Supraventricular extrasystole as bigeminia

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 [6].

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 [3]. 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.

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.
  • single;
  • 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 [9].

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 [4]. 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) [10]. A harbinger of atrial fibrillation is a frequent group supraventricular extrasystole with runs of paroxysmal (paroxysmal) supraventricular tachycardia.

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 [2].

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) [7].

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.

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 foodsProducts 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.
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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 [11].

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) [000].

What are their differences?

The normal heart rate is 60-90 beats per minute. With its violation, extrasystoles (extraordinary contractions) occur at different intervals.

When they come from the sinus node, this is called sinus arrhythmia. In other cases, they are formed not in the sinus node, but in other parts of the myocardium.

The extraordinary contraction that appears after each normal impulse is called bigeminia. In other words, the ratio of correct and premature pulses is 1: 1. This is the most common heart rhythm pathology. It is recorded in 60% of cases.

When there is one extraordinary reduction in two correct contractions, this is trigeminia (2: 1).

With a ratio of 3: 1 – after three normal strokes, one wrong one occurs, this is quadrigemia.

And also there is pentaeminia (4: 1) and paired extrasystoles – double atypical contractions.

How dangerous is this?

Heart rhythm disturbances are always dangerous. When allorhythmic impulses occur, the correct movement of blood through the heart stops, areas with stagnation, turbulence occur.

Because of this, blood clots form in areas with “incorrect” blood flow, which, when torn off, cause fatal complications.

Extrasystole as bigeminia can cause the following complications:

  • Atrial fibrillation (a pathological condition caused by an irregular contraction of fibers in the myocardium).
  • Atrial flutter (atrial fibrillation, in which an enhanced rhythm of contractions prevails – the pulse reaches 200-400 beats per minute).
  • Heart palpitations caused by frequent contraction of the ventricles.
  • Ventricular fibrillation (chaotic, uncoordinated contractions).
  • Asystole – termination of the bioelectric activity of the myocardium. This is very dangerous for the patient, since it entails cardiac arrest, after which clinical death occurs.

When predicting the effects of bigeminia, the patient’s age, physical condition, and the presence of concomitant diseases must be taken into account. If a person does not have serious pathologies of blood vessels and heart tissues, then there will be no serious complications.

When a rhythm disorder occurs due to myocardial damage, it is necessary to treat the underlying disease. Ignoring it can lead to death.

Bigeminia alone is not a disease. The appearance of extrasystoles also occurs in healthy people. Extraordinary impulses sometimes occur, and then disappear within a day, which is recognized as the norm.

If a heart rhythm failure takes 5-15 minutes a day, this is not considered a pathology. But when the episodes of chaotic contractions are greatly lengthened, you should pay attention to this and go through an examination.

Transient rhythm disturbances are common in pregnant women. A rare extrasystole does not pose a threat to the fetus. After birth, the mother’s condition usually stabilizes.

Acquired bigeminia in children is associated with past infections, heart complications after complex diseases. In older children, it occurs against the background of intoxication with drugs and food poisoning.

Other diagnostic methods

With allorrhythmia, in addition to conventional electrocardiography, comprehensive studies are carried out to identify its causes.

To clarify the degree of rhythm disturbance, an ECG is performed according to Holter. This is a diagnostic method in which prolonged registration of the electrical activity of the heart is carried out.

Holter daily monitoring is an informative examination that allows you to effectively identify cardiovascular pathologies.

Additionally, the patient is prescribed:

  • Clinical and biochemical blood tests. These studies make it possible to establish the presence of an inflammatory process in the body, the state of metabolism.
  • Ultrasound examination of the heart muscle. It allows you to detect changes in the structure of the myocardium.
  • ECG with stress tests. It is prescribed to compare cardiac arrhythmias with physical activity.

Detection on an ECG of allorhythmia is usually not difficult. In rare episodes, a rhythm disturbance can be recorded with daily monitoring according to Holter. But this does not end the diagnostic search if the cause of this arrhythmia is unknown. Therefore, patients with a newly diagnosed extrasystole are:

  • Ultrasound to detect defects, endocarditis;
  • ECG with stress tests or stress echocardiography to determine the tolerance of physical activity and possible manifestations of circulatory failure, myocardial ischemia;
  • a blood test to determine the activity of inflammation, the state of cholesterol metabolism;
  • CT and MRI scintigraphy to study the structure of the heart muscle;
  • electrophysiological study to detect hidden forms of allorhythmia.

