PVCs: Symptoms and Treatment - in Plain English!

this is dr. Joshua Cooper and I'd like to teach you a little bit about PVCs or premature ventricular contractions they're so common and they cause symptoms in many people and sometimes other more serious heart conditions and I want to explain to you what they are and how they can be treated in order to understand how PVCs cause symptoms in trouble it's important to first review a couple concepts about how the normal heartbeat works the heart squeezes in a top and then bottom pattern a top bottom top bottom every normal electrical signal starts in the top half of the heart the receiving chambers and then travels after a short delay to the bottom pumping chambers the ventricles that squeeze and create the pulse the other concept is that the heart is like a rubber band the more you stretch it the stronger it squeezes so if you take this rubber band and you give it a big stretch then the heart will give you a strong squeeze in return but if you take that same rubber band and you give it only a little stretch then the squeeze that it gives you when it beats is weaker let's look at what a normal heartbeat looks like and then a PVC I'm going to show you two normal heartbeats in a row and then an abnormal PVC here we go top bottom top bottom whoops that was a PVC let's take a look at that once again top bottom top bottom boom so that third beat that PVC beat came from an abnormal electrical signal that came early in the bottom half of the heart first instead of with a normal heartbeat where the signals come in the top half of the heart first so that changes the order of things for that PVC so we all have extra beats some people have only a few per day and others may have hundreds or thousands some people feel every single one of them and other people don't feel them at all have no idea that they're happening when I look at an EKG and I tell someone that I see PVCs and they're having extra beats they will almost always say but wait a minute doc it feels to me like I'm having a skip beat or a missing beat but you're saying extra beats why is that in order to understand the difference we have to look at the electrical system of the heart versus the physical actual pumping of the heart we look at the electrical system of the heart when we do an EKG in the office but you can record electrical signals from the heart in a whole variety of ways outside the office or Hospital setting including heart monitors that have wires or just patch monitors without wires that we prescribe or some people have smartphone apps where they have a device with little metal pads that they can put their fingertips on for it to record electrical signals from the heart or even certain watches that can record the electrical signals that come from the heart but that's a little different from the physical squeezing or pumping of the heart that generates the blood pressure or the pulse so we can look at the physical pumping of blood out into arteries by a variety of methods including machines like blood pressure cuffs that can measure the pulse and the blood pressure in the arm or the wrist or a little device called a pulse oximeter that you put on your fingertip or you can even just feel the pulse by putting fingertips over an artery in the wrist or the neck and in all cases we're actually feeling the physical squeezing of the heart and blood being pushed out of the heart into the arteries creating pulsations that these devices or your fingertips can feel here's a recording of the electrical system of the heart in yellow and the actual pulse or blood pressure in red below and it's important to see that when we have a PV C that's shown here in yellow and it looks a little different and comes a little earlier compared to all of the rest of the normal Lietz notice what's happening down here in the pulse at the same time the pulse that's generated from the PVC is actually really weak that electrical signal that started in the bottom half of the heart creates a very weak squeeze and the question is why the reason is is that you didn't have a lot of time between the last normal beat and this PVC for the heart to fill with blood so that's kind of like taking that rubber band and only stretching it just a little bit so in return you get a very weak squeeze and a pulse that you can't feel with the fingertips most of the time or even with a blood pressure cuff or a device on the finger as a result you end up with a pulse that feels like you skipped a beat look at this bracket here it looks like it's twice as long as when your heartbeat was in its normal rhythm and this is why when you have a PVC beat that actually comes early you don't feel it and it feels like you skipped a beat or missed a beat the other symptom that people sometimes describe is a strong beat they may say well I didn't notice an earlier or a late beat but I just suddenly felt a big clunk or a big thump in the chest and it even hurt because that beat felt strong but why is that people will sometimes think that it's the PVC itself that caused the strong beat but it's actually not just again like that rubber band analogy after the PVC you have extra time to fill the heart with blood it's kind of like squeezing the rubber band I should say stretching the rubber band even more than normal because you're filling the blood and stretching it open even more and as a result in that first normal beat that comes after the PVC you get a really strong squeeze and a high pulse or high blood pressure so if you're feeling your heart beating in your chest or you feel it with your fingertips or with a machine the machine may not notice it but with your fingertips and in your chest you do that that beat was really strong after the PVC so some people will say when they have PVCs that they feel a clunk or a strong beat and that's the explanation sometimes people have PV seize every other beat it's called bigeminy and here I'm gonna first show you