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

• Treatment of ventricular extrasystole
  • Prognostic value of ventricular extrasystole

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

  • Frequent ventricular premature beats require parenteral therapy in cases of its acute manifestation or increase 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 electrolyte disturbances and glycoside intoxication.
    • The frequency of ventricular extrasystole may decrease during therapy with beta-blockers (mainly with myocardial infarction). In / in the bolus in the acute period and then drip administered amiodarone or lidocaine.
    • In case of ventricular extrasystole due to hypokalemia, potassium chloride is injected 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 is determined by the level of potassium in the blood.
    • In case of ventricular extrasystole due to hypomagnesemia, magnesium sulfate is indicated intravenously at 1000 mg 4 r / day (the dose is calculated according to magnesium) until the upper limit of normal serum magnesium is reached. In severe hypomagnesemia, the daily dose can reach 8-12 g / day (the dose is calculated according to magnesium).
    • With ventricular extrasystole due to glycoside intoxication, dimercaprol IV is indicated at 5 mg / kg 3-4 r / day on the 1st day, 2 r / day on the 2nd day, then 1 r / 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 is determined by the level of potassium in the blood).

    Practically important is the question of the duration of antiarrhythmic therapy. In patients with malignant ventricular extrasystole, antiarrhythmic therapy should be carried out indefinitely. With less malignant arrhythmias, treatment should be long enough (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 it is impossible to take antiarrhythmics for a long time in combination with poor tolerability or poor prognosis - radiofrequency ablation is used.

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

To date, 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 the course of other ailments, an overdose of medicines or a toxic effect on the body.

The symptomatology of the disease is nonspecific and is characteristic of almost all cardiological ailments. In the clinical picture, there are sensations in violation of the heart, a feeling of lack of air and shortness of breath, as well as dizziness and pain in the sternum.

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

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

The international classification of diseases of the tenth revision defines a separate code for such a 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 the varieties of the disease, this form is diagnosed most often, namely in 62% of situations.

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

Cardiological disorders leading to organic extrasystole are represented by:

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

The functional type of ventricular extrasystole is determined by:

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

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

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

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

In addition, experts 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 at the time of 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 happens:

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

Based on the number of sources of excitability, there are:

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

Classification of ventricular extrasystoles by frequency:

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

According to its order, pathology is divided into:

• disordered - while there is no pattern between normal contractions and extrasystoles;
• orderly. In turn, it exists in the form of bigeminia - it is an alternation of normal and extraordinary contractions, trigeminia - the alternation of two normal contractions and an extrasystole, quadrigeminia - 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 an organic lesion of the heart and improper functioning of the myocardium is not observed. This means that the risk of developing 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 in comparison with the previous form;
• malignant course - severe organic damage to the heart is formed, which is dangerously high chance of sudden cardiac death.

A separate variety is insertion 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 sensation of a sinking heart, “interruptions” in functioning, or a kind of “shock”. Such clinical manifestations are the result of enhanced post-extrasystolic contraction.

The main symptoms of ventricular extrasystole are:

• severe dizziness;
• pallor of the skin;
• pain in the heart;
• increased fatigue and irritability;
• recurring headaches;
• weakness and weakness;
• feeling short of breath;
• fainting states;
• shortness of breath;
• causeless panic and fear of death;
• violation of heart rate;
• increased sweating;
• capriciousness - such a sign is characteristic of children.

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

Diagnostics

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

• study of the medical history - will indicate the main pathological etiological factor;
• collection and analysis of a 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 a person with a phonendoscope, as well as probing the pulse;
• a detailed survey of the patient - to compile a complete symptomatic picture and determine rare or frequent ventricular extrasystoles.

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

Instrumental diagnosis of extrasystole of the heart involves the implementation of:

• ECG and echocardiography;
• daily monitoring of electrocardiography;
• tests with loads, in particular bicycle ergometry;
• X-ray and MRI of the chest;
• rhythmocardiography;
• polycardiography;
• sphygmography;
• PECG and CT.

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

Treatment

In those situations where the development of such a disease has occurred without the occurrence of cardiac pathologies or VVD, 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 shown to have more rest;
• maintaining a correct and balanced diet;
• avoidance of stressful situations;
• performing breathing exercises;
• spending a lot of time outdoors.

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

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

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

• radiofrequency catheter ablation of ectopic lesions;
• open intervention, which involves the 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 development:

• sudden onset of cardiac death;
• heart failure;
• changes in the structure of the ventricles;
• aggravation of 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 rejection of addictions;
• limiting the consumption of strong coffee;
• avoiding physical and emotional overwork;
• rationalization of the regime of work and rest, namely a full-fledged long sleep;
• the use of drugs only under the supervision of the attending 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 the variant of its course. For example, functional extrasystole has a favorable prognosis, and pathology that develops against the background of organic heart disease has a high risk of sudden cardiac death and other complications. However, the mortality 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 of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact 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. №170

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

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Gradation of ventricular extrasystole according to ryan and laun, code for microbial 10

1 - rare, monotopic ventricular arrhythmia - no more than thirty PVCs per hour;

2 - frequent, monotopic ventricular arrhythmia - more than thirty PVCs per hour;

3 - polytopic HPS;

4a – monomorphic paired PVCs;

4b - polymorphic paired PVCs;

5 - ventricular tachycardia, three or more PVCs 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 30 s);

E - sustained VT (more than 30 s).

Absence of structural lesions of the heart;

Absence of a scar or hypertrophy of the heart;

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

Slight or moderate frequency of ventricular extrasystole;

The 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 hypertrophy of the heart;

Moderate decrease in LV EF - from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

The absence of hemodynamic consequences of arrhythmias or their insignificant presence.

The presence of structural lesions of the heart;

The presence of a scar or hypertrophy of the heart;

Significant decrease in LV EF - 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

Extrasystole of the heart is a type of heart rhythm disturbance based on an abnormal contraction of the entire heart or its individual parts. Contractions are extraordinary in 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, which is extremely difficult to get rid of. Medicinal treatment and treatment with folk remedies is practiced. Gastric extrasystole is registered in ICD 10 (code 149.3).

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

Causes of extrasystole

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

Gastric extrasystole is a consequence of various myocardial lesions (CHD, cardiosclerosis, myocardial infarction, chronic circulatory failure, heart defects). Its development is possible with febrile conditions and with VVD. And also it is a side effect of certain drugs (Eupelin, Caffeine, glucocorticosteroids and some antidepressants) and can be observed with improper treatment with folk remedies.

