Violation of the heart rhythm according to the type of ventricular extrasystole. The shape of the PVC, which is visible on the ECG, stands out. The clinical picture of paroxysmal tachycardia

Ventricular extrasystole is an arrhythmia, or disturbances in the heart rhythm. The disease is associated with the appearance of extraordinary impulses. These areas are called ectopic foci and are found in the wall of the lower parts of the heart (ventricles). Such impulses contribute to the occurrence of extraordinary, partial contractions of the heart. Extrasystoles are characterized by premature occurrence. The most accurate diagnosis of extrasystole is possible by recording a food ECG. Ventricular extrasystole can occur with premature excitation of the myocardium of the ventricles of the heart, which significantly disrupts the entire heart rhythm.

Are ventricular extrasystoles dangerous?

The prognosis of the course of the disease depends on whether the patient has anatomical pathologies of the heart;
electrophysiological parameters of extrasystole (frequency of occurrence, degree of premature manifestation, location);
the ability of ventricular extrasystoles to adversely affect the performance of the heart muscle and the body as a whole.

Why do extrasystoles occur?

The reasons are very different. Biggest Influence to the occurrence of violations parasympathetic system person. The first place among the root causes of the disease belongs to violations in neurohumoral regulation, which has a non-cardiac character and occurs at the level of the nervous and endocrine system. This affects the permeability of membranes, thereby changing the concentration of potassium and sodium ions inside the cell and in the extracellular space (the so-called potassium-sodium cellular pump). As a result, the intensity and direction of the movement of ion currents through the membrane changes.

This mechanism triggers changes in the excitability, automatism of the heart muscle, disrupts the conduction of impulses, which in turn is associated with the manifestation of PVCs. PVCs are also the result of increased automatism of the heart outside the sinus node. With the help of an ECG, not in all cases, it is possible to distinguish nodal extrasystole from atrial. To refer to both of these types of PVCs, the term supraventricular extrasystoles has been introduced. Recently, it has been proven that many ECs mistaken for PVCs are supraventricular. They appear in combination with an aberrant QRS complex.

ZhES classification

In cardiology, there are several classifications of ventricular extrasystoles. In recent years, the most common (proposed by Lown B. and Wolf M.). In accordance with this classification, in patients with myocardial infarction (MI), PVCs are divided into 5 categories.

In 1975 modified Lown's classification, adapting it for patients without MI.
Classification:
Depending on the quantity and morphological characteristics ZhES, there are several classes of gradation:

Some time later, a new modified classification was proposed, which has become widespread and is still used today. It suggests single monomorphic ventricular extrasystoles and single ventricular polymorphic extrasystoles
ZHES classification according to Myerburg, 1984.

Frequent ventricular extrasystoles treatment.

Patients with PVC without structural disturbances hearts have no prognostic value. However, if more than 10 VPC/min is detected in patients after MI, this indicates the risk of SCD. Patients with malformations and organic lesions of the heart have a high degree of risk in violation of the contraction of the heart. Patients with PVCs without visible violations do not need treatment. If symptoms are present, symptomatic treatment is prescribed, which begins with sedatives and ß-blockers. Great importance is given to the prevention of life-threatening arrhythmias.

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What is it, why are single (single) and frequent extrasystoles dangerous?

With a ventricular (ventricular) extrasystole, an impulse can occur in the right and left legs of the His bundle, Purkinje fibers, or directly in the ventricular myocardium.

Single contractions of the muscular membrane of the ventricles do not have a significant effect on blood circulation, and paired and group ones are called ventricular extrasystole, which requires treatment.

Unlike atrial extrasystole, with ventricular excitation covers only the ventricles, therefore, on the electrocardiogram, they look like expanded and deformed complexes.

Often their appearance is associated with the presence of any organic lesion of the heart, myocardial infarction and a decrease in the contractile function of the cardiac muscle membrane.

The prevalence and development of the disease

According to the national guidelines for cardiology, ventricular extrasystoles occur in 40-75% of examined patients. With simultaneous recording of an ECG, the chance of meeting PVC is approximately 5%.

Increased Risk the disease is observed in the elderly, in people with cardiovascular accidents, in the presence of various myocardial diseases.

In such a contingent of patients, the daily number of ventricular extrasystoles reaches 5000.

The mechanism of development of extrasystole is associated with premature depolarization cardiomyocytes. The presence of a refractory portion of the myocardium leads to a re-entry of excitation into the cells and an extraordinary contraction.

Ventricular extrasystoles are characterized by an incomplete compensatory pause and Occurs predominantly in the morning and afternoon.

Classification and differences of species, stages

Gradation and danger to health and life in ventricular extrasystoles are determined according to the Lown classification. The following classes of PVCs are distinguished:

• 0 – complete absence ventricular extrasystoles;
• 1 - single contractions caused by an impulse from the same source;
• 2 - the impulse is also monomorphic, but their number is more than 30 per hour;
• 3 - extrasystoles from different foci;
• 4 - is divided into two types: A - paired extrasystoles, B - group, which are also called short runs of ventricular tachycardia;
• 5 - PVC, in which the ventricular complex "fits" on the T wave of the previous cycle. Such extrasystole is the most dangerous and can lead to arrhythmia, which significantly affects hemodynamics, causes shock and death.

