Classification of supraventricular extrasystoles at the place of occurrence:
- atrial – premature contractions of the heart from impulses from the atria;
- nodal or atrioventricular – premature impulses from the AV connection.
By frequency of occurrence:
- rare – less than five per minute;
- frequent – more than five per minute.
- paired (couplets);
- group (triplets);
- jogging of paroxysmal supraventricular tachycardia (more than four extrasystoles in a row).
Single extrasystoles can occur randomly or be of the type of bigeminia (every second contraction is an extrasystole), trigeminia and quadrigeminia (every third and fourth complex is extraordinary). Such an extrasystole, when extraordinary complexes appear after one, two, three sinus, is called rhythmic.
Extrasystoles can be monotopic, emanating from the same part of the conduction system of the heart, and polytopic from different parts of it .
At the site of the formation of ectopic foci of excitation, ventricular (62,6%), atrioventricular (from the atrioventricular connection – 2%), atrial extrasystoles (25%) and various variants of their combination (10,2%) are distinguished. In extremely rare cases, extraordinary impulses come from the physiological pacemaker – the sinus-atrial node (0,2% of cases).
Sometimes the focus of the ectopic rhythm is observed, regardless of the main (sinus) rhythm, while two rhythms are noted simultaneously – extrasystolic and sinus. This phenomenon is called parasystole. Extrasystoles, following two in a row, are called paired, more than two – group (or volley).
There are bigeminia – rhythm with alternating normal systole and extrasystole, trigeminia – alternating two normal systoles with extrasystole, quadrigimenia – following extrasystole after every third normal contraction. Regularly recurring bigeminia, trigeminia and quadrigimenia are called allorhythmia.
By the time of the occurrence of an extraordinary impulse in diastole, an early extrasystole is detected that is recorded on the ECG simultaneously with the T wave or no later than 0,05 seconds after the end of the previous cycle; the average – after 0,45-0,50 s after the T wave; late extrasystole developing before the next P wave of the usual contraction.
According to the frequency of occurrence of extrasystoles, rare (less often 5 per minute), medium (6-15 per minute), and frequent (usually 15 per minute) extrasystoles are distinguished. By the number of ectopic foci of excitation, extrasystoles are monotopic (with one focus) and polytopic (with several foci of excitation). According to the etiological factor, extrasystoles of functional, organic and toxic genesis are distinguished.
Ventricular extrasystoles belong to cardiac arrhythmias. Like most heart diseases, they have several classifications.
For patients after myocardial infarction, ZhES are divided into six groups (classification according to Laun-Wolf):
- 0 – ventricular extrasystoles are not observed;
- 1 – rare single ventricular extrasystoles (up to thirty per hour), monotopic (that is, they come from one focus);
- 2 – frequent (more than thirty per hour), but still monotopic;
- 3 – polytopes (originating in several foci);
- 4a – paired extrasystoles;
- 4b – the so-called ventricular tachycardia, when extrasystoles do not go between normal contractions of the heart one by one, but three or more in a row;
- 5 – early ventricular extrasystoles.
Separately, there is a modification of the classification of ZhES according to Laun-Wolf for people who did not suffer myocardial infarction. Its difference lies in the fact that in group 4a, paired monomorphic extrasystoles are considered, and in group 4b, paired polymorphic ones. Ventricular tachycardia is considered group 5.
Currently, the most widespread classification of ZhES according to RJ Myerburg, which involves the separation in form and frequency of extrasystoles.
- 1 – rare (less than one per hour);
- 2 – infrequent (from one to nine per hour);
- 3 – moderately frequent (an hour can be from ten to thirty extrasystoles);
- 4 – frequent (from thirty one to sixty);
- 5 – very frequent (when extrasystole is more than sixty per hour).
- A – single monomorphic extrasystoles;
- B – single, but already polymorphic extrasystoles;
- C – paired;
- D – unstable ventricular tachycardia (up to thirty seconds);
- E – sustained ventricular tachycardia (for more than thirty seconds).
The classification of housing and communal services by prognostic value is of great importance:
- benign – it is observed with an unaffected heart, extrasystoles occur infrequently. They find it most often during a routine examination, since patients have no complaints or are very insignificant. The prognosis in this case is good, the risk of sudden death is practically absent.
- potentially malignant – it develops already against the background of structural damage to the heart, after a myocardial infarction, when a scar forms on the heart muscle. There is a risk of sudden death. Paired extrasystoles or unstable ventricular tachycardia are observed.
- malignant – the heart has lesions, a scar is present on the myocardium. Against the background of frequent ventricular extrasystoles, tachycardia also develops. Patients complain of a strong heartbeat. A history of fainting and even cardiac arrest may occur. The prognosis is extremely unfavorable, since the risk of death is quite high.
Extrasystoles can occur both in the left and in the right ventricle of the heart, however, they do not differ in clinical symptoms. Right ventricular extrasystole is determined only by ECG, as well as left ventricular.
According to the time of occurrence of extrasystoles, there are three types:
- early – they occur simultaneously with the reduction of the atria;
- interpolated – occur between contractions of the atria and ventricles;
- late – appear simultaneously with normal contraction of the ventricles or during complete relaxation of the heart muscle.
Extrasystole is a variant of heart rhythm disturbance characterized by extraordinary contractions of the whole heart or its individual parts (extrasystoles). It manifests itself as a sensation of a strong heart beat, a feeling of sinking heart, anxiety, lack of air. A decrease in cardiac output during extrasystole leads to a decrease in coronary and cerebral blood flow and can lead to the development of angina pectoris and transient disturbances in cerebral circulation (fainting, paresis, etc.). Increases the risk of atrial fibrillation and sudden cardiac death.
Single episodic extrasystoles can occur even in practically healthy people. According to an electrocardiographic study, extrasystole is recorded in 70-80% of patients older than 50 years. The appearance of extrasystole is explained by the appearance of ectopic foci of increased activity, localized outside the sinus node (in the atria, atrioventricular node, or ventricles). The extraordinary impulses arising in them propagate through the heart muscle, causing premature heart contractions in the diastole phase. Ectopic complexes can form in any part of the conducting system.
The volume of extrasystolic ejection of blood is lower than normal, so frequent (more than 6-8 per minute) extrasystoles can lead to a noticeable decrease in the minute volume of blood circulation. The earlier the extrasystole develops, the less blood volume accompanies the extrasystolic discharge. This, first of all, affects coronary blood flow and can significantly complicate the course of existing cardiac pathology. Different types of extrasystoles have unequal clinical significance and prognostic characteristics. The most dangerous are ventricular extrasystoles, developing against the background of organic damage to the heart.