The reason for the development of extrasystole in people who are actively involved in sports is myocardial dystrophy associated with intense physical exertion. In some cases, this disease is closely associated with a change in the amount of sodium, potassium, magnesium and calcium ions in the myocardium itself, which adversely affects its work and does not allow you to get rid of seizures.

Often, gastric extrasystole can occur during or immediately after a meal, especially in patients with VVD. This is due to the peculiarities of the work of the heart during such periods: the heart rate decreases, so there are extraordinary contractions (before or after the next one). It is not necessary to treat such extrasystoles, since they are functional in nature. In order to get rid of extraordinary contractions of the heart after eating, you can not take a horizontal position immediately after eating. It is better to sit in a comfortable chair and relax.

Classification

Depending on the place of occurrence 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 extrasystole.

A combination of several types of impulse is possible (for example, supraventricular extrasystole is combined with a stem one, gastric extrasystole occurs along 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. The extrasystole can be single or steam. If three or more extrasystoles appear in a row, then we are already talking about tachycardia (ICD code - 10: 147.x).

Supraventricular extrasystole differs from the ventricular localization of the source of the 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 bigeminia, when an extrasystole occurs after a normal contraction of the heart muscle. It is believed that the development of bigeminia is provoked by disturbances in the work of the autonomic nervous system, that is, the VSD can become a trigger for the development of bigeminia.

There are also 5 degrees of extrasystole, which are due to 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 in turn;
• the fifth degree is characterized by the presence of 3 or more extrasystoles one after another.

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

Diagnosis and treatment

Before treating any extrasystole, it is important to correctly establish its appearance. The most revealing method is electrocardiography (ECG), especially with ventricular impulses. ECG allows you to identify the presence of extrasystole and its location. However, an ECG at rest does not always reveal the disease. Diagnosis is complicated in patients suffering from VVD.

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 during the day and records the progress of the study. This ECG diagnosis allows you to identify the disease, even in the absence of complaints from the patient. A special portable device attached to the patient's body records ECG readings for 24 or 48 hours. In parallel, the patient's actions are recorded at the time of ECG diagnosis. Then the daily activity data and the ECG are compared, which makes it possible to identify the disease and treat it correctly.

In some literature, the norms of the occurrence of extrasystoles are indicated: for a healthy person, ventricular and ventricular extrasystoles per day, detected on the ECG, are considered the norm. If after the ECG studies no abnormalities were revealed, the specialist may prescribe special additional studies with a load (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, extrasystole is supraventricular in nature, and the frequency of pulses per day exceeds 200, individually selected drug therapy is necessary. To treat extrasystalia in such cases, drugs such as Propanorm, Kordaron, Lidocaine, Diltiazem, Panangin, as well as beta-blockers (Atenolol, Metoprolol) are used. Sometimes such means can get rid of the manifestations of VVD.

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

A fairly effective method to cure extrasystole forever is cauterization of its focus. This is a fairly simple surgical intervention, with practically no consequences, but it cannot be performed in children, there is an age limit.

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

Treatment of children

In most cases, the disease in children does not need to be treated. Many experts argue that in children the disease after passes without treatment. If desired, you can stop severe attacks with safe folk remedies. However, it is recommended to undergo an examination to determine the degree of neglect of the disease.

Extrasystole in children can be congenital or acquired (after nervous shocks). 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 need special treatment, but it is necessary to be examined at least once a year. At risk are children suffering from VVD.

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

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

Fight with folk remedies

You can get rid of severe attacks with folk remedies. At home, you can use the same means as in the treatment of VVD: soothing infusions and decoctions of herbs.

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

Treatment with such alternative methods should be practiced only after consulting a doctor. If they are not used correctly, then you can simply not get rid of the disease, but also aggravate it.

Prevention

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

Consequences

If the impulses are of a single nature and are not burdened by an anamnesis, then the consequences for the body can be avoided. When the patient already has heart disease, in the past there was a myocardial infarction, frequent extrasystoles can cause tachycardia, atrial fibrillation and atrial and ventricular fibrillation.

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

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Coding of ventricular extrasystole according to ICD 10

Extrasystoles are called episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular sections and ventricles. 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 noted in% of the entire population of the globe, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other cardiac arrhythmias, but the following exception options are also provided:

• rare contractions of the myocardium (bradycardia R1);
• extrasystole due to obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
• disorders in the work of the cardiovascular system in the newborn (P29.1).

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

The etiological factor in the presence of extrasystoles according to ICD 10

World nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years, 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 the processes of acute or chronic decompensation.

In most cases, episodic interruptions in the work 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, which occurs after each normal one, is called bigeminia;
• trigeminia is the process of pathological shock after several normal contractions of the myocardium;
• Quadrigeminia is characterized by the appearance of an extrasystole after three myocardial contractions.

In the presence of any kind 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 arrhythmias. And it is characterized by an extraordinary contraction of the heart muscle.

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

The nature of the disease

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

With an extraordinary heart 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 its fading. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). Daily ECG showed positive indicators in 50% of the studied people.

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.

The use of energy drinks, alcohol, smoking can also provoke extrasystoles in the heart. This type of ailment is not dangerous and passes 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 the 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 both in the right and in the left ventricle.

The focus of the occurrence of extrasystoles can be different: they can come from the same source - monotopic, or they can occur in different areas - polytopic.

Disease prognosis

Considered arrhythmias according to prognostic indications are classified into several types:

• arrhythmias of a benign nature, 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 lesions, blood ejection decreases by an average of 30%, there is a risk to health;
• ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

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

ICD code 10 arrhythmia

Violations of the automatism of the sinus node

a common part

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

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

With violations of the automatism of the sinus node, the following syndromes develop:

Sinus tachycardia is an increase in heart rate up 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 automatism of the sinus node.

Sinus arrhythmia is a sinus rhythm characterized by periods of its acceleration and slowdown, while fluctuations in the values ​​of the RR interval exceed 160 ms, or 10%.

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

At the heart of sinus arrhythmia are changes in the automatism 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, which is not associated with breathing, usually develops with heart disease.

Diagnosis of all violations of the automatism of the sinus node is based on the identification of ECG signs.

