Ventricular arrhythmia causes classification symptoms how to treat

Extrasystolic arrhythmias (extrasystoles) is the most common type of rhythm disturbance that occurs in different age groups. Given the place of formation of the ectopic focus of excitation in cardiology, ventricular, atrial-ventricular, and atrial extrasystoles are distinguished; of these, ventricular are most common (about 62%).

Ventricular extrasystole is caused by premature excitation of the myocardium with respect to the leading rhythm, emanating from the conduction system of the ventricles, mainly branching of the bundle of His and Purkinje fibers. When registering an ECG, ventricular extrasystole in the form of single extrasystoles is detected in approximately 5% of healthy young adults, and with daily ECG monitoring, in 50% of the subjects. The prevalence of ventricular extrasystole increases with age.

Symptoms of ventricular extrasystole

Subjective complaints with ventricular extrasystole may be absent or may consist in sensations of a “fading” of the heart, “interruptions” or “push” caused by increased post-extrasystolic contraction. Ventricular extrasystole in the structure of vegetative-vascular dystonia occurs against a background of increased fatigue, irritability, dizziness, and periodic headache. Frequent extrasystoles arising from organic heart diseases can cause weakness, anginal pain, a feeling of lack of air, fainting.

An objective examination reveals a pronounced presystolic pulsation of the cervical veins that occurs with premature contraction of the ventricles (venous waves of Corrigan). An arrhythmic arterial pulse with a long compensatory pause after an extraordinary pulse wave is determined. Auscultatory features of ventricular extrasystole are a change in the sonority of the I tone, splitting of the II tone. The final diagnosis of ventricular extrasystole can be carried out only with the help of instrumental studies.

Patient complaints with this pathology depend on its variety. Single and rare extrasystoles from the ventricles are often asymptomatic, and are determined only by Holter monitoring. With an increase in episodes of rhythm disturbance, the patient may indicate the following sensations:

  • feeling of lack of air;
  • “Fading” of the heart;
  • weakness and dizziness;
  • chest pains;
  • fear and panic;
  • flickering and fluttering is accompanied by loss of consciousness.

During the examination, there is a decrease in pressure, pallor of the skin and cyanosis of the nasolabial triangle. The pulse becomes irregular, with fibrillation it can hardly be felt.

Diagnosis of ventricular extrasystole

The main methods for detecting ventricular extrasystole are ECG and Holter ECG monitoring. An extraordinary premature appearance of the altered ventricular complex QRS, deformation and expansion of the extrasystolic complex (more than 0,12 seconds) are recorded on the electrocardiogram; absence of P wave before extrasystole; complete compensatory pause after ventricular extrasystoles, etc.

Bicycle ergometry or a treadmill test allows you to identify the relationship between the occurrence of rhythm disturbances and exercise: idiopathic ventricular extrasystole is usually suppressed by physical activity; the occurrence of ventricular extrasystoles in response to the load makes you think about the organic basis of rhythm disturbances.

If necessary, additional CPECG, echocardiography, rhythmocardiography, sphygmography, polycardiography are additionally performed.

On the cardiogram, the extrasystolic ventricular complex appears earlier than usual. It looks deformed, resembling a blockade of the left or right legs of the bundle of His. Unlike an ectopic atrial impulse, it has a compensatory pause, as is clearly seen in photo 1.

With tachycardia (from 100 to 200 / minute), emanating from the ventricles, deformed complexes occur one after the other. At the same time, significant ST depression and a negative T wave are observed, so the signs of ischemia appear as a result of overload and lack of oxygen supply to the heart (photo 2).

Flutter on the ECG is recorded in the form of a variety of rapidly forming and severely deformed ventricular complexes, which, when flickering, occur without any regularity (photo 3).

Case study: a young woman with frequent extrasystoles

I want to talk about an interesting case that I observed in a cardiology hospital. A 32-year-old patient was admitted; she complained of occasional heart pains, sensations of interruptions; against the background of attacks, shortness of breath, the allocation of profuse sweat and weakness appeared. Such changes were noted over the past 7 months, deterioration occurred after exercise.

