What does single ventricular extrasystole mean? 2. Frequent ventricular extrasystole: causes and treatment of the disease

Today, the most common heart disease is ventricular extrasystole. It is accompanied by rhythm disturbances and contractions of the ventricles of the heart.

All age groups of people are susceptible to this disease. Therefore, at the first manifestations of the disease, it is necessary to consult a doctor and undergo all the necessary tests. At an advanced stage, thrombosis may occur, which will lead to new problems.

To cope with the pathology, it is necessary to undergo a comprehensive diagnosis, after which the cardiologist will prescribe appropriate effective treatment. In the material below you will learn what ventricular extrasystole is and what are the signs of the disease, treatment principles and consequences.

Ventricular extrasystole

Ventricular extrasystole is the most common form of arrhythmias, in which premature excitation and contraction of the ventricular myocardium is observed. The area of ​​the myocardium that independently generates an impulse is called an arrhythmogenic focus.

According to experts, single extrasystoles are observed in every second person. This rhythm disturbance in practically healthy young people is usually asymptomatic and in most cases is an incidental finding during electrocardiography (ECG).

The occurrence of ventricular extrasystole is not a reason for panic, but a good reason for further examination. In some cases, the occurrence of this kind of arrhythmias in patients with severe heart disease (myocardial infarction, cardiomyopathy) creates a risk of developing a more serious heart rhythm disorder, such as fibrillation or ventricular fibrillation. Source "zdravoe.com"

Extrasystole is one of the most common types of arrhythmias. Long-term ECG monitoring in random samples of people over 50 years of age showed that this pathology is diagnosed in 90% of patients.

Any heart disease (myocarditis, ischemic heart disease, heart defects, cardiomyopathies, etc.) can cause extrasystole. In some cases, this cardiac arrhythmia occurs due to extracardiac diseases: systemic allergic reactions; hyperthyroidism; intoxication in infectious diseases, etc.

In addition, extrasystole can sometimes occur due to strong emotional stress and be a manifestation of viscero-visceral reflexes in case of diaphragm hernia, stomach diseases and cholecystitis. Often it is not possible to determine the exact cause of this pathology.

Experts adhere to two theories of its occurrence. The first is based on the mechanism of excitation input in Purkenje fibers. The second theory states that extrasystole is the result of periodic activation of a “dormant” focus of heterotopic automatism. The latter also applies to parasystole.

In the absence of pronounced organic changes in the myocardium, extrasystole does not affect hemodynamics. With severe heart pathology and signs of heart failure, extrasystole can significantly worsen the prognosis of patients. One of the most dangerous in prognostic terms is ventricular extrasystole (VC), which can be a harbinger of such life-threatening heart rhythm disturbances as ventricular tachyarrhythmia. Source "propanorm.ru"

There are several options for classifying ventricular extrasystole. The need to know all possible options for dividing them into groups is due to differences in symptoms, prognosis and treatment options for the pathology.

One of the most important criteria when classifying such extrasystoles is the frequency of occurrence of extrasystoles.

Extrasystole (ES) is understood as a single extraordinary contraction. Thus, we distinguish:

1. Rare (up to 5 per minute).
2. Less rare (medium frequency ES). Their number can reach 16 per minute.
3. Frequent (more than 16 within one minute).

An equally important option for dividing ES into groups is the density of their occurrence. This is sometimes called "ECG density":

1. Single extrasystoles.
2. Paired (two ES following each other).
3. Group (three or more).

Depending on the place of occurrence, there are:

1. Left ventricular.
2. Right ventricular.

Division by the number of pathological foci of excitation:

1. Monotopic (one focus).
2. Polytopic (several foci of excitation, which can be located in one ventricle or in both).

Classification by rhythm:

1. Allorhythmic - periodic extrasystoles. In this case, instead of every second, third, fourth, etc. During normal contraction, ventricular extrasystole occurs:

• bigeminy - every second contraction is an extrasystole;
• trigeminy – every third;
• quadrigeminy - every third, etc.

Sporadic - irregular extrasystoles, independent of the normal heart rhythm.

Based on the results of interpretation of Holter monitoring, several classes of extrasystoles are distinguished:

• 0 class – no ES;
• class 1 – single rare monotopic ES, not exceeding 30 per hour;
• class 2 – similar to class 1, but with a frequency of more than 30 per hour;
• class 3 – single polytopic ES;
• class 4A – polytopic paired ES;
• class 4B – any group ES with periods of ventricular tachycardia;
• class 5 – the appearance of early extrasystoles, occurring at the moment of relaxation of the muscle tissue of the heart. Such ES are extremely dangerous, because may be precursors to cardiac arrest.

This Wolf-Lown classification was developed for a more convenient assessment of the degree of risk and prognosis of the disease. Class 0 – 2 poses virtually no threat to the patient.

When choosing a treatment method, doctors rely mainly on the classification depending on the degree of benignity of the extrasystole. There are benign, potentially malignant and malignant courses. Source "webmedinfo.ru"

Depending on the meta-detection of extrasystoles, monotopic and polytopic ventricular extrasystoles should be distinguished. There are also two types depending on the location of diagnosis of extrasystoles:

1. Right ventricular - this type is less common, probably due to the peculiarities of the anatomical structure of the heart;
2. Left ventricular - occurs most often.

Thanks to the possibility of early diagnosis of the presence of extraordinary ventricular contractions, the earliest possible start of treatment is possible.

There are several types of classifications:

1. By ryan

   You should also know about methods for classifying this pathological condition depending on the method of their diagnosis; for example, the Ryan classification allows you to divide the manifestations of pathology into classes:

• class 0 is not observed, has no visible symptoms and is not detected during a 24-hour ECG;
• ventricular extrasystole grade 1 according to Ryan is characterized by the identification of infrequent monotopic contractions;
• Class 2 has frequent contractions of a monotopic nature;
• the third class according to this classification is characterized by polytopic contractions of the heart ventricle;
• ventricular extrasystole grade 3 according to Ryan - these are multiple paired polymorphic contractions that are repeated with a certain frequency;
• for class 4a monomorphic paired contractions of the ventricle should be considered characteristic;
• class 4b should be characterized by paired polymorphic abbreviations;
• in the fifth class of pathology, the development of ventricular tachycardia is observed.