With physiological sinus tachycardia and bradycardia, as with respiratory sinus arrhythmia, no treatment is required. In pathological situations, treatment is directed primarily to the underlying disease, with the induction of these conditions by pharmacological agents, the approach is individual.

Epidemiology of violations of automatism of the sinus node

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 is common in athletes and well-trained people, as well as in the elderly and those with various cardiac and non-cardiac diseases.

Respiratory sinus arrhythmia is extremely common in children, adolescents, and young adults; Non-respiratory sinus arrhythmias are rare.

One for all violations of the automatism of the sinus node.

I49.8 Other specified cardiac arrhythmias

Atrial fibrillation mkb 10

Atrial fibrillation or atrial fibrillation microbial 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 in the form of fatigue, lack of energy, dizziness, shortness of breath and heart palpitations.

What is the danger of atrial fibrillation mkb 10?

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

In addition, the clot can get into other parts of the body (kidneys, lungs, intestines) and provoke various kinds of deviations.

Atrial fibrillation, microbial code 10 (I48) reduces the ability of the heart 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 the necessary and vital data on 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 the 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 results of the examination, but most often the patient should go through 4 important stages:

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

CHAPTER 18

supraventricular arrhythmias

supraventricular extrasystole

SYNONYMS

DEFINITION

Supraventricular extrasystole - premature in relation to the main rhythm (usually sinus) excitation and contraction of the heart, caused by an electrical impulse that occurs above the level of branching of the bundle of His (i.e., in the atria, AV node, trunk of the bundle of His). Repetitive 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 slightly increases with age; frequent supraventricular extrasystole (more than 30 per hour) occurs only in 2-5% of healthy people.

PREVENTION

Prevention is mainly secondary, consisting in the elimination of non-cardiac causes and the treatment of heart diseases that lead to supraventricular extrasystoles.

SCREENING

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

CLASSIFICATION

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

According to the 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: bigeminia (every 2nd impulse is premature), trigeminia (every 3rd), quadrigeminia (every 4th); in general, these forms of supraventricular extrasystole are called allorhythmias;

By the number of extrasystoles that occur in a row: paired supraventricular extrasystole 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 mkb 10

Extrasystole (ES) is a premature excitation of the whole heart or any of its departments, caused by an extraordinary impulse emanating from the atria, AV connection or ventricles.

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

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

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

• Early extrasystoles.
• Medium extrasystoles.
• Late extrasystoles.

• Rare extrasystoles - less than 5 in 1 min.
• Medium extrasystoles - from 6 to 15 in 1 min.
• Frequent extrasystoles - more than 15 in 1 min.

• 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.

• Blockade of conduction (antero- and retrograde).
• "Gap" in carrying out.
• Supernormal performance.

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 relationship of certain forms of ventricular extrasystoles with the risk of sudden death - the classification of ventricular extrasystoles according to B.Lown, M.Wolf (1971):

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

With an increase in the class of extrasystoles, 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 value of "early" extrasystoles according to the time of appearance in diastole is disputed.

• Functional extrasystole.
• Extrasystole of organic origin.
• Extrasystole of toxic origin.

Single supraventricular ES (SVES) or ventricular ES (PV) occur in all people at some time in their lives.

Extrasystole often accompanies the course of various heart diseases.

Etiology and pathogenesis

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

  Functional extrasystole occurs as a result of a vegetative reaction on 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 occur in healthy individuals for no apparent reason (the 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 (especially with mitral valve prolapse).
  • Chronic cor pulmonale.
  • Heart damage in amyloidosis, sarcoidosis, hemochromatosis.
  • Surgical interventions on the heart.
  • "Athlete's Heart"
• Etiology of extrasystoles of toxic origin.

  Extrasystoles of toxic origin occur in the following pathological conditions:

  • Feverish conditions.
  • digitalis intoxication.
  • Exposure to antiarrhythmic drugs (proarrhythmic side effect).
  • thyrotoxicosis.
  • Reception of aminophylline, inhalation of betamimetics.
• Features of the etiology of ventricular extrasystoles.

  Ventricular extrasystoles in more than 2/3 of patients develop on the basis of various forms of coronary artery disease.

  The most common causes of the development of ventricular extrasystoles are the following forms of IHD:

  Ventricular arrhythmias (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 the exclusion of this diagnosis. Reperfusion arrhythmias (developing after successful thrombolysis) are practically untreatable and relatively benign.

  The ventricular extrasystoles coming from the aneurysm of the left ventricle may resemble an infarcted QRS in shape (QR in V1, ST elevation and "coronary" T).

  The appearance of paired ventricular extrasystoles during the treadmill test with a heart rate of less than 130 beats / min has a poor prognostic value. A particularly poor prognosis is associated with a combination of paired ventricular extrasystoles with ischemic ST changes.

  The non-coronary nature of ventricular arrhythmias can be confidently discussed only after coronary angiogarphy. In this regard, this study is indicated for the majority of patients over 40 years of age suffering from ventricular extrasystole.

  Among the causes of non-coronary 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. According to the degree of malignancy of ventricular arrhythmias, this group of diseases is close to coronary artery disease. Given the nature of the genetic defect, these diseases are classified as channelopathies. These include:

  1. Arrhythmogenic dysplasia of the left ventricle.
  2. Long QT Syndrome.
  3. Brugada syndrome.
  4. Syndrome of the shortened QT interval.
  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:

  • Re-entry of the excitation wave (re-entry) in areas of the myocardium or the conduction system of the heart, which differ in the unequal speed of the impulse and the development of a unidirectional blockade of the conduction.
  • Increased oscillatory (trigger) activity of cell membranes of individual sections of the atria, AV junction, or ventricles.
  • The ectopic impulse from the atria propagates from top to bottom along the conduction system of the heart.
  • The ectopic impulse that occurs 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 occur as a result of both the formation of a re-entry of the excitation wave (re-entry) and the functioning of the post-depolarization mechanism.
  • Repetitive 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 is the branching 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 the sick. Tolerability of extrasystole varies significantly in different patients and does not always depend on the number of extrasystoles (there may be a complete absence of complaints even in the presence of stable bi- and trigeminia).

In some cases, at the time of the occurrence of extrasystole, there is a feeling of interruptions in the work of the heart, “tumbling”, “turning the heart”. If it occurs at night, these sensations make you wake up, accompanied by anxiety.

