Causes and risk factors
Heart rate is controlled by electrical signals passing across the heart tissues. Heart is made up of primarily muscle tissue. A network of nerve fibres regulates contraction and relaxation of heart muscles to obtain wave like pumping action of heart. Electrical signals are generated by SA node placed in the right atrium of heart. Autonomic nervous system controls the rate of signals sent by SA node. Electric signals follow the following pathway in the heart – SA node, Atrioventricular node, bundle of HIS, right and left bundle branch, purkinje fibres. AV node conducts impulses from atria to ventricles. A heartbeat when originates too early in the ventricles, it disrupts normal heart rhythm. The pattern of heart beat is – a normal beat, an extra beat, a pause and then a stronger than normal beat. The heart is filled with large amount of blood during the pause giving next beat extra force. The exact cause of PVC is unknown. Factors that can cause PVC include electrolyte imbalance, injury to heart muscle, ischemia, excessive smoking, excessive alcohol consumption, stimulants like caffeine, certain medications, and drug abuse. Excessive stress, exercise can also lead to the condition. PVC in children is rare and benign unless there is congenital heart disease. In adults, PVC is common.
Clinical presentation
PVC or an ectopic heart beat may be felt like a flip or jolt in the chest, fluttering, pounding in heart, as if heart dropped or missed beat. There is increase in awareness of heart beats.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. An ECG is done which confirms the diagnosis of PVC. It shows wide QRS complex. Stress test, Holter monitoring [24 hours ECG monitoring] , echocardiogram is advised. Imaging studies such as heart CT scan; MRI is useful for further evaluation. Coronary angiography may be recommended.
Treatment
Most PVCs are harmless and do not require treatment. Treatment is required if the symptoms are severe and occur frequently. Treatment will be based upon the underlying cause if any. Medications like anti arrhythmic drugs may be required. Radiofrequency ablation therapy is required in some cases. Surgical intervention includes bypass or angioplasty. Lifestyle modifications include eating heart healthy diet, fluid and Salt restrictions, regular physical activity.
Other Modes of treatment
The other modes of treatment can also be effective in treating PVC. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating PVC.