this is from an actual patient a recording of the pulse in red here is a little tube in an artery measuring the actual pulse and blood pressure and the blue here is a pulse oximeter that's that little device on the fingertip that measures the oxygen in the blood but also measures the pulse and notice in both cases this person's pulse the squeezing in the heart and the pulsation in the arteries is 46 beats per minute which is on the slow side but if you look at the EKG at exactly the same time the machine is going to tell you that the heart rate electrically is double that in this case 92 why is there a difference well here again with every other beat being a PVC and coming early those pulsations are really weak the heart didn't have enough time to fill or stretch and generate a strong pulse with those extra PVC beats so the heart rate electrically is 92 but the pulse is 46 and someone may feel sluggish or lightheaded or tired or even short of breath when they have PVCs so frequently that they come every other beat sometimes instead of feeling a missed beat or a strong beat during a PVC people may describe a funny sensation in their neck or a suddenly took off during a PVC so let's review why that happens remember the normal heartbeat which starts in the top half of the heart involves the top and then the bottom chambers squeezing one at a time and when that happens the top chambers squeeze blood through these open heart valves that are here in white from top to bottom blood can flow forward but during a PV C where the bottom chambers instead of squeezing second squeeze at the same time or even right before the top half squeezes those heart valves end up closing and in that situation when the top chambers are trying to squeeze they're not able to squeeze blood forward into the bottom half because those valves are closed and won't blood to travel forward so where does that blood go when the top half of the heart is squeezing well instead of going forward it goes backward into the veins and if we're gonna talk about the top right half of the heart the right atrium when that chamber squeezes instead of blood going forward it goes back up into the neck and down into the belly and when it goes back up into the neck people may feel a sudden sensation in the neck and even if they looked in the mirror they might even see a little bulge in the veins in the neck during that PVC beat that's entirely normal and that's from blood being squeezed backward during the PVC because of the timing of things and when we look at the top-left part of the heart the left atrium blood goes back into the lungs instead of forward through that valve which is now closed during the PVC and when blood flows back into the lungs it temporarily increases the pressure in the lungs and gives you the feeling that you need to cough so what should we do about PVCs when they happen most of the time this really nothing medical to do they're just annoying when you feel a Mis beat or a strong beat or a funny feeling in the neck or the chest but if you get sleep stay hydrated and notice if there's any Association of PVCs with something that can be modified sometimes caffeine or alcohol can increase the number of PVCs some women may notice with their menstrual cycle that they have more PVCs at certain times of the month but other than that there's really nothing to do at least from a medical standpoint if somebody has a lot of PVCs over 10,000 or more per day every single day then there actually is a medical problem that can sometimes happen which is that the heart in the bottom half the ventricles can weaken over months and years if you have that many PVCs and we can treat the PVCs in that situation with either taking a pill on a daily basis or doing a simple minimally invasive procedure called a PVC ablation to eliminate the PVCs that involves threading tiny little wires from the blood vessels in the groin at the top of the leg up into the heart pinpointing the abnormal spot that's causing the PVCs and delivering some energy to cauterize or burn that little spot in a very precise location and permanently cure and eliminate those PVCs if we're able to suppress or eliminate PVCs then the heart that has weakened from the PVCs usually strengthens back up often back up to normal sometimes if we see enough PVCs especially if they're coming from more than one place we may look for some other heart condition that actually may have caused the PVCs to happen and there may be additional treatment that we recommend if symptoms are bothersome enough even if there isn't a heart problem associated with them then we can actually treat the PVCs anyway to try to eliminate symptoms and improve quality of life and that may include again a medication or a PVC ablation procedure symptoms that people may feel in addition to what we spoke about before might include lightheadedness palpitations fatigue or other symptoms as such as those thank you so much for watching I hope this was helpful to explain what PVCs are why they cause the symptoms they do in certain people and what we can do about them if you have any further questions please talk to your doctor and if you'd like to schedule a visit with us or reach out to ask any further questions there's a link at the top of my channel page that you can click on if you have questions about other arrhythmia conditions also feel free to visit this arrhythmia channel page which is filled with other patient education videos

Channel: Dr. Joshua Cooper - Arrhythmia Education

Views: 196,099

Keywords: PVC, Premature ventricular beats, premature ventricular contractions, palpitations, skipped heartbeat, missed heartbeat, extra heartbeat, pvc ablation, vpb, missing beat, strong heartbeat, patient education, philadelphia, lay person, heart, heart arrhythmia, arrhythmia, pvcs, symptoms, catheter ablation, treatment, cardiomyopathy, weak heart

Id: 1LKg7d2gd-Q

Length: 12min 20sec (740 seconds)

Published: Mon May 11 2020