ICD 10 frequent ventricular extrasystole. Ventricular extrasystole (premature contraction of the heart ventricle)

• Treatment of ventricular extrasystole
  • Prognostic significance of ventricular extrasystole

    The basic principle for choosing therapy for ventricular extrasystoles is to assess their prognostic significance.

  • Frequent ventricular extrasystole requires parenteral therapy in cases of its acute manifestation or increase in frequency in patients with a high risk of sudden death. That is, parenteral therapy is indicated for patients with acute myocardial infarction, severe myocardial dysfunction, episodes of ventricular tachycardia in history, as well as for electrolyte disturbances and glycoside intoxication.
    • The frequency of ventricular extrasystoles may decrease during therapy with beta blockers (mainly during myocardial infarction). Amiodarone or lidocaine is administered intravenously as a bolus during the acute period and subsequently as a drip.
    • In case of ventricular extrasystole due to hypokalemia, potassium chloride is administered intravenously up to 4-5 mEq/kg/day until the upper limit of normal serum potassium is reached. The frequency of administration and duration of treatment are determined by the level of potassium in the blood.
    • For ventricular extrasystole due to hypomagnesemia, magnesium sulfate is indicated intravenously at 1000 mg 4 times a day (the dose is calculated by magnesium) until the upper limit of normal serum magnesium is reached. In case of severe hypomagnesemia, the daily dose can reach 8-12 g/day (the dose is calculated based on magnesium).
    • For ventricular extrasystole due to glycoside intoxication, dimercaprol IV 5 mg/kg 3-4 times a day on the 1st day, 2 times a day on the 2nd day, then 1 time a day until the symptoms of intoxication are eliminated + Potassium chloride IV up to 4-5 mEq/kg/day until the upper limit of normal serum potassium is reached (the frequency of administration and duration of treatment are determined by the level of potassium in the blood).

    The question of the duration of antiarrhythmic therapy is practically important. In patients with malignant ventricular extrasystole, antiarrhythmic therapy should be continued indefinitely. For less malignant arrhythmias, treatment should be quite long (up to several months), after which an attempt to gradually discontinue the drug is possible.

    In some cases - with frequent ventricular extrasystoles (up to 20-30 thousand per day) with an arrhythmogenic focus identified during an electrophysiological study and ineffectiveness, or if long-term use of antiarrhythmics is impossible in combination with poor tolerance or poor prognosis - radiofrequency ablation is used.

Ventricular extrasystole is one of the forms of cardiac arrhythmia, which is characterized by the occurrence of extraordinary or premature contractions of the ventricles. Both adults and children can suffer from this disease.

Today, a large number of predisposing factors leading to the development of such a pathological process are known, which is why they are usually divided into several large groups. The cause may be other illnesses, drug overdose or toxic effects on the body.

The symptoms of the disease are nonspecific and are characteristic of almost all cardiac ailments. The clinical picture includes sensations of impaired heart function, a feeling of lack of air and shortness of breath, as well as dizziness and pain in the sternum.

Diagnosis is based on a physical examination of the patient and a wide range of specific instrumental examinations. Laboratory studies are of an auxiliary nature.

Treatment of ventricular extrasystole in the vast majority of situations is conservative, however, if such methods are ineffective, surgical intervention is indicated.

The International Classification of Diseases, Tenth Revision, defines a separate code for such pathology. Thus, the ICD-10 code is I49.3.

Etiology

Ventricular extrasystole in children and adults is considered one of the most common. Among all types of the disease, this form is diagnosed most often, namely in 62% of situations.

The causes are so diverse that they are divided into several groups, which also determine the course of the disease.

Cardiac disorders leading to organic extrasystole are presented:

• , formed against the background of a previous heart attack;
• malignant course;
• dilatational and hypertrophic;
• congenital or secondary formed.

The functional type of ventricular extrasystole is determined by:

• long-term addiction to bad habits, in particular, smoking cigarettes;
• chronic or severe nervous tension;
• drinking large amounts of strong coffee;
• vagotonia.

In addition, the development of this type of arrhythmia is influenced by:

• overdose of drugs, in particular diuretics, cardiac glycosides, beta-agonists, antidepressants and antiarrhythmic substances;
• leakage is the main cause of ventricular extrasystole in children;
• chronic oxygen starvation;
• electrolyte disturbances.

It is also worth noting that in approximately 5% of cases, such a disease is diagnosed in a completely healthy person.

In addition, specialists from the field of cardiology note the occurrence of such a form of the disease as idiopathic ventricular extrasystole. In such situations, arrhythmia in a child or adult develops for no apparent reason, i.e., the etiological factor is established only during diagnosis.

Classification

In addition to the fact that the type of pathology will differ in predisposing factors, there are several more classifications of the disease.

Based on the time of formation, the disease can be:

• early - occurs when the atria, which are the upper parts of the heart, contract;
• interpolated - develops at the border of the time interval between contraction of the atria and ventricles;
• late - observed during contraction of the ventricles, protruding from the lower parts of the heart. Less commonly formed in diastole - this is the stage of complete relaxation of the heart.

Based on the number of sources of excitability, the following are distinguished:

• monotopic extrasystole - in this case there is one pathological focus, leading to additional cardiac impulses;
• polytopic extrasystole - in such cases several ectopic sources are detected.

Classification of ventricular extrasystole by frequency:

• single - characterized by the appearance of 5 extraordinary heartbeats per minute;
• multiple - more than 5 extrasystoles occur per minute;
• steam room - this form is distinguished by the fact that 2 extrasystoles are formed in a row in the interval between normal heart contractions;
• group - these are several extrasystoles coming one after another between normal contractions.

According to its ordering, pathology is divided into:

• disordered - there is no pattern between normal contractions and extrasystoles;
• ordered. In turn, it exists in the form of bigeminy - it is an alternation of normal and extraordinary contractions, trigeminy - an alternation of two normal contractions and an extrasystole, quadrigeminy - there is an alternation of 3 normal contractions and an extrasystole.

According to the nature of the course and forecasts, extrasystole in women, men and children can be:

• benign course - differs in that the presence of organic damage to the heart and improper functioning of the myocardium is not observed. This means that the risk of sudden death is minimized;
• potentially malignant course - ventricular extrasystoles are observed due to organic damage to the heart, and the ejection fraction decreases by 30%, while the likelihood of sudden cardiac death increases compared to the previous form;
• malignant course - severe organic damage to the heart is formed, which is dangerous with a high chance of sudden cardiac death.

A separate type is intercalary ventricular extrasystole - in such cases there is no formation of a compensatory pause.

Symptoms

A rare arrhythmia in a healthy person is completely asymptomatic, but in some cases there is a feeling of cardiac arrest, “interruptions” in functioning or a kind of “push”. Such clinical manifestations are a consequence of increased post-extrasystolic contraction.

The main symptoms of ventricular extrasystole are presented:

• severe dizziness;
• pale skin;
• pain in the heart;
• increased fatigue and irritability;
• periodic headaches;
• weakness and weakness;
• feeling of lack of air;
• fainting states;
• shortness of breath;
• causeless panic and fear of dying;
• heart rate disturbance;
• increased sweating;
• capriciousness - this symptom is characteristic of children.

It is worth noting that the occurrence of ventricular extrasystole against the background of organic heart diseases can go unnoticed for a long period of time.

Diagnostics

The basis of diagnostic measures are instrumental procedures, which are necessarily supplemented by laboratory studies. Nevertheless, the first stage of diagnosis will be the cardiologist’s independent implementation of the following manipulations:

• studying the medical history will indicate the main pathological etiological factor;
• collection and analysis of life history - this can help in finding the causes of ventricular extrasystole of an idiopathic nature;
• a thorough examination of the patient, namely palpation and percussion of the chest, determining the heart rate by listening to the person using a phonendoscope, as well as palpating the pulse;
• a detailed survey of the patient - to compile a complete symptomatic picture and determine rare or frequent ventricular extrasystole.

Laboratory studies are limited to only general clinical analysis and blood biochemistry.

Instrumental diagnosis of cardiac extrasystole involves the following:

• ECG and EchoCG;
• daily monitoring of electrocardiography;
• load tests, in particular bicycle ergometry;
• X-rays and MRI of the chest;
• rhythmocardiography;
• polycardiography;
• sphygmography;
• TEE and CT.

In addition, consultation with a therapist, pediatrician (if the patient is a child) and obstetrician-gynecologist (in cases where extrasystole has formed during pregnancy) is necessary.

Treatment

In situations where such a disease has developed without the occurrence of cardiac pathologies or VSD, specific therapy for patients is not provided. To relieve symptoms, it is enough to follow the clinical recommendations of the attending physician, including:

• normalization of the daily routine - people are advised to rest more;
• maintaining a proper and balanced diet;
• avoidance of stressful situations;
• performing breathing exercises;
• spending a lot of time outdoors.

In other cases, it is first necessary to cure the underlying disease, which is why therapy will be individualized. However, there are several general aspects, namely the treatment of ventricular extrasystole by taking the following medications:

• antiarrhythmic substances;
• omega-3 drugs;
• antihypertensive drugs;
• anticholinergics;
• tranquilizers;
• beta blockers;
• herbal medicines - in cases of the disease in a pregnant woman;
• antihistamines;
• vitamins and restorative medications;
• drugs aimed at eliminating the clinical manifestations of such heart disease.

Surgical intervention for ventricular or ventricular extrasystole is carried out only according to indications, including the ineffectiveness of conservative treatment methods or the malignant nature of the pathology. In such cases, resort to:

• radiofrequency catheter ablation of ectopic foci;
• open intervention, which involves excision of damaged areas of the heart.

There are no other ways to treat such a disease, in particular folk remedies.

Possible complications

Ventricular extrasystole is fraught with the development of:

• sudden onset of cardiac death;
• heart failure;
• changes in the structure of the ventricles;
• worsening the course of the underlying disease;
• ventricular fibrillation.

Prevention and prognosis

You can avoid the occurrence of extraordinary contractions of the ventricles by following the following preventive recommendations:

• complete renunciation of addictions;
• limiting the consumption of strong coffee;
• avoiding physical and emotional fatigue;
• rationalization of the work and rest regime, namely full, long sleep;
• use of medications only under the supervision of a physician;
• complete and vitamin-enriched nutrition;
• early diagnosis and elimination of pathologies leading to ventricular extrasystole;
• Regularly undergoing a complete preventive examination by clinicians.

The outcome of the disease depends on its course. For example, functional extrasystole has a favorable prognosis, and pathology that develops against the background of organic heart damage has a high risk of sudden cardiac death and other complications. However, the fatality rate is quite low.

• Ectopic systoles
• Extrasystoles
• Extrasystolic arrhythmia
• Premature:
  • abbreviations NOS
  • compression

• Brugada syndrome
• Long QT syndrome
• Rhythm disturbance:
  • coronary sinus
  • ectopic
  • nodal

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Gradation of ventricular extrasystole according to Ryan and Laun, code according to ICD 10

1 – rare, monotopic ventricular arrhythmia – no more than thirty VES per hour;

2 – frequent, monotopic ventricular arrhythmia – more than thirty VES per hour;

3 – polytopic ZhES;

4a – monomorphic paired VES;

4b – polymorphic paired VES;

5 – ventricular tachycardia, three or more VES in a row.

2 – infrequent (from one to nine per hour);

3 – moderately frequent (from ten to thirty per hour);

4 – frequent (from thirty-one to sixty per hour);

5 – very frequent (more than sixty per hour).

B – single, polymorphic;

D – unstable VT (less than 30s);

E – sustained VT (more than 30 s).

Absence of structural heart lesions;

Absence of scar or cardiac hypertrophy;

Normal left ventricular ejection fraction (LVEF) – more than 55%;

Slight or moderate frequency of ventricular extrasystole;

Absence of paired ventricular extrasystoles and unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia.

The presence of a scar or cardiac hypertrophy;

Moderate decrease in LVEF – from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia or their insignificant presence.

Presence of structural heart lesions;

Presence of scar or cardiac hypertrophy;

Significant decrease in LVEF – less than 30%;

Moderate or significant ventricular extrasystole;

Paired ventricular extrasystoles or unstable ventricular tachycardia;

Persistent ventricular tachycardia;

Moderate or severe hemodynamic consequences of arrhythmia.

Extrasystole - causes and treatment of the disease

Cardiac extrasystole is a type of heart rhythm disturbance based on improper contraction of the entire heart or its individual parts. Contractions are of an extraordinary nature under the influence of any impulse or excitation of the myocardium. This is the most common type of arrhythmia, affecting both adults and children, and is extremely difficult to get rid of. Medication and folk remedies are used. Gastric extrasystole is registered in ICD 10 (code 149.3).