Less often, the patient complains of attacks of rapid arrhythmic heartbeat, which requires the exclusion of 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 “stopping” the heart, patients feel a strong push in the chest, due to 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 associated with 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 the "vulnerable window" of the cardiac cycle and the presence of other conditions for the occurrence of re-entry, it can cause supraventricular tachycardia.

The most serious consequence of supraventricular extrasystole is objectively 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, like the risk of sudden death in ventricular extrasystole.

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

Diagnostics

It is possible to suspect the presence of extrasystole when the patient complains of interruptions in the work of the heart. The main diagnostic method is the ECG, but some information can also be obtained during the physical examination of the patient.

When collecting an anamnesis, it is necessary to clarify the circumstances under which arrhythmia occurs (with 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 presence in the anamnesis of indications of past diseases that can cause organic damage to the heart, as well as their possible undiagnosed manifestations.

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

• Study of the arterial pulse.

In the study of 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 postextrasystolic ventricular complex that occurs after a long compensatory pause usually have a large amplitude.

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

During the extrasystolic contraction, somewhat weakened premature I and II (or only one) extrasystolic tones are heard, and after them - loud I and II heart sounds corresponding to the first postextrasystolic 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 the P wave, that is, the shortening of the coupling interval.

The linkage interval is the distance from the preceding 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. Distinguish between incomplete and complete compensatory pause:

• Incomplete compensatory pause.

An incomplete compensatory pause is a pause that occurs after an atrial 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 it takes 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:

• Bigeminia - after each normal contraction, an extrasystole follows.
• Trigeminia - extrasystoles follow after every two normal contractions.
• Quadrihymenia - extrasystoles follow after every three normal contractions, etc.
• Couplet - 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 - extrasystoles emanating from one ectopic source and, accordingly, having a constant coupling interval and the shape of the ventricular complex.
• Polytopic extrasystoles - 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 on the ECG of three or more extrasystoles in a row.

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

The constancy of the clutch interval (from the P wave of the previous normal complex to the P wave of the extrasystole) is a sign of monotopic supraventricular extrasystole. With "early" supraventricular extrasystole, the superimposition of the P wave on the previous T wave is characteristic, which can make diagnosis difficult.

With extrasystole from the upper sections 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 the so-called aberrant form due to the occurrence of a functional blockade of the right leg of the His bundle or its other branches. At the same time, the extrasystolic QRS complex becomes wide (≥0.12 sec), split and deformed, resembling 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 the previous P wave!), Similar in shape to the rest of the QRS complexes of sinus origin. The exception is cases of aberration of aberration of the QRS complex.

It should be remembered that sometimes with atrial and atrioventricular extrasystoles, the ventricular QRS complex can acquire the so-called aberrant form due to the occurrence of a functional blockade of the right leg of the His bundle or its other branches. At the same time, the extrasystolic QRS complex becomes wide, split and deformed, resembling the QRS complex with blockade of the legs of the His bundle 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.

Stem extrasystoles are distinguished by the occurrence of a 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 fixed. 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 R. But PQ is shortened compared to sinus cycles).
• Significant expansion (up to 0.12 s or more) and deformation of the extrasystolic QRS complex (in shape it resembles a blockade of the bundle of His bundle, 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 to the direction of the main tooth of the QRS complex).
• The presence of a complete compensatory pause after a ventricular extrasystole (it supplements the extrasystole coupling interval to double the RR of the main rhythm).

With ventricular premature beats, there is usually no "discharging" of the SA node, since the ectopic impulse that occurs in the ventricles, as a rule, cannot retrograde through the AV node and reach the atria and the SA node. In this case, the next sinus impulse freely excites the atria, passes through the AV node, but in most cases cannot cause another depolarization of the ventricles, since after ventricular extrasystole they are still in a state of refractoriness.

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 in 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 retrograde to the atria and, having reached the sinus node, discharges 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 left the state of refractoriness. In this case, the rhythm is not disturbed and ventricular extrasystoles are called "inserted".

A compensatory pause may also be absent in case of 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 value of ventricular extrasystole, it may be useful to assess the features of ventricular complexes:

• In the presence of an organic lesion of the heart, extrasystoles are often low-amplitude, wide, serrated; 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 the T wave are directed in the direction opposite to the QRS.

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

Monotopicity indicates the presence of a certain 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 leads V5-V6.
• Extrasystoles from the outflow department 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 - dominated by S 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 dilated and resembles the WPW syndrome.
• Concordant apical extrasystoles (up in both ventricles) - S dominates in leads V1-V6.
• Concordant basal extrasystoles (down in both ventricles) - R dominates in leads V1-V6.

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

Parasystoles follow each other at different intervals, however, the intervals between parasystoles are multiples of the smallest of them. Confluent complexes are characteristic, which may be preceded by a P wave.

Holter ECG monitoring is a long-term recording (up to 48 hours) of ECG. To do this, use a miniature recording device with leads, which are fixed on the patient's body. When registering indicators, in the course of their daily activities, the patient writes down in a special diary all the symptoms that appear and the nature of the activity. Then the results are 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 disease, regardless of the presence of a clinical picture of ventricular arrhythmias and their detection on standard ECG.

Holter monitoring of the ECG should be carried out before the start of treatment, and later 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 extrasystoles.
• Mono-/polytopic ventricular extrasystole.
• Dependence of extrasystole on the time of day.
• Dependence of extrasystole on physical activity.
• Communication of extrasystole with changes in the ST segment.
• Connection of extrasystole with the rhythm frequency.

Read more: Holter ECG monitoring.

The treadmill test is not used specifically to provoke ventricular arrhythmias (unless the patient himself notes the connection between the occurrence of rhythm disturbances and exercise only). In cases where the patient notes the relationship between the occurrence of rhythm disturbances and the load, during the treadmill test, conditions should be created for resuscitation.

The connection of ventricular extrasystole with the load with a high probability indicates their ischemic etiology.

Idiopathic ventricular extrasystole can be suppressed during exercise.

Treatment

The tactics of treatment depends on the location and form of extrasystole.

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

With supraventricular extrasystole that has developed against the background of heart disease or non-cardiac disease, therapy of the underlying disease / condition is necessary (treatment of endocrine disorders, correction of electrolyte imbalance, treatment of coronary artery disease or myocarditis, withdrawal of drugs that can cause arrhythmia, avoidance of alcohol, smoking, excessive consumption coffee).

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

  It is useful to identify situations and times of the day in which there are predominantly sensations of interruptions, and to time the administration of drugs to this time.

