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Normal amount of PVC's
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Normal amount of PVC's

Can you tell me what a normal number of PVC's/PAC's would be per day.  I don't know if one a minute or one an hour or one a day is considered occasional or quite a bit.  I get maybe one every hour where it feels like a skippy, flutter or bang.  I have been to a cardiologist and she says he gets them as well but I forgot to ask if let's say one every hour is okay.  Sometimes I will feel them every couple of minutes and then they just disappear for a couple of hours.  Could you please tell me from what you have seen in your practice how many skips, flips, bangs or flutters would be acceptable.  Cardiologist says I have a normal heart.  I have had these things for 20 years plus.  What would you do with a patient complaining of this if all tests come back negative.

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230125_tn?1193369457
There is no magic number for what is considered an abnormal number of PVCs.  The real question is if the heart is structurally normal, normal EKG and normal history/physical exam.  

When I have patients that with concerns despite a negative work up, I will offer to refer them for a second opinion if they want it.  I reassure them that all the data suggests that PVCs in normal hearts are not considered dangerous and that the treatment options available  (anti arrhythmic medications and ablation) have more risks.  The standard of care is reassurance.

I hope this helps.
33 Comments
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Avatar_m_tn
I have at least 10 a minute. So if I were you I would consider myself lucky. They just started three days ago. I am still freaking out about them. I'm only 23 and fear having to deal with these for the rest of my life.
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Avatar_n_tn
Oh my Philly!  Did you see a doctor about it?  That sounds like quite a few.  What do they say they are?  I think I was 23 when I first felt them as well.  Dealing on and off for around 20 years now.  Horrible aren't they.
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21064_tn?1309312333
I've had PVCs for about 30 years, and for about 10 years I had them in the thousands per day (20,000+).  The thing is if you have a structually normal heart, they are still benign.  I would get reports with over 20,000 PVCs and I was still told, not a problem.  They feel weird though.
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84483_tn?1289941537
I think that some studies have shown that 50-55% of persons under 30 years of age will probably have from 1 to100 PVCs and or PACs within in 24 hours. This is just an average from my understanding , there is no set limit, though over 10,000 in a 24 hour period would be termed very frequent.
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Avatar_n_tn
I always read "with a structurally normal heart, PVC's are benign".  So, what abnormalities could exist that would render them more of a danger?  MVP, PFO, ASD, RVH??  Just curious as to when a doctor might worry about simple rhythm abnormalities.
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16292_tn?1189759421
Very good question.  I have a pfo and I wonder...does that mean I don't have a "normal heart".  Plus I have very slightly inverted t-waves so there goes my "Normal EKG".  Oy!
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Avatar_f_tn
my last holter (48hr) recorded on average 1250pvc/hour, with the hightest recorded as 830pvc/hr. I have many couplets and triplets and long strings of them now. But they still say, benign, benign.

An echo done in March/08 was "normal", although it showed mild mitral and aortic valve regurge. Doesn't sound structrually normal to me anymore, but they say the diagnostic tests are so sensitive now mild anything is usually not worth mentioning (unless it's in their hearts lol)

I'd be skipping and singing with only one or a couple of pvcs an hour, but I do know how distressing they can be. Try to rest assured with the doctors answer. I've lived with mine for hmmm 45-18=27 years :-)
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Avatar_n_tn
Hi newby,
I understand.  I've had quite a few of them myself... I only worried because they seemed to intensify during the recovery period from exercise (running or cycling).  Needless to say, I was intent to ignore them.  I was more curious as to what constitutes the docs considering them to be a little "less benign".  A neurologist once mentioned that if frequent enough, they can produce some blood pooling, and maybe lead to other problems... not sure.  Mine are nearly gone now, but I did just have a 1.5 inch PFO surgically repaired (no rim, atrial septum severely necrotic, swinging wildly, so no device, which I'm glad). I am a young 2 - small stroke victim.
So, once I am able to start running again, I will be curious to see if I still get them :)
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248632_tn?1365307230
Hello Newby,