Ventricular extrasystole is a fairly common disease. It affects completely healthy people.

Causes of extrasystole

• overwork;
• overeating;
• presence of bad habits (alcohol, drugs and smoking);
• drinking caffeine in large quantities;
• stressful situations;
• heart disease;
• toxic poisoning;
• osteochondrosis;
• diseases of internal organs (stomach).

Gastric extrasystole is a consequence of various myocardial lesions (ischemic heart disease, cardiosclerosis, myocardial infarction, chronic circulatory failure, heart defects). Its development is possible during febrile conditions and VSD. It is also a side effect of some medications (Euphelin, Caffeine, glucocorticosteroids and some antidepressants) and can be observed with improper treatment with folk remedies.

The reason for the development of extrasystole in people actively involved in sports is myocardial dystrophy associated with intense physical activity. In some cases, this disease is closely associated with changes in the amount of sodium, potassium, magnesium and calcium ions in the myocardium itself, which adversely affects its functioning and does not allow getting rid of attacks.

Often, gastric extrasystole can occur during or immediately after a meal, especially in patients with VSD. This is due to the characteristics of the heart during such periods: the heart rate decreases, so extraordinary contractions occur (before or after the next one). There is no need to treat such extrasystoles, since they are functional in nature. In order to get rid of extraordinary contractions of the heart after eating, you should not take a horizontal position immediately after eating. It's better to sit in a comfortable chair and relax.

Classification

Depending on the location of the impulse and its cause, the following types of extrasystole are distinguished:

• ventricular extrasystole;
• atrioventricular extrasystole;
• supraventricular extrasystole (supraventricular extrasystole);
• atrial extrasystole;
• atrioventricular extrasystole;
• stem and sinus extrasystoles.

A combination of several types of impulse is possible (for example, a supraventricular extrasystole is combined with a stem one, a gastric extrasystole occurs together with a sinus one), which is characterized as parasystole.

Gastric extrasystole is the most common type of disturbance in the functioning of the cardiac system, characterized by the appearance of an additional contraction (extrasystole) of the heart muscle before its normal contraction. Extrasystole can be single or double. If three or more extrasystoles appear in a row, then we are talking about tachycardia (ICD code - 10: 147.x).

Supraventricular extrasystole differs from ventricular localization of the source of arrhythmia. Supraventricular extrasystole (supraventricular extrasystole) is characterized by the occurrence of premature impulses in the upper parts of the heart (atria or in the septum between the atria and ventricles).

There is also the concept of bigeminy, when extrasystole occurs after normal contraction of the heart muscle. It is believed that the development of bigeminy is provoked by disturbances in the functioning of the autonomic nervous system, that is, the trigger for the development of bigeminy can be VSD.

There are also 5 degrees of extrasystole, which are determined by a certain number of impulses per hour:

• the first degree is characterized by no more than 30 impulses per hour;
• for the second - more than 30;
• the third degree is represented by polymorphic extrasystoles.
• the fourth degree is when 2 or more types of impulse appear alternately;
• the fifth degree is characterized by the presence of 3 or more extrasystoles one after another.

The symptoms of this disease are in most cases invisible to the patient. The surest signs are sensations of a sharp blow in the heart, cardiac arrest, and freezing in the chest. Supraventricular extrasystole can manifest itself as VSD or neurosis and is accompanied by a feeling of fear, profuse sweating, anxiety and lack of air.

Diagnosis and treatment

Before treating any extrasystole, it is important to correctly determine its type. The most revealing method is electrocardiography (ECG), especially for ventricular impulses. An ECG can detect the presence of extrasystole and its location. However, a resting ECG does not always reveal the disease. Diagnosis becomes more complicated in patients suffering from VSD.

If this method does not show proper results, ECG monitoring is used, during which the patient wears a special device that monitors the work of the heart throughout the day and records the progress of the study. This ECG diagnosis allows you to identify the disease, even if the patient has no complaints. A special portable device attached to the patient's body records ECG readings for 24 or 48 hours. At the same time, the patient’s actions are recorded at the time of ECG diagnosis. The daily activity data and ECG are then compared, which allows the disease to be identified and treated correctly.

Some literature indicates the norms for the occurrence of extrasystoles: for a healthy person, the norm is considered to be ventricular and extraventricular extrasystoles per day, detected on an ECG. If after ECG studies no abnormalities are revealed, the specialist may prescribe special additional tests with stress (treadmill test)

In order to properly treat this disease, it is necessary to take into account the type and degree of extrasystole, as well as its location. Single impulses do not require specific treatment; they do not pose any threat to human health and life only if they are caused by a serious heart disease.

Features of treatment

To cure a disease caused by neurological disorders, sedatives (Relanium) and herbal preparations (valerian, motherwort, mint) are prescribed.

If the patient has a history of serious heart disease, the extrasystole is supraventricular in nature, and the frequency of impulses per day exceeds 200, individually selected drug therapy is necessary. To treat extrasystalia in such cases, drugs such as Propanorm, Cordarone, Lidocaine, Diltiazem, Panangin, as well as beta-blockers (Atenolol, Metoprolol) are used. Sometimes these means can get rid of the manifestations of VSD.

A drug such as Propafenone, which is an antiarrhythmic drug, is currently the most effective and allows you to treat even the advanced stage of the disease. It is quite well tolerated and absolutely safe for health. That is why it was classified as a first-line drug.

A fairly effective method to cure extrasystole forever is to cauterize its source. This is a fairly simple surgical intervention with virtually no consequences, but it cannot be performed on children; there is an age limit.

If gastric extrasystole is present in the later stages, then it is recommended to treat it with radiofrequency ablation. This is a method of surgical intervention with the help of which the source of arrhythmia is destroyed under the influence of physical factors. The procedure is easily tolerated for the patient, the risk of complications is minimized. In most cases, gastric extrasystole goes away irrevocably.

Treatment of children

In most cases, treatment for the disease in children is not necessary. Many experts claim that in children the disease goes away without treatment. If desired, you can stop severe attacks with safe folk remedies. However, it is recommended to undergo an examination to determine the extent of the disease.

Extrasystole in children can be congenital or acquired (after nervous shock). The presence of mitral valve prolapse and the occurrence of impulses in children are closely related. As a rule, supraventricular extrasystole (or gastric extrasystole) does not require special treatment, but it is necessary to be examined at least once a year. Children suffering from VSD are at risk.

It is important to limit children from provoking factors that contribute to the development of this disease (healthy lifestyle and sleep, absence of stressful situations). For children, it is recommended to eat foods enriched with elements such as potassium and magnesium, for example, dried fruits.

In the treatment of extrasystole and VSD in children, drugs such as Noofen, Aminalon, Phenibut, Mildronate, Panangin, Asparkam and others are used. Treatment with folk remedies is effective.

Fighting with folk remedies

You can get rid of severe attacks using folk remedies. At home, you can use the same remedies as in the treatment of VSD: soothing infusions and herbal decoctions.

• Valerian. If the attack is classified according to the emotional type, then a pharmaceutical infusion of valerian root will help get rid of anxiety. It is enough to take 10 - 15 drops of infusion once, preferably after a meal.
• Cornflower infusion will save you during an attack. It is recommended to drink the infusion 10 minutes before meals, 3 times a day (only on the day when the attack occurs).
• An infusion of calendula flowers will help get rid of frequent attacks.

Treatment with such traditional methods should be practiced only after consultation with a doctor. If you use them incorrectly, you may simply not get rid of the disease, but may also worsen it.

Prevention

To get rid of the risk of developing extrasystole, timely examination and treatment of heart disease is necessary. Following a diet with plenty of potassium and magnesium salts prevents the development of exacerbations. It is also necessary to give up bad habits (smoking, alcohol, coffee). In some cases, treatment with folk remedies is effective.

Consequences

If the impulses are sporadic and not burdened by anamnesis, then the consequences for the body can be avoided. When the patient already has heart disease, has had a myocardial infarction in the past, frequent extrasystole can cause tachycardia, atrial fibrillation and atrial and ventricular fibrillation.

Gastric extrasystole is considered the most dangerous, since ventricular impulses can lead to sudden death through the development of their fibrillation. Gastric extrasystole requires careful treatment, as it is very difficult to get rid of.

A good video slide show about extrasystole

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Coding of ventricular extrasystole according to ICD 10

Extrasystoles are episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular regions and ventricles. An extraordinary contraction of the heart is usually recorded against the background of normal sinus rhythm without arrhythmia.

It is important to know that ventricular extrasystole in ICD 10 has code 149.

The presence of extrasystoles is observed in% of the entire world population, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other heart rhythm disorders, but the following exceptions are also provided:

• rare myocardial contractions (bradycardia R1);
• extrasystole caused by obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
• disturbances in the functioning of the cardiovascular system in a newborn (P29.1).

The extrasystole code according to ICD 10 determines the plan of diagnostic measures and, in accordance with the examination data obtained, a set of therapeutic methods used throughout the world.

Etiological factor for the presence of extrasystoles according to ICD 10

Worldwide nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years of age, which is typical in the presence of the following organic pathologies:

• heart disease caused by inflammatory processes (myocarditis, pericarditis, bacterial endocarditis);
• development and progression of coronary heart disease;
• dystrophic changes in the myocardium;
• oxygen starvation of the myocardium due to processes of acute or chronic decompensation.

In most cases, episodic interruptions in the functioning of the heart are not associated with damage to the myocardium itself and are only functional in nature, that is, extrasystoles occur due to severe stress, excessive smoking, coffee and alcohol abuse.

Ventricular extrasystole in the international classification of diseases has the following types of clinical course:

• premature contraction of the myocardium, occurring after each normal one, is called bigeminy;
• trigeminy is the process of a pathological impulse after several normal myocardial contractions;
• quadrigeminy is characterized by the appearance of extrasystole after three myocardial contractions.

In the presence of any type of this pathology, a person feels a sinking heart, and then strong tremors in the chest and dizziness.

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Place of ventricular extrasystole in the ICD system - 10

Ventricular extrasystole is one of the types of cardiac arrhythmia. And it is characterized by an extraordinary contraction of the heart muscle.

Ventricular extrasystole, according to the International Classification of Diseases (ICD - 10), has code 149.4. and is included in the list of heart rhythm disorders in the heart disease section.

Nature of the disease

Based on the international classification of diseases of the tenth revision, doctors distinguish several types of extrasystole, the main ones being: atrial and ventricular.

In case of an extraordinary cardiac contraction, which was caused by an impulse emanating from the ventricular conduction system, ventricular extrasystole is diagnosed. The attack manifests itself as a feeling of interruptions in the heart rhythm followed by freezing. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). A 24-hour ECG showed positive results in 50% of the people studied.

Thus, it can be noted that the disease is common and can affect even healthy people. The cause of the functional nature of the disease can be stress.

Drinking energy drinks, alcohol, and smoking can also provoke extrasystoles in the heart. This type of illness is harmless and goes away quickly.

Pathological ventricular arrhythmia has more serious consequences for the health of the body. It develops against the background of serious diseases.

Classification

According to daily monitoring of the electrocardiogram, doctors consider six classes of ventricular extrasystoles.

Extrasystoles belonging to the first class may not manifest themselves in any way. The remaining classes are associated with health risks and the possibility of a dangerous complication: ventricular fibrillation, which can be fatal.

Extrasystoles can vary in frequency; they can be rare, medium and frequent. On the electrocardiogram they are diagnosed as single and paired - two pulses in a row. Impulses can occur in both the right and left ventricles.

The source of extrasystoles can be different: they can come from one source - monotopic, or they can arise in different areas - polytopic.

Disease prognosis

Based on prognostic indications, the arrhythmias under consideration are classified into several types:

• arrhythmias are benign, are not accompanied by heart damage and various pathologies, their prognosis is positive, and the risk of death is minimal;
• ventricular extrasystoles of a potentially malignant direction occur against the background of heart damage, blood output is reduced by an average of 30%, and a health risk is noted;
• ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to begin treatment, a diagnosis of the disease is required in order to find out its causes.

ICD code 10 arrhythmia

Disorders of sinus node automaticity

General part

Under physiological conditions, the cells of the sinus node have the most pronounced automaticity compared to other cells of the heart, providing a resting heart rate (HR) in the range of 60-100 per minute in a state of wakefulness.

Fluctuations in the frequency of sinus rhythm are caused by reflex changes in the activity of the sympathetic and parasympathetic parts of the autonomic nervous system in accordance with the needs of body tissues, as well as local factors - pH, concentration of K + and Ca 2+. P0 2.

