Heart rate mechanism
The function of the regulator of the number of heart contractions is performed by the conducting system of the heart, which consists of the following elements and structures:
- sinus-atrial (sinoatrial) node;
- muscle pathways;
- interstitial atria;
- atrioventricular node;
- atrioventricular bundle.
An impulse that stimulates a heartbeat begins with the sinus-atrial node. Then the excitation is transmitted along the interstitial pathways of the atria, provoking their depolarization, approaches the atrioventricular node and is transmitted to the muscles of the ventricles along the atrioventricular bundle. At the slightest failure of the pulse force, episodic or organic malfunctions of the heart rhythm (extrasystoles) can occur in any part of the conducting system.
Extrasystole (extrasystoles) is an atypical depolarization and premature contractions of the heart or its individual chambers. As a rule, patients diagnosed with extrasystole experience a short-term fading of the heart rhythm, lack of air, and an intense cardiac impulse. Such a pathological heartbeat and pauses between contractions provoke an impulse outside the cardiac sinus node.
Differential and etiological diagnosis of extrasystole is difficult in cases where cardiac arrhythmias are a side effect of another cardiovascular disease. With the manifestation of extrasystole, it is necessary to undergo a complete diagnosis without fail and evaluate the functional state of the myocardium.
Types of extrasystoles
Premature heart contractions (complexes) by the mechanism of occurrence are: parasystoles and extrasystoles. Differences between types are good in daily monitoring
2. Organic extrasystoles. Characteristic for elderly patients. As a rule, organic extrasystoles accompany endocrine disorders, heart disease, chronic intoxication. Subtle signs of premature heartbeat occur after stress or physical exertion. Such complexes do not prevent patients from leading an active lifestyle.
Bigeminia in cardiology is a certain type of supraventricular (supraventricular) or ventricular extrasystole. This kind of arrhythmia develops due to autonomic and central nervous system dysfunctions. The main cause of bigeminia is organic changes in the heart muscle. Even small deviations in the myocardium with extracardial genesis and associated factors provoke the appearance of an ectopic focus of excitation.
Ventricular bigeminia is characterized by uniform alternations of normally occurring contraction with a single ventricular extrasystole, which is a type of allorhythmia. Also, untimely excitation of the right heart ventricle is recorded. Supraventricular bigeminia is a paired alternation of one rhythmic contraction and one extrasystole.
The diagnosis of “bigeminia” is common in rheumatic heart defects (mitral valve prolapse and aortic stenosis). The disease often accompanies cardiomyopathies, myocarditis and thyrotoxicosis.
Depending on the area of localization and ectopic foci of excitation, extrasystoles are distinguished:
- Atrioventricular and nodular (atrioventricular).
- Sinus-atrial (sinus extrasystole).
In extrasystole, one or more excitation sources can be fixed. The following types of extrasystoles are diagnosed:
- Monotopic – with one focus of development and a stable interval in the areas of the cardiogram.
- Polytopes – several foci of occurrence and different intervals of cohesion.
- Unstable paroxysmal tachycardia is a series of extrasystoles that go one after another.
To date, medicine uses several classification systems for arrhythmias. The most common modified version of the graduation “Lown amp; Wolf “offers the following classification of ventricular extrasystoles:
- I-class – single extrasystoles with a repeat of less than 30 units / hour. Such arrhythmia is not life threatening and does not require correction.
- II class – single extrasystoles with a repetition of more than 30 units / hour. Minor deviations from the normal heart rate do not lead to serious consequences.
- Class III – polymorphic extrasystoles. Cardiac complexes of various shapes with a large number of episodes require therapeutic correction.
- IVa-class – paired extrasystoles following each other. High gradation class with pathological consequences.
- IV-class – volley extrasystoles (3-5 in a row). A high-grade class with irreversible consequences that poses a danger to life.
- V-class – early extrasystoles (R, T). A class of high gradation that leads to cardiac arrest.
Premature contractions can be either too frequent or vice versa rare. One fine day, a person suddenly feels that his heart is intermittent. It is this feeling that produces such a frightening effect on people. A disease associated with similar disorders in the work of the heart is called extrasystole.