I've had these darn PVC's and still can't get used to them. I've had every single test, gone to the ER at least 6 times. Doctor's have reassured me all tests point to a structurally sound heart. Have to just get used to PVC probably for the rest of my life. I was prescribed 100 ml of Toprol XL, and that has helped. Where as before I used to get PVC almost on a daily basis, now just experience PVC's maybe once a week (and bouts can run for hours). Even if benign, you can never get used to the flutters, shortness of breath, and occasional chest pain....at least that's what I feel when I get these things.
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Avatar_n_tn
Hi PVC Lady,
yes it is hard to get used to them.  I hadn't had them - at least where they were noticeable, until about a year ago, and along with them came extreme light headedness, nausea and lots of skipping.  They progressively got worse, but seem to have calmed down now.  I hope you have luck with the Toprol.  hang in there.
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Avatar_n_tn
Hi fwilson,
where have you found information/research suggesting PVC's are not benign?  I am curious, as I only read things saying they are benign (except they are more worrisome if happening during the recovery phase of exercise).
The only doctor I have ever talked to that has suggested, even lightly, that they might create mischief (if frequent and in bigeminy) is my neurologist.
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84483_tn?1289941537
Studies have been revised somewhat with regards to PVCs, nothing significant has come up with the revision. long terms studies report with long term follow up that PVCs in a normal heart suggest just slightly above 1% in mortality which the persons that conducted regarded it as an insignificant percentage , it is suggested that persons with frequent PVCs get evaluated at least every 5 years if I remember the report correctly.I can't post the information as the rules of the forum don't allow. Only the Doctor the answers the question can post references.
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Avatar_n_tn
Hi guys,
thanks for the info.  I guess if nothing else, if mine get crazy when I start running or cycling again, I will see what my cardiologist feels in terms of doing a stress test.  I know sometimes all these tests can be oversensitive.  I am hoping to be done with medical testing and surgeries for awhile :)
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230125_tn?1193369457
The most recent published study on normal heart PVCs (no heart failure or atrial fib) was January 2008.

Dewey FE et al. Ventricular arrhythmias during clinical treadmill testing and prognosis. Arch Intern Med 2008 Jan 28; 168:225.

I present the best information that I have.  There is no conspiracy on behalf of doctors to hide information about the dangers of PVCs.  If you want to find negative information, it is everywhere on the internet.  Post exercise PVCs are a risk factor for cardiovascular events, so is smoking, hypertension, diabetes, old age, family history, depression, stress, and many, many others.  My best advise is to focus on correctable risk factors -- don't focus on the negative, it is just not a fun way to live.

I hope this helps and clarifies the issue.
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Avatar_m_tn
Hello doctor.

It is exchanges like this that lead many critical thinkers into a conundrum.

We hear in clinic, "I reassure them that all the data suggests that PVCs in normal hearts are not considered dangerous...".  However, when we ask for proof of such statements, nothing is presented, or studies clearly showing a defined risk for PVCs is presented.  The study presented here appears to expand upon the risk defined in an earlier Cleveland study.  Risk has now been found to include post-exercise PVC suffers who have relatively few PVCs and have been screened for heart failure and atrial fib.

For all the data to suggest a given outcome, it would be assumed that there would be "some" data to form the body of "all" the data from.  Science dictates that for a consensus, there should be a body of evidence to draw from.

Without a body of evidence to draw this clinical opinion from, and indeed a large body of evidence to suggest there are defined risks from PVCs, it is hard (at least for a few of us critical thinkers) to draw a conclusion other than statements claiming PVCs are benign are at worst uniformed, and at best "benevolent misdirection".

I mean no malice by this post.  You certainly seem to be practicing the medical state-of-the-art, doctor.  It would just appear, in this case, that this state is not one well rooted in science.
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Avatar_n_tn
Good Morning I hope your heart issues are good Fred. I have been a long time observer and sometime post on the site so i do know the history etc etc. While i do agree with your arguments im not sure how relevant they are. For instance, If you are a frequent flyer then you surely have an increased ...risk... from being in an air accident, however that doesnt mean that just because you fly that you will be a victim. Or, if you dont fly then that means that you are NO risk from being involved in an air accident. Statistics can be misleading. Everyone, yes everyone has a pvc pac now and then. But that doesnt mean that just because they have a couple here and there... even after excersize, that they are going to suffer an event, anymore than if i get on a plane today that i am certainly going to be involved in an air incident.
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Avatar_n_tn
What a great thread this is.  I think that is what I needed is a pep talk.  So you say "everyone" gets these things every so often.  How much is every so often?  I just need someone to clarify if "every so often" is 10 times a day or 10 times a month of year?  I would consider 10 times a day "frequent" but I may be reading into this all wrong.  What is really considered "occasional".
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Avatar_f_tn
I would count myself lucky to have 10 pvcs per minute never mind in a day, what a blessing that would be!