Causes of extrasystole
Ventricular extrasystole occurs against the background of organic pathologies of the heart, but can also be idiopathic, i.e., an unidentified one. Most often, it develops in patients with myocardial infarction (in 90-95% of cases), arterial hypertension, coronary heart disease, post-infarction cardiosclerosis, myocarditis, pericarditis, hypertrophic or dilated cardiomyopathy, pulmonary heart, mitral valve prolapse, chronic heart failure.
The risk factors include:
- cervical osteochondrosis;
- cardiopsychoneurosis ;
- endocrine disorders, metabolic disorders;
- chronic hypoxia (with night apnea, anemia, bronchitis);
- taking certain medications (antidepressants, diuretics, antiarrhythmic drugs, an overdose of cardiac glycosides);
- bad habits;
- poor nutrition;
- excessive physical and mental stress.
Ventricular extrasystole can appear at rest and disappear with physical exertion in individuals with increased activity of the parasympathetic nervous system. Single ventricular extrasystoles often occur in clinically healthy people for no apparent reason.
Extrasystoles are the most common subspecies of arrhythmia, which periodically occurs in 65% of absolutely healthy people. With a normal heart rhythm, there should be about 200 ventricular and 200 supraventricular extrasystoles per day. At the time of failure, up to tens of thousands of extrasystoles are recorded.
The nature of extrasystole can be organic (there are cardiac pathologies) or neurogenic (functional). Functional extrasystole develops with:
- Taking medication.
- Cervical osteochondrosis.
- Neurocirculatory dystonia.
- Intense physical exertion.
- The abuse of nicotine, alcohol, caffeinated drinks.
An occasional increase in the number of daily extrasystoles does not pose a danger to healthy people, such bursts in medicine are called “cosmetic arrhythmias.” Heart rhythm failures must be monitored and corrected in patients with organic heart pathologies.
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The best doctors for the treatment of extrasystoles
Cardiologist Physiotherapist Therapist Doctor of the highest category
Mikhailenko Larisa Vitalevna Experience 28 years Doctor of Medical Sciences 8.4
Pulmonologist Therapist Cardiologist Doctor of the highest category
Uzakova Milana Polotzhanovna Experience 9 years 9.5
Cardiologist Homeopath First category doctor
Tikhomirova Elena Andreevna Experience 19 years Candidate of Medical Sciences 8.9
Therapist Cardiologist Rheumatologist Doctor of the highest category
Makarenko Andrey Anatolyevich Experience 33 years, Candidate of Medical Sciences 9.5
Arrhythmologist Cardiologist Functional diagnostics doctor Doctor of the highest category
Vasyutina Ekaterina Ivanovna Experience 21 years Candidate of Medical Sciences 8.7
Cardiologist Arrhythmologist Functional Diagnostic Doctor
Tartakovsky Lev Borisovich Experience 16 years Candidate of medical sciences 9.3
Functional diagnostics doctor Cardiologist Doctor of the highest category
Volgusheva Anna Eduardovna Experience 27 years Candidate of medical sciences 8.6
Cardiologist First category doctor
Praskurnichaya Natalya Aleksandrovna Experience 20 years 9.2
Cardiologist Doctor of the second category
Sinyagina Natalya Vladimirovna Experience 15 years 8.4
Kupreishvili Lali Velodievna Experience 11 years
Functional extrasystoles include rhythm disturbances of neurogenic (psychogenic) origin associated with food, chemical factors, alcohol intake, smoking, drug use, etc. Functional extrasystole is recorded in patients with autonomic dystonia, neurosis, osteochondrosis of the cervical spine, etc. An example of a functional extrasystole is arrhythmia in healthy, well-trained athletes. In women, extrasystole can develop during menstruation. Extrasystoles of a functional nature can be triggered by stress, the use of strong tea and coffee.
Functional extrasystole, developing in practically healthy people for no apparent reason, is considered idiopathic. Organic extrasystole occurs with myocardial damage: coronary heart disease, cardiosclerosis, myocardial infarction, pericarditis, myocarditis, cardiomyopathy, chronic circulatory failure, pulmonary heart disease, heart defects, myocardial damage with sarcoidosis, amyloidosis, hemochromatosis, cardiac. In some athletes, the cause of extrasystole may be myocardial dystrophy, caused by physical stress (the so-called “athlete’s heart”).
Toxic extrasystoles develop with fever, thyrotoxicosis, proarrhythmic side effect of certain drugs (aminophylline, caffeine, novodrin, ephedrine, tricyclic antidepressants, glucocorticoids, neostigmine, sympatholytics, diuretics, digitalis drugs, etc.).
The development of extrasystole is due to a violation of the ratio of sodium, potassium, magnesium and calcium ions in myocardial cells, which negatively affects the conduction system of the heart. Physical activity can provoke extrasystole associated with metabolic and cardiac disorders, and suppress extrasystoles caused by autonomic dysregulation.
The causes of ventricular extrasystole can be divided into two large groups: cardiac and extracardial.
Cardiac causes – as the name implies, these are causes associated with heart disease. It can be:
- cardiac ischemia;
- myocardial infarction;
- acquired heart defects and some other pathologies.
Extracardial (extracardiac) factors can cause extrasystole in a healthy cardiovascular system:
- disturbances in the electrolyte balance in the body – a decrease in the amount of potassium, magnesium, an increase in calcium content;
- an overdose of some drugs – cardiac glycosides (digoxin), aminophylline, some antidepressants and other groups of drugs;
- taking narcotic drugs – cocaine, amphetamines;
- excessive consumption of coffee and caffeinated drinks;
- alcohol consumption;
- some infectious diseases;
- increased emotional excitement, stress.
Normally, the heart works orderly. The rhythm of the heart sets the sinus node, which generates electrical impulses. Under their influence, the atria first contract, then the ventricles. Sometimes the rhythm of the heart is broken and premature arousal and contraction of the heart or its departments, called extrasystole, occur.
Supraventricular (supraventricular) extrasystole (NZHE) is an extraordinary premature heart contraction from impulses originating from the upper or lower atria or from the atrioventricular connection (AV connection), which is located between the atria and ventricles of the heart .
The causes of extrasystole can be cardiac and extracardiac. Cardiac are associated with diseases of the cardiovascular system (organic extrasystole). Extracardiac causes are associated with diseases of other organs and systems, as well as with the action of certain factors (functional extrasystole). In some cases, supraventricular extrasystole is not associated with problems of the heart or other organs and the action of provoking factors. In this case, idiopathic extrasystole is diagnosed.
Organic extrasystole occurs with heart diseases: coronary heart disease (CHD), arterial hypertension and with thickening of the left ventricular wall, cardiomyopathies, heart defects, heart failure and mitral valve prolapse (sagging) and other diseases of the cardiovascular system.