When the automatism of the sinus node is impaired, the following syndromes develop:

Sinus tachycardia is an increase in heart rate to 100 beats/min or more while maintaining the correct sinus rhythm, which occurs when the automatism of the sinus node increases.

Sinus bradycardia is characterized by a decrease in heart rate less than 60 beats/min while maintaining the correct sinus rhythm, which is due to a decrease in the automaticity of the sinus node.

Sinus arrhythmia is a sinus rhythm characterized by periods of acceleration and deceleration, with fluctuations in the P-P interval exceeding 160 ms, or 10%.

Sinus tachycardia and bradycardia can be observed under certain conditions in healthy people, and can also be caused by various extra- and intracardiac causes. There are three types of sinus tachycardia and bradycardia: physiological, pharmacological and pathological.

Sinus arrhythmia is based on changes in the automaticity and conductivity of the cells of the sinus node. There are two forms of sinus arrhythmia - respiratory and non-respiratory. Respiratory sinus arrhythmia is caused by physiological reflex fluctuations in the tone of the autonomic nervous system; those not related to breathing usually develop in heart disease.

Diagnosis of all disorders of sinus node automatism is based on identifying ECG signs.

For physiological sinus tachycardia and bradycardia, as well as for respiratory sinus arrhythmia, no treatment is required. In pathological situations, treatment is aimed primarily at the underlying disease; when inducing these conditions with pharmacological agents, the approach is individual.

Epidemiology of sinus node automatism disorders

The prevalence of sinus tachycardia is high at any age, both in healthy people and in people with various cardiac and non-cardiac diseases.

Sinus bradycardia often occurs in athletes and well-trained people, as well as in the elderly and people with various cardiac and non-cardiac diseases.

Respiratory sinus arrhythmia is extremely common in children, adolescents, and young adults; Non-breathing sinus arrhythmia is quite rare.

One for all disorders of sinus node automaticity.

I49.8 Other specified cardiac arrhythmias.

Atrial fibrillation ICD 10

Atrial fibrillation or atrial fibrillation ICD 10 is the most common type of arrhythmia. For example, in the United States, approximately 2.2 million people suffer from it. They often experience ailments such as fatigue, lack of energy, dizziness, shortness of breath and rapid heartbeat.

What is the danger of atrial fibrillation ICD 10?

Many people live with atrial fibrillation for a long time and do not feel much discomfort. However, they do not even suspect that instability of the blood system leads to the formation of a blood clot, which, when it enters the brain, causes a stroke.

In addition, the clot can enter other parts of the body (kidneys, lungs, intestines) and provoke various types of abnormalities.

Atrial fibrillation, ICD code 10 (I48) reduces the heart's ability to pump blood by 25%. In addition, it can lead to heart failure and heart rate fluctuations.

How to detect atrial fibrillation?

For diagnosis, specialists use 4 main methods:

• Electrocardiogram.
• Holter monitor.
• A portable monitor that transmits necessary and vital data about the patient’s condition.
• Echocardiography

These devices help doctors know if you have heart problems, how long they last, and what causes them.

There is also a so-called persistent form of atrial fibrillation. you need to know what it means.

Treatment of atrial fibrillation

Specialists select a treatment option based on the examination results, but most often the patient must go through 4 important stages:

• Restore normal heart rhythm.
• Stabilize and control heart rate.
• Prevent the formation of blood clots.
• Reduce the risk of stroke.

CHAPTER 18. DISORDERS OF RHYTHM AND CONDUCTION OF THE HEART

SUPRAVENTRICULAR ARRHYTHMIAS

SUPRAVENTRICULAR EXTRASYSTOLE

SYNONYMS

DEFINITION

Supraventricular extrasystole is a premature excitation and contraction of the heart relative to the main rhythm (usually sinus), caused by an electrical impulse occurring above the level of the branching of the His bundle (i.e. in the atria, AV node, trunk of the His bundle). Repeated supraventricular extrasystoles are called supraventricular extrasystoles.

ICD-10 CODE

EPIDEMIOLOGY

The frequency of detection of supraventricular extrasystole in healthy people during the day ranges from 43 to% and increases slightly with age; frequent supraventricular extrasystole (more than 30 per hour) occurs only in 2-5% of healthy people.

PREVENTION

Prevention is mainly secondary and consists of eliminating extra-cardiac causes and treating heart diseases that lead to supraventricular extrasystole.

SCREENING

Active detection of supraventricular extrasystole is carried out in patients with potentially high significance or in the presence of typical complaints using ECG and Holter ECG monitoring throughout the day.

CLASSIFICATION

There is no prognostic classification of supraventricular extrasystole. Supraventricular extrasystole can be classified:

By frequency of occurrence: frequent (more than 30 per hour, i.e. more than 720 per day) and rare (less than 30 per hour);

According to the regularity of occurrence: bigeminy (every 2nd impulse is premature), trigeminy (every 3rd), quadrigeminy (every 4th); in general, these forms of supraventricular extrasystole are called allorhythmia;

According to the number of extrasystoles occurring in a row: paired supraventricular extrasystoles or couplets (two supraventricular extrasystoles in a row), triplets (three supraventricular extrasystoles in a row), while the latter are regarded as episodes of unstable supraventricular tachycardia;

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Characteristics of supraventricular extrasystole

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Supraventricular extrasystole ICD 10

Extrasystole (ES) is a premature excitation of the entire heart or any part of it, caused by an extraordinary impulse emanating from the atria, AV junction or ventricles.

The causes of extrasystole are varied. There are extrasystoles of a functional, organic and toxic nature. Clinically, patients may be asymptomatic or complain of sensations of interruptions in cardiac function. Diagnosis of extrasystoles is based on ECG data and physical examination.

The clinical significance of different types of extrasystoles varies critically; Ventricular extrasystole in organic heart lesions has exceptional prognostic significance, and therefore special attention is devoted to this aspect.

• Sinus extrasystoles.
• Atrial extrasystoles.
• Extrasystoles from the AV connection.
• Ventricular extrasystoles.

• Early extrasystoles.
• Average extrasystoles.
• Late extrasystoles.

• Rare extrasystoles - less than 5 per 1 minute.
• Average extrasystoles - from 6 to 15 per minute.
• Frequent extrasystoles - more than 15 per minute.

• Single extrasystoles.
• Paired extrasystoles.

• Sporadic extrasystoles.
• Allorhythmic extrasystoles - bigeminy, trigeminy, etc.

Read more: General ECG signs of extrasystoles and morphological types of extrasystoles.

• Explicit extrasystoles.
• Hidden extrasystoles.

• Conduction block (antero- and retrograde).
• "Gap" in conduction.
• Supernormal conduction.

Due to the high clinical and prognostic significance of ventricular extrasystoles in organic heart diseases, its classification according to the morphological principle has been developed, based on the idea of ​​​​the connection between certain forms of ventricular extrasystoles and the risk of sudden death - classification of ventricular extrasystoles according to B. Lown, M. Wolf (1971):

• 0. Absence of ventricular extrasystoles within 24 hours of monitoring.
• 1. Rare, monotopic (no more than 30 ventricular extrasystoles in any hour of monitoring).
• 2. Frequent, monotopic (more than 30 ventricular extrasystoles in any hour of monitoring).
• 3. Polytopic (polymorphic).
• 4.A. - Pairs.
• 4.B. - Salvo - runs of ventricular tachycardia (more than 3 extrasystoles in a row).
• 5. Early (R to T).

As the class of extrasystole increases, the risk of sudden death increases.

• 4.A. - Monomorphic paired ventricular extrasystoles.
• 4.B. - Polymorphic paired ventricular extrasystoles.
• 5. Ventricular tachycardia (more than 3 extrasystoles in a row) - the meaning of “early” extrasystoles in terms of the time of appearance in diastole is disputed.

• Extrasystole of a functional nature.
• Extrasystole of organic origin.
• Extrasystole of toxic origin.

Single supraventricular ES (SSES) or ventricular ES (VE) occur at some time in life in all people.

Extrasystole often accompanies the course of various heart diseases.

Etiology and pathogenesis

• Etiology of extrasystoles
  • Etiology of extrasystoles of a functional (dysregulatory) nature.

  Functional extrasystole occurs as a result of a vegetative reaction in the human body to one of the following influences:

  • Emotional stress.
  • Smoking.
  • Abuse of coffee.
  • Alcohol abuse.
  • In patients with neurocirculatory dystonia.
  • Also, functional extrasystole can be observed in healthy individuals for no apparent reason (so-called idiopathic extrasystole).
• Etiology of extrasystoles of organic origin.

  Extrasystole of organic origin, as a rule, occurs as a result of morphological changes in the heart muscle in the form of foci of necrosis, dystrophy, cardiosclerosis or metabolic disorders. These organic changes in the myocardium can be observed in the following diseases:

  • IHD, acute myocardial infarction.
  • Arterial hypertension.
  • Myocarditis.
  • Postmyocaditic cardiosclerosis.
  • Cardiomyopathies.
  • Congestive circulatory failure.
  • Pericarditis.
  • Heart defects (primarily with mitral valve prolapse).
  • Chronic pulmonary heart disease.
  • Heart damage due to amyloidosis, sarcoidosis, hemochromatosis.
  • Surgical interventions on the heart.
  • "The Heart of an Athlete"
• Etiology of extrasystoles of toxic origin.

  Extrasystoles of toxic origin occur in the following pathological conditions:

  • Feverish states.
  • Digitalis intoxication.
  • Exposure to antiarrhythmic drugs (proarrhythmic side effect).
  • Thyrotoxicosis.
  • Taking aminophylline, inhaling betamimetics.
• Features of the etiology of ventricular extrasystoles.

  Ventricular extrasystoles in more than 2/3 of patients develop due to various forms of IHD.

  The most common causes of the development of ventricular extrasystoles are the following forms of ischemic heart disease:

  Ventricular rhythm disturbances (the appearance or increase in ventricular extrasystoles, the first paroxysm of ventricular tachycardia or ventricular fibrillation with the development of clinical death) may be the earliest clinical manifestation of acute myocardial infarction and always require exclusion of this diagnosis. Reperfusion arrhythmias (developed after successful thrombolysis) are practically untreatable and are relatively benign in nature.

  Ventricular extrasystoles emanating from the left ventricular aneurysm may resemble infarction QRS in shape (QR in V1, ST elevation and “coronary” T).

  The appearance of paired ventricular extrasystoles during a treadmill test at a heart rate less than 130 beats/min has a poor prognostic value. The prognosis is especially poor when paired ventricular extrasystoles are combined with ischemic ST changes.

  One can confidently speak about the non-coronary nature of ventricular arrhythmias only after coronary angioharphy. In this regard, this study is indicated for most patients over 40 years of age suffering from ventricular extrasystole.

  Among the causes of non-coronarogenic ventricular extrasystoles, in addition to those mentioned above, there is a group of genetically determined diseases. In these diseases, ventricular extrasystole and ventricular tachycardia are the main clinical manifestations. In terms of the degree of malignancy of ventricular arrhythmias, this group of diseases is close to ischemic heart disease. Taking into account the nature of the genetic defect, these diseases are classified as channelopathies. These include:

  1. Arrhythmogenic left ventricular dysplasia.
  2. Long QT syndrome.
  3. Brugada syndrome.
  4. Short QT syndrome.
  5. WPW syndrome.
  6. Catecholamine-induced trigger polymorphic ventricular tachycardia.

• Pathogenesis of extrasystoles

  The morphological substrate of extrasystole (and some other rhythm disturbances) is the electrical inhomogeneity of the heart muscle of various origins.

  The main mechanisms for the development of extrasystole:

  • Repeated entry of an excitation wave (re-entry) in areas of the myocardium or conduction system of the heart, characterized by unequal speed of impulse conduction and the development of unidirectional blockade of conduction.
  • Increased oscillatory (trigger) activity of the cell membranes of certain areas of the atria, AV junction or ventricles.
  • The ectopic impulse from the atria spreads from top to bottom along the conduction system of the heart.
  • The ectopic impulse arising at the AV junction propagates in two directions: from top to bottom along the conduction system of the ventricles and from bottom to top (retrograde) through the atria.

  Features of the pathogenesis of ventricular extrasystole:

  • Single monomorphic ventricular extrasystoles can arise as a result of both the formation of re-entry of the excitation wave (re-entry) and the functioning of the post-depolarization mechanism.
  • Repeated ectopic activity in the form of several successive ventricular extrasystoles is usually due to the re-entry mechanism.
  • The source of ventricular extrasystoles in most cases are the branches of the His bundle and Purkinje fibers. This leads to a significant disruption of the process of propagation of the excitation wave through the right and left ventricles, which leads to a significant increase in the total duration of the extrasystolic ventricular QRS complex.
  • With ventricular extrasystole, the sequence of repolarization also changes.