By Lown
The classification of ventricular extrasystole according to Lown is characterized by the following features:

• class zero has no obvious manifestations and is not diagnosed during a 24-hour ECG;
• for the first class, infrequent monotypic contractions with a repetition frequency within 30/60 contractions should be considered characteristic;
• the second class is distinguished by pronounced frequent contractions with a monotopic character;
• with the development of pathology up to the third class, polymorphic contractions of the ventricle are observed;
• class 4a - manifestation of paired contractions;
• Class 4b is characterized by the occurrence of ventricular tachycardia;
• For the fourth class with this classification option, the manifestation of early PVCs, which occur in the first 4/5 of the T wave, is characteristic.

The above two classification options are most often used today and allow us to most fully characterize the patient’s condition. Source "gidmed.com"

Causes of the disease

There are 8 groups of causes leading to the development of ventricular extrasystole.

1. Cardiac (heart) causes:

• coronary heart disease (insufficient blood supply and oxygen starvation) and myocardial infarction (death of a section of the heart muscle from oxygen starvation with its further replacement by scar tissue);
• heart failure (a condition in which the heart does not fully perform its function of pumping blood);
• cardiomyopathies (heart diseases manifested by damage to the heart muscle);
• congenital (arising in utero) and acquired heart defects (serious abnormalities in the structure of the heart);
• myocarditis (inflammation of the heart muscle).

Medicinal (medicinal) causes - prolonged or uncontrolled use of certain medications, such as:

• cardiac glycosides (drugs that improve heart function while reducing the load on it);
• antiarrhythmic drugs (drugs that affect heart rhythm);
• diuretics (medicines that increase the production and excretion of urine).

Electrolyte disturbances (changes in the proportions of the ratio of electrolytes (salt elements) in the body - potassium, sodium, magnesium).

Toxic (poisonous) effects:

• alcohol;
• smoking.

Imbalance (impaired regulation) of the autonomic nervous system (the part of the nervous system responsible for regulating the vital functions of the body - breathing, heartbeat, digestion).

Hormonal diseases (thyrotoxicosis, diabetes mellitus, adrenal gland diseases).

Chronic hypoxia (oxygen starvation) in various diseases - sleep apnea (short-term pauses in breathing during sleep), bronchitis (inflammation of the bronchi), anemia (anemia).

Idiopathic ventricular extrasystole that occurs for no apparent reason (detectable during examination). Source "lookmedbook.ru"

The most common causes of the occurrence and further development of this pathological contraction of the ventricle are organic lesions of the cardiac system, which are idiopathic in nature.

The reasons causing the development of ventricular extrasystole include:

• myocardial infarction - in this case about 95% of cases of extrasystoles are detected;
• post-infarction cardiosclerosis;
• mitral valve prolapse;
• arterial hypertension;
• pericarditis;
• heart failure.

Also, the development of the pathological condition under consideration should include the use of diuretics, pacemakers, and some types of antidepressants. Source "gidmed.com"

Single ventricular premature contractions are recorded in half of healthy young people during monitoring for 24 hours (Holter ECG monitoring). They do not affect your well-being.

Symptoms of ventricular extrasystole appear when premature contractions begin to have a noticeable effect on the normal rhythm of the heart.

Ventricular extrasystole without concomitant heart diseases is very poorly tolerated by the patient.

This condition usually develops against the background of bradycardia (slow pulse) and is characterized by the following clinical symptoms:

• a feeling of cardiac arrest, followed by a whole series of beats;
• from time to time, separate strong blows are felt in the chest;
• extrasystole may also occur after eating;
• a feeling of arrhythmia occurs in a calm position (during rest, sleep or after an emotional outburst);
• During physical activity, the disturbance practically does not appear.

Ventricular extrasystoles against the background of organic heart diseases, as a rule, are multiple in nature, but for the patient they are asymptomatic. They develop with physical activity and go away while lying down. Typically, this type of arrhythmia develops against the background of tachycardia. Source "zdorovko.info"

Extrasystole does not always have a clear clinical picture. Its symptoms depend on the characteristics of the body and the various forms of the disease. Most people do not feel discomfort and are unaware of this arrhythmia until it is accidentally detected on an ECG. But there are patients who tolerate it very hard.

As a rule, extrasystole manifests itself in the form of strong heartbeats, sensations of its fading or a short-term stop followed by a strong push to the chest. Extrasystoles can be accompanied by both pain in the heart and various vegetative and neurological symptoms: pallor of the skin, anxiety, the appearance of fear, a feeling of lack of air, increased sweating.

Depending on the location of the source of excitation, extrasystoles are divided into:

• atrial;
• atrioventricular (atrioventricular, nodal);
• ventricular;
• there is also sinus extrasystole, which occurs directly in the sinus node.

Depending on the number of excitation sources, the following are distinguished:

• monotopic extrasystoles - one focus of occurrence and a stable coupling interval in one section of the cardiogram;
• polytopic extrasystoles – several sources of occurrence at different coupling intervals;
• unstable paroxysmal tachycardia - several successive extrasystoles. Source "aritmia.info"

To determine this type of extrasystole, three main types of diagnostics are sufficient: questioning and examination of the patient, some laboratory and instrumental types of research.

First, complaints are examined. If they are similar to those described above, the presence of an organic pathology affecting the heart should be suspected or determined. The dependence of symptoms on physical activity and other provoking factors is clarified.

When listening (auscultating) the heart, the sounds may be weakened, muffled or pathological. This occurs in patients with hypertrophic cardiopathology or heart defects.

The pulse can be irregular, with different amplitudes. This is explained by the occurrence of a compensatory pause after an extrasystole. Blood pressure can be anything. With group and/or frequent ventricular ES, it may be reduced.