An objective examination: pressure 110/65 mm RT. Art., the skin is pale, the pulse is irregular. Holter monitoring was carried out. In the afternoon, episodes of tachycardia with a frequency of up to 120 strokes were noted, 34 ventricular extrasystoles were recorded, many of which were paired and group, as can be seen in photo 456.

Due to the ineffectiveness of antiarrhythmic therapy and a high risk of ventricular fibrillation, the question arose of surgical intervention. After radiofrequency ablation, the rhythm was restored, clinical symptoms were within normal limits, and exercise tolerance increased.

Before you begin to treat the patient, a full examination is carried out. It includes the implementation of laboratory and instrumental methods. After receiving an opinion, the doctor determines the further management tactics of the patient, depending on individual characteristics.

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Blood test

This survey option is one of the most affordable methods. It includes parameters that determine the likelihood of an inflammatory process. This can be done by assessing the level of leukocytes in the blood and the erythrocyte sedimentation rate (ESR). It is important to study biochemical analysis. The electrolyte composition plays an important role for the normal functioning of the myocardium. An imbalance of potassium and magnesium in the bloodstream leads to arrhythmia.

Lipid profile

This type of examination is necessary for all patients. In case of rhythm disturbance, it is necessary to assess the state of the vascular wall. Based on the results, the doctor begins treatment. If there are very few lipids with a high density, and the limits of harmful cholesterol exceed the permissible values, therapy is necessary.

The instrumental method is considered one of the main for determining cardiac arrhythmias. Any disorders that occur in the myocardium will be reflected on the film. Using electrocardiography (ECG), the following is detected:

  1. A source of rhythm whose task is to generate impulses.
  2. Heart rate.
  3. Violation of conduction from the atria to the ventricles.
  4. Possible extraordinary myocardial contractions.
  5. Atrial fibrillation or flutter.

With the help of this examination, a number of patients were able to detect changes that did not manifest themselves in any way.

Holter ECG

Using the modern research method, it is possible to detect changes that the electrocardiogram detected. The advantage is holding it for 24 hours. All this time, a sensor is attached to the patient, which removes all indicators of cardiac activity.

The patient is recommended to lead a normal lifestyle. So that he does not miss any detail concerning activity, a diary is started. On its pages the subject records his load, stress and other parameters that the doctor will recommend. The next day, he returns to his cardiologist to evaluate the results.

This research option is carried out using a portable apparatus for recording electrocardiograms. The convenience of the method lies in its application only if necessary. Indications are:

  • pain in the heart;
  • heart palpitations;
  • sensation of interruptions;
  • feeling of fading;
  • the appearance of dizziness and a sharp headache;
  • faint state

After recording the data at the right time, the patient using the sound sensor can transmit information to his doctor by phone.

Treadmill Test

During physical activity in normal mode or with severe stress, patients experience pain. Sometimes it is difficult to evaluate the indicator, and for this reason, stress tests are prescribed. The patient stands on the treadmill, and the doctor sets the necessary pace.

If there are no changes, then the angle of its inclination is changed, the speed is increased. In case of pain, interruptions and other unpleasant sensations, the procedure is completed and the received data is evaluated. When a heart rhythm disturbance is confirmed, treatment is prescribed.

Tilt test

This procedure is a variation of the one described above. Its essence lies in carrying out orthostatic load. Before starting the study, the patient is placed on a special table. It is fixed with straps and transferred from horizontal to vertical. In the process of execution, the following indicators are evaluated:

  • blood pressure
  • ECG changes;
  • cerebral hemodynamics.

When fainting conditions occur, the cause is determined using the tilt test.

The study makes it possible to assess the state of the structural elements of the heart, the level of blood flow, blood pressure in the vessels. If there are changes associated with age or an infectious disease, even slight deviations can be considered.

To assess the condition of the heart, an electrode is inserted through the nasal passage into the esophagus (transesophageal echocardiography). If it is impossible to perform it in the specified way, the procedure is done intravenously. The sensor enters the cavity, and the doctor gives a slight impulse. It provokes an attack of arrhythmia.