Clinic and complications

Extrasystole is not always felt by patients. The tolerance of extrasystoles varies significantly between different patients and does not always depend on the number of extrasystoles (a complete absence of complaints is possible even in the presence of stable bi- and trigeminy).

In some cases, at the moment of extrasystole, there is a feeling of interruptions in the work of the heart, “tumbling”, “turning the heart over”. If they occur at night, these sensations cause you to wake up, accompanied by anxiety.

Less often, the patient complains of attacks of rapid, irregular heartbeat, which requires excluding the presence of paroxysmal atrial fibrillation.

Sometimes extrasystole is perceived by patients as a “stop” or “fading” of the heart, which corresponds to a long compensatory pause following the extrasystole. Often, after such a short period of cardiac arrest, patients feel a strong push in the chest, caused by the first increased contraction of the ventricles of sinus origin after the extrasystole. The increase in stroke output in the first post-extrasystolic complex is mainly due to an increase in diastolic filling of the ventricles during a long compensatory pause (increased preload).

Supraventricular premature beats are not associated with an increased risk of sudden death. In relatively rare cases of falling into a “vulnerable window” of the cardiac cycle and the presence of other conditions for the occurrence of re-entry, it can cause supraventricular tachycardia.

Objectively, the most serious consequence of supraventricular extrasystole is atrial fibrillation, which can develop in patients with supraventricular extrasystole and atrial overload/dilatation. The risk of developing atrial fibrillation can serve as a criterion for the malignancy of supraventricular extrasystole, similar to the risk of sudden death with ventricular extrasystole.

The main complication of ventricular extrasystole, which determines its clinical significance, is sudden death. To assess the risk of sudden death with ventricular extrasystole, a number of special criteria have been developed to determine the required amount of treatment.

Diagnostics

The presence of extrasystole can be suspected if the patient complains of interruptions in the functioning of the heart. The main diagnostic method is an ECG, but certain information can also be obtained from a physical examination of the patient.

When collecting anamnesis, it is necessary to clarify the circumstances under which arrhythmia occurs (during emotional or physical stress, at rest, during sleep).

It is important to clarify the duration and frequency of episodes, the presence of signs of hemodynamic disorders and their nature, the effect of non-drug tests and drug therapy.

Close attention should be paid to the history of indications of previous diseases that may cause organic heart damage, as well as their possible undiagnosed manifestations.

During a clinical examination, it is important to form at least a rough idea of ​​the etiology of extrasystoles, since extrasystoles in the absence and presence of organic heart damage require a different approach to treatment.

• Arterial pulse examination.

When examining the arterial pulse, extrasystoles correspond to prematurely occurring pulse waves of small amplitude, which indicates insufficient diastolic filling of the ventricles during a short pre-extrasystolic period.

Pulse waves corresponding to the first post-extrasystolic ventricular complex, which occurs after a long compensatory pause, usually have a large amplitude.

In cases of bi- or trigeminy, as well as frequent extrasystole, a pulse deficiency is detected; with persistent bigeminia, the pulse can sharply decrease (less than 40/min), remaining rhythmic and accompanied by symptoms of bradyarrhythmia.

During an extrasystolic contraction, slightly weakened premature I and II (or only one) extrasystolic sounds are heard, and after them, loud I and II heart sounds, corresponding to the first post-extrasystolic ventricular complex.

Distinctive features of extrasystolic arrhythmia in the presence of organic heart disease and in its absence.

The main electrocardiographic sign of extrasystole is the premature occurrence of the ventricular QRST complex and/or P wave, that is, shortening of the coupling interval.

The coupling interval is the distance from the previous extrasystole of the next P–QRST cycle of the main rhythm to the extrasystole.

Compensatory pause - the distance from the extrasystole to the following P–QRST cycle of the main rhythm. There are incomplete and complete compensatory pauses:

• Incomplete compensatory pause.

An incomplete compensatory pause is a pause that occurs after an atrial extrasystole or extrasystole from the AV junction, the duration of which is slightly longer than the usual P–P (R–R) interval of the main rhythm.

An incomplete compensatory pause includes the time required for the ectopic impulse to reach the SA node and “discharge” it, as well as the time required to prepare the next sinus impulse in it.

A complete compensatory pause is a pause that occurs after a ventricular extrasystole, and the distance between the two sinus P-QRST complexes (pre-extrasystolic and post-extrasystolic) is equal to twice the R-R interval of the main rhythm.

Allorhythmia is the correct alternation of extrasystoles and normal contractions. Depending on the frequency of occurrence of extrasystoles, the following types of allorhythmias are distinguished:

• Bigeminy - each normal contraction is followed by an extrasystole.
• Trigeminy - extrasystoles occur after every two normal contractions.
• Quadrihymenia - extrasystoles occur after every three normal contractions, etc.
• A couplet is the occurrence of two extrasystoles in a row.
• Three or more extrasystoles in a row are regarded as a run of supraventricular tachycardia.

The following types of extrasystoles are also distinguished:

• Monotopic extrasystoles are extrasystoles emanating from one ectopic source and, accordingly, having a constant coupling interval and the shape of the ventricular complex.
• Polytopic extrasystoles are extrasystoles emanating from different ectopic foci and differing from each other in the coupling interval and the shape of the ventricular complex.
• Group (volley) extrasystole - the presence of three or more extrasystoles in a row on the ECG.

• Premature extraordinary appearance of the P wave and the QRST complex that follows it (the P-P interval is less than the main one).

The constancy of the coupling interval (from the P wave of the previous normal complex to the P wave of the extrasystole) is a sign of the monotopy of supraventricular extrasystole. With “early” supraventricular extrasystole, the P wave is typically superimposed on the preceding T wave, which can complicate diagnosis.

With extrasystole from the upper parts of the atria, the P wave differs little from the norm. With extrasystole from the middle sections, the P wave is deformed, and with extrasystole from the lower sections, it is negative. The need for more accurate topical diagnosis arises when surgical treatment is necessary, which is preceded by an electrophysiological study.

It should be remembered that sometimes with atrial and atrioventricular extrasystoles, the ventricular QRS complex can acquire a so-called aberrant form due to the occurrence of functional blockade of the right bundle branch or its other branches. In this case, the extrasystolic QRS complex becomes wide (≥0.12 sec), split and deformed, reminiscent of the QRS complex with bundle branch block or ventricular extrasystole.

Blocked atrial extrasystoles are extrasystoles emanating from the atria, which are represented on the ECG only by the P wave, after which there is no extrasystolic ventricular QRST complex.

• Premature extraordinary appearance on the ECG of an unchanged ventricular QRS complex (without a preceding P wave!), similar in shape to other QRS complexes of sinus origin. The exception is in cases of QRS complex aberration.

It should be remembered that sometimes with atrial and atrioventricular extrasystoles, the ventricular QRS complex can acquire a so-called aberrant form due to the occurrence of functional blockade of the right bundle branch or its other branches. In this case, the extrasystolic QRS complex becomes wide, split and deformed, reminiscent of the QRS complex with bundle branch block or ventricular extrasystole.

If the ectopic impulse reaches the ventricles faster than the atria, the negative P wave is located after the extrasystolic P-QRST complex. If the atria and ventricles are excited simultaneously, the P wave merges with the QRS complex and is not detected on the ECG.

Trunk extrasystoles are distinguished by the occurrence of complete blockade of the retrograde extrasystolic impulse to the atria. Therefore, a narrow extrasystolic QRS complex is recorded on the ECG, after which there is no negative P wave. Instead, a positive P wave is recorded. This is another atrial P wave of sinus origin, which usually falls on the RS-T segment or the T wave of the extrasystolic complex.

• Premature appearance on the ECG of an altered ventricular QRS complex, in front of which there is no P wave (with the exception of late ventricular extrasystoles, in front of which there is a P. But the PQ is shortened compared to sinus cycles).
• Significant expansion (up to 0.12 s or more) and deformation of the extrasystolic QRS complex (the shape resembles a bundle branch block opposite to the side of the occurrence of extrasystoles - the location of the RS-T segment and the T wave of the extrasystole is discordant with the direction of the main wave of the QRS complex).
• The presence of a complete compensatory pause after the ventricular extrasystole (it complements the coupling interval of the extrasystoles until the RR of the main rhythm is doubled).

With ventricular extrasystole, there is usually no “discharge” of the SA node, since the ectopic impulse arising in the ventricles, as a rule, cannot retrogradely pass through the AV node and reach the atria and the SA node. In this case, the next sinus impulse unimpededly excites the atria, passes through the AV node, but in most cases cannot cause another depolarization of the ventricles, since after the ventricular extrasystole they are still in a state of refractory.

The usual normal excitation of the ventricles will occur only after the next (second after the ventricular extrasystole) sinus impulse. Therefore, the duration of the compensatory pause during ventricular extrasystole is noticeably longer than the duration of the incomplete compensatory pause. The distance between the normal (sinus origin) ventricular QRS complex preceding the ventricular extrasystole and the first normal sinus QRS complex recorded after the extrasystole is equal to twice the R-R interval and indicates a complete compensatory pause.

Occasionally, ventricular extrasystoles can be carried out retrogradely to the atria and, upon reaching the sinus node, discharge it; in these cases, the compensatory pause will be incomplete.

Only sometimes, usually against the background of a relatively rare main sinus rhythm, a compensatory pause after a ventricular extrasystole may be absent. This is explained by the fact that the next (first after the extrasystole) sinus impulse reaches the ventricles at the moment when they have already emerged from the refractory state. In this case, the rhythm is not disturbed and ventricular extrasystoles are called “intercalated”.

A compensatory pause may also be absent with ventricular extrasystole against the background of atrial fibrillation.

It should be emphasized that none of the listed ECG signs has 100% sensitivity and specificity.

To assess the prognostic significance of ventricular extrasystole, it may be useful to evaluate the characteristics of the ventricular complexes:

• In the presence of organic damage to the heart, extrasystoles are often low-amplitude, wide, jagged; The ST segment and T wave may be directed in the same direction as the QRS complex.
• Relatively “favorable” ventricular extrasystoles have an amplitude of more than 2 mV, are not deformed, their duration is about 0.12 seconds, the ST segment and T wave are directed in the direction opposite to the QRS.

Of clinical importance is the determination of mono-/polytopic ventricular extrasystole, which is carried out taking into account the constancy of the coupling interval and the shape of the ventricular complex.

Monotopy indicates the presence of a specific arrhythmogenic focus. The location of which can be determined by the shape of the ventricular extrasystole:

• Left ventricular extrasystoles – R dominates in leads V1-V2 and S in V5-V6.
• Extrasystoles from the outflow tract of the left ventricle: the electrical axis of the heart is located vertically, rS (with their constant ratio) in leads V1-V3 and a sharp transition to the R-type in leads V4-V6.
• Right ventricular extrasystoles - S dominates in leads V1-V2 and R in leads V5-V6.
• Extrasystoles from the outflow tract of the right ventricle – high R in II III aVF, transition zone in V2-V3.
• Septal extrasystoles - the QRS complex is slightly widened and resembles WPW syndrome.
• Concordant apical extrasystoles (up both ventricles) – S dominates in leads V1-V6.
• Concordant basal extrasystoles (down both ventricles) - R dominates in leads V1-V6.

With a monomorphic ventricular extrasystole with an inconsistent coupling interval, one should think about parasystole - the simultaneous work of the main (sinus, less often atrial fibrillation/flutter) and an additional pacemaker located in the ventricles.

Parasystoles follow each other at different intervals, but the intervals between parasystoles are a multiple of the smallest of them. Characteristic are confluent complexes, which may be preceded by a P wave.

Holter ECG monitoring is a long-term recording (up to 48 hours) of an ECG. For this purpose, a miniature recording device with leads is used, which are attached to the patient’s body. When recording indicators during his daily activities, the patient records in a special diary all the symptoms that appear and the nature of the activity. The results obtained are then analyzed.

Holter ECG monitoring is indicated not only in the presence of ventricular extrasystole on the ECG or in history, but also in all patients with organic heart diseases, regardless of the presence of a clinical picture of ventricular arrhythmias and their detection on standard ECGs.

Holter ECG monitoring should be performed before the start of treatment, and subsequently to assess the adequacy of the therapy.

In the presence of extrasystole, Holter monitoring makes it possible to evaluate the following parameters:

• Frequency of extrasystoles.
• Duration of extrasystole.
• Mono-/polytopic ventricular extrasystole.
• Dependence of extrasystole on the time of day.
• Dependence of extrasystole on physical activity.
• Relationship between extrasystole and ST segment changes.
• Relationship between extrasystole and rhythm frequency.