In order to exclude pathology of the endocrine system, hormone tests are prescribed and biochemical blood parameters are studied.

Among the instrumental studies, the main ones are electrocardiography and Holter monitoring.

By interpreting the ECG results, one can detect an extended, altered ventricular QRS complex, in front of which there is no atrial P-wave. This indicates contraction of the ventricles, before which there are no atrial contractions. After this deformed extrasystole, a pause is observed, followed by a normal sequential contraction of the cardiac chambers.

In cases of the presence of an underlying disease, the ECG reveals signs of myocardial ischemia, left ventricular aneurysm, hypertrophy of the left ventricle or other chambers of the heart, and other disorders.

Sometimes, to provoke ventricular extrasystole and study the characteristics of the heart muscle at this moment, stress ECG tests are performed. The occurrence of ES indicates the appearance of arrhythmia due to coronary pathology. Due to the fact that this study, if performed incorrectly, can be complicated by ventricular fibrillation and death, it is carried out under the supervision of a physician. The testing room must be equipped with an emergency resuscitation kit.

Echocardiography detects signs of ischemia or hypertrophy of the left ventricle only in the presence of concomitant myocardial damage.

Coronary angiography is performed to exclude the coronary origin of extrasystole. Source "webmedinfo.ru"

The diagnosis can be made based on:

• analysis of complaints (feeling of “interruptions” in the work of the heart, heartbeats “out of rhythm”, shortness of breath, weakness) and anamnesis of the disease (when the symptoms appeared, what is associated with their appearance, what treatment was carried out and its effectiveness, how the symptoms of the disease changed over the course of time);
• analysis of life history (past diseases and operations, bad habits, lifestyle, level of work and living) and heredity (presence of heart disease in close relatives);
• general examination, palpation of the pulse, auscultation (listening) of the heart (the doctor can detect changes in the rhythm and frequency of heart contractions, as well as the difference between the heart rate and pulse rate), percussion (tapping) of the heart (the doctor can detect changes in the boundaries of the heart caused by its disease , which is the cause of ventricular extrasystole);
• indicators of general and biochemical analysis of blood and urine, analysis of hormonal status (hormone levels), which can identify extracardiac (not related to heart disease) causes of extrasystole;
• electrocardiography (ECG) data, which makes it possible to identify changes characteristic of each type of ventricular extrasystole;
• indicators of daily ECG monitoring (Holter monitoring) - a diagnostic procedure that involves the patient wearing a portable ECG device throughout the day.

  At the same time, a diary is kept in which all the patient’s actions are recorded (getting up, eating, physical activity, emotional anxiety, deterioration in health, going to bed, waking up at night).

  ECG and diary data are compared, thus identifying unstable heart rhythm disturbances (associated with physical activity, food intake, stress, or nocturnal ventricular extrasystoles);

• data from an electrophysiological study (stimulation of the heart with small electrical impulses with simultaneous recording of an ECG) - the electrode is inserted into the heart cavity by inserting a special catheter through a large blood vessel.

  It is used in cases where ECG results do not provide unambiguous information about the type of arrhythmia, as well as to assess the state of the cardiac conduction system;

• Echocardiography data - EchoCG (ultrasound examination of the heart), which allows to identify cardiac causes of ventricular extrasystole (heart disease leading to cardiac arrhythmia);
• the results of stress tests - ECG recordings during and after physical activity (squats, walking on a treadmill or exercise on an exercise bike) - which help identify arrhythmias that occur during physical activity;
• data from magnetic resonance imaging (MRI), which is carried out when echocardiography is not informative, as well as to identify diseases of other organs that may cause arrhythmia (heart rhythm disturbances).

A consultation with a therapist is also possible. Source "lookmedbook.ru"

Basic principles of treatment

Regardless of the causes of ventricular extrasystole, first of all, the doctor is obliged to explain to the patient that PVC, in itself, is not a life-threatening condition. The prognosis in each specific case depends on the presence or absence of other heart diseases, the effective treatment of which can reduce the severity of arrhythmia symptoms, the number of extrasystoles and increase life expectancy.

Due to the presence of so-called minor psychiatric pathology (primarily anxiety disorder) in many patients with PVCs accompanied by symptoms, consultation with an appropriate specialist may be required.

Currently, there is no data on the beneficial effect of antiarrhythmic drugs (with the exception of beta blockers) on the long-term prognosis in patients with PVCs, and therefore the main indication for antiarrhythmic therapy is the presence of an established cause-and-effect relationship between extrasystole and symptoms, with their subjective intolerance.

The most optimal means for treating extrasystole are beta blockers. The prescription of other antiarrhythmic drugs, and especially their combinations, is in most cases unjustified, especially in patients with asymptomatic extrasystole.

If antiarrhythmic therapy is ineffective or the patient does not want to receive antiarrhythmic drugs, radiofrequency catheter ablation of the arrhythmogenic focus of ventricular extrasystole is possible. This procedure is highly effective (80-90% effective) and safe in most patients.

In some patients, even in the absence of symptoms, antiarrhythmic drugs or radiofrequency ablation may be necessary. In this case, indications for intervention are determined individually. Source "mertsalka.net"

To achieve a good therapeutic effect, you must adhere to a healthy diet and regimen.
Requirements that a patient suffering from cardiac pathology must comply with:

• give up nicotine, alcoholic beverages, strong tea and coffee;
• eat foods with a high concentration of potassium - potatoes, bananas, carrots, prunes, raisins, peanuts, walnuts, rye bread, oatmeal;
• in many cases, the doctor prescribes the drug “Panangin”, which contains “heart” microelements;
• give up physical training and hard work;
• during treatment, do not adhere to strict diets for weight loss;
• if the patient faces stress or has restless and intermittent sleep, then light sedatives (motherwort, lemon balm, peony tincture), as well as sedatives (valerian extract, Relanium) are recommended.

The treatment regimen is prescribed on an individual basis and depends entirely on morphological data, the frequency of arrhythmias and other concomitant cardiac diseases.