The presented method is prescribed for each patient with arrhythmia. The cause of this condition may be caused by altered thyroid function. If the patient has it reduced, then bradycardia and blockade occur, which is easy to detect with an ECG. With hyperthyroidism, tachycardia and extrasystoles are noted.

The most important role for detecting ventricular arrhythmias, as well as determining its type, is played by electrocardiography, and in particular its variety such as Holter monitoring – “Holter”.

    Ultrasound of the heart – reveals a w >

Why does a heart rhythm disturbance occur and what is it? The term “arrhythmia” is understood as changes accompanied by a disorder in the sequence and regularity of myocardial contractions. The frequency of beats per minute will be unstable.

Heart rate becomes unlike sinus. It is observed normally in a healthy person. Any cause that causes arrhythmia can lead to a violation of the vital functions for which the heart is responsible.

The most widespread classification of rhythm disturbances according to Zhuravleva and Kushavsky from 1981. It includes the following pathology of the cardiovascular system:

  1. Change in automatism in the sinus node (nomotopic arrhythmia):
    1. sinus bradycardia;
    2. sinus tachycardia;
    3. weak conductivity of the sinus node;
    4. sinus arrhythmia.
  2. Ectopic rhythm (heterotopic arrhythmia):
    1. atrial heart rate;
    2. atrioventricular (nodular) rhythm;
    3. dissociation of atrioventricular type function;
    4. idioventricular rhythm (ventricular);
    5. migration of supraventricular pacemaker;
  3. Rhythm disturbance associated with a change in myocardial excitability:
    1. paroxysmal variant of tachycardia;
    2. extrasystole.
  4. Rhythm disturbances by the type of change in conductivity and excitability:
    1. ventricular fibrillation (fibrillation, flutter);
    2. atrial fibrillation (atrial fibrillation);
    3. atrial flutter;
  5. Rhythm disturbance associated with a change in conductivity:
    1. interatrial block
    2. sinoatrial blockade.
  6. Atrioventricular form of blockade:
    1. premature ventricular arousal;
    2. blockages of the ventricles (branches of the bundle of His).

Each disease from the listed classification has its own causes, treatment. Symptoms of heart rhythm disturbances are expressed depending on the severity of the condition and the therapy.

  • The first type: single (after each extrasystole follows a normal heart beat), monomorphic (having the same view on the ECG), monotopic (the same source of pathological excitation), rare (no more than thirty extrasystoles for any hour of control).
  • The second type: extrasystoles have a characteristic similar to the first type, however, for any hour of monitoring more than thirty extrasystoles are recorded.
  • The third type: this type of extrasystole is established regardless of the frequency of registration of extrasystoles and is diagnosed in the presence of polymorphic (polytopic) extrasystoles.
  • Fourth A type: paired (not separated by normal heart beat) monomorphic extrasystoles.
  • Fourth B type: paired polymorphic extrasystoles.
  • Fifth type: runs of ventricular tachycardia – on the cardiogram three consecutive extrasystoles are recorded polymorphic or monomorphic does not matter.

Other classifications of ventricular arrhythmias are mainly of academic and educational importance than described, used in practical medicine.

Based on the results of daily ECG monitoring according to Holter, 6 classes of ventricular extrasystole were identified:

  • Grade 0 – ventricular extrasystoles are absent;
  • Grade 1 – less than 30 single monomorphic (monotopic) ventricular extrasystoles are recorded during any hour of monitoring;
  • Grade 2 – during any hour of monitoring, more than 30 frequent single monomorphic (monotopic) ventricular extrasystoles are recorded;
  • Grade 3 – polymorphic (polyfocal) ventricular extrasystoles are recorded;
  • Grade 4a – monomorphic paired (2 at a time) ventricular extrasystoles are recorded;
  • Grade 4b – polymorphic paired ventricular extrasystoles are recorded.
  • Grade 5 – volley (group) polymorphic ventricular extrasystoles (3-5 in a row for 30 seconds), as well as episodes of paroxysmal ventricular tachycardia, are recorded.