Causes of functional extrasystole:
- electrolyte imbalance: a decrease or increase in the blood concentration of potassium, calcium and sodium, a decrease in magnesium;
- various types of intoxication, including infectious diseases;
- diseases accompanied by oxygen starvation of tissues: anemia, bronchopulmonary diseases;
- rearrangement and diseases of the endocrine system: decrease or increase in hormonal activity of the adrenal glands and thyroid gland, diabetes mellitus, formation / imbalance / extinction of ovarian function (the onset of menstruation, menopause), pregnancy;
- imbalance of the autonomic nervous system: vegetative-vascular dystonia, autonomic effects in diseases of the gastrointestinal tract.
- smoking, stress, the use of a large amount of caffeinated or alcoholic beverages, leading to an increase in the activity of the sympathetic-adrenal system and the accumulation of catecholamines (adrenaline, norepinephrine, etc.), which sharply increase myocardial excitability. In this case, there is a clear connection with the provoking factor, but there are no organic changes in the heart muscle.
It is very important to identify the etiological factor that caused supraventricular extrasystole: the recommended treatment will depend on this.
|Group of reasons||Causative factors|
|Cardiovascular diseases||⠀ • ⠀ Chronic ischemic heart disease (CHD) and myocardial infarction|
⠀ • ⠀ Cardiomyopathies
⠀ • ⠀ Arterial hypertension leading to left ventricular hypertrophy
⠀ • ⠀ Myocarditis (inflammation of the heart muscle)
⠀ • ⠀ Heart failure
⠀ • ⠀ Congenital and acquired heart defects
⠀ • ⠀ Mitral valve prolapse
|The effect of drugs||⠀ • ⠀ Overdose or uncontrolled medication (Digoxin, antiarrhythmic, diuretics, beta-adrenostimulants, antidepressants, Eufillina, Beroduala, Salbutamol)|
|Violation of electrolyte balance||⠀ • ⠀ Decrease or increase in blood concentration of potassium, calcium and sodium, decrease in magnesium|
|Intoxication||⠀ • ⠀ Alcohol, chemicals, industrial hazards, smoking|
⠀ • ⠀ Infectious diseases
|Imbalance of the autonomic nervous system||⠀ • ⠀ Vegetative-vascular dystonia, autonomic effects in diseases of the gastrointestinal tract|
|Diseases accompanied by oxygen starvation of tissues||⠀ • ⠀ Anemia, pathology of the bronchopulmonary system|
|Diseases and conditions of endocrine system restructuring||⠀ • ⠀ Decreased or increased hormonal activity of the adrenal gland and thyroid gland|
⠀ • ⠀ Diabetes
⠀ • ⠀ Formation / imbalance / extinction of ovarian function (the beginning of menstruation, menopause)
⠀ • ⠀ Pregnancy
|Lifestyle features||⠀ • ⠀ Nervousness, feelings, negative emotions|
⠀ • ⠀ Frequent stressful situations
⠀ • ⠀ Excessive physical activity, low physical activity
|Reason not identified||⠀ • ⠀ There is no association of arrhythmia with diseases or other factors|
If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!
The difficulty in diagnosing extrasystole is the lack of a characteristic pronounced clinical picture. Symptoms depend on the state of the vascular and cardiovascular systems, the age of the patient, the reactivity of the body, and the form of the disease. In 70% of patients, arrhythmia is detected at a routine examination.
Frequent cardiac contractions of a group or early nature provoke a decrease in cardiac output and a slowdown in cerebral, coronary and renal circulation. In patients with cerebral arteriosclerosis, the following occur:
With coronary heart disease, extrasystoles cause angina attacks.
The duration and effectiveness of therapy, as well as the normal functioning of the patient after undergoing treatment, largely depend on ventricular dysfunction and the degree of pathology of the heart muscle. The most dangerous are extrasystoles provoked by myocarditis, cardiomyopathy, acute myocardial infarction. Against the background of pronounced morphological abnormalities of the myocardium, cardiac complexes pass into the fibrillation of the ventricles or atria.
The course of supraventricular extrasystoles, complicated by other diseases, leads to the appearance of atrial fibrillation. The development of ventricular extrasystoles is dangerous with persistent tachycardia and sudden cardiac arrest.
In healthy patients with no congenital or developed diseases of the cardiovascular system, extrasystole does not significantly affect the state of health, activity and lifestyle.
If you find yourself having similar symptoms, consult a doctor immediately. It’s easier to prevent the disease than to deal with the consequences.
It is not difficult to suspect a supraventricular extrasystole in a patient if it is felt. Most often, patients complain of a feeling of interruption in the work of the heart: premature contractions, pauses, fading. If arrhythmia occurs at night, the patient may wake up and feel anxiety. Less often, patients are disturbed by attacks of frequent irregular heartbeats, in this case, the exception of paroxysmal (paroxysmal) atrial fibrillation is required.
Sometimes a curious pattern may be noted: the most unpleasant are the “harmless” functional extrasystoles that are not associated with heart damage. And a person may not even feel more serious rhythm disturbances. This is probably due to the threshold of sensitivity to arrhythmias in patients and the degree of damage to the heart muscle.
Periods of supraventricular extrasystole are usually not accompanied by serious hemodynamic disturbances (blood supply). However, in patients with organic damage to the heart, chest pain of various types may occur, the appearance or intensification of shortness of breath, weakness, dizziness is possible, and the tolerance of physical activity is also reduced.
Supraventricular extrasystole during vegetative-vascular dystonia is accompanied by severe fatigue, weakness, increased sweating, periodic headache, dizziness, irritability.
The occurrence of interruptions in the work of the heart with extrasystole can be associated with the action of provoking factors (smoking, alcohol, excessive physical activity, etc.), exacerbation of the disease that caused the extrasystole. However, symptoms of arrhythmias can also appear without regard to any provoking factors .
Subjective sensations with extrasystole are not always expressed. Tolerance of extrasystoles is harder in people suffering from vegetative-vascular dystonia; patients with organic heart damage, on the contrary, can tolerate estrasystole much easier. More often, patients feel extrasystole as a stroke, a push of the heart into the chest from the inside, due to an energetic contraction of the ventricles after a compensatory pause.
Also, there are “somersaults or flipping” of the heart, interruptions and fading in his work. Functional extrasystole is accompanied by hot flashes, discomfort, weakness, anxiety, sweating, lack of air.
Frequent extrasystoles, which are early and group, cause a decrease in cardiac output, and, consequently, a decrease in coronary, cerebral and renal blood circulation by 8-25%. In patients with signs of cerebral arteriosclerosis, dizziness is noted, transient forms of cerebrovascular accident (fainting, aphasia, paresis) may develop; in patients with coronary heart disease – angina attacks.
Subjective complaints in patients with ventricular extrasystole are often absent, and it is detected only during an ECG – a planned preventive or for another reason. In some cases, ventricular extrasystole manifests itself as discomfort in the heart.