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

  The absence of antiarrhythmic treatment (along with etiotropic) increases the risk of fixing supraventricular extrasystoles. Frequent supraventricular extrasystole in such cases is "potentially malignant" in relation to the development of atrial fibrillation.

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

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

  Treatment is carried out sequentially with the following drugs:

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

  Taking into account possible side effects, it is not necessary to start treatment with retard drugs due to the need for rapid withdrawal in the event of bradycardia and disorders of sinoatrial and / or atrioventricular conduction.

  Supraventricular extrasystoles, along with paroxysmal supraventricular tachycardias, are arrhythmias 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 damage to the heart and severe atrial dilatation.

  These groups of drugs are not indicated in patients with vagus-mediated supraventricular extrasystole, which develops against the background of bradycardia, mainly at night. Such patients are shown the appointment of Belloid, small doses of Teopec or Corinfar, taking into account their action that speeds up the rhythm.

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

  The use of drugs in this group is often accompanied by side effects. Possible violations of SA- and AV-conduction, as well as an arrhythmogenic effect. In the case of taking quinidine, prolongation of the QT interval, a drop in contractility and myocardial dystrophy (negative T waves appear in the chest leads). Quinidine should not be prescribed with the simultaneous presence of ventricular extrasystoles. Caution is also required in the presence of thrombocytopenia.

  The appointment of these drugs makes sense in patients with a high prognostic value 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 disease, atrial dilatation, "threatened" by the development of atrial fibrillation.

  Class IA or IC drugs should not be used for supraventricular extrasystoles, as well as for other forms of cardiac arrhythmias, in patients who have had a myocardial infarction, as well as in 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), with moderate sinus bradycardia (up to 50) is 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 myocardial damage).

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

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

  The Laun-Wolf classification is not exhaustive. Bigger (1984) proposed a prognostic classification that characterizes benign, potentially malignant, and malignant ventricular arrhythmias.

  Prognostic value of ventricular arrhythmias.

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

  • Benign ventricular extrasystole - any ventricular extrasystole in patients without heart damage (including myocardial hypertrophy) with a frequency of less than 10 per hour, without syncope and a history of cardiac arrest.
  • Potentially malignant ventricular extrasystole - any ventricular extrasystole with a frequency of more than 10 per hour or ventricular tachycardia runs in patients with left ventricular dysfunction, without syncope and a history of cardiac arrest.
  • Malignant ventricular extrasystole - any ventricular extrasystole with a frequency of more than 10 per hour in patients with severe myocardial pathology (most often with an LV ejection fraction of less than 40%), syncope or a history of cardiac arrest; sustained ventricular tachycardia often occurs.
  • 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 improve the accuracy of the forecast, in addition to the fundamental signs, a complex of clinical and instrumental predictors of sudden death is used, each of which individually is not critical:

  • Ejection fraction of the left ventricle. If the left ventricular ejection fraction decreases to less than 40% in coronary artery disease, the risk increases by 3 times. With non-coronary ventricular extrasystole, the significance of this criterion may decrease).
  • The presence of late potentials of the ventricles - 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, make it more serious to treat it, although the sensitivity of the method depends on the underlying disease; the ability to control therapy with ventricular late potentials is questionable.
  • Increasing the variance of the QT interval.
  • Decreased heart rate variability.

• Tactics of therapy for ventricular extrasystoles

  After the patient is assigned to a particular risk category, the question of the choice of treatment can be decided.

  As in the treatment of supraventricular extrasystole, 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.

  Tactics of treatment for patients with different prognostic ventricular extrasystoles:

  • In patients with benign ventricular extrasystole, which is subjectively well tolerated by patients, it is possible to refuse antiarrhythmic therapy.
  • Patients with benign ventricular extrasystole, which is subjectively poorly tolerated, as well as patients with potentially malignant arrhythmias of non-ischemic etiology, should preferably receive class I antiarrhythmics.

  If they are ineffective - 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, a pronounced proarrhythmic effect of flecainide, encainide and etmozine is associated with an increase in the risk of death by 2.5 times! The risk of proarrhythmic action is also increased in active myocarditis.

  Of the class I antiarrhythmics, the following are effective:

  • Propafenone (Propanorm, Ritmonorm) orally pomg / day, or retard forms (propafenone SR 325 and 425 mg, are prescribed twice a day). The 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) in dozemg / day.
  • Etatsizin inside pomg / day. Therapy begins with the appointment of half doses (0.5 tab. 3-4 times a day) to assess tolerance. Combinations with class III drugs may be arrhythmogenic. The combination with beta-blockers is appropriate for myocardial hypertrophy (under the control of heart rate, in a small dose!).
  • Etmozin inside pomg / day. Therapy begins with the appointment of smaller doses - 50 mg 4 times a day. Etmozin does not prolong the QT interval and is generally well tolerated.
  • Flecainide intramg/day Quite effective, somewhat reduces myocardial contractility. Causes paresthesia in some patients.
  • 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 patients with a tendency to bradycardia. It is prescribed as monotherapy at a dose of 75 mg / day. in the form of monotherapy or 50 mg / day. in combination with beta-blockers or d, l-sotalol (no more than 80 mg / day). This combination is often appropriate, since it increases the antiarrhythmic effect, reducing the effect of drugs on heart rate and allows you to prescribe smaller doses if each drug is poorly tolerated.
  • Less commonly used drugs such as Difenin (with ventricular extrasystole against the background of digitalis intoxication), mexiletine (with intolerance to other antiarrhythmics), aymalin (with WPW syndrome accompanied by paroxysmal supraventricular tachycardia), Novocainamide (with ineffectiveness or tolerance of 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 premature beats, 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 extrasystoles is undesirable.

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

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

  In some cases, you can get by with the use of Valocordin, 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 when amiodarone is intolerant or ineffective. The risk of developing an arrhythmogenic effect (ventricular tachycardia of the “pirouette” type against the background of QT prolongation over ms) increases significantly with the transition to doses above 160 mg / day. and most often manifests itself in the first 3 days.

