Why do you all think you have PVCs?

[is_something_wrong]

I can't help but notice since I joined this community some months ago, people with skipped beats or palpitations tend to ask questions about PVCs. Like all flips in the chest are PVCs.

The upper chambers in the heart are more "irritable" than the main chambers. In other words, they are more likely to produce premature beats (PACs). A few examples:

Which is more common - A-fib (atrial) or V-fib (ventricular)?
Which is more common - SVT (atrial) or VT (V-tach) (ventricular)?

Both PACs and PVCs are usually benign, so it's really not an issue, I was just a little curious.

Even so-called "wide complex beats" on EKG are often PACs. If a PAC occurs very early, it can show as a wide complex on EKG, because the right ventricle is a little slower recovering than the left, leading the electricity to the left ventricle, and then to the right, thus mimic a PVC that origin in the left ventricle.

Just so you know :-)

[itdood]

I've never seen an ecg with a PAC that contains a wide QRS.  Of all the ecgs I've seen with a PAC (not that many), the only way I can even see a PAC is the R-R timing..  PACs are tiny little things.

Compare that to a PVC ecg, the entire QRS is bizarre, I mean the thing stands out like a sore thumb.  Because the ventricles are firing at different times it's the widest QRS you will ever see.

A picture is worth a thousand words, so here's my point

http://imgur.com/CJUJL.jpg


So, just based on the electrical activity we see with a PAC versus a PVC, it's a logical conclusion to state that PVCs can be felt more and will cause the person more distress in terms of symptoms.   This isn't a blanket statement, but I think for the majority of people this applies.

[is_something_wrong]

Hi,

This is an interesting discussion :)

I know that PVCs sometimes causes the next sinus beat to occur when the AV valves are shut, causing backfiring of blood and pulsations in the neck. But a PAC can, too, if it occurs extremely early. Though, the atrias won't be completely filled and the sensation will be less bothersome.

What I don't understand, is the sensation of LV and RV contracting at different times. PACs often have a RBBB morphology and it occurs because the RV is still refractory when the PAC fires, causing a wide QRS complex. Permanent RBBB or LBBB is not uncommon, and I don't think people with this phenomenon are suffering from permanent palpitations?

Ventricles have more muscle mass than atrias, but a PAC also activates the ventricles? I would assume (and my cardiologist told me) the PAC itself causes a more noticeable beat than the PVC, thus PACs are often perceived as a "double" beat, and PVCs as skipped beats.

What I can strongly agree, though, is that the compensatory pause after a PVC is somewhat longer than after a PAC, and the next beat will be stronger after a PVC. However, I've monitored PACs on EKG and they felt terrible. So I guess there are individual differences.

[kay2486]

i know what you mean by the feeling, i know they are pvcs because ive been told and they are an awful thud and then the feeling of the hearts stopped for longer than it has, pacs are much lighter  feeling they dont bother me but the pvcs do, they can't go unnoticed

[chuparosa]

I'm kinda like ireneo. I gave up trying to figure out why I have palps. It's just what my heart does. I think its only natural to try to figure out why you have them and what they are. It is kinda fascinating in a way and also a bit disconcerting that you have little control over them.

[itdood]

p.s., another reason PVCs get more attention too is because they feel so horrible.  People with PVCs tend to seek medical attention more often.  People with PVCs tend to reach out more for help due to the severity of the sensations.    Like I said in my post above, if I had just PACs I wouldn't even go the doc for them.  Perhaps most people are like this and that's why we see this skew towards people with PVCs on the board looking for answers.

[itdood]

I've caught PAC's and PVCs on ekg during holters and stress tests.  I know the difference by the way they feel.  PACs are more of a tiny flutter that don't bother me at all.  They're kinda cute in a way.  I wouldn't even seek medical attention for them.  PVCs make my entire chest move.  they are a wicked thud.  The main diff being that a PVC will cause the right and left ventricle to contract at different times, where a PAC will trigger the ventricle through the AV node so at least the ventricles contract at the same time.  The ventricles have so much more muscle mass than the atria that yea, you'd expect to feel those more.  Valves slam shut when the atria is contracting.  It's nasty.  Some of the regulars on this board have this level of experience.

I think what you're trying to say is that people are wrongly diagnosing themselves with PVCs by feeling, or, answerers on this board are skewed in this direction.  I've never gotten this impression.  Almost all the interaction I've had are with people that have been formally diagnosed with PVCs.  Those that are not formerly diagnosed but asking for opinion on this board what their "flutter" is for the most part get the proper advise of it's probably ectopic activity of some sort but it needs to be seen on an EKG to be sure.