The provoking factors

The reasons why allorhythmia occurs are divided into external and internal.

External include functional causes (the functions of an organ fail without destroying its structure). To internal – organic disturbances.

And it is also possible idiopathic development of pathology, when the cause could not be identified.

The functional causes of rhythm disturbances can be caused by mental disorders (stress, neurosis) or intoxication of the body.

Extrasystoles, provoked by intoxication, arise due to:

  • chemical poisoning of the body;
  • frequent smoking or alcoholism;
  • abuse of coffee, strong tea, energy;
  • antibiotic treatment for severe infections;
  • long-term use of steroids;
  • overdose of cardiac glycosides;
  • thyroid dysfunction.

Poisoning the body provokes ventricular type bigeminia.

Organic factors include the following diseases:

  • Coronary heart disease.
  • Inflammation of the tissues of the heart muscle.
  • Atherosclerosis is the appearance of plaques on the walls of the coronary arteries that impede blood circulation.
  • High blood pressure.
  • Cardiosclerosis.
  • Defects of the mitral and aortic valves.
  • Cardiomyopathy is a chronic neuromuscular pathology of the heart.
  • Pulmonary heart – an increase in the right heart due to lung disease.
  • Damage to the serous membrane of the heart.
  • Disruption of the heart due to strong physical exertion.
  • Heart defects.

Sometimes a heart rhythm failure causes surgery. As well as extrasystoles can appear due to coronary angiography, sensing of the heart muscle.

Treatment options

The restoration of heart rhythm with allorhythmia is carried out by selecting antiarrhythmic drugs, with inefficiency, radiofrequency ablation is prescribed.

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Medicamentous

Votoka are indications for the appointment of drugs that block:

  • beta-adrenergic receptors – Bisoprolol, Atenol;
  • calcium channels – Verapamil, Diltiazem;
  • sodium channels – Novocainam >

If a steady improvement is achieved, then a gradual dose reduction is possible after two months of rhythm stabilization. With a malignant form of arrhythmia, the threat of its transformation into atrial or ventricular fibrillation, taking antiarrhythmic medications can be lifelong. For effective treatment, it is required to find the cause of extrasystole and conduct a full therapy of the background disease.

When taking tablets, activated carbon in high doses is prescribed, Unitiol, potassium salts are introduced. Gastric lavage, infusion therapy, and hemodialysis are ineffective.

Surgical

In some cases, it is not possible to restore the normal rhythm even when changing several drugs and when combining them. In this case, the procedure of radiofrequency ablation (cauterization) of the source of extrasystoles is prescribed, if it was possible to identify. If it is impossible to detect a pathological zone of excitation and in a serious condition of the patient by ablation, you can create an artificial complete transverse blockade, then set a pacemaker.

Alorrhythmia is the alternation of extrasystoles with normal contractions in a certain ratio. Bigeminia and trigeminia are the most common options; they occur when there are scars in the myocardium, an inflammatory process, or an overdose of glycosides. Manifestations of allorhythmia are associated with impaired functioning of the heart and insufficient blood flow to the brain cells.

Diagnosis of the pathology includes the detection of arrhythmias, stress tests and the search for the cause of development. For treatment, antiarrhythmic drugs and radiofrequency ablation of the source of extrasystoles are used.

symptomatology

Bigeminia and trigeminia do not have specific symptoms. This means that there are no pronounced signs by which pathology can be determined.

Manifestations of heart rhythm disturbances are similar to other cardiac pathologies: discomfort behind the sternum, a feeling of interruptions in the work of the heart, a general deterioration in well-being.

Symptoms are divided into cardiac and somatic. Patients suffer seizures differently. Their well-being depends on the physical condition, individual characteristics, age.

CardiacSomatic
Strong tremors of the heart, alternating with fadingLethargy, weakness
NauseaDizziness
Feeling of lack of airVisual disturbances
Heaviness, chest pressureOccurrence of anxiety
ShiverFainting
Pallor of the skinDecreased sensitivity of arms and legs
Increased sweatingRarely – speech impairment

Treatment of pathology

In the normal state of the body, cardiac structures contract autonomously. This provides a certain margin of safety for the body to maintain the minimum necessary activity in emergency cases when the mind is disconnected or the brain is damaged.