Extrasystole – classification by location
A feature of the occurrence of extrasystole is that its signs can occur in almost every person, regardless of their state of health or age. In addition, there are a number of reasons that can cause this pathology:
- the presence of heart disease – ischemia of the heart, myocardial infarction, myocarditis and cardiomyopathy, heart failure;
- diseases associated with disruption of the endocrine system – diabetes, diseases of the thyroid gland and adrenal glands;
- side effects with prolonged use of antiarrhythmic drugs, diuretics, glycosides;
- the presence of electrolyte imbalance in the human body;
- the negative effects of toxins in the use of alcohol and tobacco products;
- oxygen starvation caused by anemia or bronchopulmonary diseases.
In the presence of the above reasons, the patient needs a thorough examination and comprehensive treatment aimed at eliminating the root cause or stabilizing his condition.
Types of supraventricular extrasystole
Such a violation of heart contraction is divided into types, groups and degrees of danger. But, be that as it may, supraventricular extrasystoles are a violation of the heart rhythm, badly affecting the blood circulation and the health of the main muscle.
There are two types of extrasystolic arrhythmia, and they depend on the reasons that influenced the appearance of pathology:
Functional arrhythmia is characteristic of people who do not have any complaints about the work of the heart, as well as for very young tall people. This type of extrasystole is quite rare and most often solitary. With this type, extraordinary excitations are observed less than 30 times per hour.
Functional extrasystoles are divided by these types of origin:
The first subspecies is provoked by physical exertion, the use of alcoholic beverages, smoking, spicy food. Often rhythm disturbances occur in a horizontal position, during rest or after eating. The reasons for the appearance of the remaining four types can be determined based on their names.
Organic extrasystole is a violation of the rhythm of the heart muscle, provoked by its diseases. These are diseases such as myocarditis, cardiomyopathy and others. Any heart disease affects the normal functioning of the heartbeat, this leads to the appearance of extrasystoles.
In turn, all extrasystoles are:
According to the frequency of occurrence, they are divided into the following types:
- Rare impulses – less than five times per minute
- Average pulses – more than ten, but less than 15 times, reductions per minute
- Frequent cuts – more than 15 times per minute
Recognize the type and type of the disease, as well as determine the source, can only be a specialist in the field of heart function, namely: cardiologist. Suspecting a heart rhythm disturbance, one should not resort to self-medication.
There are several classifications of supraventricular extrasystole.
- atrioventricular extrasystoles (the lesion is located in the atrioventricular septum);
- atrial extrasystoles (an additional impulse occurs in the atria).
By the number of sources of excitability:
- single supraventricular extrasystole;
- polytropic extrasystole.
By time of manifestation:
- rare single supraventricular extrasystole;
- frequent supraventricular extrasystole;
- paired extrasystole;
- group extrasystole.
The classification of supraventricular or atrial premature beats is based on the following symptoms:
- at the site of the lesion – atrial or atrioventricular;
- by the number of foci – monotropic, polytropic;
- by the frequency of ineffective contractions – single, paired, multiple, group;
- as you streamline;
- by time of occurrence – early, middle, late.
A single heart failure may be caused by an adrenaline rush or excessive caffeine consumption. Functional extrasystole, which occurs sporadically and does not cause discomfort to the patient, does not require treatment. For women, the physiological norm is cases of extrasystole several days before menstruation and during ovulation.
In patients with vegetovascular dystonia, there may be an uncomfortable manifestation of extrasystoles. If an abnormal heart rhythm failure is difficult to tolerate, it is necessary to reduce intense stress, abandon stimulants, be less nervous and include foods rich in magnesium in the diet.
With existing heart defects, cardiomyopathy, coronary artery disease and other types of arrhythmias, extrasystoles exacerbate the course of diseases, entail fibrillation of the ventricles or atria of the heart, and are dangerous for the patient’s life. In such cases, a complex scheme of therapeutic effect on the cardiovascular system of the body is required.
Fading of the heart can be a sign of increased thyroid function (hyperthyroidism). Excessive production of thyroid hormones poisons the circulatory system and the entire body, the heart muscle also responds to the stimulus.