Read more: Holter ECG monitoring.

The treadmill test is not used specifically to provoke ventricular arrhythmias (except for cases where the patient himself notes the connection between the occurrence of rhythm disturbances solely with exercise). In cases where the patient notes a connection between the occurrence of rhythm disturbances and exercise, during the treadmill test, conditions must be created for resuscitation.

The connection between ventricular extrasystoles and load most likely indicates their ischemic etiology.

Idiopathic ventricular extrasystole can be suppressed by exercise.

Treatment

Treatment tactics depend on the location and form of extrasystole.

In the absence of clinical manifestations, supraventricular extrasystole does not require treatment.

In case of supraventricular extrasystole, which has developed against the background of heart disease or non-cardiac disease, treatment of the underlying disease/condition is necessary (treatment of endocrine disorders, correction of electrolyte imbalances, treatment of ischemic heart disease or myocarditis, discontinuation of medications that can cause arrhythmia, cessation of alcohol, smoking, excess consumption coffee).

• Indications for drug therapy for supraventricular extrasystole
  • Subjectively poor tolerance of supraventricular extrasystole.

  It is useful to identify situations and times of day in which the sensations of interruptions predominantly occur, and time the intake of medications to this time.

  Supraventricular extrasystole in these cases serves as a harbinger of the appearance of atrial fibrillation, which is objectively the most serious consequence of supraventricular extrasystole.

  The lack of antiarrhythmic treatment (along with etiotropic) increases the risk of perpetuating supraventricular extrasystole. Frequent supraventricular extrasystole in such cases is “potentially malignant” with respect to the development of atrial fibrillation.

  The choice of antiarrhythmic is determined by the tropism of its action, side effects and partly the etiology of supraventricular extrasystole.

  It should be remembered that patients with coronary artery disease who have recently suffered a myocardial infarction are not advised to prescribe class I drugs due to their arrhythmogenic effect on the ventricles.

  Treatment is carried out sequentially with the following medications:

  • β-blockers (Anaprilin 30-60 mg/day, atenolol (Atenolol-nikomed, Atenolol) mg/day, bisoprolol (Concor, Bisocard) 5-10 mg/day, metoprolol (Egilok, Vazocardin) mg/day, Nebilet 5- 10 mg/day, Lokrenmg/day - long-term or until the cause of supraventricular extrasystole is eliminated) or calcium antagonists (Verapamilmg/day, diltiazem (Cardil, Diltiazem-Teva) mg/day, long-term or until the cause of supraventricular extrasystole is eliminated).

  Taking into account possible side effects, treatment with retard drugs should not be started due to the need for rapid withdrawal if bradycardia and sinoatrial and/or atrioventricular conduction disturbances occur.

  Supraventricular extrasystoles, along with paroxysmal supraventricular tachycardias, are rhythm disturbances in which otherwise ineffective beta blockers and calcium channel blockers (for example, verapamil (Isoptin, Finoptin)) are often ineffective, especially in patients with a tendency to tachycardia without serious organic heart damage and pronounced dilatation of the atria.

  These groups of drugs are not indicated for patients with vagal-mediated supraventricular extrasystole, which develops against the background of bradycardia, mainly at night. Such patients are prescribed Belloid, small doses of Teopek or Corinfar, taking into account their rhythm-increasing effect.

  Disopyramide (Ritmilen) mg/day, Quinidine-durules mg/day, allapinin mg/day. (an additional indication for their use is a tendency to bradycardia), propafenone (Ritionorm, Propanorm) mg/day, Etacizin mg/day.

  Taking drugs in this group is often accompanied by side effects. There may be disturbances in SA and AV conduction, as well as an arrhythmogenic effect. In the case of taking quinidine, there is a prolongation of the QT interval, a decrease in contractility and myocardial dystrophy (negative T waves appear in the chest leads). Quinidine should not be prescribed in the presence of ventricular extrasystole. Caution is also necessary in the presence of thrombocytopenia.

  Prescribing these drugs makes sense in patients with a high prognostic significance of supraventricular extrasystole - in the presence of an active inflammatory process in the myocardium, a high frequency of supraventricular extrasystole in patients with organic heart damage, atrial dilatation, “threatened” by the development of atrial fibrillation.

  Class IA or IC drugs should not be used for supraventricular extrasystole, as well as for other forms of cardiac arrhythmias, in patients who have had myocardial infarction, as well as for other types of organic damage to the heart muscle due to the high risk of proarrhythmic action and the associated deterioration in life prognosis .

  It should be noted that a moderate and non-progressive increase in the duration of the PQ interval (up to 0.22-0.24 s), as well as moderate sinus bradycardia (up to 50) are not an indication for discontinuation of therapy, subject to regular ECG monitoring.

  When treating patients with an undulating course of supraventricular extrasystole, one should strive for the complete abolition of drugs during periods of remission (excluding cases of severe organic damage to the myocardium).

  Along with the prescription of antiarrhythmics, it is necessary to remember about the treatment of the cause of supraventricular extrasystole, as well as about drugs that can improve the subjective tolerability of supraventricular extrasystole: benzodiazepines (Phenazepam 0.5-1 mg, clonazepam 0.5-1 mg), hawthorn tincture, motherwort.

  The basic principle for choosing therapy for ventricular extrasystoles is to assess their prognostic significance.

  The Lown-Wolf classification is not exhaustive. Bigger (1984) proposed a prognostic classification that provides characteristics of benign, potentially malignant and malignant ventricular arrhythmias.

  Prognostic significance of ventricular arrhythmias.

  A brief description of ventricular extrasystoles can also be presented as follows:

  • Benign ventricular extrasystoles - any ventricular extrasystoles in patients without cardiac damage (including myocardial hypertrophy) with a frequency of less than 10 per hour, without fainting or cardiac arrest in history.
  • Potentially malignant ventricular extrasystoles - any ventricular extrasystoles with a frequency of more than 10 per hour or ventricular tachycardia in patients with left ventricular dysfunction, without a history of syncope or cardiac arrest.
  • Malignant ventricular extrasystoles - any ventricular extrasystoles with a frequency of more than 10 per hour in patients with severe myocardial pathology (most often with a LV ejection fraction of less than 40%), a history of fainting or cardiac arrest; Sustained ventricular tachycardia is often detected.
  • Within the groups of potentially malignant and malignant ventricular extrasystoles, the potential risk is also determined by the gradation of ventricular extrasystoles (According to the Laun-Wolf classification).

  To increase the accuracy of the prognosis, in addition to the fundamental signs, a complex of clinical and instrumental predictors of sudden death is used, each of which individually is not of decisive importance:

  • Left ventricular ejection fraction. If, with coronary artery disease, the left ventricular ejection fraction decreases to less than 40%, the risk increases 3 times. With non-coronarogenic ventricular extrasystole, the significance of this criterion may decrease).
  • The presence of late ventricular potentials is an indicator of areas of slow conduction in the myocardium, detected on a high-resolution ECG. Late ventricular potentials reflect the presence of a substrate for re-entry and, in the presence of ventricular extrasystole, force one to take its treatment more seriously, although the sensitivity of the method depends on the underlying disease; the ability to monitor therapy using late ventricular potentials is questionable.
  • Increased QT interval dispersion.
  • Reduced heart rate variability.

• Treatment tactics for ventricular extrasystole

  Once a patient is classified into a particular risk category, the choice of treatment can be decided.

  As in the treatment of supraventricular extrasystoles, the main method of monitoring the effectiveness of therapy is Holter monitoring: a decrease in the number of ventricular extrasystoles by 75-80% indicates the effectiveness of treatment.

  Treatment tactics for patients with ventricular extrasystoles of different prognosis:

  • In patients with benign ventricular extrasystole, which is subjectively well tolerated by the patient, it is possible to refuse antiarrhythmic therapy.
  • For patients with benign ventricular extrasystole, which is subjectively poorly tolerated, as well as for patients with potentially malignant arrhythmias of non-ischemic etiology, it is preferable to prescribe class I antiarrhythmics.

  If they are ineffective, use amiodarone or d,l-sotalol. These drugs are prescribed only for non-ischemic etiology of ventricular extrasystole - in post-infarction patients, according to evidence-based studies, the pronounced proarrhythmic effect of flecainide, encainide and ethmosin is associated with a 2.5-fold increase in the risk of death! The risk of proarrhythmic effects is also increased with active myocarditis.

  Of class I anitiarrhythmics, the following are effective:

  • Propafenone (Propanorm, Ritmonorm) orally mg/day, or retard forms (propafenone SR 325 and 425 mg, prescribed twice a day). Therapy is usually well tolerated. Possible combinations with beta blockers, d,l-sotalol (Sotahexal, Sotalex), verapamil (Isoptin, Finoptin) (under the control of heart rate and AV conduction!), as well as with amiodarone (Cordarone, Amiodarone) up to a day.
  • Etacizin orally mg/day. Therapy begins with the appointment of half doses (0.5 tablets 3-4 times a day) to assess tolerability. Combinations with class III drugs can be arrhythmogenic. Combination with beta blockers is advisable for myocardial hypertrophy (under heart rate control, in a small dose!).
  • Ethmozin orally mg/day. Therapy begins with the appointment of smaller doses - 50 mg 4 times a day. Ethmozin does not prolong the QT interval and is usually well tolerated.
  • Flecainide intramg/day. Quite effective, somewhat reduces myocardial contractility. In some patients it causes paresthesia.
  • Disopyramide intramg/day. It can provoke sinus tachycardia, and therefore combinations with beta blockers or d,l-sotalol are advisable.
  • Allapinin is the drug of choice for a tendency to bradycardia. Prescribed as monotherapy at a dose of 75 mg/day. as monotherapy or 50 mg/day. in combination with beta blockers or d,l-sotalol (not more than 80 mg/day). This combination is often advisable because it increases the antiarrhythmic effect, reducing the effect of drugs on heart rate and allows you to prescribe lower doses if each drug is poorly tolerated separately.
  • Less commonly used are drugs such as Difenin (for ventricular extrasystole due to digitalis intoxication), mexiletine (for intolerance to other antiarrhythmics), ajmaline (for WPW syndrome accompanied by paroxysmal supraventricular tachycardia), Novocainamide (for ineffectiveness or intolerance to other antiarrhythmics; the drug is quite effective , however, it is extremely inconvenient to use and, with prolonged use, can lead to agranulocytosis).
  • It should be noted that in most cases of ventricular extrasystole, verapamil and beta blockers are ineffective. The effectiveness of first class drugs reaches 70%, but strict consideration of contraindications is necessary. The use of quinidine (Kinidin Durules) for ventricular extrasystole is undesirable.

  It is advisable to give up alcohol, smoking, and excessive coffee consumption.

  In patients with benign ventricular extrasystoles, an antiarrhythmic can be prescribed only at the time of day when manifestations of extrasystoles are subjectively felt.

  In some cases, you can get by with the use of Valocordin and Corvalol.

  In some patients, it is advisable to use psychotropic and/or vegetotropic therapy (Phenazepam, Diazepam, Clonazepam).

  d,l-sotalolol (Sotalex, Sotahexal) is used only if amiodarone is intolerant or ineffective. The risk of developing an arrhythmogenic effect (ventricular tachycardia of the “pirouette” type against the background of QT prolongation beyond MS) increases significantly when moving to doses above 160 mg/day. and most often manifests itself in the first 3 days.

  Amiodarone (Amiodarone, Cordarone) is effective in approximately 50% of cases. Careful addition of beta blockers, especially in cases of coronary artery disease, reduces both arrhythmic and overall mortality. Abrupt replacement of beta blockers with amiodarone is contraindicated! Moreover, the higher the initial heart rate, the higher the effectiveness of the combination.

  Only amiodarone simultaneously suppresses ventricular extrasystole and improves the prognosis of life in patients who have suffered myocardial infarction and suffering from other organic lesions of the heart muscle. Treatment is carried out under ECG control - 1 time every 2-3 days. After reaching amiodarone saturation (increasing the duration of the Q-T interval, widening and thickening of the T wave, especially in leads V5 and V6), the drug is prescribed in a maintenance dose (mg 1 time / day for a long time, usually from the 3rd week). The maintenance dose is determined individually. Treatment is carried out under ECG control - once every 4-6 weeks. If the duration of the Q-T interval increases by more than 25% of the initial value or up to 500 ms, temporary discontinuation of the drug and subsequent use of it in a reduced dose are required.