  Amiodarone (Amiodarone, Kordaron) is effective in about 50% of cases. Careful addition of beta-blockers to it, especially in coronary artery disease, reduces both arrhythmic and overall mortality. A sharp replacement of beta-blockers with amiodarone is contraindicated! At the same time, 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 with myocardial infarction and suffering from other organic lesions of the heart muscle. Treatment is carried out under the control of the ECG - 1 time in 2-3 days. After reaching saturation with amiodarone (an increase in the duration of the QT interval, expansion and thickening of the T wave, especially in leads V5 and V6), the drug is prescribed at a maintenance dose (mg 1 r / day for a long time, usually from the 3rd week). The maintenance dose is determined individually. Treatment is carried out under the control of ECG - 1 time in 4-6 weeks. With an increase in the duration of the Q-T interval by more than 25% of the original or up to 500 ms, a temporary withdrawal of the drug is required and then its use at a reduced dose.

  In patients with life-threatening ventricular extrasystoles, the development of thyroid dysfunction is not an indication for the abolition of amiodarone. It is mandatory to monitor the function of the thyroid gland with the appropriate correction of violations.

  "Pure" class III antiarrhythmics, as well as class I drugs, are not recommended due to a pronounced proarrhythmic effect. A meta-analysis of 138 randomized placebo-controlled trials on the use of antiarrhythmic drugs in patients with ventricular premature beats after myocardial infarction (total number of patients -) shows that the use 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).

  Practically important is the question of the duration of antiarrhythmic therapy. In patients with malignant ventricular extrasystole, antiarrhythmic therapy should be carried out indefinitely. With less malignant arrhythmias, treatment should be long enough (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 inefficiency or if it is impossible to take antiarrhythmics for a long time in combination with poor tolerability or a 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 value.

  In fact, the prognosis of extrasystoles is more dependent 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 of malignancy of supraventricular extrasystoles is the risk of developing atrial fibrillation, ventricular extrasystoles - 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, Holter monitoring registers individual ventricular extrasystoles, the source of which in most cases is localized in the right ventricle. Such monomorphic isolated ventricular extrasystoles, as a rule, belonging to the 1st class according to the classification of V. 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., with sudden arrhythmic death. To determine the degree of its risk in real clinical practice, the classification according to B.Lown, M.Wolf, in the modification of 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, more often single (there may be other forms), asymptomatic or asymptomatic, but most importantly, occurring in people who do not have signs of heart disease. The life prognosis 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 the prevention of sudden death, they do not require any treatment. It is only necessary to dynamically monitor them, because, at least in some patients, ventricular extrasystole can be the debut of cardiac pathology.

  The only fundamental difference between potentially malignant ventricular arrhythmias from the previous category is the presence of an organic heart disease. Most often, these are various forms of coronary heart disease (the most significant myocardial infarction), heart damage in arterial hypertension, primary myocardial diseases, etc. These patients with ventricular extrasystole of various gradations ( potential trigger 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 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 of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact 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. №170

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

With amendments and additions by 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 arrhythmias. And it is characterized by an extraordinary contraction of the heart muscle.

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

The nature of the disease

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

With an extraordinary heart 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 its fading. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). Daily ECG showed positive indicators in 50% of the studied people.

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.

The use of energy drinks, alcohol, smoking can also provoke extrasystoles in the heart. This type of ailment is not dangerous and passes 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 the 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 both in the right and in the left ventricle.

The focus of the occurrence of extrasystoles can be different: they can come from the same source - monotopic, or they can occur in different areas - polytopic.

Disease prognosis

Considered arrhythmias according to prognostic indications are classified into several types:

• arrhythmias of a benign nature, 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 lesions, blood ejection decreases by an average of 30%, there is a risk to health;
• ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to start 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 for microbial 10

1 - rare, monotopic ventricular arrhythmia - no more than thirty PVCs per hour;

2 - frequent, monotopic ventricular arrhythmia - more than thirty PVCs per hour;

3 - polytopic HPS;

4a – monomorphic paired PVCs;

4b - polymorphic paired PVCs;

5 - ventricular tachycardia, three or more PVCs 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 30 s);

E - sustained VT (more than 30 s).

Absence of structural lesions of the heart;

Absence of a scar or hypertrophy of the heart;

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

Slight or moderate frequency of ventricular extrasystole;

The 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 hypertrophy of the heart;

Moderate decrease in LV EF - from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

The absence of hemodynamic consequences of arrhythmias or their insignificant presence.

The presence of structural lesions of the heart;

The presence of a scar or hypertrophy of the heart;

Significant decrease in LV EF - 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

Extrasystole of the heart is a type of heart rhythm disturbance based on an abnormal contraction of the entire heart or its individual parts. Contractions are extraordinary in 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, which is extremely difficult to get rid of. Medicinal treatment and treatment with folk remedies is practiced. Gastric extrasystole is registered in ICD 10 (code 149.3).

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

Causes of extrasystole

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

Gastric extrasystole is a consequence of various myocardial lesions (CHD, cardiosclerosis, myocardial infarction, chronic circulatory failure, heart defects). Its development is possible with febrile conditions and with VVD. And also it is a side effect of certain drugs (Eupelin, Caffeine, glucocorticosteroids and some antidepressants) and can be observed with improper treatment with folk remedies.

The reason for the development of extrasystole in people who are actively involved in sports is myocardial dystrophy associated with intense physical exertion. In some cases, this disease is closely associated with a change in the amount of sodium, potassium, magnesium and calcium ions in the myocardium itself, which adversely affects its work and does not allow you to get rid of seizures.

Often, gastric extrasystole can occur during or immediately after a meal, especially in patients with VVD. This is due to the peculiarities of the work of the heart during such periods: the heart rate decreases, so there are extraordinary contractions (before or after the next one). It is not necessary to treat such extrasystoles, since they are functional in nature. In order to get rid of extraordinary contractions of the heart after eating, you can not take a horizontal position immediately after eating. It is better to sit in a comfortable chair and relax.

Classification

Depending on the place of occurrence 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 extrasystole.

A combination of several types of impulse is possible (for example, supraventricular extrasystole is combined with a stem one, gastric extrasystole occurs along 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. The extrasystole can be single or steam. If three or more extrasystoles appear in a row, then we are already talking about tachycardia (ICD code - 10: 147.x).

Supraventricular extrasystole differs from the ventricular localization of the source of the 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 bigeminia, when an extrasystole occurs after a normal contraction of the heart muscle. It is believed that the development of bigeminia is provoked by disturbances in the work of the autonomic nervous system, that is, the VSD can become a trigger for the development of bigeminia.