Ventricular extrasystole that occurs in the absence of any heart disease can be difficult to tolerate by the patient. It develops against the background of bradycardia and may be accompanied by a sinking heart (a sensation of a cardiac arrest), followed by a series of heart contractions, and separate strong strokes in the chest.
In patients with organic heart diseases, extrasystoles, on the contrary, occur during physical exertion and pass when taking a horizontal position. In this case, ventricular extrasystoles appear on the background of tachycardia. They are accompanied by weakness, a feeling of lack of air, fainting, anginal pain. The characteristic pulsation of veins on a neck (venous waves of Corrigan) is noted.
Ventricular extrasystole against a background of vegetovascular dystonia causes complaints of irritability, increased fatigue, recurring headaches, dizziness, anxiety, a sense of fear, panic attacks.
Ventricular extrasystole often occurs in women during pregnancy along with tachycardia and pain in the left side of the chest. In this case, the pathology, as a rule, is benign in nature and lends itself well to therapy after childbirth.
Ventricular extrasystole can occur both asymptomatically and have severe symptoms. The most common patient complaints:
- Malfunctions of the heart – patients note an increased heartbeat or, conversely, the heart seems to freeze. Often these two symptoms combine: first, the heart seems to freeze, and immediately after that it intensely contracts;
- Heart palpitations;
- Frequent dizziness;
- Symptoms of ventricular extrasystole include unpleasant sensations in the heart, sometimes painful;
- Ripple of the cervical veins – this occurs when the atria are reduced, but the atrioventricular valves are closed, because the ventricles of the heart prematurely contracted;
- If extrasystoles occur frequently, fatigue, a feeling of lack of air, shortness of breath, and sometimes loss of consciousness join the symptoms.
Diagnosis of extrasystole
The diagnosis of ventricular extrasystole is based on patient complaints, as well as laboratory and instrumental examinations.
During the collection of an anamnesis, complaints about well-being, the time and frequency of their occurrences are clarified, as well as information is collected about the patient’s bad habits, past illnesses, heredity, lifestyle.
Laboratory diagnostics – laboratory tests and examinations are prescribed to determine the cause of extrasystole. The body is checked for hormonal imbalances, changes in electrolyte balance, the presence of toxins, infections, ischemic disorders in the myocardium of the heart.
Instrumental diagnostics is aimed at identifying and assessing the degree of damage to the left ventricle due to extrasystoles. ECG is important in the diagnosis of ventricular extrasystole. Its correct decoding makes it possible not only to detect extrasystoles, but also to determine where the impulses come from. In case of left ventricular extrasystole, premature contraction of the heart, resembling a blockade of the right bundle of His bundle, is recorded on an ECG on ECG, with a right ventricular – left leg.
Useful for diagnosis is a stress test. An ECG is removed to the patient, then a little physical activity is given, and then the ECG is removed again. Idiopathic ventricular extrasystole after exercise passes. If it arises due to heart disease, then the load only strengthens it.
On the ECG, you can also identify the time of appearance of extrasystoles. In early or late extrasystoles, a complete compensatory pause usually follows. With interpolated, that is, the so-called intercalated ventricular extrasystole, there is no such pause. It is called insertion because it is inserted between two normal contractions of the parts of the heart.
However, with single extrasystoles that occur less often, an ECG may not give the desired result. Then Holter monitoring comes to the rescue. Electrocardiographic readings are recorded during the day, they can already be used to judge the incidence of extrasystoles, as well as the degree of electrical instability of the heart.
In addition, the following methods of instrumental diagnostics are used:
- Echocardiography – it allows you to find out structural changes in the heart;
- Electrophysiological examination – a special catheter is inserted into the heart cavity, which stimulates the contraction of the heart muscle with the help of electrical pulses. At the same time, a cardiogram of the heart is recorded. This method is used when the ECG did not give unambiguous results, and also to evaluate the functioning of the cardiac conduction system.
- Cardiac MRI is rarely performed, mainly when the data obtained by echocardiography were not very informative.
The diagnosis of supraventricular extrasystole can be made on the basis of patient complaints, according to an objective examination, auscultation (listening) of the heart, according to the results of an electrographic examination (ECG), daily ECG monitoring according to Holter.
After evaluating complaints during an objective examination during auscultation or palpation of the pulse, extrasystoles are defined as premature contractions against a background of normal sinus rhythm. A pause after a supraventricular extrasystole is not very long (on this basis, its supraventricular origin can be suspected). With bigeminia and trigeminia, as well as frequent extrasystole, a pulse deficiency can be determined. However, the diagnosis of NJE can be confirmed only with the help of instrumental studies.
First of all, the patient is given an ECG, which can fix an extraordinary complex. Often on an ECG supraventricular extrasystoles are detected by chance (in the absence of complaints).
Characteristic signs of supraventricular extrasystoles:
- QRS ventricular complex, which appears not from the sinus node with a certain frequency, but prematurely;
- a deformed (different from sinus) atrial P wave preceding the QRS complex indicates the supraventricular origin of the extrasystole;
- incomplete compensatory pause (i.e., lengthening the interval from one P wave to the next) after the supraventricular extrasystole (the sum of the intervals before and after the extrasystole is less than two normal PP intervals, this is the difference from the full compensatory pause that occurs after ventricular extrasystole);
- narrow QRS complex (less than 0,12 sec.) without detectable P wave with atrioventricular extrasystole .
An important role is played by the assessment of the adhesion interval (from the P wave preceding the normal complex to the P wave of the extrasystole). Its constancy indicates the monotopy of supraventricular extrasystoles (that is, they come from one focus) .
Since the ECG is carried out in a short period of time, and extraordinary excitation does not always occur at the time of its removal, this type of study does not allow to identify the problem in 100% of cases. For an accurate diagnosis, a daily or longer (for two days, for example) ECG monitoring, which is called Holter monitoring (by the name of the author who proposed this technique), must be used. To assess the frequency of supraventricular extrasystoles, the study should be carried out in the absence of antiarrhythmic therapy. An acceptable amount of extrasystoles is not more than 30 per hour.
After recording, the ECG monitoring data is decrypted by a specialist and it becomes possible:
- specify the number of supraventricular extrasystoles, their shape, determine the presence of pairs, groups, as well as runs of paroxysmal supraventricular tachycardia;
- determine at what point they occur, whether the appearance of extrasystoles depends on physical activity or other factors (the patient indicates these data in the diary, which he keeps during the monitoring);
- to fix the dependence of the occurrence of supraventricular extrasystole on the state of sleep or wakefulness;
- monitor the effectiveness of drug therapy;
- identify other possible rhythm and conduction disturbances.