I currently experience pvcs on average about 20 per minute. They come mostly in trigeminy (a pvc on every third beat), but it is fairly common for me to have couplets (two in a row) and triplets (three in a row), and sometimes I will get 35 pvcs per minute.

But talking about risk as this thread seems to be going, the electrophysiologist I saw, still considers them to be benign, and that anti-arrhytmic drugs (especially) are greater risk for developing a dangerous rhythm than doing nothing at all. He doesn't feel ablation is a good answer either because the risk is greater for serious side-effects. However, if the pvcs become intolerable ablation may be considered.

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Avatar_n_tn
I don't think I could stand it having that many.  I stress about 10 a day.  Can I ask what yours feel like?  I get a bubbly sensation in my heart, pause and then hard thump sometimes and then other times it will be three or four quick beats and a hard thud and other times just a quick sqeeze kind of sensation in my heart and then it goes back to normal.  I feel them hard in the left hand side of my neck as well and sometimes my fingers go tingley when it does the hard thump.  Unnerving to say the least.  

So does your EP doc say you have a normal heart and not to worry?  That is what mine has said but I can't believe it.  How long have you had yours for?  Mine started in my 20's and I am not in my late 40's.  I just want to find some way to get rid of them but I guess I am probably stuck with them for life.
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Avatar_f_tn
I had an echocardiogram in March (I requested it since it was two years since a stress echo in 2005). It was "normal".

So the party line is still the same, pvcs in a structurally normal heart are benign.

The EP then said we should do a stress-echo just to make sure. But I countered that when I exercise they go away, and I get no chest pain or shortness of breath with exercise. He was thinking ischemia might cause the pvcs. I declined the stress-echo. The one I had in 2005 was normal and the pvcs went away during exercise, and he said "exactly", and smiled.

I've had pvcs at least since I was 18--that was the first time I went to the doctor about it. But I remember when I was a little girl, my sister and I went for our afternoon nap and she kept saying "quit shaking the bed", and I never knew what she was talking about. I think it was the pvcs. Sooooo, from at least age 18 to now, that would be 27 years.
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Avatar_n_tn
Well that makes me feel a bit better when your EP says "benign".  I just can't seem to wrap my head around it that all the bumps, flutters and bangs are normal.  I ask all sorts of people if they feel them and they say "nope, my ticker always beats normal".  I do get some sort of gratification when I come to this website and see I am not crazy though when I see others suffer as well.  I didn't have any PVC's when I was having my stress test so they said that was good as well.  

So can you tell me what yours feel like though?  Does yours skip or flutter or what?  I get so many different feelings it is hard to explain.  I am very over-sensitized to these things.  I have been told my my doctor that she probably gets them as well but just doesn't pay attention.  I thought how in the world could you not pay attention?  It is slightly obvious when they are happening.  

I remember my first one I felt was at work when my boss was hanging over me and I was typing a letter and I was stressed.  I went direct to the doctor and said there was something wrong with my heart hence all the workups I have had in the past 20 something years!  That is weird about your sister saying that huh.  Must have been some pretty strong PVC's for her to feel them as well.  
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433892_tn?1208435343
Hi Newby123:

I too get these PVC's really bad.  My holter showed 4,280 in 24 hours!  926 of those was in 1 hour alone while I was sleeping.  

I had an EKG, Echo, Stress test, Ct Scan of the chest, and my Cardiologist says, my heart looks beautiful. Sure doesn't feel that way though.  She said she use to get Pvc's as well, and that they are BENIGN.  The problem is not that we "get pvc/pac's" th problem is that "we feel them."  Which in turn causes us anxiety, and creates the viscous cycle of aniety, pvc's, increased adrenaline, which then aggravates the heart leading to yet more pvc's...  The key is to try (I know this is so hard too) to relax when you get them.  Focus on your breathing, and importantly, distract yourself when you get these.

In a structurally, normal heart (and yours is by the testing you have had done), these will not harm you!  There are too many of us out there who have these and we are ll being told the SAME thing, that with negative testing and a structurally normal heart, these are benign.  