The so-called sinus node is responsible for generating an electrical signal that excites the muscle structures of the myocardium. It is located in the upper part of the organ.

The ventricles and atria are not normal only conduct impulse, they themselves do not create it. In the case of bigeminia, pathological activity occurs in these structures. As the name implies, for each normal contraction, there is one abnormal (extrasystole).

This alternation is clearly visible on the ECG, which makes diagnosis even in the early stages relatively easy.

It is impossible to talk about the severity and prospects of the process by one factor alone. Much depends on the location of the anomaly (atrial forms of extrasystole almost never carry a danger, not to say about the ventricular). The main disease, general health, the moment of going to the doctor also plays a role.

As already mentioned, the deviation is not primary. It is secondary to cardiac diseases, less often to extracardiac pathologies.

Which one – you need to look during the diagnosis. Usually these are congenital and acquired defects, hormonal disruptions, bad habits that provoke temporary or permanent changes in the work of the whole organism, etc.

In some cases, bigeminia can be completely eliminated. This happens in situations where it is possible to eliminate the cause of allorhythmia, for example, thyrotoxicosis, myocarditis, infectious disease, electrolyte imbalance. In severe cases, get rid of bigeminia allows surgical intervention – the destruction (ablation) of the focus of pathological impulses using high-frequency current.

Antiarrhythmic drugs for any type of extrasystole, including bigeminia, are used according to strict indications. According to studies, occasionally occurring episodes of bigeminia in themselves do not harm the body and rarely lead to circulatory disorders.

Deciding on the need for antiarrhythmic therapy depends on a risk assessment. Firstly, with supraventricular bigeminia, there is a danger of developing supraventricular tachycardia, a rhythm disturbance in which the frequency of contractions reaches 140–180 per minute. The condition is dangerous due to the possibility of developing heart failure and requires urgent measures to normalize the rhythm.

Indications for the appointment of antiarrhythmic drugs with extrasystole:

  • frequent attacks of bigeminia, leading to impaired blood movement in the body;
  • severe tolerance by the patient of extrasystole;
  • deterioration of the functional ability of the heart muscle during ultrasound examination of the heart, tracked in dynamics.

In supraventricular bigeminia, the drugs of choice are beta adrenoblocker groups (anaprilin, atenolol, metoprolol) or calcium antagonists (verapamil, diltiazem). With their lack of effectiveness, effective drugs from other groups or a combination of two drugs are selected.

With ventricular extrasystole, regarded as potentially dangerous or malignant, amiodarone and beta-blockers are prescribed. These drugs can improve the prognosis of heart disease and reduce the risk of death.

Class 1 antiarrhythmics (propafenone, etatsizin, etmozin) are prescribed only for arrhythmias that are not associated with coronary artery disease.

Radiofrequency ablation is indicated for bigeminia, leading to impaired blood movement in the body and an increased risk of sudden death, in the case of ineffective antiarrhythmic therapy. This surgical procedure is possible only with a detected focus of extrasystole. The electrodes are introduced through venous access and, after conducting an electrophysiological study, exert a radiofrequency effect on the source of arrhythmia, destroying it.

Click on the photo to enlarge

Signs on an ECG

Electrocardiography is a reliable way to detect bigeminia and other types of allorrhythmias.

Heart rhythm disturbance is easily recognized on the charts of the cardiogram. Upon examination, the doctor sees that behind each normal heart contraction there is an extraordinary impulse. It looks like two QRS prongs nearby. They are separated by a horizontal line showing relaxation of the heart muscles.

The shape of the pulse is determined by the change in electric forces when overcoming the excitation wave in the myocardium. Extrasystole has a long narrow tooth preceding the normal QRS complex. Its frequency is less than that of a pulse coming from the sinus node.

When decoding the ECG, the cardiologist should pay attention to the site of the occurrence of a premature impulse. Of great concern is the early ventricular impulse (when the next tooth is superimposed on the previous tooth).

In the case when rare extrasystoles are recorded on the ECG and bigeminia is not systemic, but the patient complains of a heart, he is sent for an additional examination.

  • The premature appearance of the QRS complex (in itself it is already 0.12 seconds) and P wave. Against the background of the ventricular type, the situation is exactly the opposite.
  • Small compensatory pause with atrial varieties.

Possible other deviations. The assessment is carried out by the doctor of functional diagnostics. Repeated decoding and clarification falls on the shoulders of an already treating specialist.

