What Premature Ventricular Contraction (PVC) Looks Like on Your Watch ECG

PVC ECG
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Qaly is built by Stanford engineers and cardiologists, including Dr. Marco Perez, a Stanford Associate Professor of Medicine, Stanford Cardiac Electrophysiologist, and Co-PI of the Apple Heart Study.

Key Takeaways

  • PVCs are abnormal heartbeats that disrupt the regular heart rhythm, causing the heart to skip a beat or flutter. These irregular beats originate in your heart's lower chambers, or ventricles, instead of your heart's sinus node, which normally controls your heart's rhythm. PVCs can be caused by factors such as reduced blood flow, heart problems, electrolyte imbalances, stress, and anxiety.
  • To identify PVCs on your watch ECG, look for inverted or absent P waves, wide QRS complexes, and changes in T waves.
  • Occasional PVCs are generally not concerning for individuals without underlying heart conditions. However, frequent PVCs can increase the risk of developing more serious heart conditions. Symptoms may include dizziness, palpitations, fainting, and anxiety. As always, if you're experiencing worsening symptoms, contact your healthcare provider to rule out harmful underlying conditions.

Got other questions on PVC? See the Qaly guides on PVC:

Introduction

Have you ever had a feeling that your heart skipped a beat? How about a fluttering sensation in your chest? Romantics would argue that these are signs of a person in love, but from a medical standpoint, these may be signs of an abnormal heart rhythm called Premature Ventricular Contraction, or Premature Ventricular Complex, or PVC. PVCs are relatively common in younger and older people, alike. But what exactly are these heartbeats that make your heart flutter, and should you be concerned about them? Let's dive in.

What's a Premature Ventricular Contraction?

Premature Ventricular Contractions are abnormal heartbeats. These irregular heartbeats disrupt your regular heart rhythm and cause your heart to skip a beat. PVCs are also known as:

  • Premature Ventricular Complexes
  • Extrasystoles
  • Ventricular Premature Beats

Understanding how the heart rhythm works are essential to understanding premature ventricular contractions. The SA node is the area responsible for sending electrical impulses that cause your heart chambers to contract. There is a signal misfire in a PVC, and the electrical impulse is sent from one of your heart's chambers, or ventricles, instead of coming from the SA node. This causes a premature heart contraction, leading to irregular or skipped heartbeat.

Some notable causes of PVCs are:

  • Reduced blood flow
  • Underlying heart problems
  • Electrolyte imbalance
  • Stress and anxiety

PVCs can often be confused with PACs or PJCs.

How to Spot PVCs on Your Watch ECG

The ultimate PAC watch ECG guide, created with love by the team at Qaly ❤️ Find us on App Store or Play Store.
The ultimate PVC watch ECG guide, created with love by the team at Qaly ❤️ Find us on App Store or Play Store.

PVCs usually do not present with any symptoms and are typically noticed during a routine electrocardiogram or ECG. Another test to rule out PVCs is a Holter Monitor. This is a portable device that you need to wear for some time to detect abnormal heart rhythms. You can also use compatible smartwatches to monitor your heart rhythm for any PVCs.

To identify a PVC, look for the following characteristics in your ECG:

  • Inverted or absent P wave
  • A wide and bizarre-looking QRS complex
  • ST-segment and T wave are opposite in direction to the majority direction of the QRS complex

Also, PVCs interfere with the normal rhythm by coming in before the next anticipated beat. If you're monitoring your ECG on your smartwatch, a professional can help point out these abnormalities.

PVC beat on an Apple Watch ECG. Notice how the PVC has a wide QRS complex, no preceding P wave, and looks different from the normal heartbeats.
PVC beat on an Apple Watch ECG. Notice how the PVC has a wide QRS complex, no preceding P wave, and looks different from the normal heartbeats.

Are There Different Types of PVCs?

There are 2 kinds of PVCs, unifocal and multifocal. Unifocal PVCs look identical in appearance, and they originate from a single site in the ventricles.

Unifocal PVCs. Notice how the PVCs are identical in appearance.
Unifocal PVCs. Notice how the PVCs are identical in appearance.

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Multifocal PVCs, on the other hand, arise from two or more ventricular sites. They also have different QRS shapes.

Multifocal PVCs. Notice how the PVC at the top has a different shape than the two PVCs at the bottom.
Multifocal PVCs. Notice how the PVC at the top has a different shape than the two PVCs at the bottom.

What Patterns Do They Occur In?

PVCs can be called f they appear more than five times in a routine ECG test or more than thirty times per hour during ambulatory Holter Monitoring.

  • Bigeminy: A PVC after every normal heartbeat
  • Trigeminy: A PVC after every two normal heartbeats
  • Quadrigeminy: A PVC after every three normal heartbeats
  • Couplet: Two successive heartbeats are PVCs
  • Non-sustained Ventricular Tachycardia (NSVT): PVCs occurring anywhere consecutively between three to thirty times

PVCs in a bigeminy pattern, also known as ventricular bigeminy. Notice how there's a PVC occurring every other beat.
PVCs in a bigeminy pattern, also known as ventricular bigeminy. Notice how there's a PVC occurring every other beat.

A PVC couplet, also known as ventricular couplet. This occurs when two extra heartbeats in a row originate at the bottom of the heart (ventricles).
A PVC couplet, also known as ventricular couplet. This occurs when two extra heartbeats in a row originate at the bottom of the heart (ventricles).

Are PVCs a Cause for Concern?

PVCs are ubiquitous, and nearly everyone experiences a few of them every day. PVCs should not be a cause of concern for people who have no underlying heart conditions. However, according to the National Library of Medicine, people who have frequent PVCs that occur more than one thousand times a day are at a greater risk of developing a condition called dilated cardiomyopathy. This is a serious condition wherein the heart chambers weaken and lose their ability to contract and pump blood.

PVCs can also increase mortality rates in people with an underlying heart condition. If you notice a PVC episode on your smartwatch ECG reading, it would be best to bring it up with your healthcare provider. Additional tests may be required to determine how the PVCs relate to your heart health.

What Are Common Symptoms and Treatment Options?

Most people who have PVCs do not exhibit any physical symptoms and are usually only identified through routine ECG tests. Those who present with symptoms, however, typically identify feeling the following:

  • Dizziness
  • Palpitations
  • Fainting
  • Anxiety
  • Pounding sensation in the neck

Your healthcare provider can assist you in managing your PVCs depending on the underlying cause. These may involve medications, surgical interventions, and lifestyle modifications.

Some treatments may include:

  • Medications such as beta-blockers or antiarrhythmics
  • Cardiac ablation - a surgical procedure used to block irregular heart rhythms
  • Eating a diet rich in Omega 3
  • Reducing alcohol and caffeine intake
  • Avoiding stress and fatigue
  • Managing underlying heart conditions

Conclusion

Well, that just about wraps up our guide on what PVCs look like on your watch ECG. We hope this could be of some help to you.

If you still need help interpreting your ECGs, don't worry, we understand how scary and confusing it can be to experience irregular heartbeats. That's why we created the Qaly app for you and for the hundreds of millions of people around the world who live with heart palpitations and abnormal heart rhythms. On the Qaly app, human experts will interpret your ECGs within minutes for clarity and peace of mind.

To get started with the Qaly app, grab the Qaly app from the App Store or Play Store today. If you have any more questions, or if you need our help in any other way, don't hesitate to reach out to us at support@qaly.co.

As always from the team at Qaly, stay heart healthy ❤️

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Wondering if it's a PVC? On the Qaly app, human experts will interpret your ECG for PVC within minutes. Get started today.

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