PACs vs PVCs

Hi everyone - What is the difference when you feel a PAC vs a PVC?? I had a follow up 24 holter monitor last week stemming from a bad episode of PVCs (trigeminy) caught on my ECG at the ER. I just received the results and all that was detected was 6 PACS!! Where were the PVCs?? As expected, I didn't encounter a "bad PVC episode" while wearing the monitor, but did feel a few brief bumps and thumps and flutters. I was really surprised that the findings were so low, as I probably felt each one, and apparently many people can have 100's or 1000's a day without noticing them...very odd. Over the weekend, I have had quite a few hard beats, while relaxing, and even while working out. I also felt a few of the long pauses between beats, followed by a hard beat. Just curious, but do any of you know if there is a difference in the sensation of a PAC vs a PVC?? I thought PVCs were my main enemy, now I am not sure what I am feeling....

[is_something_wrong]

You are doing the same mistake many of you are doing here. You think every skip or flip in the chest is a PVC. When you are stressed, especially if your heart rate is a little high, had a little too much coffee, etc, you most often have PACs.

The sensation depends on when in the heart rhythm cycle the PAC decides to "strike", what your BP is, how well your heart can contract, and more exotic causes like where in the atria the PAC origin, how long refractory/recovery time your sinus node have, etc.

Generally, you will more often feel the PAC than the PVC. In other words, PACs are more likely to produce "double" beats followed by a pause, rather than a completely skipped beat. Also, most PACs produces an "incomplete pause", so the timing between two normal beats aren't exactly two beats long. This variation can be in milliseconds, so it's hard for us to notice exactly what is a complete and what is an incomplete pause.

PACs can also cause longer pauses than two heart beats.

Also, PACs can feel as a punch in the throat/neck, followed by a hard heart beat.

[IMFletcher]

Thanks for your reply. I am aware of the mechanics of PVCs and PACs, just not always sure what I am feeling. Last few days I have been having a lot of hard beats, and sensations in the throat and chest... more isolated, and very brief. My real dilemma was the episodic PVCs that drove me to the ER a few months ago...I was having PVCs every third beat. Now my tendency is to attribute every flutter, thump, or hard beat to PVCs... ironically, as you posted, my holter only picked up PACs. Clearly, I am dealing with a mix of both. I am quite certain that the longer episodes, where I get the high occurrence of uncomfortable beats (up to 10 - 20 a minute), is likely an episode of PVCs, where as some of the isolated events may well be PACs as you mentioned. Either way, it's safe to say - I hate them both!!!