Medical Specialty >> Cardiology

Doctors Lounge - Cardiology Answers

Back to Cardiology Answers List

If you think you may have a medical emergency, call your doctor or 911 immediately. Doctors Lounge ( does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. 

DISCLAIMER: The information provided on is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Please read our 'Terms and Conditions of Use' carefully before using this site.

Date of last update: 10/20/2017.

Forum Name: Arrhythmias

Question: PVC/PAC Couplet vs. Run...

 Blueshirts - Mon Apr 06, 2009 2:33 pm

I was wondering if you can you tell me the difference between a couplet and run of a PVC/PAC? Last night, in bed, when I went to turn over on my right side I got a scary PVC (I think) that went about 4 beats in a row before my heart returned to it's normal rhythm. I get these a couple times a month and they really freak me out. I know what a regular PVC feels like (not sure what a PAC feels like - although my Cardiologist has recorded them), but the long ones scare me. Also, I was a bit bloated and gassy - can this cause them too?

Thanks for you time.
 John Kenyon, CNA - Fri Apr 10, 2009 12:33 am

User avatar Hi there --

This is an easy question to answer, yet difficult. You'll see. FIrst, the difference between a couplet and a run is one beat (or more). A couple is two in a row without a break or normal beat in between. A run is technically three or more. That was the easy part.

What's more difficult is to tell the perceived difference between a PAC and PVC. Depending upon the timing, they can feel the same and both can feel quite different depending on timing and area of origin. So generally we consider that they feel the same. Usually they do, at least for practical purposes. Further, a three or four beat run of either can feel the same and both are quite common in young, healthy people. Runs of more than three or four are most often (statistically) atrial beats. In the absence of any structural heart disease neither has much diagnostic nor prognostic significance.

Bloating, gas, GI upset, etc., as well as slowing down and nearing sleep (along with a lot of other innocent factors) can cause or predispose to both isolated and paired premature beats (usually ventricular) and runs. The list of benign causes is as long as your arm.

The act of rolling over onto one's side (usually the left, sometimes the right) can often bring the stomach into close enough contact with the heart to trigger and/or make these events much more noticeable. It generally means nothing, but it can feel creepy at the least.

I hope this helps answer your concerns. Please follow up with us here as needed.
 Blueshirts - Mon Apr 13, 2009 8:52 am

Thank you Dr. Kenyon. You have been a big help! Thanks for putting my mind more at ease.

| Check a doctor's response to similar questions

Are you a Doctor, Pharmacist, PA or a Nurse?

Join the Doctors Lounge online medical community

  • Editorial activities: Publish, peer review, edit online articles.

  • Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.

Doctors Lounge Membership Application

Tools & Services: Follow DoctorsLounge on Twitter Follow us on Twitter | RSS News | Newsletter | Contact us