There are also 5 degrees of extrasystole, which are due to 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 in turn;
• the fifth degree is characterized by the presence of 3 or more extrasystoles one after another.

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

Diagnosis and treatment

Before treating any extrasystole, it is important to correctly establish its appearance. The most revealing method is electrocardiography (ECG), especially with ventricular impulses. ECG allows you to identify the presence of extrasystole and its location. However, an ECG at rest does not always reveal the disease. Diagnosis is complicated in patients suffering from VVD.

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 during the day and records the progress of the study. This ECG diagnosis allows you to identify the disease, even in the absence of complaints from the patient. A special portable device attached to the patient's body records ECG readings for 24 or 48 hours. In parallel, the patient's actions are recorded at the time of ECG diagnosis. Then the daily activity data and the ECG are compared, which makes it possible to identify the disease and treat it correctly.

In some literature, the norms of the occurrence of extrasystoles are indicated: for a healthy person, ventricular and ventricular extrasystoles per day, detected on the ECG, are considered the norm. If after the ECG studies no abnormalities were revealed, the specialist may prescribe special additional studies with a load (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, extrasystole is supraventricular in nature, and the frequency of pulses per day exceeds 200, individually selected drug therapy is necessary. To treat extrasystalia in such cases, drugs such as Propanorm, Kordaron, Lidocaine, Diltiazem, Panangin, as well as beta-blockers (Atenolol, Metoprolol) are used. Sometimes such means can get rid of the manifestations of VVD.

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

A fairly effective method to cure extrasystole forever is cauterization of its focus. This is a fairly simple surgical intervention, with practically no consequences, but it cannot be performed in children, there is an age limit.

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

Treatment of children

In most cases, the disease in children does not need to be treated. Many experts argue that in children the disease after passes without treatment. If desired, you can stop severe attacks with safe folk remedies. However, it is recommended to undergo an examination to determine the degree of neglect of the disease.

Extrasystole in children can be congenital or acquired (after nervous shocks). 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 need special treatment, but it is necessary to be examined at least once a year. At risk are children suffering from VVD.

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

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

Fight with folk remedies

You can get rid of severe attacks with folk remedies. At home, you can use the same means as in the treatment of VVD: soothing infusions and decoctions of herbs.

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

Treatment with such alternative methods should be practiced only after consulting a doctor. If they are not used correctly, then you can simply not get rid of the disease, but also aggravate it.

Prevention

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

Consequences

If the impulses are of a single nature and are not burdened by an anamnesis, then the consequences for the body can be avoided. When the patient already has heart disease, in the past there was a myocardial infarction, frequent extrasystoles can cause tachycardia, atrial fibrillation and atrial and ventricular fibrillation.

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

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Coding of ventricular extrasystole according to ICD 10

Extrasystoles are called episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular sections and ventricles. 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 noted in% of the entire population of the globe, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other cardiac arrhythmias, but the following exception options are also provided:

• rare contractions of the myocardium (bradycardia R1);
• extrasystole due to obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
• disorders in the work of the cardiovascular system in the newborn (P29.1).

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

The etiological factor in the presence of extrasystoles according to ICD 10

World nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years, 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 the processes of acute or chronic decompensation.

In most cases, episodic interruptions in the work 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, which occurs after each normal one, is called bigeminia;
• trigeminia is the process of pathological shock after several normal contractions of the myocardium;
• Quadrigeminia is characterized by the appearance of an extrasystole after three myocardial contractions.

In the presence of any kind 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 of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact 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. №170

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

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

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

• rare contractions of the myocardium (bradycardia R1);
• extrasystole due to obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
• disorders in the work of the cardiovascular system in the newborn (P29.1).

In most cases, episodic interruptions in the work 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, which occurs after each normal one, is called bigeminia;
• trigeminia is the process of pathological shock after several normal contractions of the myocardium;
• Quadrigeminia is characterized by the appearance of an extrasystole after three myocardial contractions.

Gradation of ventricular extrasystole according to ryan and laun, code for microbial 10

1 - rare, monotopic ventricular arrhythmia - no more than thirty PVCs per hour;

2 - frequent, monotopic ventricular arrhythmia - more than thirty PVCs per hour;

3 - polytopic HPS;

4a – monomorphic paired PVCs;

4b - polymorphic paired PVCs;

5 - ventricular tachycardia, three or more PVCs 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 30 s);

E - sustained VT (more than 30 s).

Absence of structural lesions of the heart;

Absence of a scar or hypertrophy of the heart;

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

Slight or moderate frequency of ventricular extrasystole;

The 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 hypertrophy of the heart;

Moderate decrease in LV EF - from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

The absence of hemodynamic consequences of arrhythmias or their insignificant presence.

The presence of structural lesions of the heart;

The presence of a scar or hypertrophy of the heart;

Significant decrease in LV EF - 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 arrhythmias. And it is characterized by an extraordinary contraction of the heart muscle.

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

The nature of the disease

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

With an extraordinary heart 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 its fading. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). Daily ECG showed positive indicators in 50% of the studied people.

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.

The use of energy drinks, alcohol, smoking can also provoke extrasystoles in the heart. This type of ailment is not dangerous and passes 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 the 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 both in the right and in the left ventricle.

The focus of the occurrence of extrasystoles can be different: they can come from the same source - monotopic, or they can occur in different areas - polytopic.

Disease prognosis

Considered arrhythmias according to prognostic indications are classified into several types:

• arrhythmias of a benign nature, 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 lesions, blood ejection decreases by an average of 30%, there is a risk to health;
• ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

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

Atrial extrasystole ICb code 10

Clinical picture

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

Causal factors

Consequences of arrhythmia

• paroxysmal tachycardia;
• angina;
• myocardial infarction;

Diagnostic methods

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

Therapy regimen

Medication regimen

Surgical intervention

Folk remedies

Dangers of atrial extrasystole

Single atrial extrasystoles

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

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

Clinical picture

Single extrasystoles may not appear at all. The blood flow is not disturbed, 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 push and subsequent fading in the region of the heart;
• general weakness;
• breathing problems (shortness of breath);
• feeling of heat;
• signs of angina;
• panic attacks;
• manifestation of a veil or flickering of "flies" before the eyes.

It is more difficult to endure arrhythmia provoked by vegetovascular dystonia. Some people already have atrial extrasystole on inspiration, especially against the background of stress and overload. Organic forms have a more negative prognosis, but are more easily tolerated. The situation changes with the development of complications.