Extrasystoles over 200 units / day should be alarming, systemic excess of the norm requires therapeutic correction. The technique for treating heart rhythm malfunctions depends on the state of the cardiovascular system, etiology, severity of symptoms and adverse pathologies.
- The normal operation of the digestive tract and endocrine system is controlled.
- Products rich in magnesium are added to the diet: lettuce, nuts, persimmons, dried apricots, raisins, prunes, cereals, bananas, apples, sea kale, beans.
- The load is adjusted: preference is given to walking at a moderate pace, swimming, cycling.
- For patients with sleep and performance disorders due to heart fluctuations, the cardiologist may prescribe tranquilizers or sedatives.
When confirming the diagnosis – extrasystole, the first thing is to reconsider your lifestyle. Eliminate bad habits – smoking, alcohol. Establish your diet and daily routine. Long walks in the fresh air and moderate physical activity will provide significant support to the human cardiovascular system.
The main objective of drug treatment is to eliminate the symptoms of extrasystole and the prevention of arrhythmia. In treatment, light sedatives and β-blockers are used.
Surgical treatment is used only in cases where the medication does not have a positive effect and there is a risk of fibrillation. The procedure consists of radiofrequency ablation and is performed in a hospital. A patient is injected with a catheter with a radiation source into the subclavian vein, and with the help of radio waves, the foci of extrasystoles are cauterized.
During arrhythmia, called supraventricular extrasystole, premature impulses occur, which provoke extraordinary activity mainly in the upper parts of the heart.
Supraventricular extrasystole in children can occur against the background of tachycardia, cardiovascular diseases. There are cases when the disease occurs in children with an absolutely healthy heart.
It is important to note that in some cases you can do without any treatment, since the nature of the disease is benign. If possible, it is necessary to eliminate the factor that provokes supraventricular extrasystole, and conduct antiarrhythmic therapy. Indications for this procedure are as follows:
- Intolerance to supraventricular extrasystole.
- There is a high risk of complications, as a rule, this is noted in patients with heart defects and other diseases of the cardiovascular system.
- Too frequent supraventricular extrasystole.
In addition to the fact that the characteristic symptoms of the disease are manifested, the emotional and psychological state of the patient changes. This creates anxiety and an unconscious sense of fear. Often the patient is completely unreasonably in a panic, afraid to die.
The main causes of the disease can be divided into several types.
- Initially, the occurrence of supraventricular extrasystole is caused by pathologies of the cardiovascular system. This includes coronary artery disease, a person suffered myocardial infarction. Pathology of the heart muscle due to congenital or acquired heart defects.
- Preparations taken without a doctor’s prescription or a chaotic and uncontrolled medication when the dose is often exceeded can provoke disturbances in cardiac work.
- The use of anti-arrhythmic drugs, as well as taking diuretics.
- The abuse of tobacco and alcohol leads to toxic poisoning of the body and provokes the occurrence of extrasystole.
- A violation of the thyroid gland, hormonal imbalance can also become another cause of the disease.
The causes of the disease are often the result of both the patient’s abnormal lifestyle and various operations that he endured during his life, and serious illnesses.
Treatment of supraventricular extrasystole can only be prescribed by a specialist, after a thorough diagnosis. This disease is divided into several types based on this, the doctor will decide on the use of a particular treatment method.
In general, non-surgical methods of treatment as well as surgery can be used.
After a thorough diagnosis, when the diagnosis is accurately established and the cause is identified, which provoked the onset of the disease, appropriate treatment will be prescribed.
With the medical method, the specialist prescribes antiarrhythmic drugs that normalize the heart rhythm. Moreover, the doctor can prescribe both several drugs, and one. It all depends on what kind of supraventricular extrasystole is revealed and what kind of disturbances in the rhythm work are.
It should be noted that drugs in this group have many contraindications and side effects, which, of course, any specialist should consider when prescribing.
Sometimes a specialist may prescribe cardiac glycosides. They help reduce the load on the heart muscle and improve the function of the heart. Perhaps the appointment of drugs of the group that normalize blood pressure.