Antiarrhythmic drugs used in practice for PVCs are divided into the following categories:

• sodium channel blockers - “Novocainamide” (usually used for first aid), “Gilurythmal”, “Lidocaine”;
• beta-blockers - “Cordinorm”, “Carvedilol”, “Anaprilin”, “Atenolol”;
• potassium channel blockers - Amiodarone, Sotalol;
• calcium channel blockers - Amlodipine, Verapamil, Cinnarizine;
• if the patient’s extrasystole is accompanied by high blood pressure, then antihypertensive drugs are prescribed - “Enaprilin”, “Captopril”, “Ramipril”;
• to prevent blood clots - Aspirin, Clopidogrel.

In cases where the result has improved slightly during treatment, treatment is continued for several more months. In the case of a malignant course of extrasystole, drugs are taken for life.

Surgery is prescribed only in cases of ineffective drug therapy. Often this type of treatment is recommended for patients who have organic ventricular extrasystole.

Types of cardiac surgery:

• Radiofrequency ablation (RFA). A small catheter is inserted through a large vessel into the cavity of the heart (in our case, these are the lower chambers) and using radio waves, problem areas are cauterized. The search for the “operated” zone is determined using electrophysiological monitoring. The effectiveness of RFA in many cases is 75-90%.
• Installation of a pacemaker. The device is a box equipped with electronics, as well as a battery that lasts ten years. Electrodes extend from the pacemaker and are attached to the ventricle and atrium during surgery.

  They send electronic impulses that cause the myocardium to contract. The pacemaker essentially replaces the sinus node, which is responsible for rhythm. An electronic device allows the patient to get rid of extrasystole and return to a full life. Source "zdorovko.info"

Treatment goals:

• Identification and treatment of the underlying disease.
• Decrease in mortality.
• Reduced symptoms.

Indications for hospitalization:

• Newly diagnosed PVC.
• Prognostically unfavorable PVC.

Benign ventricular extrasystole, which patients subjectively tolerate well. It is possible to refuse to prescribe antiarrhythmic drugs.

Benign ventricular extrasystole:

• poor subjective tolerability;
• frequent PVC (including idiopathic);
• potentially malignant PVC without pronounced LVH (LV wall thickness not more than 14 mm) of non-ischemic etiology.

Class I antiarrhythmic drugs (allapinine, propafenone, etacizine, moracisine) can be prescribed.

Phenytoin is prescribed for PVCs due to digoxin intoxication. Drugs are prescribed only during the period of subjective sensation of extrasystoles.

It is possible to prescribe sedatives and psychotropic drugs (phenazepam, diazepam, clonazepam).

The prescription of class III antiarrhythmic drugs (amiodarone and sotalol) for benign PVCs is indicated only when class I drugs are ineffective.

Contraindications to the use of class I antiarrhythmic drugs:

• post-infarction cardiosclerosis;
• LV aneurysm;
• LV myocardial hypertrophy (wall thickness >1.4 cm);
• LV dysfunction;

In patients with reduced LV ejection fraction, the prescription of class I antiarrhythmic drugs, aimed only at reducing the number of PVCs, worsens the prognosis by increasing the risk of SCD.

When taking class IC antiarrhythmic drugs (encainide, flecainide, moricizine) to suppress PVCs in patients who had an MI, mortality significantly increased (2.5 times) due to the proarrhythmic effect.

The risk of proarrhythmic action also increases with severe LV myocardial hypertrophy and active myocarditis.
All antiarrhythmic drugs of class IA and C must be prescribed with caution in case of conduction disturbances along the bundle branch system and distal AV block of the first degree; in addition, they are contraindicated when the QTc interval is prolonged by more than 440 ms of any etiology.

Verapamil and β-blockers are ineffective in the vast majority of ventricular arrhythmias.

β-Blockers do not have a direct antiarrhythmic effect in ventricular arrhythmias and do not affect the frequency of PVCs. However, by reducing sympathetic stimulation, anti-ischemic effects and preventing catecholamine-induced hypokalemia, they reduce the risk of developing ventricular fibrillation.

β-Adrenergic blockers are used for primary and secondary prevention of SCD; they are indicated for all patients with coronary artery disease and PVCs (in the absence of contraindications). Malignant and potentially malignant ventricular extrasystoles.

Amiodarone is the drug of choice.

Sotalol is prescribed when amiodarone is contraindicated or ineffective.

The addition of β-blockers or co-administration with amiodarone (especially for coronary artery disease) reduces both arrhythmic and overall mortality. Source "cardioplaneta.ru"

Previously, it was believed that the more common form of extrasystole in children was ventricular. But now all types of extrasystoles occur with almost the same frequency.

This is due to the fact that the child’s body grows quickly, and the heart, unable to cope with such a load, “turns on” compensatory functions due to the same extraordinary contractions. Usually, once the child's growth slows down, the disease disappears on its own.

But extrasystole cannot be ignored: it may be a sign of a serious disease of the heart, lungs or thyroid gland. Children usually present the same complaints as adults, that is, they complain of “interruptions” in the functioning of the heart, dizziness, and weakness. Therefore, if such symptoms occur, the child must be carefully examined.

If a child has been diagnosed with ventricular extrasystole, then it is quite possible that treatment will not be required. The child must be registered with a dispensary and examined once a year. This is necessary in order not to miss the deterioration of his condition and the appearance of complications.

Drug treatment of extrasystoles in children is prescribed only if the number of extrasystoles per day reaches 15,000. Then metabolic and antiarrhythmic therapy is prescribed. Source "sosudinfo.ru"

Traditional methods of treating extrasystole

If the extrasystole is not life-threatening and is not accompanied by hemodynamic disturbances, you can try to defeat the disease on your own.

For example, when taking diuretics, potassium and magnesium are removed from the patient’s body. In this case, it is recommended to eat foods containing these minerals (but only in the absence of kidney disease) - dried apricots, raisins, potatoes, bananas, pumpkin, chocolate.