Three types are distinguished according to the time of occurrence:

• early - ventricular contraction occurs during the passage of an impulse through the atria;
• interpolated ventricular extrasystoles - simultaneously with the contraction of the upper chambers of the heart;
• late - occurrence during diastole.

Ordered ventricular extrasystoles are called allorhythmia. When a heart rhythm disorder (HRD) by the type of ventricular extrasystole occurs after each normal complex, they talk about bigeminy, when after two normal - o trigeminia and so on.

Causes and risk factors

The reasons that lead to PVC can be grouped into several groups:

1. cardiac causes.

   These include past heart attacks, the presence of angina pectoris, cicatricial changes in the heart muscle, CHF, cardiomyopathy, inflammatory diseases muscular membrane, various malformations of the heart.

2. Change in electrolyte concentration especially potassium and magnesium.
3. Reception of some medicines . PVCs can cause cardiac glycosides, antiarrhythmics, diuretics.
4. Bad habits, uncontrolled smoking, alcohol abuse.
5. Diseases of the endocrine organs that lead to a change in hormone production: thyrotoxicosis, diabetes, pheochromocytoma.

Symptoms

The clinical picture of VE is characterized by symptoms of directly extraordinary contraction and circulatory disorders. The patient may feel heart palpitations, irregularity, some describe "coups" of the heart in the chest.

Similar symptoms often combined with fright, anxiety, fear of death.

Changes in hemodynamics cause weakness, dizziness, may experience shortness of breath at rest. Sometimes there are pains in the heart of the type of angina pectoris.

On examination, you can see pulsation of the veins of the neck, arrhythmia of the pulse. In severe cases, ventral extrasystole provokes fainting, loss of consciousness.

In many patients, PVC is no obvious clinical.

Diagnosis and signs on the ECG

The diagnosis is established on the basis questioning and inspection. The patient complains of interruptions, somersaults of the heart, irregular rhythm. On examination, you can notice a pulse deficit, pallor, according to auscultation - arrhythmia.

An important diagnostic method is the ECG., which shows the presence of a premature gastric complex without a preceding atrial wave. The QRS complex is wide and irregular. Additionally, echocardiography, intracardiac EFI are used.

For diagnosis, refer to the data of an electrocardiographic study. Supraventricular extrasystoles are characterized by an undeformed QRS, a P wave in front of all extraordinary ventricular complexes.

The differential diagnosis of different types of extrasystoles is described in the video:

For first aid it is necessary lay the patient down, provide fresh air. In some cases, when the diagnosis is established, it will be necessary to take antiarrhythmic drugs, for example, amiodarone, propafenone.

It is also necessary deliver the patient to a specialized cardiological hospital for diagnosis and treatment.

Therapy tactics

With benign ventricular extrasystole, which is well tolerated by patients, drug treatment is not carried out. Recommend rejection bad habits , modification of risk factors, it is possible to take Corvalol.

With frequent PVCs, a pronounced clinic, a malignant course, antiarrhythmic drugs are prescribed:

• Propafenone is a class I antiarrhythmic, used for benign course. Contraindicated in LV aneurysm, severe heart failure.
• Bisoprolol is an adrenergic blocker, prevents the occurrence of ventricular fibrillation, regulates the heart rate. Contraindicated in patients with bronchial asthma.
• Cordarone is the drug of choice for malignant and prognostically unfavorable PVCs. Reduces rates of cardiac death.

Surgery carried out with frequent ventricular extrasystole, which are difficult to drug treatment. An electrophysiological study is performed to establish the exact location of the focus and its radiofrequency ablation.

Rehabilitation

Rehabilitation is indicated for patients with previous infarctions and high-grade PVC, which led to complications in the form of ventricular tachycardia or ventricular flutter, after surgical treatment arrhythmias.

Prognosis, complications and consequences

The prognosis of rhythm disturbances largely depends on the severity of the disease, on the risk cardiovascular diseases to which it may lead.

With rare single (monomorphic) ventricular extrasystoles, the prognosis is good, frequent and polymorphic prognostically unfavorable, require careful monitoring of the condition of patients and treatment.

High class ventricular extrasystoles (4, 5) may be complicated by serious arrhythmias. Ventricular flutter can lead to loss of consciousness, significant hemodynamic disturbance, and reduced blood supply to the brain.

The transition to ventricular fibrillation without timely defibrillation leads to death.

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What it is?

A feature of this cardiac pathology is its risk of occurrence even at a young age, while the frequency of manifestations of this type of extrasystole increases with age. The most common are isolated cases of extrasystole; however, particularly complex variants of the disease are also identified, in which a repeated rise in excitation of ventricular tissues is diagnosed.

Morning hours should be considered the most favorable for the manifestation of ventricular extrasystole, and a significant number of variants of this condition makes it difficult to identify the disease and determine the most right system his treatment. Ventricular extrasystole is an extraordinary contraction of the ventricle, which subjectively manifests itself as an untimely contraction of the heart muscle, there is a lack of air.

• During pregnancy, single ventricular extrasystoles may occur, since at this time a significant load is placed on the woman's body, and the general hormonal background, which can also lead to some interruptions in the work of the heart. Any complaints of an unstable heart rhythm should be the reason for a full examination of the pregnant woman.
• The detection of this cardiac pathology is usually carried out already in the neonatal period, and it can be caused by a hereditary factor or congenital anomalies heart development.
• At a later age in children, this condition occurs with nervous or physical excessive stress, with poisoning food products or medicines. Most often, ventricular extrasystole in a child is detected by chance, during the next preventive examination. An older child may already complain of discomfort in the heart and interruptions in the heart rhythm.