If the medications prescribed by a specialist do not bring a useful result and their reception is ineffective, the doctor will consider the possibility of a surgical operation if the patient does not tolerate the resulting extrasystole. Because there are cases when patients live with such a disease and do not complain about the manifestation of symptoms or discomfort.
The surgical method is preferably used at a young age. During the operation, a catheter is inserted into the atrial region, which promotes the wire of the electrode, which, by acting, cauterizes a modified portion of the heart.
An open method during the operation is performed when there is an urgent need for valve replacement. With such operations, ectopic areas are excised.
Arrhythmia is a serious pathology of the heart, so immediately forget about self-medication. Only a specialist in this field will be able to establish an accurate diagnosis and prescribe the appropriate treatment.
The safest form of premature contractions is functional. It does not require any treatment, since it does not pose a threat. To reduce the risk of further development, you should abandon the use of coffee, alcohol, cigarettes and strong tea.
If the cause of the disease was stress, then the patient is prescribed sedative drops and drugs that strengthen the heart muscle.
Supraventricular extrasystoles resulting from osteochondrosis need medical treatment. Most often these are drugs that strengthen blood vessels, relaxing muscles and lung sedatives.
If a rhythm disturbance has arisen due to overwork, it is worth adjusting the regime of the day. Try to relax more and spend time outdoors. The patient is recommended a full eight-hour sleep. Medicines in this case, arrhythmias are not needed. If heart failure is accompanied by insomnia, then lung sedatives or sleeping pills are prescribed.
Organic extrasystole is treated with appropriate therapy, which consists of beta-blockers.
During treatment, strictly adhere to all recommendations and, in no case, exceed the dosage of drugs.
Most often, the disease does not require special treatment. Often enough to review the regimen of the day, habits, to reduce symptoms and unpleasant manifestations.
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If there are no pathologies of the heart and endocrine system, you just need to follow the doctor’s recommendations:
- Allocate time to rest during the day;
- streamline the diet, include more fiber-containing foods in it, minimize the amount of fatty, spicy, fried foods;
- if possible, avoid stress, great physical exertion;
- daily walk in the fresh air.
In cases where the number of extrasystoles exceeds 200 units per day or they are provoked by some disease, prescribe drug therapy:
- antiarrhythmic drugs, depending on the type of disease – Verapamil, Etatsizin;
- medicines based on potassium and magnesium – “Concor”, “Propafenone”;
- to normalize the heart rhythm, “Panangin” and “Asparkam” are prescribed as complementary drugs.
In addition, depending on the clinical picture, beta-blockers (Bisoprolol), sodium and potassium channel blockers (Allapinin, Amiodarone) are prescribed.
If conservative therapy fails, surgical intervention is used – open heart surgery, radiofrequency catheter ablation of ectopic foci.
Do I need to treat extrasystole?
The main criterion for determining the need for treatment of extrasystole, according to experts, is the patient’s individual intolerance to the symptoms of pathology. And also compulsory treatment is required when the amount of extrasystoles exceeds 1200–2000 per day.
In each case, the doctor makes a decision based on the individual characteristics of the patient’s health, since in some cases 200 unplanned contractions per day can lead to a significant decrease in the quality of life of a person, and in other cases he feels great at higher rates.
If the studies have proved that extrasystole can pose a threat to the patient’s life (most often it relates to ventricular extrasystole) or the person has severe cardiac pathologies, treatment should be carried out immediately.
Lifestyle with extrasystole
Complications and danger with extrasystole
The danger of frequent group extrasystoles is their degeneration. Ventricular vibrations transform into paroxysmal
and ventricular fibrillation, and atrial during dilatation into atrial flutter or
. Untimely diagnosed extrasystoles lead to chronic insufficiency of renal, coronary and cerebral circulation.
The algorithm for a sudden attack of arrhythmia:
- Provide access to fresh air, unfasten tight clothes.
- Relax, calm down, take a horizontal position.
- In a stressful situation, take Valerian, motherwort or Corvalol. For patients with frequent bouts of anxiety and fear, a neurologist may prescribe Persen, hydozepam.
- If the condition worsens, emergency care must be called up.
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