Also, to treat extrasystole, you can use an infusion of medicinal herbs. It has cardiotonic, antiarrhythmic, sedative and mild sedative effects. It should be taken one tablespoon 3-4 times a day. For this you will need hawthorn flowers, lemon balm, motherwort, heather and hop cones.

They need to be mixed in the following proportions:

• 5 parts each of lemon balm and motherwort;
• 4 parts heather;
• 3 parts hawthorn;
• 2 parts hops.

Important! Before starting treatment with folk remedies, you should consult your doctor, because many herbs can cause allergic reactions. Source "sosudinfo.ru"

With physiological extrasystole that occurs benignly, without hemodynamic disturbances, complications rarely arise. But if it is malignant, then complications occur quite often. This is precisely why extrasystole is dangerous.

The most common complications of extrasystole are ventricular or atrial fibrillation, paroxysmal tachycardia. These complications can threaten the patient's life and require urgent, emergency care.

In severe forms of extrasystole, the heart rate can exceed 160 beats per minute, which can result in the development of arrhythmic cardiogenic shock and, as a consequence, pulmonary edema and cardiac arrest.

Extrasystole can be accompanied not only by tachycardia, but also by bradycardia. In this case, the heart rate does not increase, but, on the contrary, decreases (there can be up to 30 contractions per minute or less). This is no less dangerous for the patient’s life, since with bradycardia conduction is impaired and there is a high risk of heart block. Source "sosudinfo.ru"

Complications mainly occur with malignant variants with frequent attacks. These include ventricular tachycardia with circulatory failure, ventricular flutter/fibrillation, leading to complete cardiac arrest.

In other cases, the prognosis is often favorable. If all treatment recommendations are followed, even in the presence of concomitant diseases, mortality from this disease is significantly reduced. Source "webmedinfo.ru"
The prognosis of PVCs depends entirely on the severity of the impulse disorder and the degree of ventricular dysfunction.

With pronounced pathological changes in the myocardium, extrasystoles can cause atrial and ventricular fibrillation, persistent tachycardia, which in the future can lead to death.

If an extraordinary blow during relaxation of the ventricles coincides with contraction of the atria, then the blood, without emptying the upper compartments, flows back into the lower chambers of the heart. This feature provokes the development of thrombosis.

This condition is dangerous because a clot consisting of blood cells, when it enters the bloodstream, becomes the cause of thromboembolism. When the lumen of blood vessels is blocked, depending on the location of the lesion, the development of such dangerous diseases as stroke (damage to the blood vessels of the brain), heart attack (damage to the heart) and ischemia (impaired blood supply to internal organs and limbs) is possible.

To prevent complications, it is important to consult a specialist (cardiologist) in time. Properly prescribed treatment and following all recommendations are the key to a quick recovery. Source "zdorovko.info"

• maintaining a more active and mobile lifestyle;
• giving up bad habits, including smoking, excessive consumption of alcohol and strong coffee;
• regular medical examinations.

Detection of a disease can occur even during a routine preventive examination; for this reason, a health check in a medical institution is a mandatory event for everyone. Source"gidmed.com"

Prevention of extrasystole, like any other heart rhythm disorder, consists of preventing and treating pathologies of the cardiovascular system - arterial hypertension, coronary heart disease, chronic heart failure, etc.

Prevention measures:

1. Avoiding stress

   If the extrasystole was caused by emotional stress or the patient’s work involves constant stress. A series of sessions with a psychologist should be conducted. With the help of a specialist, you can master various methods of self-control and auto-training. To provide a sedative effect, the doctor may prescribe appropriate medications (leonwort tincture, Corvalol, etc.)

2. Taking vitamins

   One of the traditional preventive measures for extrasystole is taking vitamins and minerals containing potassium. To restore normal potassium levels in the body, the attending physician may also prescribe not only taking potassium-containing medications, but also following a certain diet. Apples, bananas, zucchini, dried apricots, pumpkin, etc. are rich in potassium.

3. Diet

   Most cardiologists advise reducing the amount of vegetable fats consumed and minimizing spicy foods, coffee, and spices in your menu. Alcohol and smoking should also be avoided.

4. Treatment of current diseases

   A large number of diseases can lead to heart rhythm disturbances. These include pathologies of the gastrointestinal tract and spine. Timely diagnosis and proper treatment of osteochondrosis can prevent the occurrence of extrasystole.

   Often, attending physicians recommend morning exercises, breathing exercises and massages to their patients. In some cases, when diagnosing arrhythmias, taking antiarrhythmic drugs (for example, Cordarone, Propafenone, etc.) under the supervision of a doctor is indicated. Source "propanorm.ru"

To prevent relapses, it is necessary to select high-quality drug therapy and take it daily. It is important to modify risk factors, stop smoking and drugs, limit alcohol intake, and carefully use medications without exceeding the permitted dosage.

By reducing the impact of risk factors and timely diagnosis, a patient with ventricular extrasystole has a good prognosis. Source "oserdce.com"

Used for prognostic assessment of ventricular extrasystoles in intensive care units in patients with coronary artery disease.

0 – there are no ventricular extrasystoles;

1 – 30 or less ventricular extrasystoles per hour;

2 – > 30 ventricular extrasystoles per hour;

3 – polymorphic (polytopic) ventricular extrasystoles;

4A– paired extrasystoles;

4B– 3 in a row and > ventricular extrasystoles (short episodes of paroxysms of ventricular tachycardia);

5 – ventricular extrasystoles of the “R to T” type;

Threatening extrasystoles are considered 3 – 5 gradations, since the likelihood of ventricular fibrillation and ventricular tachycardia is high.

Classification of supraventricular arrhythmias

Automatic arrhythmias

Some atrial tachycardias associated with acute medical conditions.

Some multifocal atrial tachycardias.