According to its manifestations and impact on the patient's life, ventricular extrasystole does not pose a significant threat to human health, but without necessary treatment probably a significant increase in risk sudden death, this becomes especially true in the presence of any other cardiac pathologies.

You will learn about what a single ventricular extrasystole is, idiopathic, rare and frequent, as well as its other types, in the next section.

The following video will tell you more about such a pathology as ventricular extrasystole:

Classification

When this pathological condition of the cardiac system today, the disease is classified depending on the degree of its development and the symptoms that appear. And according to the data obtained during the daily ECG, it is customary to classify ventricular extrasystoles into the following classes:

• 0 class corresponds to a state in which there are no manifestations of this state;
• Class 1 is characterized by the detection of no more than 30 cases during any hour during the day single extrasystoles ventricle of the heart. They have a pronounced monomorphic character;
• class 2 - a condition in which more than 30 single frequent monomorphic ventricular extrasystoles are detected during a daily ECG;
• Class 3 can be established with frequent polymorphic ventricular extrasystoles;
• class 4a is characterized by the detection of repeated (paired, one after the other) extrasystoles of a monomorphic nature during the daily ECG;
• 4b class - a condition in which paired polymorphic extrasystoles of the ventricle are recorded;
• class 5 is characterized by the detection of volley (or group) polymorphic extrasystoles of the ventricle.

The first class can be considered as having no external and organic manifestations, therefore negative impact both on the condition of the patient and on health in general. And from the 2nd to the 5th class, extrasystoles already carry a certain danger for deepening the existing organic lesions: if the patient already has lesions of the cardiac system of any nature, then the development of extrasystoles exacerbates the impact on the state of health of pathological conditions.

Classes 2-5 are characterized by an increased risk of sudden death from coronary heart failure. Therefore, when diagnosing this pathological condition, it is imperative to carry out full examination cardiac system and appropriate treatment.

About the violation of the heart rhythm by the type of ventricular extrasystole, the next section will tell in more detail.

By type of main characteristics

Depending on the main characteristics, which usually include heart rate and the location of the manifestations of this pathology, the following types of this pathological condition should be distinguished:

• single, or single extrasystoles of the ventricles, are extraordinary contractions of the muscles of the ventricle, which are observed infrequently, after about 25-30 normal contractions of the heart;
• group contractions of the ventricle are 3-5 contractions of an ectopic nature between normal heart rhythms;
• bigeminia - this condition is characterized by the repetition of one-time contractions for each normal heart rhythm;
• if an extraordinary contraction is observed after every third contraction, then trigymenia occurs.

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

1. right ventricular - this type is less common, probably due to the peculiarities anatomical structure hearts;
2. left ventricular - occurs most often.

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

by ryan

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

• 0 class is not observed, does not have visible symptoms and is not detected during daily ECG;
• ventricular extrasystole 1 gradation according to ryan is characterized by the detection of infrequent monotopic contractions;
• Grade 2 has frequent monotopic abbreviations;
• for the third class according to this classification, polytopic contractions of the ventricle of the heart are characteristic;
• ventricular extrasystole 3 gradation according to ryan - these are multiple paired polymorphic contractions that are repeated at a certain frequency;
• for class 4a, monomorphic paired contractions of the ventricle should be considered characteristic;
• 4b class should be characterized by paired polymorphic abbreviations;
• in the fifth class of pathology, the development of ventricular tachycardia is observed.

According to Laun

The following features are characteristic for the classification of ventricular extrasystole according to Lown:

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

These two classification options are most often used today and allow the most complete characterization of the patient's condition.

Causes of ventricular extrasystole

The most common causes and further development of this pathological contraction of the ventricle are organic lesions of the cardiac system, which are idiopathic in nature. To the reasons causing development ventricular extrasystoles include:

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

Symptoms of the disease

The most commonly reported manifestations of this condition include:

• noticeable disruptions in the work of the heart,
• lack of air
• uneven heart rhythm.

You may also experience:

• fainting
• sudden dizziness, which can be quite severe and prolonged.

Increased irritability, rapid onset of fatigue even with a slight load, headache, localized in different parts of the head - all these manifestations are also characteristic of ventricular extrasystole.

Diagnostic methods

Diagnosis of the disease is carried out by two main methods, which include daily ECG and Holter ECG monitoring.

• An electrocardiogram records all unplanned contractions of the ventricle, allowing you to determine the frequency and sequence of the heart rhythm.
• The method of bicycle ergometry makes it possible to identify the dependence of the manifestations of ventricular extrasystoles on the load received, as well as to classify the disease, which greatly facilitates the preparation of a program for its treatment.
• Polycardography, PECG, sphygmography and other methods can also be used as diagnostic methods.

A specialist will tell you more about the diagnosis of ventricular extrasystole in the following video:

Treatment

Depending on the symptoms and the stage of development of the disease, treatment is prescribed that restores normal work cardiac system.

Therapeutic

In the absence of objective signs of ventricular extrasystole, treatment is not required for patients. Recommendations in this condition include following a diet that is rich in potassium salts, as well as increasing the level of activity when sedentary manner life.

You should also completely exclude provoking factors, which include smoking and excessive alcohol consumption, as well as taking strong tea and coffee.