It should be noted that it is fundamentally important to evaluate the frequency of NJE, since treatment tactics will depend on this.
Supraventricular extrasystole can be first detected during a physical exercise test (bicycle ergometry or treadmill test).
An indication for an electrophysiological study (EFI) may be the need to more accurately establish the occurrence of extrasystoles (with frequent monotopic supraventricular extrasystoles) in case of subsequent surgical treatment. With EFI, through electrical stimulation of the myocardium, the load on the heart increases. Such stimulation is carried out with the help of electrodes that supply electric currents of physiological power to the heart muscle with a high frequency. As a result, the myocardium begins to contract faster, there is a provoked heart rate (tachycardia). At a high heart rate, various types of arrhythmias may appear, including supraventricular extrasystole.
The main objective method for diagnosing extrasystole is an ECG study, however, it is possible to suspect the presence of this type of arrhythmia during a physical examination and analysis of the patient’s complaints. When talking with the patient, the circumstances of the occurrence of arrhythmia (emotional or physical stress, in a calm state, during sleep, etc.) are clarified, the frequency of episodes of extrasystole, the effect of taking medication. Particular attention is paid to the anamnesis of past diseases that can lead to organic damage to the heart or their possible undiagnosed manifestations.
During the examination, it is necessary to determine the etiology of extrasystole, since extrasystoles with organic damage to the heart require a different therapeutic tactic than functional or toxic. On palpation of the pulse on the radial artery, extrasystole is defined as a prematurely occurring pulse wave followed by a pause or as an episode of a pulse loss, which indicates insufficient diastolic filling of the ventricles.
During auscultation of the heart during an extrasystole above the apex of the heart, premature I and II tones are heard, while I tone is strengthened due to the small filling of the ventricles, and II – as a result of a small discharge of blood into the pulmonary artery and aorta – is weakened. The diagnosis of extrasystole is confirmed after an ECG in standard leads and daily monitoring of the ECG. Often using these methods, extrasystole is diagnosed in the absence of patient complaints.
Electrocardiographic manifestations of extrasystole are:
- premature onset of P wave or QRST complex; indicating a shortening of the pre-extrasystolic adhesion interval: with atrial extrasystoles, the distance between the P wave of the main rhythm and the P wave of the extrasystole; with ventricular and atrioventricular extrasystoles – between the QRS complex of the main rhythm and the QRS complex of extrasystoles;
- significant deformation, expansion and high amplitude of the extrasystolic QRS complex with ventricular extrasystole;
- lack of a tooth of P before ventricular extrasystole;
- following a full compensatory pause after ventricular extrasystoles.
Holter ECG monitoring is a long-term (24-48 hours) ECG recording using a portable device mounted on the patient’s body. Registration of ECG indicators is accompanied by a patient activity diary, where he notes all his feelings and actions. Holter ECG monitoring is performed for all patients with cardiopathology, regardless of the presence of complaints indicating extrasystole and its detection with a standard ECG.
To identify extrasystole that is not fixed on the ECG at rest and during Holter monitoring, allow the treadmill test and bicycle ergometry – tests that determine rhythm disturbances, which appear only under load. Diagnosis of concomitant cardiopathology of an organic nature is carried out using ultrasound of the heart, stress Echo-KG, cardiac MRI.
A preliminary diagnosis of “extrasystole” is made by a specialist on the basis of an initial examination and a medical history: genetic predispositions, already diagnosed pathologies and complaints of the patient.
NJE may be benign. In this case, the risk of sudden death is very low, sometimes the patient does not even feel a rhythm disturbance. Such extrasystole does not always require treatment.
If possible, it is necessary to eliminate the etiological factor:
- normalize sleep;
- limit or completely stop taking provocative drugs and drinks;
- quit smoking:
- normalize thyroid function with hyperthyroidism;
- adjust the level of potassium in the blood;
- remove the gallbladder in case of gallstone disease;
- avoid horizontal position after eating with a hernia of the esophageal opening of the diaphragm;
- normalize blood pressure;
- increase physical activity according to the capabilities of the body;
- eliminate excessive physical exertion (weightlifting, weight lifting).
The patient is recommended to establish a daily regimen. The diet should be supplemented with foods rich in potassium and magnesium, they favorably affect the cardiovascular system.
|Potassium containing foods||Products containing magnesium|
|⠀ • ⠀ dried apricots;|
⠀ • ⠀ cocoa powder;
⠀ • ⠀ wheat bran;
⠀ • ⠀ raisins;
⠀ • ⠀ sunflower seeds;
⠀ • ⠀ nuts (cedar, almonds, peanuts, walnuts);
⠀ • ⠀ legumes (peas, lentils, beans);
⠀ • ⠀ jacket potatoes;
⠀ • ⠀ avocado;
⠀ • ⠀ ceps;
⠀ • ⠀ bananas;
⠀ • ⠀ citrus fruits;
⠀ • ⠀ Brussels sprouts and kohlrabi;
⠀ • ⠀ milk and dairy products;
⠀ • ⠀ cereals (oat, buckwheat, pearl barley, rice);
⠀ • ⠀ fruits (peaches, pears, watermelon, apples, prunes, apricots, melon);
⠀ • ⠀ chicory;
⠀ • ⠀ vegetables (carrots, spinach, green onions, eggplant, cucumbers);
⠀ • ⠀ chicken eggs;
⠀ • ⠀ fish and meat;
⠀ • ⠀ apple juice.
|⠀ • ⠀ oil (sesame, linseed, peanut);|
⠀ • ⠀ cheese (Dutch, Poshekhonsky, goat, with mold);
⠀ • ⠀ cottage cheese (fat-free and low-fat, curd cheese);
⠀ • ⠀ dark chocolate;
⠀ • ⠀ almost all types of meat;
⠀ • ⠀ fish (halibut, sturgeon, perch, haddock, cod, saury);
⠀ • ⠀ duck eggs;
⠀ • ⠀ cereals (hercules, chickpeas, peas, buckwheat, brown rice, lentils);
⠀ • ⠀ fruits and berries (cherries, kiwi, pineapple, feijoa, raspberries, pear, peach, persimmon);
⠀ • ⠀ many varieties of tea (for example, “Ivan-tea”) and juices;
⠀ • ⠀ ginger;
⠀ • ⠀ mustard;
⠀ • ⠀ vanilla.
Indications for antiarrhythmic therapy are:
1. Poor tolerance of supraventricular extrasystole. In this case, it is necessary to determine in what situations and at what time of the day a heart rhythm disturbance most often occurs, after which the drug is timed to coincide with this time.
2. The emergence of NJE (not necessarily frequent) in patients with heart defects (primarily with mitral stenosis) and other organic heart diseases. In such patients, congestion and enlargement of the atria progress. Supraventricular extrasystole in this case serves as a harbinger of the onset of atrial fibrillation.