  In patients with life-threatening ventricular extrasystoles, the development of thyroid dysfunction is not an indication for discontinuation of amiodarone. Monitoring of thyroid function with appropriate correction of disorders is mandatory.

  “Pure” class III antiarrhythmics, like class I drugs, are not recommended due to their pronounced proarrhythmic effect. A meta-analysis of 138 randomized placebo-controlled studies on the use of antiarrhythmic therapy in patients with ventricular extrasystole after myocardial infarction (total number of patients) shows that the prescription of class I drugs in this category of patients is always associated with an increased risk of death, especially if these are class IC drugs. The risk of death is reduced by β-blockers (class II).

  The question of the duration of antiarrhythmic therapy is practically important. In patients with malignant ventricular extrasystole, antiarrhythmic therapy should be continued indefinitely. For less malignant arrhythmias, treatment should be quite long (up to several months), after which an attempt to gradually discontinue the drug is possible.

  In some cases - with frequent ventricular extrasystoles (up to a thousand per day) with an arrhythmogenic focus identified during an electrophysiological study and ineffectiveness, or if long-term use of antiarrhythmics is impossible in combination with poor tolerance or poor prognosis - radiofrequency ablation is used.

  Forecast

  Organic extrasystole, which develops in patients with acute myocardial infarction, myocarditis, cardiomyopathy, chronic heart failure, arterial hypertension, etc., has a more serious prognostic significance.

  In fact, the prognosis of extrasystoles depends more on the presence or absence of organic heart disease and its severity than on the characteristics of the extrasystoles themselves; Accordingly, in the broadest sense, the main method of preventing extrasystoles is the timely treatment of these diseases.

  Organic atrial extrasystoles that occur in patients with coronary artery disease, acute myocardial infarction, arterial hypertension against the background of pronounced morphological changes in the atria can be harbingers of paroxysmal atrial fibrillation or supraventricular tachycardia.

  The criterion for the malignancy of supraventricular extrasystoles is the risk of developing atrial fibrillation, and ventricular extrasystoles is the risk of sudden death.

  Assessing the prognostic value of ventricular extrasystoles, it should be emphasized that in approximately 65–70% of people with a healthy heart, individual ventricular extrasystoles are recorded during Holter monitoring, the source of which in most cases is localized in the right ventricle. Such monomorphic isolated ventricular extrasystoles, usually belonging to class 1 according to the classification of B. Lown and M. Wolf, are not accompanied by clinical and echocardiographic signs of organic heart pathology and hemodynamic changes. Therefore, they are called “functional ventricular extrasystoles.”

  The main complication of ventricular extrasystole, which determines its clinical significance, is sudden death. Ventricular arrhythmias are associated with the likelihood of developing fatal arrhythmias, i.e., sudden arrhythmic death. To determine the degree of its risk in real clinical practice, the classification according to B. Lown, M. Wolf, as modified by M. Ryan, and the risk stratification of ventricular arrhythmias by J. T. Bigger are used. It involves analyzing not only the nature of ventricular ectopic activity, but also its clinical manifestations, as well as the presence or absence of organic heart damage as the cause of its occurrence. In accordance with these signs, 3 categories of patients are distinguished.

  Benign ventricular arrhythmias include extrasystole, often single (there may be other forms), asymptomatic or asymptomatic, but most importantly, it occurs in individuals who do not have signs of heart disease. The prognosis for the life of these patients is favorable, due to the very low probability of fatal ventricular arrhythmias, which does not differ from that in the general population, and from the standpoint of preventing sudden death, they do not require any treatment. All that is necessary is dynamic monitoring of them, because, at least in some patients, ventricular extrasystole may be the debut of cardiac pathology.

  The only fundamental difference between potentially malignant ventricular arrhythmias and the previous category is the presence of organic heart disease. Most often these are various forms of ischemic heart disease (the most significant is previous myocardial infarction), heart damage due to arterial hypertension, primary myocardial diseases, etc. These patients have ventricular extrasystole of various gradations ( potential triggering factor for ventricular tachyarrhythmias) there have not yet been paroxysms of ventricular tachycardia, flutter or ventricular fibrillation, but the likelihood of their occurrence is quite high, and the risk of sudden death is characterized as significant. Patients with potentially malignant ventricular arrhythmias require treatment aimed at reducing mortality, treatment based on the principle of primary prevention of sudden death.

• Ectopic systoles
• Extrasystoles
• Extrasystolic arrhythmia
• Premature:
  • abbreviations NOS
  • compression

• Brugada syndrome
• Long QT syndrome
• Rhythm disturbance:
  • coronary sinus
  • ectopic
  • nodal

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Place of ventricular extrasystole in the ICD system - 10

Ventricular extrasystole is one of the types of cardiac arrhythmia. And it is characterized by an extraordinary contraction of the heart muscle.

Ventricular extrasystole, according to the International Classification of Diseases (ICD - 10), has code 149.4. and is included in the list of heart rhythm disorders in the heart disease section.

Nature of the disease

Based on the international classification of diseases of the tenth revision, doctors distinguish several types of extrasystole, the main ones being: atrial and ventricular.

In case of an extraordinary cardiac contraction, which was caused by an impulse emanating from the ventricular conduction system, ventricular extrasystole is diagnosed. The attack manifests itself as a feeling of interruptions in the heart rhythm followed by freezing. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). A 24-hour ECG showed positive results in 50% of the people studied.

Thus, it can be noted that the disease is common and can affect even healthy people. The cause of the functional nature of the disease can be stress.

Drinking energy drinks, alcohol, and smoking can also provoke extrasystoles in the heart. This type of illness is harmless and goes away quickly.

Pathological ventricular arrhythmia has more serious consequences for the health of the body. It develops against the background of serious diseases.

Classification

According to daily monitoring of the electrocardiogram, doctors consider six classes of ventricular extrasystoles.

Extrasystoles belonging to the first class may not manifest themselves in any way. The remaining classes are associated with health risks and the possibility of a dangerous complication: ventricular fibrillation, which can be fatal.

Extrasystoles can vary in frequency; they can be rare, medium and frequent. On the electrocardiogram they are diagnosed as single and paired - two pulses in a row. Impulses can occur in both the right and left ventricles.

The source of extrasystoles can be different: they can come from one source - monotopic, or they can arise in different areas - polytopic.

Disease prognosis

Based on prognostic indications, the arrhythmias under consideration are classified into several types:

• arrhythmias are benign, are not accompanied by heart damage and various pathologies, their prognosis is positive, and the risk of death is minimal;
• ventricular extrasystoles of a potentially malignant direction occur against the background of heart damage, blood output is reduced by an average of 30%, and a health risk is noted;
• ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to begin treatment, a diagnosis of the disease is required in order to find out its causes.

Characteristics of supraventricular extrasystole

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Gradation of ventricular extrasystole according to Ryan and Laun, code according to ICD 10

1 – rare, monotopic ventricular arrhythmia – no more than thirty VES per hour;

2 – frequent, monotopic ventricular arrhythmia – more than thirty VES per hour;

3 – polytopic ZhES;

4a – monomorphic paired VES;

4b – polymorphic paired VES;

5 – ventricular tachycardia, three or more VES in a row.

2 – infrequent (from one to nine per hour);

3 – moderately frequent (from ten to thirty per hour);

4 – frequent (from thirty-one to sixty per hour);

5 – very frequent (more than sixty per hour).

B – single, polymorphic;

D – unstable VT (less than 30s);

E – sustained VT (more than 30 s).

Absence of structural heart lesions;

Absence of scar or cardiac hypertrophy;

Normal left ventricular ejection fraction (LVEF) – more than 55%;

Slight or moderate frequency of ventricular extrasystole;

Absence of paired ventricular extrasystoles and unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia.

The presence of a scar or cardiac hypertrophy;

Moderate decrease in LVEF – from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia or their insignificant presence.

Presence of structural heart lesions;

Presence of scar or cardiac hypertrophy;

Significant decrease in LVEF – less than 30%;

Moderate or significant ventricular extrasystole;

Paired ventricular extrasystoles or unstable ventricular tachycardia;

Persistent ventricular tachycardia;

Moderate or severe hemodynamic consequences of arrhythmia.

Extrasystole - causes and treatment of the disease

Cardiac extrasystole is a type of heart rhythm disturbance based on improper contraction of the entire heart or its individual parts. Contractions are of an extraordinary nature under the influence of any impulse or excitation of the myocardium. This is the most common type of arrhythmia, affecting both adults and children, and is extremely difficult to get rid of. Medication and folk remedies are used. Gastric extrasystole is registered in ICD 10 (code 149.3).

Ventricular extrasystole is a fairly common disease. It affects completely healthy people.

Causes of extrasystole

• overwork;
• overeating;
• presence of bad habits (alcohol, drugs and smoking);
• drinking caffeine in large quantities;
• stressful situations;
• heart disease;
• toxic poisoning;
• osteochondrosis;
• diseases of internal organs (stomach).

Gastric extrasystole is a consequence of various myocardial lesions (ischemic heart disease, cardiosclerosis, myocardial infarction, chronic circulatory failure, heart defects). Its development is possible during febrile conditions and VSD. It is also a side effect of some medications (Euphelin, Caffeine, glucocorticosteroids and some antidepressants) and can be observed with improper treatment with folk remedies.

The reason for the development of extrasystole in people actively involved in sports is myocardial dystrophy associated with intense physical activity. In some cases, this disease is closely associated with changes in the amount of sodium, potassium, magnesium and calcium ions in the myocardium itself, which adversely affects its functioning and does not allow getting rid of attacks.

Often, gastric extrasystole can occur during or immediately after a meal, especially in patients with VSD. This is due to the characteristics of the heart during such periods: the heart rate decreases, so extraordinary contractions occur (before or after the next one). There is no need to treat such extrasystoles, since they are functional in nature. In order to get rid of extraordinary contractions of the heart after eating, you should not take a horizontal position immediately after eating. It's better to sit in a comfortable chair and relax.

Classification

Depending on the location of the impulse and its cause, the following types of extrasystole are distinguished:

• ventricular extrasystole;
• atrioventricular extrasystole;
• supraventricular extrasystole (supraventricular extrasystole);
• atrial extrasystole;
• atrioventricular extrasystole;
• stem and sinus extrasystoles.

A combination of several types of impulse is possible (for example, a supraventricular extrasystole is combined with a stem one, a gastric extrasystole occurs together with a sinus one), which is characterized as parasystole.

Gastric extrasystole is the most common type of disturbance in the functioning of the cardiac system, characterized by the appearance of an additional contraction (extrasystole) of the heart muscle before its normal contraction. Extrasystole can be single or double. If three or more extrasystoles appear in a row, then we are talking about tachycardia (ICD code - 10: 147.x).

Supraventricular extrasystole differs from ventricular localization of the source of arrhythmia. Supraventricular extrasystole (supraventricular extrasystole) is characterized by the occurrence of premature impulses in the upper parts of the heart (atria or in the septum between the atria and ventricles).

There is also the concept of bigeminy, when extrasystole occurs after normal contraction of the heart muscle. It is believed that the development of bigeminy is provoked by disturbances in the functioning of the autonomic nervous system, that is, the trigger for the development of bigeminy can be VSD.

There are also 5 degrees of extrasystole, which are determined by a certain number of impulses per hour:

• the first degree is characterized by no more than 30 impulses per hour;
• for the second - more than 30;
• the third degree is represented by polymorphic extrasystoles.
• the fourth degree is when 2 or more types of impulse appear alternately;
• the fifth degree is characterized by the presence of 3 or more extrasystoles one after another.

The symptoms of this disease are in most cases invisible to the patient. The surest signs are sensations of a sharp blow in the heart, cardiac arrest, and freezing in the chest. Supraventricular extrasystole can manifest itself as VSD or neurosis and is accompanied by a feeling of fear, profuse sweating, anxiety and lack of air.

Diagnosis and treatment

Before treating any extrasystole, it is important to correctly determine its type. The most revealing method is electrocardiography (ECG), especially for ventricular impulses. An ECG can detect the presence of extrasystole and its location. However, a resting ECG does not always reveal the disease. Diagnosis becomes more complicated in patients suffering from VSD.

If this method does not show proper results, ECG monitoring is used, during which the patient wears a special device that monitors the work of the heart throughout the day and records the progress of the study. This ECG diagnosis allows you to identify the disease, even if the patient has no complaints. A special portable device attached to the patient's body records ECG readings for 24 or 48 hours. At the same time, the patient’s actions are recorded at the time of ECG diagnosis. The daily activity data and ECG are then compared, which allows the disease to be identified and treated correctly.