Class 1 ventricular extrasystoles do not manifest clinically, are not accompanied by hemodynamic disturbances, therefore they are classified as functional. Grade 2-5 ventricular extrasystoles are associated with an increased risk of ventricular fibrillation and sudden coronary death.

According to the prognostic classification of ventricular arrhythmias, there are:

  • benign ventricular arrhythmias – characterized by the absence of signs of organic damage to the heart and objective signs of left ventricular myocardial dysfunction; the risk of sudden cardiac death with them is minimal;
  • ventricular arrhythmias of a potentially malignant course – are characterized by the presence of ventricular extrasystoles against the background of organic lesions of the heart, reducing the ejection fraction to 30%; accompanied by an increased risk of sudden cardiac death;
  • malignant ventricular arrhythmias – characterized by the presence of ventricular extrasystoles against severe organic heart lesions; accompanied by a maximum risk of sudden cardiac death.

Case study: a young woman with frequent extrasystoles

I want to talk about an interesting case that I observed in a cardiology hospital. A 32-year-old patient was admitted; she complained of occasional heart pains, sensations of interruptions; against the background of attacks, shortness of breath, the allocation of profuse sweat and weakness appeared. Such changes were noted over the past 7 months, deterioration occurred after exercise.

An objective examination: pressure 110/65 mm RT. Art., the skin is pale, the pulse is irregular. Holter monitoring was carried out. In the afternoon, episodes of tachycardia with a frequency of up to 120 strokes were noted, 34 ventricular extrasystoles were recorded, many of which were paired and group, as can be seen in photo 456.

Due to the ineffectiveness of antiarrhythmic therapy and a high risk of ventricular fibrillation, the question arose of surgical intervention. After radiofrequency ablation, the rhythm was restored, clinical symptoms were within normal limits, and exercise tolerance increased.

Treatment of heart rhythm disorders

Treatment of ventricular arrhythmia is not carried out in the case when it is manifested by single extrasystoles and does not lead to hemodynamic disorders. But most often, treatment of this symptom is necessary, since it accompanies severe heart pathology.

The treatment protocol requires mandatory prescription of drugs or the use of pacemaker. Usually my colleagues and I use such tools and methods:

  1. Beta-blockers (Bisoprolol, Egilok). They help reduce heart rate and restore rhythm, increase exercise tolerance and prevent the possibility of sudden death in high-risk patients.
  2. With a frequent and recurring form of rhythm disturbance, Amiodarone or Sotalol is added to therapy. When I make a choice between these drugs, I always take into account the likelihood of extracardiac complications and the possibility of developing bradycardia.
  3. If there is no result, radiofrequency ablation or implantation of a defibrillator-cardioverter is recommended.

In an acute condition with severe hemodynamic impairment, resuscitation is performed using a defibrillator and indirect heart massage. Used simultaneously intravenous or intracardiac administration of adrenaline, as well as lidocaine or amiodarone.

Doctor’s advice: prevention of ventricular arrhythmia

I want to remind you that usually severe forms of rhythm disturbance develop against the background of serious diseases (ischemic disease, heart failure, increased thyroid function, and many others). Timely started treatment, disciplined taking of recommended drugs and regular visits to a doctor with these pathologies is the only way to avoid the problem of developing ventricular arrhythmias.

My recommendations for all patients who have a high risk of this deviation will be:

  • try to avoid situations when there is an imbalance of electrolytes and fluids (vomiting, diarrhea, independent use of diuretics);
  • exercise should be only after consultation and determining the maximum allowable loads;
  • nerve strain to stop sedative drugs, learn auto-training techniques, visit a psychotherapist.

For persons with asymptomatic ventricular extrasystole without signs of organic heart disease, special treatment is not indicated. Patients are advised to follow a diet enriched with potassium salts, the exclusion of provoking factors (smoking, drinking alcohol and strong coffee), increased physical activity with physical inactivity.