3. Supraventricular extrasystole, which arose as a result of a time-prolonged etiological factor in patients without previous organic heart disease and atrial enlargement (with thyrotoxicosis, inflammatory process in the heart muscle, etc.). If antiarrhythmic treatment is not carried out (along with etiotropic), the risk of NJE consolidation increases. Frequent supraventricular extrasystole in such situations is potentially malignant in relation to the development of atrial fibrillation.
4. Frequent (700-1000 extrasystoles per day or more) NZhE also requires the appointment of antiarrhythmic therapy, even if it is regarded as idiopathic, since there is a risk of complications. The approach in these cases should be differentiated. Refusal of antiarrhythmic therapy is possible, if there are grounds for this:
- lack of subjective symptoms and complaints;
- boundary number of extrasystoles;
- intolerance to antiarrhythmic drugs;
- signs of sick sinus syndrome or abnormalities in AB-conduction.
Antiarrhythmic drugs used in NZhE:
- Beta-blockers (Metoprolol, Bisoprolol), calcium antagonists (Verapamil). It is pathogenetically justified to prescribe drugs in this group to patients with hyperthyroidism, a tendency to tachycardia, when NZhE occurs against the background of stress and is provoked by sinus tachycardia. Beta-blockers are indicated for coronary heart disease, arterial hypertension, sympatho-adrenal crises. “Verapamil” is prescribed for concomitant bronchial asthma, variant angina, intolerance to nitrates, patients with coronary artery disease.
- “Belloid”, “Theopec” are indicated for patients with vagus-mediated NJE, which develops at night amid a decrease in heart rate. These drugs speed up the rhythm, they are prescribed for the night.
- Sotalol (Sotaleks, Sotageksal). It is necessary to select a dose depending on blood pressure and heart rate, the duration of the PQ and QT intervals. It is indicated with a combination of NJE and ventricular extrasystole.
- Antiarrhythmics of IA and IC classes (“Disopyramide”, “Allapinin”, “Propanorm”, “Etatsizin”). The use is not indicated in patients with coronary artery disease who have recently suffered myocardial infarction due to arrhythmogenic effect on the ventricles.
- Amiodarone (“Cordaron”). Amiodarone is the most effective antiarrhythmic drug available. May be prescribed to patients with organic heart damage.
- With insufficient effectiveness of monotherapy (i.e., the use of a single antiarrhythmic), combinations of drugs can be used.
With a good effect of the prescribed therapy, antiarrhythmics should not be quickly canceled. Treatment is carried out for several weeks (months). If there is a risk of developing atrial fibrillation or if there are any episodes in the history, the therapy of NZhE is carried out for life. In the case of continuous antiarrhythmic therapy, the minimum effective doses are selected. Patients with a wave-like course of NZhE should strive to cancel the antiarrhythmic during periods of improvement (excluding cases of severe organic damage to the myocardium). The abolition of antiarrhythmics is carried out gradually with a decrease in dosages and the number of doses per day. After cancellation, the patient is recommended to have a drug with him (the “pill in your pocket” strategy) in order to take it quickly when arrhythmia resumes .
If there is no effect of antiarrhythmic therapy, with frequent NJE (up to 10 per day), surgical treatment is considered – radiofrequency ablation of arrhythmogenic foci (destruction of foci using electric current) .
When determining medical tactics, the form and localization of extrasystole is taken into account. Single extrasystoles that are not caused by cardiac pathology do not require treatment. If the development of extrasystole is due to diseases of the digestive, endocrine systems, heart muscle, treatment begins with the underlying disease.
With extrasystole of neurogenic origin, a consultation of a neurologist is recommended. Soothing preparations (motherwort, lemon balm, peony tincture) or sedative preparations (orehotel, diazepam) are prescribed. Extrasystole caused by drugs requires their abolition. Indications for the appointment of drug treatment are the daily amount of extrasystoles gt; 200, the presence of subjective complaints and cardiac pathology in patients.
The choice of drug is determined by the type of extrasystole and heart rate. The appointment and selection of the dosage of the antiarrhythmic agent is carried out individually under the control of Holter ECG monitoring. Extrasystole responds well to treatment with procainamide, lidocaine, quinidine, amiodoron, ethylmethylhydroxypyridine succinate, sotalol, diltiazem and other drugs.
With a reduction or disappearance of extrasystoles recorded within 2 months, a gradual decrease in the dose of the drug and its complete cancellation are possible. In other cases, the treatment of extrasystole proceeds for a long time (several months), and with a malignant ventricular form, antiarrhythmics are taken for life. Treatment of extrasystole with radiofrequency ablation (RFA) is indicated for the ventricular form with a frequency of extrasystoles up to 20-30 thousand per day, as well as in cases of ineffective antiarrhythmic therapy, its poor tolerance or poor prognosis.
Sudden contractions of the left or right ventricles of the heart are associated with the occurrence of foci of excitation in the Purkinje fibers or in the distal areas after branching of the legs of the bundle of His. This phenomenon can be observed in severe diseases of the heart muscle caused by intoxication, overexcitation, and congenital features of the cardiac conduction system.
Single ventricular extrasystoles are observed normally in completely healthy people. They usually do not manifest clinically and do not require special treatment. With age, their number increases.
|Types||Cause||How to suspect|
|Organic||The symptoms of the main pathology come first, extrasystole acts as a complication.|
|Extracardiac||Anamnesis, examination of the internal organs, the study of the ionic composition of the blood, ultrasound and x-ray diagnostics.|
|Functional||A clear connection between the development of arrhythmia after exposure to a provoking factor, the absence of organic changes.|
|Idiopathic||There is no connection with the disease and other factors.||Only with the help of ECG and Holter monitoring.|
For any disease, the only examination that clearly shows the presence of additional ventricular contractions is electrocardiography. If it is not possible to register a deviation during an ECG, then a special device is used that records the activity of the heart for a given time.
Most often, single extrasystoles appear without clinical symptoms. According to statistics, disruptions in this case develop in 30% of patients, and approximately 7% believe that this phenomenon significantly worsens their well-being. Complaints of the patient at the time of the onset of arrhythmia are as follows:
- sinking hearts, tremors and interruptions;
- dizziness and general weakness;
- shortness of breath, lack of air;
- volley and frequent ventricular extrasystoles can cause pain against a background of an ischemic attack, impaired consciousness.
Complications and danger with extrasystole
Supraventricular extrasystole can provoke the development of supraventricular tachycardia, which is characterized by suddenly beginning and stopping pathologically increased cardiac activity. During an attack, the heart rate rises to 220-250 beats per minute . If at this moment it is possible to remove the ECG, then you can fix the paroxysm (attack) of supraventricular tachycardia.