Medicinal

The appointment of drugs is made in the presence of symptoms of a more serious stage of the development of the disease.

The doctor may prescribe a number of sedative drugs, which include small doses of tranquilizers, as well as adrenoblockers. This approach allows to reduce the frequency of extraordinary contractions of the ventricle and thus improve general state sick.

Anticholinergic drugs allow you to quickly restore the heart rhythm and normalize the condition with existing bradycardia. In the absence of a pronounced positive effect, antiarrhythmic drugs can be prescribed.

Surgical intervention

In especially severe cases, radiofrequency ablation with a catheter is indicated. This operation is performed in a hospital side in conditions of absolute sterility.

Traditional medicine methods

This method of treatment does not always bring tangible results, and drugs traditional medicine can be prescribed for the zero class of the disease and in the absence of pronounced manifestations.

Also can be used folk remedies, which have a relaxing and sedative effect.

Even more about the methods of diagnosis and methods of treatment of ventricular extrasystole will tell famous doctor in the next video:

Disease prevention

• leading a more active and mobile lifestyle;
• giving up bad habits, including smoking, excessive drinking of alcohol and strong coffee;
• regular medical checkups.

Complications

In the presence of any heart disease, extrasystole can become dangerous disease, because in some cases it can lead to unexpected cardiac arrest. Also, extrasystole of the ventricle entails a deepening of already existing diseases of the cardiac system.

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Types of extrasystole

Extrasystoles are classified:

1. By localization:

• Sinus.
• Atrial.
• Atrioventricular.
• Ventricular.

2. Time of appearance in diastole:

• Early.
• Medium.
• Late.

3. By frequency:

• Rare (up to 5 / min).
• Medium (6-15/min).
• Frequent (more than 15/min).

4. By density:

• Single.
• Paired.

5. By frequency:

• Sporadic (random).
• Allorhythmic - systematic - bigeminy, trigeminy, etc.

6. For carrying out:

• Re-entry of an impulse by the re-entry mechanism.
• Blockade of conduction.
• Supernormal performance.

7. By etiology:

• Organic.
• Toxic.
• Functional.

8. By the number of sources:

• Monotopic.
• Polytopic.

Sometimes there is a so-called interpolated ventricular extrasystole- it is characterized by the absence of a compensatory pause, that is, a period after an extrasystole, when the heart restores its electrophysiological state.

The classification of extrasystole according to Laun and its modification Ryan.

Laun's classification of extrasystole

Creating a classification of ventricular extrasystoles according to Laun - important step in the history of arrhythmology. Using the classification in clinical practice, the doctor can adequately assess the severity of the disease in each patient. The fact is that PVC is a common pathology and occurs in more than 50% of people. In some of them, the disease has a benign course and does not threaten the state of health, but others suffer from a malignant form, and this requires treatment and constant monitoring of the patient. The main function of ventricular extrasystoles is the classification according to Lown - to distinguish malignant pathology from benign.

Ventricular extrasystole gradation according to Lown includes five classes:

1. Monomorphic ventricular extrasystole with a frequency of less than 30 per hour.

2. Monomorphic PVC with a frequency of more than 30 per hour.

3. Polytopic ventricular extrasystole.

• Paired ZhES.
• 3 or more ZhES in a row - ventricular tachycardia.

5. PVC type R to T. ES is assigned the fifth class when the R wave falls on the first 4/5 of the T wave.

ZHES classification according to Laun used by cardiologists, cardiac surgeons and other medical specialties for many years. Appeared in 1971 thanks to the work of B. Lown and M. Wolf, the classification, as it seemed then, would become reliable support physicians in the diagnosis and treatment of PVCs. And so it happened: until now, several decades later, doctors are guided mainly by this classification and its modified version by M. Ryan. Since that time, researchers have not been able to create a more practical and informative gradation of PVCs.

However, attempts to introduce something new have been made repeatedly. For example, the already mentioned modification by M. Ryan, as well as the classification of extrasystoles by frequency and form from R. J. Myerburg.

Classification of extrasystole according to Ryan

The modification made changes to the 4A, 4B and 5 class of ventricular extrasystoles according to Lown. The complete classification looks like this.

1. Ventricular extrasystole 1 gradation according to Ryan - monotopic, rare - with a frequency of less than 30 per hour.

2. Ventricular extrasystole 2 gradations according to Ryan - monotopic, frequent - with a frequency of more than 30 per hour.

3. Ventricular extrasystole 3 gradation according to Ryan - polytopic PVC.

4. The fourth class is divided into two subclasses:

• Ventricular extrasystole 4a gradation according to Ryan - monomorphic paired PVCs.
• Ventricular extrasystole 4b gradation according to Ryan - paired polytopic extrasystole.

5. Ventricular extrasystole 5 gradation according to Ryan - ventricular tachycardia - three or more PVCs in a row.

Ventricular extrasystole - classification according to R. J. Myerburg

The Myerburg classification divides ventricular arrhythmias depending on the form and frequency of PVCs.

Frequency division:

1. Rare - less than one EC per hour.
2. Infrequent - from one to nine ES per hour.
3. Moderate frequency - from 10 to 30 per hour.
4. Frequent ES - from 31 to 60 per hour.
5. Very frequent - more than 60 per hour.

