Arrhythmias
Ventricular ectopics
Ventricular ectopics are extra heartbeats produced in the lower chambers of the heart. The extra beats themselves are not dangerous, but they affect people in very different ways, with some noticing every one of them and others never feeling them at all. Most people who do feel them describe palpitations or the sense that the heart has skipped a beat.
What ventricular ectopics are
Ventricular ectopics are extra heartbeats produced in the lower chambers of the heart. Those lower chambers are the ventricles, and they are the main pumping chambers. The right ventricle pumps blood to the lungs to exchange carbon dioxide for fresh oxygen, while the left ventricle delivers freshly oxygenated blood to the rest of the body. Because they are premature beats arising from the ventricles, they are also described as premature ventricular contractions.
Your heart relies on a precise electrical system to control each beat. Electrical signals begin in a small structure called the sinus node, often described as the heart's natural pacemaker, and travel through specialised pathways in the heart muscle so that the chambers contract in a coordinated sequence. An ectopic beat is an extra beat that arises early and interrupts that normal rhythm, and in ventricular ectopics it comes from the ventricles rather than from the usual pathway.
The extra beats themselves are not dangerous, but they affect people in very different ways. Some people are very aware of them and others do not feel them at all, which is why some ectopics are only picked up when a heart tracing is recorded.
What you may notice
Most people who feel ventricular ectopics describe palpitations, which simply means becoming aware of your own heartbeat. It may feel like a skipped beat, and people describe the sensation in several different ways.
Palpitations of this kind often occur at rest, particularly in the evening when the body is quieter and you are more aware of internal sensations.
Palpitations are a symptom rather than a diagnosis. The pattern of what you feel, how it feels and when it happens all help to work out what is behind it, which is why Dr Jogiya will usually start with a detailed history of your symptoms.
- Palpitations, meaning an awareness of your own heartbeat
- A feeling that the heart has skipped or missed a beat
- A sudden thump in the chest followed by a pause
- A fluttering sensation in the chest
- Nothing at all, with the extra beats only showing up on a heart tracing
What can trigger extra beats
Many people experience occasional premature beats, particularly during periods of stress, fatigue or caffeine intake. They can occur in otherwise healthy hearts.
Common everyday triggers for palpitations include the following.
These factors can increase adrenaline levels or affect the heart's electrical activity, which leads to temporary changes in rhythm. A common mistake is to assume that any noticeable heartbeat must indicate a serious problem, when in reality many palpitations are simply the body's response to lifestyle factors.
Heart rhythm disturbances can also develop alongside underlying heart conditions such as coronary artery disease, high blood pressure, heart valve disease and cardiomyopathy. Electrolyte imbalances, thyroid disorders and certain medications can affect the heart's electrical activity as well, so part of the assessment is looking for anything of that kind rather than treating the beats in isolation.
- Stress or anxiety
- Caffeine
- Poor sleep
- Dehydration
- Alcohol
How ventricular ectopics are diagnosed
The diagnosis of heart rhythm issues is usually made with an ECG, or with a Holter monitor, which is a prolonged ECG recording, to build an understanding of the heart rhythm over time.
The most important step is to capture what the heart is doing during an episode. One of the practical challenges is that ectopics may not happen during a short clinic visit, which is where longer monitoring becomes particularly valuable. Wearable technology and remote monitoring are increasingly helping to pick up irregular rhythms earlier.
Investigations that may be arranged include the following.
Where treatment is started, regular ECGs will be conducted to make sure it is working as intended.
- A 12 lead ECG to record the heart's electrical activity
- Holter monitoring over 24 to 48 hours
- Longer term wearable monitors for symptoms that come and go
- An echocardiogram to assess the structure of the heart
How ventricular ectopics are treated
Most ectopics can resolve themselves, and in many cases no treatment is needed. Where that is so, the value of the assessment is a clear picture of your heart rhythm and, when the cause turns out to be benign, the reassurance that comes with it.
In cases where treatment is required, medication can be used to reduce the ectopics and manage symptoms. Sometimes a procedure might be required to isolate and disable the part of the heart that causes the ectopics if they become too frequent. In ventricular rhythm problems that procedure is an ablation, which removes or isolates the part of the heart from which an abnormal rhythm originates.