Atrial fibrillation (atrial fibrillation) may be one of the consequences of this disease. These are chaotic and frequent excitations and contractions of the atria, as well as twitching of some groups of atrial muscle fibers. During an attack, the heart rate rises significantly, the correct heart rhythm is disturbed. The risk of atrial fibrillation should serve as a criterion for malignancy of supraventricular extrasystole (high risk of sudden death) . A harbinger of atrial fibrillation is a frequent group supraventricular extrasystole with runs of paroxysmal (paroxysmal) supraventricular tachycardia.
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.
Pathological ventricular extrasystole, especially without the right treatment, if all medical appointments are not followed, can lead to serious complications. Why is it dangerous:
- may lead to a change in the ventricles of the heart;
- worsen the work of the heart – it becomes unable to properly pump blood through the body, cardiac output decreases;
- frequent extrasystoles exacerbate the current disease of the cardiovascular system even more;
- ventricular fibrillation may occur, which in turn often leads to death;
- increased risk of sudden cardiac arrest.
Group extrasystoles can transform into more dangerous rhythm disturbances: atrial – into atrial flutter, ventricular – into paroxysmal tachycardia. In patients with overload or dilatation of the atria, extrasystole can go into atrial fibrillation.
Frequent extrasystoles cause chronic failure of coronary, cerebral, renal circulation. The most dangerous are ventricular extrasystoles due to the possible development of ventricular fibrillation and sudden death.
Ventricular extrasystole can be complicated by a change in the configuration of the ventricle of the heart, the formation of blood clots, the development of atrial fibrillation, atrial flutter, paroxysmal tachycardia, chronic renal failure, cerebral or coronary circulation, stroke, myocardial infarction, sudden coronary death.
Prevention of heart failure
In order to prevent the development of ventricular extrasystole, it is recommended:
- timely treatment of diseases that can lead to a violation of the heart rhythm;
- avoidance of irrational use of drugs;
- rational and balanced nutrition;
- rejection of bad habits;
- full night’s sleep;
- avoidance of stressful situations;
- rational mode of work and rest;
- sufficient physical activity;
- normalization of body weight.
In a broad sense, the prevention of extrasystole involves the prevention of pathological conditions and diseases underlying its development: coronary heart disease, cardiomyopathies, myocarditis, myocardial dystrophy, etc., as well as the prevention of their exacerbations. It is recommended to exclude drug, food, chemical intoxications that provoke extrasystole.
Patients with asymptomatic ventricular extrasystole and without signs of cardiac pathology are recommended a diet enriched with magnesium and potassium salts, quitting smoking, drinking alcohol and strong coffee, moderate physical activity.
The main rules of prevention are:
- Therapy of concomitant pathologies of the cardiovascular, circulatory, endocrine and nervous systems.
- Do not self-medicate and do not take potent tranquilizers, hormones, sedatives.
- Time to undergo control diagnostics.
Relapse is characteristic of extrasystole disease, therefore, after the end of the course of therapy, a control diagnosis of heart rhythm should be regularly performed.
This article is posted for educational purposes only and is not scientific material or professional medical advice.
The consequences of ventricular extrasystoles can be extremely dangerous, even fatal, therefore their prevention is important. It includes:
- Maintaining a healthy lifestyle. It is necessary to observe the daily regimen, to devote enough time to sleep and rest, to avoid excessive physical and emotional stress;
- Balanced diet. Do not eat a lot of fried, salty, spicy. It is helpful to include foods that are high in fiber in your diet;
- Rejection of bad habits. Alcohol and smoking exacerbate many diseases of the cardiovascular system;
- Periodic examination of the body. It is necessary to consult a doctor on time in case of any complaints, as well as periodically undergo medical examination according to age;
- Treatment of diseases, compliance with all doctor’s prescriptions. It is not necessary to treat diseases on their own, folk remedies, as well as arbitrarily cancel or change the dosage of drugs prescribed by a cardiologist.
Supraventricular extrasystole refers to common heart rhythm disturbances. Rare, solitary premature heart contractions in healthy people do not lead to dangerous consequences for health and life. More dangerous is the frequent extrasystole with the presence of episodes of paroxysmal supraventricular tachycardia, which can lead to hemodynamic disorders and the development of atrial fibrillation.
The following measures are recommended for prevention of NZhE:
- If you have a hereditary predisposition to heart disease, you need to contact a cardiologist as soon as possible.
- Very carefully and only under the supervision of a doctor, use drugs that affect the heart rate and electrolyte composition of the blood (diuretics, glycos >
Having dealt with the classification of ventricular extrasystole, realizing what it is, against the background of what diseases it occurs, a few words should be said about the prognosis.
A prognostic assessment of extrasystole depends on the presence of organic damage to the heart and the degree of ventricular dysfunction. The most serious concerns are caused by extrasystoles that developed against the background of acute myocardial infarction, cardiomyopathy, and myocarditis. With severe morphological changes in the myocardium, extrasystoles can go into atrial fibrillation or ventricular fibrillation. In the absence of structural damage to the heart, extrasystole does not significantly affect the prognosis.
The malignant course of supraventricular extrasystoles can lead to the development of atrial fibrillation, ventricular extrasystoles – to persistent ventricular tachycardia, ventricular fibrillation and sudden death. The course of functional extrasystoles is usually benign.
The prognosis depends on the degree of ventricular dysfunction of the heart and impulse disturbance. Ventricular extrasystoles in the absence of organic lesions of the heart, as a rule, do not pose a danger to life. With timely, correctly selected treatment and the implementation of the recommendations of the attending physician, the prognosis is favorable.
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.
There are several mechanisms of the origin of extrasystoles:
- Re-entry of the excitation wave (re-entry). Normally, an electrical impulse passes through the conduction system of the heart only once, after which it fades. Upon re-entry, the impulse can again spread to the myocardium, causing its premature excitation. Then there is a circulation with repeated re-excitation of tissue in the absence of an interval of relaxation of the heart.
- An increase in myocardial excitability that occurs below the sinus node as a result of various factors. At the same time, the activity of the cell membranes of individual sections of the atria and the AV connection increases.
It should be noted that the ectopic (incorrect) impulse from the atria spreads from top to bottom along the conduction system of the heart. The extraordinary impulse arising in the AV connection spreads in two directions: from top to bottom along the conduction system of the ventricles and from bottom to top (in the opposite direction) through the atria.
The identification of the etiopathogenetic mechanism (i.e., the cause and development mechanism) of the occurrence of supraventricular extrasystoles is very important, since this determines the therapeutic tactics.
With a thorough questioning of the patient, it is possible not only to identify signs of various heart diseases, but also to establish the frequency and regularity of smoking, drinking tea, coffee, alcohol, psychostimulants and drugs, as well as a number of medications that provoke supraventricular extrasystole. The mechanism of the appearance of extrasystoles in this case is associated with stimulation of the sympathetic nervous system.