Some literature indicates the norms for the occurrence of extrasystoles: for a healthy person, the norm is considered to be ventricular and extraventricular extrasystoles per day, detected on an ECG. If after ECG studies no abnormalities are revealed, the specialist may prescribe special additional tests with stress (treadmill test)

In order to properly treat this disease, it is necessary to take into account the type and degree of extrasystole, as well as its location. Single impulses do not require specific treatment; they do not pose any threat to human health and life only if they are caused by a serious heart disease.

Features of treatment

To cure a disease caused by neurological disorders, sedatives (Relanium) and herbal preparations (valerian, motherwort, mint) are prescribed.

If the patient has a history of serious heart disease, the extrasystole is supraventricular in nature, and the frequency of impulses per day exceeds 200, individually selected drug therapy is necessary. To treat extrasystalia in such cases, drugs such as Propanorm, Cordarone, Lidocaine, Diltiazem, Panangin, as well as beta-blockers (Atenolol, Metoprolol) are used. Sometimes these means can get rid of the manifestations of VSD.

A drug such as Propafenone, which is an antiarrhythmic drug, is currently the most effective and allows you to treat even the advanced stage of the disease. It is quite well tolerated and absolutely safe for health. That is why it was classified as a first-line drug.

A fairly effective method to cure extrasystole forever is to cauterize its source. This is a fairly simple surgical intervention with virtually no consequences, but it cannot be performed on children; there is an age limit.

If gastric extrasystole is present in the later stages, then it is recommended to treat it with radiofrequency ablation. This is a method of surgical intervention with the help of which the source of arrhythmia is destroyed under the influence of physical factors. The procedure is easily tolerated for the patient, the risk of complications is minimized. In most cases, gastric extrasystole goes away irrevocably.

Treatment of children

In most cases, treatment for the disease in children is not necessary. Many experts claim that in children the disease goes away without treatment. If desired, you can stop severe attacks with safe folk remedies. However, it is recommended to undergo an examination to determine the extent of the disease.

Extrasystole in children can be congenital or acquired (after nervous shock). The presence of mitral valve prolapse and the occurrence of impulses in children are closely related. As a rule, supraventricular extrasystole (or gastric extrasystole) does not require special treatment, but it is necessary to be examined at least once a year. Children suffering from VSD are at risk.

It is important to limit children from provoking factors that contribute to the development of this disease (healthy lifestyle and sleep, absence of stressful situations). For children, it is recommended to eat foods enriched with elements such as potassium and magnesium, for example, dried fruits.

In the treatment of extrasystole and VSD in children, drugs such as Noofen, Aminalon, Phenibut, Mildronate, Panangin, Asparkam and others are used. Treatment with folk remedies is effective.

Fighting with folk remedies

You can get rid of severe attacks using folk remedies. At home, you can use the same remedies as in the treatment of VSD: soothing infusions and herbal decoctions.

• Valerian. If the attack is classified according to the emotional type, then a pharmaceutical infusion of valerian root will help get rid of anxiety. It is enough to take 10 - 15 drops of infusion once, preferably after a meal.
• Cornflower infusion will save you during an attack. It is recommended to drink the infusion 10 minutes before meals, 3 times a day (only on the day when the attack occurs).
• An infusion of calendula flowers will help get rid of frequent attacks.

Treatment with such traditional methods should be practiced only after consultation with a doctor. If you use them incorrectly, you may simply not get rid of the disease, but may also worsen it.

Prevention

To get rid of the risk of developing extrasystole, timely examination and treatment of heart disease is necessary. Following a diet with plenty of potassium and magnesium salts prevents the development of exacerbations. It is also necessary to give up bad habits (smoking, alcohol, coffee). In some cases, treatment with folk remedies is effective.

Consequences

If the impulses are sporadic and not burdened by anamnesis, then the consequences for the body can be avoided. When the patient already has heart disease, has had a myocardial infarction in the past, frequent extrasystole can cause tachycardia, atrial fibrillation and atrial and ventricular fibrillation.

Gastric extrasystole is considered the most dangerous, since ventricular impulses can lead to sudden death through the development of their fibrillation. Gastric extrasystole requires careful treatment, as it is very difficult to get rid of.

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Coding of ventricular extrasystole according to ICD 10

Extrasystoles are episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular regions and ventricles. An extraordinary contraction of the heart is usually recorded against the background of normal sinus rhythm without arrhythmia.

It is important to know that ventricular extrasystole in ICD 10 has code 149.

The presence of extrasystoles is observed in% of the entire world population, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other heart rhythm disorders, but the following exceptions are also provided:

• rare myocardial contractions (bradycardia R1);
• extrasystole caused by obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
• disturbances in the functioning of the cardiovascular system in a newborn (P29.1).

The extrasystole code according to ICD 10 determines the plan of diagnostic measures and, in accordance with the examination data obtained, a set of therapeutic methods used throughout the world.

Etiological factor for the presence of extrasystoles according to ICD 10

Worldwide nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years of age, which is typical in the presence of the following organic pathologies:

• heart disease caused by inflammatory processes (myocarditis, pericarditis, bacterial endocarditis);
• development and progression of coronary heart disease;
• dystrophic changes in the myocardium;
• oxygen starvation of the myocardium due to processes of acute or chronic decompensation.

In most cases, episodic interruptions in the functioning of the heart are not associated with damage to the myocardium itself and are only functional in nature, that is, extrasystoles occur due to severe stress, excessive smoking, coffee and alcohol abuse.

Ventricular extrasystole in the international classification of diseases has the following types of clinical course:

• premature contraction of the myocardium, occurring after each normal one, is called bigeminy;
• trigeminy is the process of a pathological impulse after several normal myocardial contractions;
• quadrigeminy is characterized by the appearance of extrasystole after three myocardial contractions.

In the presence of any type of this pathology, a person feels a sinking heart, and then strong tremors in the chest and dizziness.

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• Ectopic systoles
• Extrasystoles
• Extrasystolic arrhythmia
• Premature:
  • abbreviations NOS
  • compression

• Brugada syndrome
• Long QT syndrome
• Rhythm disturbance:
  • coronary sinus
  • ectopic
  • nodal

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Extrasystoles are episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular regions and ventricles. An extraordinary contraction of the heart is usually recorded against the background of normal sinus rhythm without arrhythmia.

• rare myocardial contractions (bradycardia R1);
• extrasystole caused by obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
• disturbances in the functioning of the cardiovascular system in a newborn (P29.1).

In most cases, episodic interruptions in the functioning of the heart are not associated with damage to the myocardium itself and are only functional in nature, that is, extrasystoles occur due to severe stress, excessive smoking, coffee and alcohol abuse.

• premature contraction of the myocardium, occurring after each normal one, is called bigeminy;
• trigeminy is the process of a pathological impulse after several normal myocardial contractions;
• quadrigeminy is characterized by the appearance of extrasystole after three myocardial contractions.

Gradation of ventricular extrasystole according to Ryan and Laun, code according to ICD 10

1 – rare, monotopic ventricular arrhythmia – no more than thirty VES per hour;

2 – frequent, monotopic ventricular arrhythmia – more than thirty VES per hour;

3 – polytopic ZhES;

4a – monomorphic paired VES;

4b – polymorphic paired VES;

5 – ventricular tachycardia, three or more VES in a row.

2 – infrequent (from one to nine per hour);

3 – moderately frequent (from ten to thirty per hour);

4 – frequent (from thirty-one to sixty per hour);

5 – very frequent (more than sixty per hour).

B – single, polymorphic;

D – unstable VT (less than 30s);

E – sustained VT (more than 30 s).

Absence of structural heart lesions;

Absence of scar or cardiac hypertrophy;

Normal left ventricular ejection fraction (LVEF) – more than 55%;

Slight or moderate frequency of ventricular extrasystole;

Absence of paired ventricular extrasystoles and unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia.

The presence of a scar or cardiac hypertrophy;

Moderate decrease in LVEF – from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia or their insignificant presence.

Presence of structural heart lesions;

Presence of scar or cardiac hypertrophy;

Significant decrease in LVEF – less than 30%;

Moderate or significant ventricular extrasystole;

Paired ventricular extrasystoles or unstable ventricular tachycardia;

Persistent ventricular tachycardia;

Moderate or severe hemodynamic consequences of arrhythmia.

Place of ventricular extrasystole in the ICD system - 10

Ventricular extrasystole is one of the types of cardiac arrhythmia. And it is characterized by an extraordinary contraction of the heart muscle.

Ventricular extrasystole, according to the International Classification of Diseases (ICD - 10), has code 149.4. and is included in the list of heart rhythm disorders in the heart disease section.

Nature of the disease

Based on the international classification of diseases of the tenth revision, doctors distinguish several types of extrasystole, the main ones being: atrial and ventricular.

In case of an extraordinary cardiac contraction, which was caused by an impulse emanating from the ventricular conduction system, ventricular extrasystole is diagnosed. The attack manifests itself as a feeling of interruptions in the heart rhythm followed by freezing. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). A 24-hour ECG showed positive results in 50% of the people studied.

Thus, it can be noted that the disease is common and can affect even healthy people. The cause of the functional nature of the disease can be stress.

Drinking energy drinks, alcohol, and smoking can also provoke extrasystoles in the heart. This type of illness is harmless and goes away quickly.

Pathological ventricular arrhythmia has more serious consequences for the health of the body. It develops against the background of serious diseases.

Classification

According to daily monitoring of the electrocardiogram, doctors consider six classes of ventricular extrasystoles.

Extrasystoles belonging to the first class may not manifest themselves in any way. The remaining classes are associated with health risks and the possibility of a dangerous complication: ventricular fibrillation, which can be fatal.

Extrasystoles can vary in frequency; they can be rare, medium and frequent. On the electrocardiogram they are diagnosed as single and paired - two pulses in a row. Impulses can occur in both the right and left ventricles.

The source of extrasystoles can be different: they can come from one source - monotopic, or they can arise in different areas - polytopic.

Disease prognosis

Based on prognostic indications, the arrhythmias under consideration are classified into several types:

• arrhythmias are benign, are not accompanied by heart damage and various pathologies, their prognosis is positive, and the risk of death is minimal;
• ventricular extrasystoles of a potentially malignant direction occur against the background of heart damage, blood output is reduced by an average of 30%, and a health risk is noted;
• ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to begin treatment, a diagnosis of the disease is required in order to find out its causes.

Atrial extrasystole code according to ICD 10

Clinical picture

• general weakness;
• breathing problems (shortness of breath);
• feeling of heat;
• signs of angina pectoris;
• panic attacks;

Causal factors

Consequences of arrhythmia

• paroxysmal tachycardia;
• angina pectoris;
• myocardial infarction;

Diagnostic methods

• radiography;
• echocardiography (EchoCG);
• urine and blood analysis;
• electrocardiography.

Treatment regimen

Medication regimen

Surgical intervention

Folk remedies

Dangers of atrial extrasystole

Single atrial extrasystoles

According to the ICD (International Classification of Diseases), extrasystole is assigned code I49.1. It is described as premature atrial depolarization. In the absence of pathologies, there should be no more unnecessary contractions per day. Annoying factors (stress, overload) can affect the indicator.

You can understand what a single atrial extrasystole is by focusing on the generally accepted classification:

Clinical picture

Single extrasystoles may not appear at all. The blood flow is not disrupted, so the person does not experience any discomfort. Certain signs begin to become apparent as the arrhythmia worsens.

The following clinical picture may correspond to it:

• sensation of a jolt and subsequent freezing in the heart area;
• general weakness;
• breathing problems (shortness of breath);
• feeling of heat;
• signs of angina pectoris;
• panic attacks;
• the appearance of a veil or the flickering of “flies” before the eyes.

It is more difficult to tolerate arrhythmia caused by vegetative-vascular dystonia. Some people already experience atrial extrasystole during inspiration, especially against the background of stress and overload. Organic forms have a more negative prognosis, but are easier to tolerate. The situation changes as complications develop.

Causal factors

It is customary to divide extrasystoles into organic, caused by other diseases, and functional, resulting from exposure to irritating factors.

The first group arises for the following reasons:

Functional disturbances in the heartbeat are a consequence of the following factors:

• constant exposure to stressful situations;

Separately, we can distinguish idiopathic extrasystole. The cause of its occurrence cannot be identified during the examination. In the absence of organic lesions and pronounced symptoms, this form is classified as a functional group.

Overeating causes a harmless form of functional arrhythmia. Its essence is to increase the activity of the parasympathetic nervous system. The patient's heart rate slows down, which is characteristic of bradycardia. Extrasystoles occur as compensation. This type of disturbance is especially pronounced if you take a horizontal position after a heavy meal.