Division by shape:

1. Single, monotopic.
2. Solitary, polytopic.
3. Double.
4. Ventricular tachycardia lasting less than 30 seconds.
5. Ventricular tachycardia lasting more than 30 seconds.
6. R. J. Meyerburg published his classification in 1984, 13 years later than B. Lown. It is also actively used, but significantly less than those described above.

Classification of extrasystole according to J. T. Bigger

By itself, the diagnosis of PVC does not say anything about the patient's condition. More important information about concomitant pathology and organic changes in the heart. To assess the likelihood of complications, J. T. Bigger proposed his own version of the classification, on the basis of which it is possible to draw a conclusion about the malignancy of the course.

In the classification of J. T. Bigger, PVC is evaluated according to a number of criteria:

• clinical manifestations;
• PVC frequency;
• the presence of a scar or signs of hypertrophy;
• the presence of persistent (lasting more than 30 seconds) or unstable (less than 30 seconds) tachycardia;
• ejection fraction of the left ventricle;
• structural changes in the heart;
• influence on hemodynamics.

Malignant is considered to be PVC with pronounced clinical manifestations(palpitations, syncope), the presence of scarring, hypertrophy or other structural lesions, a significantly reduced left ventricular ejection fraction (less than 30%), a high frequency of PVCs, with the presence of persistent or non-persistent ventricular tachycardia, a slight or pronounced effect on hemodynamics.

Potentially malignant PVC: symptomatically manifested poorly, occurs against the background of scars, hypertrophy or other structural changes, accompanied by a slightly reduced left ventricular ejection fraction (30-55%). The frequency of PVCs can be high or moderate, ventricular tachycardia is either unstable or absent, hemodynamics suffers slightly.

Benign PVC: not clinically manifested, there are no structural pathologies in the heart, the ejection fraction is preserved (more than 55%), the frequency of ES is low, ventricular tachycardia is not recorded, hemodynamics does not suffer.

J. T. Bigger classification criteria for extrasystole give an idea of ​​the risk of sudden death, the most formidable complication of ventricular tachycardia. So, with a benign course, the risk of sudden death is considered very low, with a potentially malignant one - low or moderate, and the malignant course of PVC is accompanied by high risk of sudden death.

Sudden death refers to the transition of PVCs to ventricular tachycardia and then to atrial fibrillation. With the development of atrial fibrillation, a person goes into a state of clinical death. If you don't start within a few minutes resuscitation(best of all - defibrillation with an automatic defibrillator), clinical death will be replaced by biological and it will become impossible to bring a person back to life.

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Ventricular extrasystoles (PVC) are extraordinary contractions of the heart that occur under the influence of premature impulses that originate from the intraventricular conduction system.
Under the influence of an impulse that has arisen in the trunk of the bundle of His, its legs, branching of the legs or Purkinje fibers, the myocardium of one of the ventricles, and then the second ventricle, contracts without prior atrial contraction. This explains the main electrocardiographic signs of PVC: a premature dilated and deformed ventricular complex and the absence of a normal P wave preceding it, indicating atrial contraction.

In this article, we will consider the causes of ventricular extrasystole, its symptoms and signs, and talk about the principles of diagnosis and treatment of this pathology.

Extrasystoles can appear in healthy people after taking stimulants (caffeine, nicotine, alcohol).

Ventricular extrasystole can be observed in healthy people, especially with (Holter ECG). Functional PVCs are more common in people younger than 50 years of age. It can be provoked by physical or emotional fatigue, stress, hypothermia or overheating, acute infectious diseases, stimulants (caffeine, alcohol, tannin, nicotine) or certain medications.

Functional PVCs are quite often detected with increased activity vagus nerve. In this case, they are accompanied by a rare pulse, increased salivation, cold wet extremities, arterial hypotension.

Functional PVCs do not have a pathological course. With the elimination of provoking factors, they most often go away on their own.

In other cases, ventricular extrasystole is due to organic heart disease. For its occurrence, even against the background of heart disease, additional exposure to toxic, mechanical or autonomic factors is often required.

Often, PVCs accompany chronic coronary heart disease (). With daily ECG monitoring, they occur in almost 100% of these patients. Arterial hypertension, heart defects, heart failure and myocardial infarction are also often accompanied by ventricular extrasystole.

This symptom is observed in patients with chronic lung diseases, with rheumatism. There is extrasystole of reflex origin associated with diseases of the organs abdominal cavity: cholecystitis, peptic ulcer stomach and duodenum, pancreatitis, colitis.
Another common cause ventricular extrasystole is a metabolic disorder in the myocardium, especially associated with the loss of potassium cells. These diseases include pheochromocytoma (a hormone-producing tumor of the adrenal gland) and hyperthyroidism. PVCs can occur in the third trimester of pregnancy.

Drugs that can cause ventricular arrhythmias include primarily cardiac glycosides. They also occur with the use of sympathomimetics, tricyclic antidepressants, quinidine, anesthetics.

Most often, PVCs are recorded in patients who have serious changes at rest: signs, myocardial ischemia, rhythm and conduction disturbances. The frequency of this symptom increases with age, it is more common in men.

Clinical signs

With a certain degree of conditionality, one can speak of different symptoms with functional and "organic" PVCs. Extrasystoles in the absence serious illnesses hearts are usually solitary, but poorly tolerated by patients. They may be accompanied by a feeling of fading, interruptions in the work of the heart, individual strong beats in the chest. These extrasystoles often appear at rest, in the supine position or during emotional stress. physical stress or even a simple transition from horizontal to vertical causes them to disappear. They often occur against the background of a rare pulse (bradycardia).