When I get them, mine feel like butteflies in my upper stomach on the left side (Like when you feel nervous when speaking in public, or whatever) alone with the big thump.  Sometimes it feels like a sking in my heart when I get them too...  It can be a different feeling all the time!

Just think---  we are all told they are benign.  I don't think the Cardiologists, are keeping anything from us as to not scare us.  They are telling us what they know from current medical knowledge and are doing the best they can for us.  They are Dr's not GOD!  =o)

There would be many cardio's with lawsuits on their hands if everyone of us died from these.  We will not!  I hope this helps some....

You will get through this..  Look how far you have come!  I would be so happy if I had even 200 in a day, or heck 1,000! I get them all day, everyday and I am still here!  

Steph
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Avatar_n_tn
WOW!  I know I shouldn't complain and what a wonderful post you did!  I know everything you say is true but they feel so awful you just think something is wrong.  I get one and then wait for the next one and so on.  I can actually make my heart do it which is pretty darn scarey.  

It is somewhat comforting to hear you get those strange sensations as well.  They are so hard to explain.  I remember telling my doctor that is was like I was on a plane that hit an air pocket and my heart just kind of drops and them goes funky and then goes back to its rythum.  She looked at my like I had three heads.  She also said that 50 - 60% of the people walking around out there on the streets have these things and have never had a second thought about them.  Wish I was one of them!!!!!  
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Avatar_f_tn
I guess I've had every sensation there is with respect to how the pvcs feel. No wait, probably not, every time it feels different I wonder if something has changed.

Point is, when you focus on them, you feel them. I get on average 1200/hr, every hour. I don't feel every one, thank goodness, but I do feel a lot of thumps, and drops and, like I said just about everything you could describe. I've come to learn that just because it's different, doesn't mean it's something bad. It's just different.

Funny thing is, when I do get a lot in a row, 10 or 20, I usually don't feel much different. When I get a break and have normal beats for a couple of minutes, that feels strange! Go figure.
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Avatar_m_tn
Hi there!  I remember that name!

You are right, having PVCs CERTAINLY does not mean you are going to die from them.  That is not the definition of risk.

Modifying your airplane analogy a bit, the chance that if you would be in a fatal car crash on the way to work today is slim.  Isn't it silly to REQUIRE seatbelts be installed in all cars for what is an admitedly slim possibility?

If I am overweight, it does not mean I will die from a complication of it.  It simply means I am at increased risk.  Likewise with smoking and many other risk factors; NONE of them are automatic death sentences, simply risk factors.



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Avatar_f_tn
I mean no offense in my post to you, as you said you mean no offense in your post to the doctor, but you seem a bit like a dog with a bone, unwilling to give it up.

I think the medical doctors, cardiologists and EP's are giving the best answer possible, based on the information on hand, they don't really know what causes pvcs, there are triggers for some people, there really isn't anything that works well to suppress them but treatment of beta-blockers is suggested.

Anti-arrhythmic drugs and/or ablation carries greater risk of serious side-effects--greater than the pvcs themselves. And in ONE GROUP OF SUBJECTS studied, *POST-EXERCISE* pvcs increased the risk of cardiovascular death in a small percentage of participants. Maybe you can aprise me of other facts of the study: did they screen for all other possible risk factors for cardiovascular disease besides the subjects being free of heart attack before the study? I've had post-exercise pvcs for 27 years at a greater frequency than listed in that study, I'm hopeful I'll be around for at least another 27.

Oh, and I think that the chances of being in a motor vehicle collision on the way to work are actually very high. Fatal? Who is to say. But seat belts protect against injury they don't prevent a fatality.
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Avatar_m_tn
No offense taken, but your arguements are non sequiturs.

The cause of PVCs is not relevant to if they pose a risk.  Whether or not effective treatments exist for them is not relevant to if they pose a risk.  Whether or not you, as a sample size of one, has lived with PVCs for decades is not relevant to if they pose a risk.

Changing the definition of risk to mean certainty is incorrectly applying the term, and is also not relevant to if they pose a risk.

Choosing a positive outlook by not worrying about something over which you may have no control also is not relevant to if they pose a risk.

The risk is inherent.  It is there or it is not.  We test for these risk factors with studies.  For an assertion to be rooted in science and not wishful thinking, there should be repeatable, experimental evidence (which in medicine seems to generally take the form of studies) that can be analyzed to give information about these risk factors.  These seem to be in short supply, while other, albiet imperfect (few studies are perfect) studies showing risk are abundant.
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Avatar_f_tn
You, friend, like to dance around an old bush.

