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PVC & Menopause

Premature ventricular contraction---or PVC---is a serious heart arrhythmia that has been associated with women in their menopausal years. During a PVC event, the ventricle exhibits an unusual QRS complex (ventricular waves representing the three different aspects of the ventricle -- Q, R and S) which is often larger or wider than 120 msec on the EKG readout.. Women who have PVC events should be under the care of a doctor and the significance of the event depends on how often they occur, how intense they are and the response in the circulatory system.

  1. Definition

    • According to James E Keany, MD, FACEP of Mission Hospital Regional Medical Center and Aseem D Desai, MD, FACC of Mission Medical Group, premature ventricular contractions are the most common form of arrhythmia that is experienced in the United States. Most often, the PVC occurs in the right ventricle. However, the rates of occurrence are difficult to ascertain because, in many cases, patients with this phenomenon do not show any symptoms. Population studies indicate that PVCs are most common among older African Americans and least common in young white women. PVCs are more common among men than women and risk factors increase with age. Risk factors include hypertension, underlying heart disease and increased weight. Although menopause can be a factor for women as they age, it is not a risk factor for PVC events.

    Causes

    • According to Keany and Desai there are several potential reasons for PVC events. These include a history of heart attacks or myocardial infarctions. An enlarged heart or a blockages in the arteries and veins of the heart can also lead to a PVC event. Other conditions that might lead to premature ventricular contraction include mitral valve prolapse, heart injury, the use of illicit drugs (cocaine, meth, alcohol) and other medications or substances (caffeine, digoxin, tricyclic antidepressants).

    Symptoms

    • Keany and Desai state that patients who experience PVC events often do not have any symptoms at all until after the event is over. This is when they feel as if their heart has stopped, although it has not. For patients who have symptoms, a PVC event can feel like palpitations or a fluttering in the chest. Women may experience this sensation along with a hot flash which occurs with menopausal symptoms. A period of several PVC events can result in lowered blood pressure, since the heart is not beating adequately or normally.

    Treatments

    • Isolated incidents of PVC do not require treatments according to Keany and Desai. However, if an irregular heart beat continues or reoccurs with increasing frequency, then a doctor may decide to treat the event. The first line is to treat any acute heart events, such as a heart attack. Oxygen may be administered and an EKG attached to monitor heart functioning. Medications that can be used to treat arrhythmia include Cordarone, Dilocane, Procanbid and Bretylate.

    Prognosis

    • For patients who do not have symptoms and are asymptomatic, the prognosis is good and is similar to that of the general population, according to Kearny and Desai. Simple PVC, even if it occurs in conjunction with a heart attack, rarely progresses to the point of being malignant or deadly. However, in patients with significant underlying heart disease and increased PVC events (greater than 10 per hour) the levels of mortality associated with PVC go up dramatically.

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