Organic PVCs are often multiple, but patients usually do not notice them. They appear during physical exertion and pass at rest, in the supine position. In many cases, these PVCs are accompanied by rapid heartbeat (tachycardia).

Diagnostics

main methods instrumental diagnostics ventricular extrasystoles are ECG at rest and 24-hour Holter ECG monitoring.

Signs of PVC on the ECG:

• premature dilated and deformed ventricular complex;
• discordance (multidirectionality) of the ST segment and the T wave of the extrasystole and the main wave of the QRS complex;
• absence of P wave before PVC;
• the presence of a complete compensatory pause (not always).

Interpolated PVCs are distinguished, in which the extrasystolic complex is, as it were, inserted between two normal contractions without a compensatory pause.

If PVCs come from the same pathological focus and have the same shape, they are called monomorphic. Polymorphic PVCs emanating from different ectopic foci have a different shape and a different coupling interval (the distance from the previous contraction to the R wave of the extrasystole). Polymorphic PVCs are associated with severe heart disease and a more serious prognosis.
In a separate group, early PVCs ("R on T") are distinguished. The criterion of prematurity is the shortening of the interval between the end of the T wave of the sinus contraction and the beginning of the extrasystole complex. There are also late PVCs that occur at the end of diastole, which may be preceded by a normal sinus P wave, superimposed on the beginning of the extrasystolic complex.

ZhES are single, paired, group. Quite often they form episodes of allorhythmia: bigeminy, trigeminy, quadrigeminy. With bigeminy, PVC is recorded through each normal sinus complex, with trigeminy, PVC is every third complex, and so on.

With daily ECG monitoring, the number and morphology of extrasystoles, their distribution during the day, dependence on load, sleep, and medication are specified. This important information helps to determine the prognosis, clarify the diagnosis and prescribe treatment.

The most dangerous in terms of prognosis are frequent, polymorphic and polytopic, paired and group PVCs, as well as early extrasystoles.

The differential diagnosis of ventricular extrasystole is carried out with supraventricular extrasystoles, complete blockade of the legs of the His bundle, slipping ventricular contractions.

If ventricular extrasystole is detected, the patient should be examined by a cardiologist. Additionally, general and biochemical blood tests, an electrocardiographic test with a dosed physical activity, echocardiography.

Treatment

Treatment of ventricular extrasystole depends on its causes. With functional PVCs, it is recommended to normalize the daily regimen, reduce the use of stimulants, reduce emotional stress. A diet enriched with potassium is prescribed, or preparations containing this trace element ("Panangin").
With rare extrasystoles, special antiarrhythmic treatment is not prescribed. Assign vegetable sedatives(valerian, motherwort) in combination with beta-blockers. With HS against the background of vagotonia, sympathomimetics and anticholinergics, for example, Bellataminal, are effective.
At organic nature extrasystole treatment depends on the number of extrasystoles. If there are few, ethmosine, ethacizine, or allapinin may be used. The use of these drugs is limited due to the possibility of their arrhythmogenic effect.

If extrasystole occurs in the acute period of myocardial infarction, it can be stopped with lidocaine or trimecaine.

Cordarone (amiodarone) is currently considered the main drug for suppressing ventricular extrasystoles. It is prescribed according to the scheme with a gradual decrease in dosage. When treating with cordarone, it is necessary to periodically monitor liver function, thyroid gland, external respiration and the level of electrolytes in the blood, as well as undergo an examination by an ophthalmologist.

In some cases, persistent ventricular premature beats from a known ectopic lesion are well treated with radiofrequency ablation surgery. During such an intervention, cells that produce pathological impulses are destroyed.

The presence of ventricular extrasystole, especially its severe forms worsens the prognosis in patients with organic heart disease. On the other hand, functional PVCs most often do not affect the quality of life and prognosis in patients.

Video course “ECG is within the power of everyone”, lesson 4 - “Heart rhythm disorders: sinus arrhythmias, extrasystole "(ZHES - from 20:14)

Article publication date: 12/19/2016

Article last updated: 12/18/2018

From this article you will learn: what is ventricular extrasystole, its symptoms, types, methods of diagnosis and treatment.

With ventricular extrasystole (this is one of the types), untimely contractions of the ventricles of the heart occur - in another way, such contractions are called extrasystoles. This phenomenon does not always indicate any diseases, extrasystole sometimes occurs in completely healthy people.

If the extrasystole is not accompanied by any pathologies, does not cause inconvenience to the patient and is visible only on the ECG, no special treatment is required. In the event that ventricular extrasystole was provoked by a violation of the heart, you will need additional examination a cardiologist or arrhythmologist who will prescribe medication or surgery.

This pathology can be cured completely (if treatment is necessary) if surgical correction the defect that caused it - or you can achieve a lasting improvement in well-being with the help of medications.

Causes of ventricular extrasystole

The reasons for this phenomenon can be divided into two groups:

1. organic are pathologies of cardio-vascular system;
2. functional - stress, smoking, excessive coffee consumption, etc.

