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

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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 Contractions or PVCs. Premature ventricular contractions are relatively common in the young and old populations alike.

But what exactly are these that make your heart flutter, and should you be concerned about them?

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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

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How to Spot PVCs on Your Watch ECG

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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.

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*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.*

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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.

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Unifocal PVCs cought with Apple Watch — *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.

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Multifocal PVCs cought with Apple Watch — *Multifocal PVCs. Notice how the PVC at the top has a different shape than the two PVCs at the bottom*

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What Patterns Do They Occur In?

PVCs can be called "frequent" if they appear more than five times in a routine ECG test or more than thirty times per hour during ambulatory Holter Monitoring. A professional can identify these PVCs and classify them according to their presenting pattern.

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

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PVCs in a bigeminy pattern cought with Apple Watch — *PVCs in a bigeminy pattern, also known as ventricular bigeminy. Notice how there's a PVC occurring every other beat.*

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A PVC couplet, also know as a ventricular couplet cought with Apple Watch — *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).*

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Any 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.

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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

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Still Not Sure How to Spot PVCs on Your Watch ECG?

A healthy heart is crucial for a healthy life. Although most PVCs should not be a cause of concern, you must seek expert advice if you feel that you may have frequent PVC episodes. Your smartwatch can be your partner in looking after your heart. Get your smartwatch ECGs reviewed by experts for PVCs within minutes on QALY (Android or iOS) today.