Sustainable bigeminia on the ECG is clearly visible, even a novice cardiologist can ascertain the fact, without much experience in the practical management of patients.

Complications

Terrible in nature, but again due to extrasystole, rarely occur. The greatest danger is its ventricular type.

Among the possible consequences:

  • Heart failure. Perhaps the main cause of death for patients of all ages. With competent resuscitation, you can return a person to life.
  • Cardiogenic shock. As a result of a generalized hemodynamic disorder or severe heart attack. Recovery is possible in an extremely limited number of cases, and even then no one will guarantee no relapse. Mortality is almost 100%.
  • Fainting and subsequent trauma.
  • Stroke. Acute cerebrovascular accident, death of nerve tissue.
  • Vascular dementia. It is similar to Alzheimer’s disease, but it flows relatively favorably, it has prospects for reverse development.
  • Heart attack. Necrosis of cardiomyocytes, replacement of functional structures by connective, cicatricial.
  • Multiple organ failure. Over time, as distant systems receive less blood.

Complications are potentially fatal, but they can be avoided with timely medical attention.

Any kind of rhythm disturbance can be complicated by the development of life-threatening conditions. Supraventricular arrhythmias can cause atrial fibrillation and flutter, ventricular extrasystoles, including those of the type of bigeminia and trigeminia, are complicated by fibrillation and complete cardiac arrest. Premature contraction, causing a malfunction in the biomechanics of the heart, leads to a violation of blood rheology. Generated turbulent blood flows become sources of blood clots.

Atherosclerotic vascular disease aggravates a similar condition. Frequent ventricular extrasystole as bigeminia worsens the supply of blood to the brain and heart. Ischemia of the tissues of these organs is manifested by dizziness, loss of consciousness and cardialgia. Timely diagnosis with an assessment of the nature of rhythm disturbances, elimination of provoking factors, treatment of the underlying and concomitant diseases – all this will help to avoid the development of complications.

preventive measures

Prevention of allorhythmia consists in procedures for the general improvement of the body:

  • Refusal of bad habits (smoking, drinking).
  • Performing moderate physical exertion with the exception of weight lifting.
  • Normalization of nutrition. It is necessary to refuse harmful food – fatty, fried, spicy, in favor of natural – vegetables, fruits, herbs, dietary meat, fish.
  • Stabilization of the mental state. Well healing baths, walks in the fresh air help.
  • Therapeutic physical education, spa treatment

To prevent heart disease, prevention is essential.

A correct lifestyle and a comfortable mental state of a person are the key to his good health.

Forecast

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:

  1. If you have a hereditary predisposition to heart disease, you need to contact a cardiologist as soon as possible.
  2. Very carefully and only under the supervision of a doctor, use drugs that affect the heart rate and electrolyte composition of the blood (diuretics, glycosides).
  3. In the presence of endocrine diseases (diabetes mellitus, hyperfunction of the adrenal glands or thyroid gland), it is necessary to undergo an examination for the development of cardiovascular pathologies.
  4. Refuse bad habits: smoking, drinking, etc.
  5. Observe the regimen of the day (you need a good sleep and rest). Eating in a balanced way: include foods enriched with potassium, magnesium in the diet; eliminate too hot, fried and spicy foods.
  6. If possible, reduce the effect of stressful factors, avoid emotional overstrain. You can consider the use of relaxation methods and autogenic training.

Even a leading doctor will not be able to give exact numbers. Approximately 12% of patients with atrial bigemia over the course of 10 years without treatment suffer from complications of a fatal or disabling plan.

The ventricular form is even more severely tolerated – 30-40% are fatal. Against the background of therapy, the forecasts are much more optimistic.

You can say something specific after a long observation of the patient, his response to treatment and general developmental paths. All questions should be asked to the doctor.

A single rare atrial failure of the rhythm or ventricular extrasystoles occur in completely healthy people without any manifestations. Estimation of the prognostic significance of ventricular bigeminias and trigeminias will be allowed by the division into classes according to Laun:

  • Grade 1 – no more than 30 units per hour;
  • 2 – more than 30 solo per hour;
  • 3 – polymorphic (unequal in shape) and polytopic type (having a different source of occurrence);
  • Grade 4 – paired or group;
  • Grade 5 – “early” extrasystoles.
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    The first two classes are regarded as non-hazardous. Starting from the 3rd, the risk of developing fatal rhythm disturbances increases significantly.

    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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