1. Organic causes

The occurrence of ventricular extrasystole is possible with such diseases:

• Ischemia (impaired blood supply) of the heart;
• cardiosclerosis;
• dystrophic changes in the heart muscle;
• myocarditis, endocarditis, pericarditis;
• myocardial infarction and postinfarction complications;
• congenital heart defects (, coarctation of the aorta, defects interventricular septum, mitral valve prolapse and others);
• the presence of extra conductive bundles in the heart (Kent's bundle in WPW syndrome, James's bundle in CLC syndrome);
• arterial hypertension.

Also, untimely contractions of the ventricles appear with an overdose of cardiac glycosides, so always consult your doctor before using them.

Diseases that cause ventricular extrasystole are dangerous and require timely treatment. If untimely contractions of the ventricles were found on your ECG, be sure to undergo an additional examination to check if you have the heart pathologies listed above.

2. Functional reasons

These are stress, smoking, drinking alcohol, illegal substances, a large amount energy drinks, coffee or strong tea.

Functional ventricular extrasystole usually does not require treatment - it is enough to eliminate its cause and once again undergo a heart examination in a couple of months.

3. Idiopathic form of extrasystole

In this state, completely healthy person ventricular extrasystoles are observed, the cause of which is not clear. In this case, the patient usually does not have any symptoms, so treatment is not carried out.

Classification and severity

To begin with, we suggest that you familiarize yourself with what types of ventricular extrasystoles exist:

Three scientists (Laun, Wolf and Ryan) proposed the following classification of ventricular extrasystoles (from mildest to most severe):

• 1 type. Up to 30 single extrasystoles of the ventricles per hour (up to 720 pieces per day with a Holter study). Most often, such extrasystole is functional or idiopathic in nature and does not indicate any diseases.
• 2 type. More than 30 single untimely contractions per hour. It may indicate, and may be functional. By itself, such an extrasystole is not very dangerous.
• 3 type. Polymorphic ventricular extrasystoles. May indicate the presence of additional conducting bundles in the heart.
• 4A type. Paired extrasystoles. More often they are not functional, but organic in nature.
• 4B type. Group extrasystoles (unstable). This form occurs due to cardiovascular disease. Dangerous development of complications.
• 5 type. Early group ventricular extrasystoles (visible on the cardiogram in the first 4/5 of the T wave). This is the most dangerous form of ventricular extrasystole, as it often causes life-threatening forms of arrhythmias.

Symptoms of ventricular extrasystole

Rare single extrasystoles of a functional or idiopathic nature are usually visible only on the ECG or during the daily. They do not show any symptoms, and the patient is not even aware of their presence.

Sometimes patients with functional ventricular extrasystole complain of:

• feeling as if the heart stops (this is due to the fact that an extrasystole can be followed by an extended diastole (pause) of the ventricles);
• feeling of tremors in the chest.

Immediately after exposure to the cardiovascular system unfavorable factor(stress, smoking, alcohol, etc.) the following signs may appear:

• dizziness,
• pallor,
• sweating,
• feeling as if there is not enough air.

Organic ventricular extrasystole, which requires treatment, is manifested by symptoms of the underlying disease that caused them. There are also signs listed in the previous lists. They are often accompanied by bouts of squeezing pain in the chest.

Attacks of unstable paroxysmal tachycardia are manifested by the following symptoms:

• severe dizziness,
• fainting state,
• fainting
• "fading" of the heart,
• strong heartbeat.

If the treatment of the disease that caused this type of ventricular extrasystole is not started on time, life-threatening complications may appear.

Diagnostics

Most often, ventricular extrasystole is detected during a preventive medical examination during an ECG. But sometimes, if the symptoms are pronounced, the patients themselves come to the cardiologist with complaints about the heart. For an accurate diagnosis, as well as determining the primary disease that caused ventricular extrasystole, it will be necessary to undergo several procedures.

Initial inspection

If the patient himself came with complaints, the doctor will interview him to find out how severe the symptoms are. If the signs are paroxysmal in nature, the cardiologist must know how often they occur.

Also, the doctor will immediately measure blood pressure and pulse rate. At the same time, he can already notice that the heart is contracting irregularly.

After the initial examination, the doctor immediately prescribes an ECG. Focusing on its results, the cardiologist prescribes all other diagnostic procedures.

Electrocardiography

According to the cardiogram, doctors immediately determine the presence of ventricular extrasystoles.

Not on the cardiogram, ventricular extrasystole manifests itself as follows:

1. the presence of extraordinary ventricular QRS complexes;
2. extrasystolic QRS complexes are deformed and expanded;
3. there is no P wave before the ventricular extrasystole;
4. after an extrasystole there is a pause.

Holter examination

If the ECG shows pathological changes, the doctor prescribes daily ECG monitoring. It helps to find out how often the patient has extraordinary contractions of the ventricles, whether there are paired or group extrasystoles.

After a Holter examination, the doctor can already determine whether the patient needs treatment, whether extrasystole is life-threatening.

Ultrasound of the heart

It is carried out to find out which disease provoked ventricular extrasystole. It can be used to identify ischemia, congenital and acquired heart defects.

coronary angiography

This procedure allows you to assess the condition of the coronary vessels that supply oxygen and nutrients to the myocardium. Angiography is prescribed if the ultrasound showed signs of coronary heart disease (CHD). After examining the coronary vessels, you can find out exactly what provoked coronary artery disease.

Blood analysis

It is carried out to find out the level of cholesterol in the blood and to exclude or confirm atherosclerosis, which could provoke ischemia.