Reciprocal arrhythmias

SA nodal reentrant tachycardia

Intraatrial reentrant tachycardia

Atrial flutter and fibrillation

AV nodal reentrant tachycardia

Automatic arrhythmias

Causes of ventricular extrasystole (acute myocardial infarction)

PVCs are recorded in almost all patients. There is a relationship between the size of myocardial infarction and the frequency of PVCs, as well as between the degree of weakening of the contractile function of the left ventricle and the number of PVCs during the period of recovery of patients from myocardial infarction.

In intensive care wards, for the prognostic assessment of PVCs, a grading system developed by V. Lown and M. Wolf is used: 0 no PVCs, 1 - 30 or less PVCs in 1 hour, 2 - more than 30 PVCs in 1 hour, 3 - polymorphic PVCs, 4A - paired PVCs, 4B - three or more PVCs in a row (attacks of unsustained ventricular tachycardia), 5 - PVCs of type R on T. PVCs of high gradations (3-5) are considered “threatening”, i.e., threatening the occurrence of VF or VT [ Mazur N.A. 1985].

In 1975, M. Ryan et al. (Laun group) modified their grading system: 0 — absence of PVCs during 24 hours of monitoring, 1 — no more than 30 PVCs for any hour of monitoring, 2 — more than 30 PVCs for any hour of monitoring, 3 — polymorphic PVCs, 4 A — monomorphic paired PVCs, 4B — polymorphic paired PVCs, 5 — VT (three or more consecutive VTs with a frequency above 100 per 1 min). The modification of W. Me Kenna et al. is close to this grading system. (1981).

The new versions emphasize the pathological significance of VT and do not mention type R PVCs on T, since it is becoming increasingly clear that early PVCs are no more likely, and sometimes less so, than late PVCs to cause VT attacks. The Lown grading system was subsequently extended to ventricular arrhythmias in chronic ischemic heart disease and other heart diseases.

Currently, it is very popular, although it is not without its shortcomings [Orlov V.N. Shpektor A.V. 1988]. You can, for example, point out that half of the patients with coronary artery disease who develop VF do not have “threatening” PVCs, and half of those who have such extrasystoles do not develop VF.

Nevertheless, this and other comments regarding the gradation of ventricular arrhythmias cannot erase the fundamental position that frequent and complex (high gradation) PVCs are among the factors that adversely affect the prognosis in patients with coronary artery disease, especially in those who have suffered a myocardial infarction .

“Arrhythmias of the heart”, M.S. Kushakovsky

Causes of ventricular extrasystole (clinical significance)

Extrasystole

premature depolarization and contraction of the heart or its individual chambers, the most frequently recorded type of arrhythmias. Extrasystoles can be detected in 60-70% of people. Basically, they are functional (neurogenic) in nature, their appearance is provoked by stress, smoking, alcohol, strong tea and especially coffee. Extrasystoles of organic origin occur when the myocardium is damaged (ischemic heart disease, cardiosclerosis, dystrophy, inflammation). Extraordinary impulses can come from the atria, atrioventricular junction and ventricles. The occurrence of extrasystoles is explained by the appearance of an ectopic focus of trigger activity, as well as the existence of a reentry mechanism. The temporal relationship between the extraordinary and normal complexes is characterized by the coupling interval. Classification

Monotonous extrasystoles - one source of occurrence, a constant coupling interval in the same ECG lead (even with different durations of the QRS complex) Polytopic extrasystoles - from several ectopic foci, different coupling intervals in the same ECG lead (differences are more than 0.02 -0.04 s) Unsustainable paroxysmal tachycardia - three or more consecutive extrasystoles (previously designated as group, or volley, extrasystoles). Just like polytopic extrasystoles, they indicate pronounced electrical instability of the myocardium. Compensatory pause

- duration of the period of electrical diastole after extrasystole. Divided into complete and incomplete Complete - the total duration of the shortened diastolic pause before and the extended diastolic pause after the extrasystole is equal to the duration of two normal cardiac cycles. Occurs when the impulse does not propagate in the retrograde direction to the sinoatrial node (its discharge does not occur) Incomplete - the total duration of the shortened diastolic pause before and the extended diastolic pause after the extrasystole is less than the duration of two normal cardiac cycles. Typically, the incomplete compensatory pause is equal to the duration of the normal cardiac cycle. Occurs when the sinoatrial node is discharged. Lengthening of the post-ectopic interval does not occur with interpolated (insertion) extrasystoles, as well as late replacement extrasystoles. Gradation of ventricular extrasystoles

up to 30 extrasystoles in any hour of monitoring II - over 30 extrasystoles in any hour of monitoring III - polymorphic extrasystoles IVa - monomorphic paired extrasystoles IVb - polymorphic paired extrasystoles V - three or more extrasystoles in a row with an ectopic rhythm frequency of more than 100 per minute. Frequency

(the total number of extrasystoles is taken as 100%) Sinus extrasystoles - 0.2% Atrial extrasystoles - 25% Extrasystoles from the atrioventricular junction - 2% Ventricular extrasystoles - 62.6% Various combinations of extrasystoles - 10.2%. Etiology

Acute and chronic heart failure IHD Acute respiratory failure Chronic obstructive pulmonary diseases Osteochondrosis of the cervical and thoracic spine Viscerocardiac reflexes (diseases of the lungs, pleura, abdominal organs) Intoxication with cardiac glycosides, aminophylline, adrenomimetic drugs Taking TAD, B-adrenomimetics Physical and mental stress Focal infections Caffeine, nicotine Electrolyte imbalance (especially hypokalemia). Clinical picture

Manifestations are usually absent, especially when the extrasystoles are of organic origin. Complaints of tremors and strong heartbeats caused by vigorous ventricular systole after a compensatory pause, a feeling of freezing in the chest, a feeling of a stopped heart. Symptoms of neurosis and dysfunction of the autonomic nervous system (more typical for extrasystoles of functional origin): anxiety, pallor, sweating, fear, feeling of lack of air. Frequent (especially early and group) extrasystoles lead to a decrease in cardiac output, a decrease in cerebral, coronary and renal blood flow by 8-25%. With stenosing atherosclerosis of the cerebral and coronary vessels, transient disturbances of cerebral circulation (paresis, aphasia, fainting), and attacks of angina may occur. TREATMENT