Non sequiturs: An inference or conclusion that does not follow from the premises or evidence, Or a statement that does not follow logically from what preceded it.

I really don't see how you can infer that I am changing the meaning of the term risk. I don't see that anywhere in my post. Further, I don't see your point in being negative--if as you say, I am being positive. I like my position a whole lot better.

Am I to sit and brood, and worry about "something I have no control over", nor do any doctors because there isn't effective treatment without greater risk, even if there IS a risk associated with post exercise pvcs in a small percentage of study participants from one study?

Show me a study that clearly points to less risk of mortality from post exercise pvcs-- because of intervention--and I'll gladly read it and show it to as many doctors as I possibly can. I mean, that's the point right? Helping people.

You still hold tight to that ONE study, which as you point out, studies are imperfect. So I have every confidence in using my own case history as a single individual, especially as I believe the subjects of the study you mention were all men. Older men. And I still haven't been convinced that they were screened for anything other than "no previous heart attack history". So what is to say there weren't multiple factors in that small percentage who had post exercice pvcs and later died of cardiovascular event?

You also suggest that whether effective treatments exist, or not, is irrelevant if pvcs pose a risk. WHAT? Isn't the whole point of intervention, for any condition, to decrease the risk of a serious consequence or complication from the condition without causing further assult from the treatment itself? It is highly relevant. The fact remains unchanged, there is increased risk of mortality in a small percentage of participants who had post exercise pvcs.

But I suppose if you want to twist and turn my statements, so be it. But I'm not here to define, or challenge the meaning of words.
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Avatar_f_tn
The study states that there was a greater risk to those who had PVC"s in the recovery phase after maxium heart rate has been reached. I also think that the subjects did not have PVC's like we, (upbeat and I) have. I interperted the study not to mean if you have PVC's you are at risk, cause if you have PVC's you have them at any point,before during and after excercise. If  PVC's  have been diagnosed as benign they are benign. I think that the subjects in this study were not PVC sufferers. I think they were using PVC's as a sign of posible problems in an otherwis asymptomatic person.
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Avatar_m_tn
Upbeat,

You have not tried to change the meaning of the word risk.  I tried to seperate out YOUR non sequiturs from others with a new paragraph, but I certainly could have been more explicit.

The first paragraph however does list non sequiturs you have stated to support a conclusion that PVCs are benign.  The listed non sequiturs are in fact not relevant to whether or not PVCs are associated with greater risks.  If you wish to have a positive outlook, that is great!  I do too.  However I do not confuse my outlook with critical thinking and examining studies.  

If one of us, tomorrow, was to find out we had terminal cancer and had at most 6 months to live, I would hope we would use that 6 months to live life to the fullest, not to "sit and brood".  However to somehow bend this positive attitude into suggesting that having the terminal cancer is not a risk factor is...intellectually dishonest.

There are many studies showing greater risk in those with PVCs (in one form or another).  I will not post citations here.  I have in a previous post listed topics that will bring up these studies in a simple Medscape search.  The study THE DOCTOR listed in this thread is in addition to a previous Cleveland study on post-exercise PVCs.  If you read the abstract, you will note they screened for heart failure, afib and SVT.

"Whether or not effective treatments exist for them (PVCs) is not relevant to if they pose a risk."

That is what I actually said and it is quite different from:

"...whether effective treatments exist, or not, is irrelevant if pvcs pose a risk."

If PVCs pose a risk, as I believe the studies show, then effective treatments are indeed VERY important.  However, whether effective treatments for PVCs exist, does not effect whether or not they pose risks.  See the difference?

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433892_tn?1208435343
That makes perfect sense to me!

That those who suffered had pvc's and cardiovascular events post exercise did not have them all the time like we do.  The PVC's were probably an isolated event, post exercise, which was a "symptom" of a problems within the heart.  It makes perfect sense...

And as Artskip and others have said, if you have had all needed tests and have been deemed to have a "structurally normal heart" besides having pvc's, then the pvc's are benign, benign, benign, benign, benign!!

Thanks for putting it into persepctive for us Artskip.  =o)

Steph
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Avatar_n_tn
Thank you very much for the information. We appreciate your input.
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