Depending on the patient’s age and situation, arrhythmia occurs for the following reasons:

Consequences of arrhythmia

Frequent extrasystoles over time provoke the development of certain complications:

• renal and heart failure;
• atrial or ventricular fibrillation;
• paroxysmal tachycardia;
• coronary heart disease (CHD);
• angina pectoris;
• myocardial infarction;
• complete or partial heart block.

Diagnostic methods

If signs of extrasystole are detected, you must make an appointment with a cardiologist. The doctor will interview the patient to find out about bothersome symptoms. Then he will perform auscultation (listening) and measure blood pressure and pulse.

Based on the results obtained, a number of examinations will be prescribed:

• radiography;
• echocardiography (EchoCG);
• urine and blood analysis;
• magnetic resonance imaging (MRI);
• electrocardiography.

The bulk of the required information will be obtained by deciphering the electrocardiogram. Other methods will help determine the cause of the failure and the severity of hemodynamic disorders.

As an addition, an ECG with exercise (bicycle ergometry) and daily monitoring using the Holter method may be required. The results obtained will make it possible to evaluate the work of the heart in various situations.

Signs of atrial extrasystole on an ECG are usually the following:

• the QRS complex is changed;
• the T wave overlaps the P;
• the ventricular extrasystole complex is not deformed;
• the compensatory pause lasts less than expected;
• Q-P interval over 0.12 seconds;
• the P wave is modified and appears prematurely;

Treatment regimen

Depending on the results, the interpretation of the cardiogram and the causative factor, the course of treatment may differ:

Medication regimen

In addition to treatments for the underlying pathological process, medications are used to relieve arrhythmia and normalize heart function:

Medicines and their dosages are selected by the attending physician. It is not recommended to independently change the drawn up treatment regimen in order to avoid the development of adverse reactions and complications.

Surgical intervention

It is not possible to achieve results using only drug treatment in all cases. In order to relieve arrhythmia or eliminate the source of ectopic impulses, surgical intervention may be required:

• Carrying out radiofrequency ablation to cauterize the source of false impulses.
• Installation of a pacemaker to control the heartbeat and prevent attacks of dangerous forms of arrhythmias.

Folk remedies

Traditional medicine is represented by various infusions, decoctions and tinctures based on natural ingredients. To treat extrasystole at home, medications that have a diuretic and sedative effect are used:

Folk remedies only in rare cases cause adverse reactions, but before using them you should definitely consult with your doctor. The duration of use of such medications is usually 1-2 months. To avoid overdose, you must prepare and take them according to prescription.

Coding of ventricular extrasystole according to ICD 10

It is important to know that ventricular extrasystole in ICD 10 has code 149.

The presence of extrasystoles is observed in% of the entire world population, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other heart rhythm disorders, but the following exceptions are also provided:

The extrasystole code according to ICD 10 determines the plan of diagnostic measures and, in accordance with the examination data obtained, a set of therapeutic methods used throughout the world.

Etiological factor for the presence of extrasystoles according to ICD 10

Worldwide nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years of age, which is typical in the presence of the following organic pathologies:

• heart disease caused by inflammatory processes (myocarditis, pericarditis, bacterial endocarditis);
• development and progression of coronary heart disease;
• dystrophic changes in the myocardium;
• oxygen starvation of the myocardium due to processes of acute or chronic decompensation.

Ventricular extrasystole in the international classification of diseases has the following types of clinical course:

In the presence of any type of this pathology, a person feels a sinking heart, and then strong tremors in the chest and dizziness.

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Ventricular extrasystole: symptoms and treatment

Ventricular extrasystole - main symptoms:

• Headache
• Weakness
• Dizziness
• Dyspnea
• Fainting
• Lack of air
• Irritability
• Increased fatigue
• Heart sinking
• Pain in the heart
• Heart rhythm disturbance
• Increased sweating
• Pale skin
• Interruptions in heart function
• Panic attacks
• Moodiness
• Fear of death
• Feeling broken

Ventricular extrasystole is one of the forms of cardiac arrhythmia, which is characterized by the occurrence of extraordinary or premature contractions of the ventricles. Both adults and children can suffer from this disease.

Today, a large number of predisposing factors leading to the development of such a pathological process are known, which is why they are usually divided into several large groups. The cause may be other illnesses, drug overdose or toxic effects on the body.

The symptoms of the disease are nonspecific and are characteristic of almost all cardiac ailments. The clinical picture includes sensations of impaired heart function, a feeling of lack of air and shortness of breath, as well as dizziness and pain in the sternum.

Diagnosis is based on a physical examination of the patient and a wide range of specific instrumental examinations. Laboratory studies are of an auxiliary nature.

Treatment of ventricular extrasystole in the vast majority of situations is conservative, however, if such methods are ineffective, surgical intervention is indicated.

The International Classification of Diseases, Tenth Revision, defines a separate code for such pathology. Thus, the ICD-10 code is I49.3.

Etiology

Ventricular extrasystole in children and adults is considered one of the most common types of arrhythmias. Among all types of the disease, this form is diagnosed most often, namely in 62% of situations.

The causes are so diverse that they are divided into several groups, which also determine the course of the disease.

Cardiac disorders leading to organic extrasystole are presented:

The functional type of ventricular extrasystole is determined by:

• long-term addiction to bad habits, in particular, smoking cigarettes;
• chronic stress or severe nervous tension;
• drinking large amounts of strong coffee;
• neurocirculatory dystonia;
• osteochondrosis of the cervical spine;
• vagotonia.

In addition, the development of this type of arrhythmia is influenced by:

• hormonal imbalance;
• overdose of drugs, in particular diuretics, cardiac glycosides, beta-agonists, antidepressants and antiarrhythmic substances;
• the occurrence of VSD is the main cause of ventricular extrasystole in children;
• chronic oxygen starvation;
• electrolyte disturbances.

It is also worth noting that in approximately 5% of cases, such a disease is diagnosed in a completely healthy person.

In addition, specialists from the field of cardiology note the occurrence of such a form of the disease as idiopathic ventricular extrasystole. In such situations, arrhythmia in a child or adult develops for no apparent reason, i.e., the etiological factor is established only during diagnosis.

Classification

In addition to the fact that the type of pathology will differ in predisposing factors, there are several more classifications of the disease.

Based on the time of formation, the disease can be:

• early - occurs when the atria, which are the upper parts of the heart, contract;
• interpolated - develops at the border of the time interval between contraction of the atria and ventricles;
• late - observed during contraction of the ventricles, protruding from the lower parts of the heart. Less commonly formed in diastole - this is the stage of complete relaxation of the heart.

Based on the number of sources of excitability, the following are distinguished:

• monotopic extrasystole - in this case there is one pathological focus, leading to additional cardiac impulses;
• polytopic extrasystole - in such cases several ectopic sources are detected.

Classification of ventricular extrasystole by frequency:

• single - characterized by the appearance of 5 extraordinary heartbeats per minute;
• multiple - more than 5 extrasystoles occur per minute;
• steam room - this form is distinguished by the fact that 2 extrasystoles are formed in a row in the interval between normal heart contractions;
• group - these are several extrasystoles coming one after another between normal contractions.

According to its ordering, pathology is divided into:

• disordered - there is no pattern between normal contractions and extrasystoles;
• ordered. In turn, it exists in the form of bigeminy - it is an alternation of normal and extraordinary contractions, trigeminy - an alternation of two normal contractions and an extrasystole, quadrigeminy - there is an alternation of 3 normal contractions and an extrasystole.

According to the nature of the course and forecasts, extrasystole in women, men and children can be:

• benign course - differs in that the presence of organic damage to the heart and improper functioning of the myocardium is not observed. This means that the risk of sudden death is minimized;
• potentially malignant course - ventricular extrasystoles are observed due to organic damage to the heart, and the ejection fraction decreases by 30%, while the likelihood of sudden cardiac death increases compared to the previous form;
• malignant course - severe organic damage to the heart is formed, which is dangerous with a high chance of sudden cardiac death.

A separate type is intercalary ventricular extrasystole - in such cases there is no formation of a compensatory pause.

Symptoms

A rare arrhythmia in a healthy person is completely asymptomatic, but in some cases there is a feeling of cardiac arrest, “interruptions” in functioning or a kind of “push”. Such clinical manifestations are a consequence of increased post-extrasystolic contraction.

The main symptoms of ventricular extrasystole are presented:

• severe dizziness;
• pale skin;
• pain in the heart;
• increased fatigue and irritability;
• periodic headaches;
• weakness and weakness;
• feeling of lack of air;
• fainting states;
• shortness of breath;
• causeless panic and fear of dying;
• heart rate disturbance;
• increased sweating;
• capriciousness - this symptom is characteristic of children.

It is worth noting that the occurrence of ventricular extrasystole against the background of organic heart diseases can go unnoticed for a long period of time.

Diagnostics

The basis of diagnostic measures are instrumental procedures, which are necessarily supplemented by laboratory studies. Nevertheless, the first stage of diagnosis will be the cardiologist’s independent implementation of the following manipulations:

• studying the medical history will indicate the main pathological etiological factor;
• collection and analysis of life history - this can help in finding the causes of ventricular extrasystole of an idiopathic nature;
• a thorough examination of the patient, namely palpation and percussion of the chest, determining the heart rate by listening to the person using a phonendoscope, as well as palpating the pulse;
• a detailed survey of the patient - to compile a complete symptomatic picture and determine rare or frequent ventricular extrasystole.

Laboratory studies are limited to only general clinical analysis and blood biochemistry.

Instrumental diagnosis of cardiac extrasystole involves the following:

• ECG and EchoCG;
• daily monitoring of electrocardiography;
• load tests, in particular bicycle ergometry;
• X-rays and MRI of the chest;
• rhythmocardiography;
• polycardiography;
• sphygmography;
• TEE and CT.

In addition, consultation with a therapist, pediatrician (if the patient is a child) and obstetrician-gynecologist (in cases where extrasystole has formed during pregnancy) is necessary.

Treatment

In situations where such a disease has developed without the occurrence of cardiac pathologies or VSD, specific therapy for patients is not provided. To relieve symptoms, it is enough to follow the clinical recommendations of the attending physician, including:

• normalization of the daily routine - people are advised to rest more;
• maintaining a proper and balanced diet;
• avoidance of stressful situations;
• performing breathing exercises;
• spending a lot of time outdoors.

In other cases, it is first necessary to cure the underlying disease, which is why therapy will be individualized. However, there are several general aspects, namely the treatment of ventricular extrasystole by taking the following medications:

• antiarrhythmic substances;
• omega-3 drugs;
• antihypertensive drugs;
• anticholinergics;
• tranquilizers;
• beta blockers;
• herbal medicines - in cases of the disease in a pregnant woman;
• antihistamines;
• vitamins and restorative medications;
• drugs aimed at eliminating the clinical manifestations of such heart disease.

Surgical intervention for ventricular or ventricular extrasystole is carried out only according to indications, including the ineffectiveness of conservative treatment methods or the malignant nature of the pathology. In such cases, resort to:

• radiofrequency catheter ablation of ectopic foci;
• open intervention, which involves excision of damaged areas of the heart.

There are no other ways to treat such a disease, in particular folk remedies.

Possible complications

Ventricular extrasystole is fraught with the development of:

• sudden onset of cardiac death;
• heart failure;
• changes in the structure of the ventricles;
• worsening the course of the underlying disease;
• ventricular fibrillation.

Prevention and prognosis

You can avoid the occurrence of extraordinary contractions of the ventricles by following the following preventive recommendations:

• complete renunciation of addictions;
• limiting the consumption of strong coffee;
• avoiding physical and emotional fatigue;
• rationalization of the work and rest regime, namely full, long sleep;
• use of medications only under the supervision of a physician;
• complete and vitamin-enriched nutrition;
• early diagnosis and elimination of pathologies leading to ventricular extrasystole;
• Regularly undergoing a complete preventive examination by clinicians.

The outcome of the disease depends on its course. For example, functional extrasystole has a favorable prognosis, and pathology that develops against the background of organic heart damage has a high risk of sudden cardiac death and other complications. However, the fatality rate is quite low.

If you think that you have ventricular extrasystole and the symptoms characteristic of this disease, then a cardiologist can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

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Vegetovascular dystonia (VSD) is a disease that involves the entire body in the pathological process. Most often, the peripheral nerves, as well as the cardiovascular system, receive negative effects from the autonomic nervous system. The disease must be treated without fail, since in its advanced form it will have serious consequences on all organs. In addition, medical care will help the patient get rid of the unpleasant manifestations of the disease. In the international classification of diseases ICD-10, VSD is coded G24.

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With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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