Elimination of provoking factors, treatment of the underlying disease. Single extrasystoles without clinical manifestations are not corrected. Treatment of neurogenic extrasystoles Compliance with work and rest regime Dietary recommendations Regular exercise Psychotherapy Tranquilizers or sedatives (for example, diazepam, valerian tincture). Indications for treatment with specific antiarrhythmic drugs Pronounced subjective sensations (interruptions, a feeling of heart sinking, etc.), sleep disturbances Extrasystolic allorhythmia Early ventricular extrasystoles overlapping the T wave of the previous cardiac cycle Frequent single extrasystoles (more than 5 per minute) Group and polytopic extrasystoles Extrasystoles in in the acute period of myocardial infarction, as well as in patients with post-infarction cardiosclerosis.

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According to the place of occurrence of extrasystoles, there are 3 types:

• atrial: altered P wave, normal ventricular QRS complex;
• atriventricular(from the AV connection): the QRS complex is not changed, the P wave is absent or changed and is recorded after the QRS complex;
• ventricular: The QRS complex is widened and altered, and the P wave is usually not visible.

Atrial extrasystole.

Variants of extrasystoles from the AV node.
a) the P wave merges with the QRS complex,
b) a modified P wave is visible after the QRS complex.

Ventricular extrasystole.

What follows from the above definition?

1) On the ECG we see only electrical stimulation, and whether there was a corresponding contraction of the myocardium is determined by other methods (auscultation, pulse examination, etc.).

True, almost always excitation corresponds to contraction of the myocardium.

2) It is appropriate to talk about premature excitations and contractions with a correct (rhythmic) heart rate, when we can guess at what time intervals the next excitations should occur.

For example, with atrial fibrillation, the muscle fibers of the atria are excited and contract chaotically, so talking about atrial extrasystoles in this context looks ridiculous.

At the same time, with uncomplicated atrial fibrillation, the ventricular QRS complex does not change, therefore, in the presence of single widened and altered QRS complexes, we can talk about ventricular extrasystole.

There are extrasystoles both in sick and healthy people.

During normal ECG recording they are recorded in 5% of people, and with long-term (24-hour or Holter) monitoring they are detected in 35-50% of people.

Extrasystole can be caused by stress, overwork, extreme temperatures, changes in body position, coffee, tea, smoking, infections, etc.

I will especially focus on infections.

In the 6th year in winter I began to worry feeling of heart failure, similar to extrasystole. The interruptions only occurred at rest and went away on their own after 1-2 weeks. A regular ECG showed nothing wrong (extrasystoles were not captured on film), but at first I was scared (“what if I die?”). Subsequently pondering the cause of my interruptions, I came to the conclusion that, most likely, they were the only symptom viral myocarditis after suffering from acute respiratory viral infection shortly before.

For reference:

Viral myocarditis can cause Coxsackie viruses A and B, ECHO viruses, influenza A and B, cytomegalovirus, polio viruses, Epstein-Barr. Myocarditis develops either during or after an infectious disease within the time frame from several days to 4 weeks. Most often, viral myocarditis goes away on its own and only in rare cases is it believed that it can lead to dilated cardiomyopathy(dilatatio - Latin expansion; the heart expands, and its muscle wall becomes thinner and becomes like a rag).

On the left - the heart is normal, on the right - dilated cardiomyopathy
(the cavities of the heart are expanded, the wall of the heart is thinned).

At what extrasystoles should the alarm be sounded?

Since almost every person has extrasystoles, you need to know what types of them are life-threatening, primarily in terms of the development of fatal arrhythmias. At the same time, let's touch on classification.

So, treatment is necessary in cases where extrasystoles can be attributed to at least one of the 4 types listed below:

1) frequent.

Extrasystoles are common more than 30 per hour(previously it was considered more than 5 per minute).

This also includes frequency allorhythmia- correct alternation of extrasystoles and normal contractions.

For example, bigeminy(from “bi” - two) - after each normal contraction there is an extrasystole. Bigeminy usually occurs when overdose of cardiac glycosides, prescribed for the treatment of heart failure and reduction of heart rate with persistent atrial fibrillation.

Bigeminy.

2) group.

Extrasystoles are:

• single;
• paired (double, 2 extrasystoles in a row);
• group, salvo (3-5 extrasystoles in a row);
• longer (up to 30 seconds) group extrasystoles are more often called “unsustained tachycardia” or “short episodes of unsustained tachycardia.”

Group extrasystole (3 ventricular complexes in a row).

3) polytopic.

There are extrasystoles monotopic or monofocal(arise from one place in the conduction system of the heart), and polytopic, or polyfocal(from different places).

Naturally, if the extrasystoles are polytopic, it means that there are several foci of pathological excitation in the heart, which increases the risk of fatal arrhythmia.

How to identify different sources of arousal? Define the so-called clutch interval. This is the distance from the extrasystole to the preceding complex in seconds (from P to P or from QRS to QRS).

Monotopic (monofocal) extrasystole.

Polytopic (polyfocal) extrasystole.

Approximately constant coupling interval of extrasystoles (varying no more than 0.02-0.04 seconds) speaks of one source of their occurrence, that is, monotopic extrasystoles.

Usually monotopic extrasystoles look very similar to each other in the same lead and are therefore called monomorphic(from “morphos” - form).

Occasionally monotopic monofocal extrasystoles with the same coupling interval may differ in shape in the same lead, which is caused differing conditions for their implementation, such extrasystoles are called monofocal polymorphic.

4) early ventricular extrasystoles of the “R to T” type.

In this case, the QRS complex of the extrasystole is layered at the apex or descending limb of the T wave the previous complex.

Early extrasystole type "R on T".
Arose on the descending limb of the T wave.

Ventricular extrasystoles are generally considered more dangerous than supraventricular extrasystoles (emanating from the atria and AV node).

