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Tests and diagnosis
By Mayo Clinic staffIf your doctor suspects that you have premature ventricular contractions, you may have an electrocardiogram initially. This test can detect the extra beats, identify their pattern and their source, and look for any underlying heart disease.
Electrocardiogram (ECGs)
If you experience infrequent premature ventricular contractions, they may not be detected during the brief time a standard ECG is being done. You may need a Holter monitor ECG or event recorder ECG for 24 hours or more to capture any abnormal rhythms:
- Standard ECG. During a standard ECG test, sensors (electrodes) are attached to your chest and limbs to create a graphical record of the electrical signals traveling through your heart. It is usually done in a clinic or hospital setting and lasts only a few minutes.
- Exercise stress ECG This diagnostic test uses electrocardiography to record your heart's electrical activity while you walk on a treadmill or pedal an exercise bike. It can help determine the significance of your premature ventricular contractions. When premature beats disappear or dwindle during an exercise test, they're usually considered harmless. On the other hand, if exercise provokes extra beats, it may indicate higher risk of serious heart rhythm problems.
- Holter monitor. This portable device is carried in your pocket or in a pouch on a belt or shoulder strap. It automatically records your heart's activity for an entire 24-hour period, which provides your doctor with an extended look at your heart rhythms.
- Event recorder ECG. This portable electrocardiogram device can also be carried in your pocket or worn on a belt or shoulder strap for home monitoring of your heart's activity. But, unlike a Holter monitor, it doesn't record continuously. When you feel symptoms, you push a button, and a brief ECG strip recording is made. This allows your doctor to see your heart rhythm at the time of your symptoms.
A Holter monitor or event recorder ECG can help identify the pattern of your premature ventricular contractions. Two premature beats in a row are called a couplet. Some patterns, such as ventricular trigeminy — two normal beats followed by a premature beat — tend to be harmless. Others, such as ventricular bigeminy — a pattern of alternating normal beats and premature beats — may be associated with symptoms. More than three premature ventricular beats in a row is called ventricular tachycardia — which can cause symptoms and be a sign of serious heart disease.
- Yealy DM, et al. Dysrhythmias. In: Marx JA, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006. http://www.mdconsult.com/das/book/body/130129214-4/826148372/1365/221.html#4-u1.0-B0-323-02845-4..50083-4_3679. Accessed April 2, 2009.
- Arrhythmias. In: Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50054-6--cesec188&displayedEid=4-u1.0-B978-1-4160-4106-1..50054-6--cesec196&uniq=130129214&isbn=978-1-4160-4106-1&sid=826147556. Accessed April 2, 2009.
- Podrid PJ. Clinical significance and treatment of ventricular premature beats. http://www.uptodate.com/home/index.html. Accessed April 2, 2009.
- Arrhythmia. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/arr/arr_whatis.html. Accessed April 2, 2009.
- Martin DT. Arrhythmias. In: Noble J, et al. Noble: Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo.: Mosby; 2001. http://www.mdconsult.com/das/book/body/130129214-5/826149799/959/391.html#4-u1.0-B0-323-00828-3..50066-2_1733. Accessed April 2, 2009.
