Which physical exam findings are significant in patients with premature ventricular contractions (PVCs)?

Updated: Jan 13, 2017
  • Author: James E Keany, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Important findings on the physical examination are those that provide clues to the underlying cause of the ventricular ectopy, including the following:

  • Blood pressure - Frequent PVCs may result in hemodynamic compromise; frank hypotension is rare, but relative hypotension is not uncommon, particularly in patients with underlying cardiac disease
  • Pulse - The ectopic beat may produce a diminished or absent pulse, depending on the force of the ventricular contraction
  • Pulse oximetry - Hypoxia may precipitate PVCs
  • Cardiac findings - Cannon A waves may be observed in the jugular venous pulse if the timing of the PVC causes an atrial contraction against a closed tricuspid valve
  • Cardiopulmonary findings - Findings in conjunction with longstanding hypertension (elevated BP and an S ) or congestive heart failure (S and rales) are important clues to the cause and clinical significance of PVCs
  • Neurologic findings - Agitation and findings of sympathetic activation (eg, dilated pupils, warm and dry skin, tremor, tachycardia, hypertension) suggest that catecholamines may be the cause of the ectopy

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