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Ectopic heartbeat

PVB (premature ventricular beat); Premature beats; PVC (premature ventricular complex/contraction); Extrasystole; Premature supraventricular contractions; PAC; Premature atrial contraction; Abnormal heartbeat

Ectopic heartbeats are small changes in a heartbeat that is otherwise normal. These changes lead to extra or skipped heartbeats. Often there is not a clear cause for these changes. They are mostly harmless.

The 2 most common types of ectopic heartbeats are:

  • Premature ventricular contractions (PVC)
  • Premature atrial contractions (PAC)

Causes

Sometimes ectopic heartbeats are seen with:

  • Changes in the blood, such as a low potassium level (hypokalemia)
  • Decrease in blood supply to the heart
  • When the heart is enlarged

Ectopic beats may be caused or made worse by smoking, alcohol use, caffeine, stimulant medicines, and some street drugs.

Ectopic heartbeats are rare in children without heart disease that was present at birth (congenital). Most extra heartbeats in children are PACs. These are almost always harmless.

In adults, ectopic heartbeats are common. They are most often due to PACs or PVCs. Your health care provider should look into the cause when they are frequent. Most of the time no treatment is needed.

Symptoms

Symptoms include:

  • Feeling your heartbeat (palpitations)
  • Feeling like your heart stopped or skipped a beat
  • Feeling of occasional, forceful beats

Note: There may be no symptoms.

Exams and Tests

A physical exam may show an occasional uneven pulse. If the ectopic heartbeats DO NOT occur very often, your provider may not find them during a physical exam.

Blood pressure is most often normal.

An ECG will be done. Often, no further testing is needed when your ECG is normal and the symptoms are not severe or worrisome.

If your doctor wants to know more about your heart rhythm, he or she may order:

  • A monitor that you wear that records and stores your heart rhythm for 24 to 48 hours (Holter monitor)
  • A recording device that you wear, and records your heart rhythm whenever you feel a skipped beat

An echocardiogram may be ordered if your doctor suspects problems with the size or structure of your heart are the cause.

Treatment

The following may help reduce ectopic heartbeats for some people:

  • Limiting caffeine, alcohol, and tobacco
  • Regular exercise for people who are inactive

Most ectopic heartbeats DO NOT need to be treated. The condition is only treated if your symptoms are severe or if the extra beats occur very often.

The cause of the heartbeats, if it can be found, may also need to be treated.

Outlook (Prognosis)

In some cases, ectopic heartbeats may mean you are at greater risk for serious abnormal heart rhythms, such as ventricular tachycardia.

When to Contact a Medical Professional

Call your provider if:

  • You keep feeling the sensation of your heart pounding or racing (palpitations).
  • You have palpitations with chest pain or other symptoms.
  • You have this condition and your symptoms get worse or DO NOT improve with treatment.

References

Olgin JE. Approach to the patient with suspected arrhythmias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 62.

Rubart M, Zipes D. Genesis of cardiac arrhythmias: electrophysiologic considerations. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 33.

    • Heart, section through the middle

      Heart, section through the middle - illustration

      The interior of the heart is composed of valves, chambers, and associated vessels.

      Heart, section through the middle

      illustration

    • Heart, front view

      Heart, front view - illustration

      The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

      Heart, front view

      illustration

    • Electrocardiogram (ECG)

      Electrocardiogram (ECG) - illustration

      An electrocardiogram is a test that measures the electrical activity of the heart. This includes the rate and regularity of beats as well as the size and position of the chambers, any damage to the heart, and effects of drugs or devices to regulate the heart.

      Electrocardiogram (ECG)

      illustration

      • Heart, section through the middle

        Heart, section through the middle - illustration

        The interior of the heart is composed of valves, chambers, and associated vessels.

        Heart, section through the middle

        illustration

      • Heart, front view

        Heart, front view - illustration

        The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

        Heart, front view

        illustration

      • Electrocardiogram (ECG)

        Electrocardiogram (ECG) - illustration

        An electrocardiogram is a test that measures the electrical activity of the heart. This includes the rate and regularity of beats as well as the size and position of the chambers, any damage to the heart, and effects of drugs or devices to regulate the heart.

        Electrocardiogram (ECG)

        illustration

      Review Date: 5/5/2016

      Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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