For many people, simple lifestyle adjustments can reduce how often palpitations are noticed.
Consistency matters more than intensity here, and small changes to daily habits often have a noticeable effect over time. Every patient has a different story, so Dr Jogiya will tailor any treatment to your symptoms, your lifestyle and your medical history.
- Reducing caffeine and alcohol intake
- Staying well hydrated
- Improving sleep quality
- Managing stress effectively
- Maintaining regular physical activity
When to seek advice
It is always reasonable to seek advice if you are unsure about your symptoms. Early assessment gives reassurance when the cause is benign and allows timely treatment when it is not.
An assessment is worth arranging in the following situations.
Ventricular ectopics on their own are not dangerous. Ventricular arrhythmias as a group are very rare but can be life threatening if they are not treated appropriately, and that is the reason persistent or worsening symptoms are always looked at properly rather than dismissed.
Call 999 immediately if you have severe or persistent chest pain, if you collapse or lose consciousness, or if someone near you becomes unresponsive or stops breathing. Do not wait for a clinic appointment for symptoms of that kind.
- Palpitations that are frequent or getting worse
- Palpitations that come with dizziness, fainting or breathlessness
- Palpitations that come with chest discomfort
- Palpitations that happen during physical exertion or last for prolonged periods
- Any palpitations in someone with known heart disease
- Episodes that feel different from anything you have experienced before
More in arrhythmias
Related conditions he treats.
- Atrial fibrillationAtrial fibrillation, commonly known as AF, is a condition where the atria, or upper chambers of the heart, fire chaotic electrical impulses. This leads the muscle to quiver, or fibrillate, instead of beat, so the heartbeat becomes irregular and is often faster than normal. It is one of the most common heart rhythm issues and around 1.7 million people in the UK have been diagnosed with it.
- Atrial flutterAtrial flutter is a heart rhythm problem that affects the upper chambers of the heart, known as the atria. Instead of beating at a normal pace, the atria beat rapidly, but in a regular and organised pattern rather than a chaotic one. Because the chambers do not have enough time to fill properly, blood is not pumped efficiently from the top chambers to the bottom chambers, which is what leads to shortness of breath.
- Atrial tachycardiaAtrial tachycardia is a fast heart rhythm that starts in the atria, the two upper chambers of the heart. An electrical signal emerges from another section of the atria and causes a rapid repeating beat, which means the atria beat very fast. It is one form of supraventricular tachycardia, or SVT, and short bouts of it can be common.
- Bundle branch blockBundle branch block describes a block in the part of the heart's conduction system known as the bundle branches. These branches carry the electrical impulse from the AV node down to each ventricle, and when one of them is blocked the signal reaches one side of the heart before the other, so the two ventricles no longer contract in step. It is a pattern picked up on an ECG, and mostly it is something monitored rather than actively treated.
- First degree heart blockFirst degree heart block is common, and it can affect anyone at any age. It describes a delay in the electrical signal as it travels from the upper chambers of the heart to the lower chambers, rather than a true blockage. Every signal still gets through, which is why many people notice nothing at all and why the condition is usually diagnosed when testing is being done for something else.
- Second degree heart blockSecond degree heart block is a fault in the heart's electrical wiring, not a blockage in an artery. Some of the electrical signals travelling from the upper chambers of the heart fail to reach the lower chambers, so a heartbeat is occasionally missed. There are two types, known as Mobitz I and Mobitz II, and they are treated very differently.
- Sick sinus syndromeSick sinus syndrome, also called sinus node disease, is a condition where the sinus node, the small area of tissue that acts as the heart's own natural pacemaker, is not functioning properly. Sometimes the node will send an impulse as it should, and sometimes it may not fire an impulse at all, or the impulses may be out of sync. Some patients notice symptoms such as palpitations and shortness of breath, and because the node is unreliable rather than permanently stopped, those symptoms often come and go.
- Supraventricular tachycardiaSupraventricular tachycardia, usually shortened to SVT, is a fast heart rhythm that starts above the ventricles, in the upper part of the heart. Symptoms vary widely from one person to another, so some people are very aware of an episode while others barely notice one. Short bouts of SVT can be common, and can usually be treated very easily.