Organic and functional extrasystoles

There is also a division of extrasystoles into organic(dangerous) and functional(safe).

Extrasystoles of organic origin are based on some serious pathology and more often occur with coronary heart disease (including myocardial infarction), arterial hypertension, heart defects, myocarditis, endocrine diseases (thyrotoxicosis and pheochromocytoma).

Usually extrasystoles occur from the more affected (hypertrophied) ventricle by the underlying disease.

Curious features overdose of cardiac glycosides.

With hypertrophy of one of the ventricles, due to a relative lack of blood supply, less glycosides have time to enter there than into a healthy ventricle, therefore, with an overdose of cardiac glycosides, extrasystoles usually occur from a healthy ventricle.

Functional extrasystoles are not associated with serious health problems and are more common when increased tone of the vagus nerve(bradycardia - heart rate< 60, холодные влажные ладони, пониженное артериальное давление и т.д.) и провоцируются стрессами.

They are considered safe.

Functional extrasystoles are more often:

• in persons under 50 years of age
• single
• subjectively poorly tolerated, because cause discomfort
• appear while lying down at rest, often accompanied by bradycardia
• disappear after moving to a vertical position or after physical activity
• these are single monotopic ventricular extrasystoles, there is no allorhythmia and early “R to T” extrasystoles
• after extrasystoles there are no changes in the ST segment and T wave in subsequent complexes
• ECG is normal
• disappear after taking atropine
• are well treated with sedatives and usually do not respond to antiarrhythmic drugs such as procainamide, quinidine, etc.

Organic extrasystoles:

• more common in people over 50 years of age
• multiple
• well tolerated, because patients do not notice them
• occur in an upright position and after physical activity, pass while lying down and at rest
• often accompanied by tachycardia (heart rate > 90 per minute)
• often these are multiple, polytopic extrasystoles; characterized by early, group extrasystoles and allorhythmia
• ECG is pathologically changed
• changes in the ST segment and T wave are possible in the complexes following extrasystoles
• after taking atropine, their number does not change
• amenable to treatment with antiarrhythmic drugs

– a type of cardiac arrhythmia characterized by extraordinary, premature contractions of the ventricles. Ventricular extrasystole is manifested by sensations of interruptions in the work of the heart, weakness, dizziness, anginal pain, and lack of air. The diagnosis of ventricular extrasystole is established on the basis of data from cardiac auscultation, ECG, and Holter monitoring. In the treatment of ventricular extrasystole, sedatives, ß-blockers, and antiarrhythmic drugs are used.

General information

Extrasystolic arrhythmias (extrasystoles) are the most common type of rhythm disturbances, occurring in different age groups. Taking into account the place of formation of the ectopic focus of excitation in cardiology, ventricular, atrioventricular and atrial extrasystoles are distinguished; Of these, ventricular ones are the most common (about 62%).

Ventricular extrasystole is caused by premature excitation of the myocardium in relation to the leading rhythm, emanating from the conduction system of the ventricles, mainly the branches of the His bundle and Purkinje fibers. When recording an ECG, ventricular extrasystoles in the form of single extrasystoles are detected in approximately 5% of healthy young people, and with 24-hour ECG monitoring - in 50% of subjects. The prevalence of ventricular extrasystole increases with age.

Causes of ventricular extrasystole

Ventricular extrasystole can develop in connection with organic heart diseases or be idiopathic in nature.

Most often, the organic basis of ventricular extrasystole is ischemic heart disease; in patients with myocardial infarction it is recorded in 90-95% of cases. The development of ventricular extrasystole may be accompanied by the course of post-infarction cardiosclerosis, myocarditis, pericarditis, arterial hypertension, dilated or hypertrophic cardiomyopathy, chronic heart failure, cor pulmonale, mitral valve prolapse.

Idiopathic (functional) ventricular extrasystole can be associated with smoking, stress, consumption of caffeine-containing drinks and alcohol, leading to increased activity of the sympathetic-adrenal system. Ventricular extrasystole occurs in persons suffering from cervical osteochondrosis, neurocirculatory dystonia, and vagotonia. With increased activity of the parasympathetic nervous system, ventricular extrasystole can be observed at rest and disappear during physical activity. Quite often, single ventricular extrasystoles occur in healthy individuals for no apparent reason.

Possible causes of ventricular extrasystole include iatrogenic factors: overdose of cardiac glycosides, use of ß-adrenergic stimulants, antiarrhythmic drugs, antidepressants, diuretics, etc.

Classification of ventricular extrasystoles

An objective examination reveals pronounced presystolic pulsation of the jugular veins, which occurs when the ventricles contract prematurely (venous Corrigan waves). An arrhythmic arterial pulse with a long compensatory pause after an extraordinary pulse wave is determined. Auscultatory features of ventricular extrasystole are a change in the sonority of the first tone and splitting of the second tone. The final diagnosis of ventricular extrasystole can be carried out only with the help of instrumental studies.

Diagnosis of ventricular extrasystole

The main methods for detecting ventricular extrasystole are ECG and Holter ECG monitoring. The electrocardiogram records the extraordinary premature appearance of an altered ventricular QRS complex, deformation and expansion of the extrasystolic complex (more than 0.12 sec.); absence of P wave before extrasystole; complete compensatory pause after ventricular extrasystole, etc.

Treatment of ventricular extrasystole

Special treatment is not indicated for persons with asymptomatic ventricular extrasystole without signs of organic heart pathology. Patients are recommended to follow a diet enriched with potassium salts, eliminate provoking factors (smoking, drinking alcohol and strong coffee), and increase physical activity during physical inactivity.

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

In cases of severe health problems and in cases of ineffectiveness of therapy with beta-blockers and sedatives, it is possible to use antiarrhythmic drugs (procainamide mexiletine, flecainide, amiodarone, sotalol). The selection of antiarrhythmic drugs is made by a cardiologist under the control of ECG and Holter monitoring.

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

Forecast of ventricular extrasystole

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