In other cases, the goal of therapy is to eliminate the symptoms associated with ventricular extrasystole, and the prevention of life-threatening arrhythmias. Treatment begins with the appointment of sedatives (phytopreparations or small doses of tranquilizers) and ß-blockers (anaprilin, obzidan). In most cases, these measures can achieve a good symptomatic effect, manifested in a decrease in the number of ventricular extrasystoles and the strength of post-extrasystolic contractions. With existing bradycardia, relief of ventricular extrasystole can be achieved by prescribing anticholinergic drugs (belladonna alkoboids phenobarbital, ergotoxin belladonna extract, etc.).

With severe disturbances in health and in cases of ineffectiveness of therapy with ß-blockers and sedatives, it is possible to use antiarrhythmic drugs (procainamide mexiletine, flecainide, amiodarone, sotalol). The selection of antiarrhythmic drugs is performed by a cardiologist under the supervision of an ECG and Holter monitoring.

With frequent ventricular extrasystole with an established arrhythmogenic focus and the absence of the effect of antiarrhythmic therapy, radiofrequency catheter ablation is indicated.

In the case of functional ventricular arrhythmia, it is necessary to deal with the causes that cause it, but since objective connection usually cannot be established, a multivariate simultaneous approach is needed:

  1. Fighting bad habits: smoking, excessive drinking of alcohol, coffee, tea, overeating;
  2. Compliance with the regime of work and rest: sufficient, but not excessive sleep, moderate physical activity;
  3. Stress management: trainings, sedatives.

More severe cases require the work of a cardiologist or at least an appropriately qualified emergency doctor. The first urgent step in the treatment of ventricular arrhythmias is the restoration of sinus rhythm.

At the very beginning of the provision of medical care after the diagnosis of ventricular arrhythmia (that is, the ECG apparatus is already connected), you need to ask the patient to cough, which sometimes leads to restoration of the rhythm, as this simple manipulation improves coronary circulation. In this case, it is not recommended to use the method of “pericardial stroke.”

Further treatment is carried out depending on the features of the detected arrhythmia, using antiarrhythmic drugs and other methods of arresting arrhythmias.

Procainamide (procainamide) is a drug with pronounced antiarrhythmic activity, while it has a much lower number of side effects than lidocaine. It is administered intravenously dropwise in a total dose of 500-1000 mg and a rate of administration of 20-30 mg per minute.

Amiodarone is used in cases where there is a slight drop in blood pressure, there are signs of heart failure and impaired conduction of the heart. The scheme of its administration is as follows: amiodarone in a dosage of 150 mg is dissolved in 100 ml of glucose and drip is injected into a vein for 10 minutes, after which 900 mg of amiodarone is dissolved in 500 ml of glucose and dripped for the first 6 hours at a speed of 1 mg per minute, then reduce speed to 0,5 mg per minute.

Since this form of ventricular arrhythmia has a high risk of transition to ventricular fibrillation, electro-pulse therapy (EIT) is immediately performed.

If for any reason there is no possibility of EIT, amiodarone is administered according to the above scheme.

Treatment is carried out by introducing a 25% solution of magnesia sulfate of 8 ml for one minute, which restores the sinus rhythm almost instantly (in the absence of effect, you can repeat it in 10-15 minutes).

In this case, antiarrhythmic drugs are not effective, and the introduction of some of them of classes 1A and 3 (quinidine, procainamide, disopyramide, amiodarone, sotalol, dofetilide) is extremely dangerous and unacceptable.

  • Identify the cause of ventricular arrhythmias and treat it purposefully: for atherosclerosis of the heart vessels, it is advisable to undergo shunting or angioplasty, with coronary heart disease and a decrease in left ventricular function, ACE inhibitors (lisinopril, ramipril, etc.) and beta-blockers (atenolol, metaprolol and others) are used. .), while diuretics are often used, which requires monitoring of blood electrolytes;
  • With persistent ventricular tachycardia, frequent relapses accompanied by heart failure, fainting, severe hypotension, implantation of a cardioverter-defibrillator is indicated, if implantation is not possible for any reason, a combination of drugs is used on an ongoing basis: amiodarone and beta-blockers;
  • At the current stage of development of medical science, to maintain sinus rhythm, two drugs are preferred: amiodarone and sotalol, the appointment and selection of dosages of which are often carried out under the control of Holter monitoring;
  • In some cases of ventricular arrhythmias (with the reentry mechanism), radiofrequency catheter ablation can be extremely effective, minimally invasive manipulation, the effectiveness of which in some cases reaches 95%, which allows you to completely refuse to take antiarrhythmic drugs.

