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Heart

Ectopic heartbeat

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Definition

Ectopic heartbeats are small changes in an otherwise normal heartbeat that lead to extra or skipped heartbeats. They often occur without a clear cause and are most often harmless.

The two most common types of ectopic heartbeats are:

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

Alternative Names

PVB (premature ventricular beat); Premature beats; PVC (premature ventricular complex/contraction); Extrasystole

Causes, incidence, and risk factors

Sometimes ectopic heartbeats are seen with: 

  • Changes in the blood, such as a low potassium level (hypokalemia)
  • Decrease in blood supply to the heart
  • Heart muscle disease (cardiomyopathy)

Ectopic beats may be caused or made worse by smoking, alcohol use, caffeine, medications such as stimulants, and some illicit drugs.

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

In adults, ectopic heartbeats are common. They are most often due to PACs or PVCs. Their causes should be investigated, although usually no treatment is needed.

Symptoms

Symptoms include:

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

Note: There may be no symptoms.

Signs and tests

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

Blood pressure is usually normal.

The following tests may be done:

  • Continuous ambulatory cardiac monitoring (Holter monitor, patient-activated recording device, or implanted loop recorder)
  • Coronary angiography
  • ECG
  • Echocardiogram

Treatment

Limiting caffeine, alcohol, and tobacco may reduce the risk and frequency of ectopic heartbeats in certain people. Exercise often helps 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 discovered, may also need to be treated.

Expectations (prognosis)

Sometimes, ectopic heartbeats may mean you are at increased risk for other serious abnormal heart rhythms, such as ventricular tachycardia.

Calling your health care provider

Call your health care 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. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap. 62.

Rubart M, Zipes D. Genesis of cardiac arrhythmias: electrophysiologic considerations. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 35.

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