In all patients with NZhE, it is necessary to check the function of the thyroid gland, since a change in its functional state sometimes causes arrhythmia. For example, an increase in the level of thyroid hormones can cause palpitations, supraventricular and ventricular extrasystoles, and atrial fibrillation. If you subsequently need to prescribe the antiarrhythmic drug Amiodarone, you must definitely check the level of hormones TSH, T3 and T4.
In the case of acute development of supraventricular extrasystole, it is necessary to exclude hypokalemia, i.e., a decrease in the level of potassium in the blood.
The connection of the first episode and repeated intensifications of extrasystole, which flows in waves, with infections indicates myocarditis. The appearance or intensification of extrasystole may be the only or one of the manifestations of IHD. In this case, an increase in interruptions in the work of the heart during physical exertion is characteristic, when a mismatch in the blood supply to the heart and an increased need for blood flow is manifested. With other identified organic heart diseases (heart defects, cardiomyopathies, hypertension, mitral valve prolapse), the severity of supraventricular extrasystole is often associated with the magnitude of the expansion of the atria.
Often, it is possible to identify a connection between NJE and activation of the sympathetic (during exertion) or parasympathetic (during sleep, after eating, with gallstone disease, prostate adenoma) nervous system . In the first case, during exercise, the amplitude and heart rate increases, which can provoke supraventricular extrasystole. In the second, the heart rate slows down, which can also cause rhythm disturbance.
The phenomenon of ventricular extrasystole (VES) is an extraordinary single myocardial contractions that occur under the influence of premature electrical impulses that come from the walls of the chambers of the right or left ventricle, as well as nerve fibers of the cardiac conduction system (His bundle, Purkinje fibers). As a rule, extrasystoles that occur during ZhES negatively affect only the ventricular rhythm, without disturbing the functioning of the upper parts of the heart.
The standard classification according to Laun was created on the basis of the results of daily monitoring of the ECG according to Holter. 6 classes of ventricular extrasystole are distinguished in it:
- 0 class. On the ECG, frequent ventricular extrasystole is absent, the patient does not have any changes in the work of the heart or morphological changes.
- 1 class. During one hour of observation, less than 25-30 single monomorphic (monotopic, identical) ventricular pathological contractions were recorded.
- 2nd grade. During the hour of the study, more than 30 single monomorphic or 10-15 paired extrasystoles were recorded.
- 3rd grade. During the first 15 minutes, at least 10 paired, polymorphic (polytopic, heterotypic) extrasystoles are recorded. Often this class is combined with atrial fibrillation.
- 4a grade. Monomorphic paired ventricular extrasystoles were recorded for an hour;
- 4b class. Throughout the study, polymorphic paired ventricular extraordinary contractions are recorded.
- 5th grade. Group or salvo (3-5 consecutive for 20-30 minutes) polymorphic contractions were recorded.
Frequent ventricular extrasystole of class 1 does not manifest symptomatically, is not accompanied by serious pathological changes in hemodynamics, therefore it is considered a variant of the physiological (functional) norm. Extraordinary reductions of grades 2-5 are combined with a high risk of developing atrial fibrillation, sudden cardiac arrest and death. According to the clinical classification of ventricular arrhythmias (according to Mayerburg), there are:
- Extrasystoles of a benign, functional course. They are characterized by the absence of vivid clinical symptoms of organic pathology of the myocardium and any objective signs of left ventricular dysfunction. The function of the ventricular node is preserved and the risk of cardiac arrest is minimal.
- Ventricular arrhythmias of a potentially malignant course. They are characterized by the presence of extraordinary contractions against the background of morphological lesions of the heart muscle, a decrease in cardiac output by 20-30%. They are accompanied by a high risk of sudden cardiac arrest, characterized by gradation to the malignant course.
- Arrhythmias of the malignant course. They are characterized by the presence of ventricular extraordinary contractions against the background of severe organic myocardial lesions, accompanied by a maximum risk of sudden cardiac arrest.
The appearance of extraordinary contractions of the ventricles is due to organic pathologies of the myocardium, the use of drugs. In addition, extrasystole is a frequent complication of other systemic lesions: endocrine diseases, malignant tumors. One of the most common causes of HPP are:
- ischemic disease;
- myocardial infarction;
- arterial hypertension;
- pulmonary heart;
- chronic heart failure;
- mitral valve prolapse;
- uncontrolled intake of M-anticholinergics, sympathomimetics, diuretics, cardiac glycosides, etc.
Functional or idiopathic ventricular arrhythmia is associated with smoking, stressful conditions, the use of large quantities of caffeinated drinks and alcohol, which lead to an increase in the activity of the autonomic nervous system. Often extrasystole occurs in patients who suffer from cervical osteochondrosis.
Single premature myocardial contractions are recorded in many healthy young people in the process of monitoring heart function during the day (Holter ECG monitoring). They do not have a negative impact on well-being, a person does not note their presence in any way. Symptoms of extraordinary contractions occur when hemodynamics are disturbed due to extrasystoles.
Ventricular arrhythmia without morphological lesions of the myocardium by the patient is difficult to tolerate, there are attacks of suffocation, panic. This condition, as a rule, develops against the background of bradycardia, the following clinical manifestations are characteristic of it:
- sensation of sudden cardiac arrest;
- individual strong blows in the chest;
- worsening after eating;
- disruption of the heart in the morning after waking up, an emotional outburst or during physical activity.
Extraordinary contractions of the ventricular myocardium on the background of morphological disorders of the heart, as a rule, are multiple (polymorphic) in nature, but for the patient often proceed without clinical manifestations.
Symptoms develop with significant physical exertion, disappear when lying or sitting.
This type of right ventricular or left ventricular arrhythmia develops against the background of tachycardia and is characterized by:
- a feeling of panic, fear;
- darkening in the eyes;
- loss of consciousness.
The main diagnostic method for frequent ventricular extrasystole is to record an electrocardiogram at rest and a -hour Holter monitor.
A daily study of the ECG helps to determine the number, morphology of pathological contractions, how they are distributed throughout the day, depending on various factors and conditions of the body (sleep, wakefulness, and the use of drugs). In addition, the patient, if necessary, is additionally prescribed:
- electrophysiological study of the myocardium by stimulating the heart muscle with electric pulses while observing the result on an ECG;
- echocardiography or ultrasound (ultrasound) – determination of the morphological cause of arrhythmia, which, as a rule, is associated with impaired hemodynamics;
- laboratory tests for the determination of fast phase protein, electrolytes, the level of pituitary hormones, adrenal glands and the thyroid gland, the number of globulins.
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