The choice of treatment method is based on the causes of arrhythmia, clinical manifestations, concomitant diseases. It includes several options:

In the absence of effect, the treatment of cardiac arrhythmias is carried out by cardiac surgeons.

To choose the right tool, a comprehensive examination is carried out. Under the control of electrocardiography, the results of treatment with antiarrhythmic drugs are evaluated. The following classes of drugs are prescribed (depending on the indications):

  1. Preparations stabilizing cell membranes (Grade 1) – Lidocaine, Quinidine, Propafenone.
  2. Beta-blockers (Grade 2) – Metoprolol, Atenolol.
  3. Potassium channel blockers (Grade 3) – Amiodarone, Sotalol.
  4. Calcium channel blockers (Grade 4) – Verapamil, Diltiazem.

The patient is under the control of a doctor, if necessary, he must take tests. Depending on the psychosomatics and the patient’s attitude to his health, a consultation of other specialists is prescribed. According to indications, additional funds may be required. They should go well with arrhythmia pills.

If therapy is carried out successfully and the condition normalizes, then folk remedies can be prescribed. For this, medicinal herbs are used, which are mixed in a certain ratio. Widely used valerian root, lemon balm, motherwort and anise. The ingredients are combined, poured with boiling water and insisted for about half an hour. Then the resulting infusion is taken in a dose of ½ cup three times a day.

One of the healing methods is a proper lifestyle and nutrition. It is necessary to abandon tobacco, alcoholic beverages and junk food. To maintain heart health, it is recommended to drink water (1,5-2 liters per day). If there is swelling, then this issue is resolved with your doctor.

A lot of fresh vegetables and fruits should be present in the diet. For the myocardium, bananas, dried fruits and baked potatoes are considered especially useful. They are more than other foods rich in potassium, which is needed for the work of the heart.

In the absence of dynamics from treatment at home, the patient is referred for surgery. The most common and effective are:

  • cardioversion;
  • production of an artificial pacemaker;
  • ablation

Doctor’s advice: prevention of ventricular arrhythmia

I want to remind you that usually severe forms of rhythm disturbance develop against the background of serious diseases (ischemic disease, heart failure, increased thyroid function, and many others). Timely started treatment, disciplined taking of recommended drugs and regular visits to a doctor with these pathologies is the only way to avoid the problem of developing ventricular arrhythmias.

My recommendations for all patients who have a high risk of this deviation will be:

  • try to avoid situations when there is an imbalance of electrolytes and fluids (vomiting, diarrhea, independent use of diuretics);
  • exercise should be only after consultation and determining the maximum allowable loads;
  • nerve strain to stop sedative drugs, learn auto-training techniques, visit a psychotherapist.

Prognosis of ventricular extrasystole

For life and health, the prognosis is favorable with early diagnosis and treatment. If complications and concomitant pathology are present, then it is evaluated based on the severity, form of arrhythmia, and the dynamics of the condition after therapy.

Patients at risk of heart rhythm disturbances should remember this and avoid factors provoking this condition. If the unpleasant symptoms mentioned above appear, it is necessary to undergo a comprehensive examination. Early treatment allows you to maintain health and avoid complications.

The course of ventricular extrasystole depends on its shape, the presence of organic pathology of the heart and hemodynamic disorders. Functional ventricular extrasystoles do not pose a threat to life. Meanwhile, ventricular extrasystole, developing against the background of organic damage to the heart, significantly increases the risk of sudden cardiac death due to the development of ventricular tachycardia and ventricular fibrillation.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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