionally, stress-related chest pain and muscle spasms may feel like PVCs.

3. What should raise an alarm about PVCs? 

Seek emergency care if PVCs are accompanied by chest discomfort, severe dizziness, fainting, or difficulty breathing. Frequent PVCs — over 1,000 episodes in a day, continuous abnormal rhythms, or occurring during activity — should also be evaluated by a doctor.

4. What foods curb PVCs?

Eating magnesium-rich foods like leafy greens, nuts, and seeds can help. Potassium-rich foods such as bananas, avocados, and sweet potatoes are also beneficial. Omega-3 fatty acids from fish support heart health. Avoid known triggers like caffeine and alcohol.

5. What is the best exercise for PVCs? 

Gentle, moderate activities like walking, swimming, or yoga are ideal. Start slow and gradually increase intensity. High-intensity exercises should be avoided when symptoms are present. Deep breathing exercises and gentle stretching may also help manage PVC episodes.