Causal factors

It is customary to divide extrasystoles into organic, provoked by other diseases, and functional, which are the result of exposure to irritating factors.

The first group arises for the following reasons:

Functional failures in the heartbeat are the result of the following factors:

• constant exposure to stressful situations;

Separately, one can distinguish idiopathic extrasystole. The cause of its occurrence cannot be identified during the examination. In the absence of organic lesions and pronounced symptoms, a similar form is referred to a functional group.

Overeating causes a benign 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 violation is especially pronounced if, after a heavy meal, take a horizontal position.

Depending on the age of the patient and the 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 fibrillation or ventricular fibrillation;
• paroxysmal tachycardia;
• ischemic heart disease (CHD);
• angina;
• myocardial infarction;
• complete or partial heart block.

Diagnostic methods

If signs of extrasystole are detected, it is necessary to make an appointment with a cardiologist. The doctor will interview the patient to find out about disturbing symptoms. Then he will conduct auscultation (listening) and measure the pressure and pulse.

Based on the results obtained, a series of examinations will be assigned:

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

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

As an addition, an ECG with exercise (veloergometry) and daily monitoring by 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 the ECG are usually the following:

• changed QRS complex;
• the T wave is superimposed on the P;
• the ventricular extrasystole complex is not deformed;
• compensatory pause lasts less than expected;
• Q-P interval over 0.12 sec.;
• the P wave is modified and occurs ahead of time;

Therapy 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 the means of treating the main pathological process, medicines are used to stop arrhythmia and normalize the work of the heart:

Medicines and their dosages are selected by the attending physician. It is not recommended to independently change the compiled therapy 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 stop arrhythmia or eliminate the focus of ectopic impulses, surgical intervention may be required:

• Carrying out radiofrequency ablation in order 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. As a treatment for extrasystole at home, diuretic and sedative agents are used:

Folk remedies only in rare cases cause adverse reactions, but before using them, you should always consult with your doctor. The duration of use of such drugs is usually 1-2 months. In order to avoid overdose, it is necessary to prepare and take them according to the 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 noted in% of the entire population of the globe, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other cardiac arrhythmias, but the following exception options are also provided:

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

The etiological factor in the presence of extrasystoles according to ICD 10

World nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years, 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 the 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 kind 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 - the main symptoms:

• Headache
• Weakness
• Dizziness
• Dyspnea
• Fainting
• Lack of air
• Irritability
• Fatigue
• fading heart
• Heartache
• Heart rhythm disorder
• Increased sweating
• Pale skin
• Interruptions in the work of the heart
• panic attacks
• Capriciousness
• Fear of death
• Feeling broken

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

To date, 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 the course of other ailments, an overdose of medicines or a toxic effect on the body.

The symptomatology of the disease is nonspecific and is characteristic of almost all cardiological ailments. In the clinical picture, there are sensations in violation of the heart, a feeling of lack of air and shortness of breath, as well as dizziness and pain in the sternum.

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

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

The international classification of diseases of the tenth revision defines a separate code for such a 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 the varieties of the disease, this form is diagnosed most often, namely in 62% of situations.

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

Cardiological disorders leading to organic extrasystole are represented by:

The functional type of ventricular extrasystole is determined by:

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

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

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

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

In addition, experts 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 at the time of 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 happens:

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

Based on the number of sources of excitability, there are:

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

Classification of ventricular extrasystoles by frequency:

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

According to its order, pathology is divided into:

• disordered - while there is no pattern between normal contractions and extrasystoles;
• orderly. In turn, it exists in the form of bigeminia - it is an alternation of normal and extraordinary contractions, trigeminia - the alternation of two normal contractions and an extrasystole, quadrigeminia - 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 an organic lesion of the heart and improper functioning of the myocardium is not observed. This means that the risk of developing 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 in comparison with the previous form;
• malignant course - severe organic damage to the heart is formed, which is dangerously high chance of sudden cardiac death.

A separate variety is insertion 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 sensation of a sinking heart, “interruptions” in functioning, or a kind of “shock”. Such clinical manifestations are the result of enhanced post-extrasystolic contraction.

The main symptoms of ventricular extrasystole are:

• severe dizziness;
• pallor of the skin;
• pain in the heart;
• increased fatigue and irritability;
• recurring headaches;
• weakness and weakness;
• feeling short of breath;
• fainting states;
• shortness of breath;
• causeless panic and fear of death;
• violation of heart rate;
• increased sweating;
• capriciousness - such a sign is characteristic of children.

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

Diagnostics

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

• study of the medical history - will indicate the main pathological etiological factor;
• collection and analysis of a 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 a person with a phonendoscope, as well as probing the pulse;
• a detailed survey of the patient - to compile a complete symptomatic picture and determine rare or frequent ventricular extrasystoles.

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

Instrumental diagnosis of extrasystole of the heart involves the implementation of:

• ECG and echocardiography;
• daily monitoring of electrocardiography;
• tests with loads, in particular bicycle ergometry;
• X-ray and MRI of the chest;
• rhythmocardiography;
• polycardiography;
• sphygmography;
• PECG and CT.

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

Treatment

In those situations where the development of such a disease has occurred without the occurrence of cardiac pathologies or VVD, 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 shown to have more rest;
• maintaining a correct and balanced diet;
• avoidance of stressful situations;
• performing breathing exercises;
• spending a lot of time outdoors.

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

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

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

• radiofrequency catheter ablation of ectopic lesions;
• open intervention, which involves the 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 development:

• sudden onset of cardiac death;
• heart failure;
• changes in the structure of the ventricles;
• aggravation of 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 rejection of addictions;
• limiting the consumption of strong coffee;
• avoiding physical and emotional overwork;
• rationalization of the regime of work and rest, namely a full-fledged long sleep;
• the use of drugs only under the supervision of the attending 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 the variant of its course. For example, functional extrasystole has a favorable prognosis, and pathology that develops against the background of organic heart disease has a high risk of sudden cardiac death and other complications. However, the mortality 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, based on the symptoms entered, selects probable diseases.

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Heart defects are anomalies and deformations of individual functional parts of the heart: valves, septa, openings between vessels and chambers. Due to their improper functioning, blood circulation is disturbed, and the heart ceases to fully fulfill its main function - supplying oxygen to all organs and tissues.

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

Symptoms and treatment of human diseases

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