EFI - electrophysiological study

It is carried out if there are signs of WPW- or CLC-syndrome on the cardiogram. Allows you to accurately determine the presence of an additional conductive bundle in the heart.

Therapy of ventricular extrasystoles

Treatment of untimely contractions of the ventricles is to get rid of the cause that provoked them, as well as stopping attacks of severe ventricular arrhythmia, if any.

Treatment of the functional form of extrasystole

If ventricular extrasystole is functional, then you can get rid of it in the following ways:

• quit bad habits;
• take medication to relieve nervous tension(valerian, sedatives or tranquilizers, depending on the severity of the anxiety);
• adjust the diet (refuse coffee, strong tea, energy drinks);
• observe the regime of sleep and rest, engage in physiotherapy exercises.

Organic Form Treatment

Treatment of the organic form of type 4 disease involves taking that helps get rid of attacks of ventricular arrhythmia. The doctor prescribes Sotalol, Amiodarone or other similar medicines.

Also, with pathologies of types 4 and 5, the doctor may decide that it is necessary to implant a cardioverter-defibrillator. This is a special device that corrects the heart rate and stops ventricular fibrillation if it occurs.

Treatment of the underlying disease that caused ventricular extrasystole is also required. Often, various surgical procedures are used for this.

Surgical treatment of the causes of ventricular extrasystole

Consequences of ventricular extrasystole

Type 1 ventricular extrasystole, according to the classification given above in the article, does not pose a threat to life and usually does not cause any complications. With type 2 ventricular extrasystole, complications may develop, but the risk is relatively low.

If the patient has polymorphic extrasystole, paired extrasystoles, unstable paroxysmal tachycardia or early group extrasystoles, the risk of life-threatening consequences is high:

To avoid life-threatening consequences, do not delay starting treatment if you have a ventricular premature beat.

Prognosis for pathology

With extrasystole of the ventricles of types 1 and 2, the prognosis is favorable. The disease practically does not affect the quality of life of the patient and does not cause serious consequences.

With ventricular extrasystoles of type 3 and above, the prognosis is relatively favorable. At timely detection disease and the beginning of therapy, you can completely get rid of the symptoms and prevent complications.

Ventricular extrasystole is a common heart rhythm disturbance that develops under the influence of premature impulses emanating from the wall of the left or right ventricle. Extrasystoles that occur in this case, as a rule, affect only ventricular rhythm, that is, do not affect the upper sections of the heart. However, extraordinary heart contractions that come from the atria and the atrioventricular septum can provoke ventricular extrasystoles.

Source: serdtse24.ru

Ventricular extrasystoles in the absence of organic heart disease, as a rule, do not pose a danger to life.

The cardiac cycle is a sequence of processes that occur in one contraction of the heart and its subsequent relaxation. Each cardiac cycle consists of atrial systole, ventricular systole and diastole (relaxed state of the heart muscle in the interval between systoles, expansion of the heart cavities). Distinguish between electrical electrical activity, which stimulates the myocardium) and mechanical systole (contraction of the heart muscle, a decrease in the volume of the heart chambers). At rest, the ventricle of the adult heart ejects 50-70 ml of blood for each systole. The normal impulses of the heart originate in the sinus node, which is located at the top of the heart. Ventricular extrasystole is characterized by premature excitation of the ventricles in relation to the leading heart rhythm, which comes from the conduction system of the heart, in particular, the branches of the His bundle and Purkinje fibers.

Ventricular extrasystole is registered in all age groups. The frequency of detection of this pathology depends on the diagnostic method and the contingent of the examined. In people over 50 years of age, ventricular extrasystole is diagnosed in 40–75% of cases of extrasystolic arrhythmias.

When conducting an electrocardiogram, single ventricular extrasystoles are determined in 5% of clinically healthy individuals young age, and during the daily ECG monitoring - in about 50% of cases. A connection was established between the appearance of ventricular extrasystoles and the time of day (in the morning hours they are recorded more often, and during nighttime sleep they are observed less frequently). The risk of developing ventricular extrasystole increases with age, as well as in the presence of pathologies of the cardiovascular system.

Ventricular extrasystole can be complicated by a change in the configuration of the ventricle of the heart, the development atrial fibrillation, paroxysmal tachycardia, stroke, myocardial infarction, sudden coronary death.

Causes and risk factors

Ventricular extrasystole occurs against the background of organic pathologies of the heart, but it can also be idiopathic, that is, unidentified. Most often, it develops in patients with myocardial infarction (in 90-95% of cases), arterial hypertension, coronary heart disease, postinfarction cardiosclerosis, myocarditis, pericarditis, hypertrophic or dilated cardiomyopathy, cor pulmonale, mitral valve prolapse, chronic heart failure.

Risk factors include:

• vagotonia;
• endocrine disorders, metabolic disorders;
• chronic hypoxia (with sleep apnea, anemia, bronchitis);
• taking certain medications (antidepressants, diuretics, antiarrhythmic drugs, overdose of cardiac glycosides);
• bad habits;
• irrational nutrition;
• excessive physical and mental stress.

Ventricular extrasystole may appear at rest and disappear with exercise in individuals with increased activity parasympathetic nervous system. Single ventricular extrasystoles often occur in clinically healthy people for no apparent reason.

Forms of ventricular extrasystole

Depending on the results of daily ECG monitoring, the following classes of ventricular extrasystoles are distinguished:

• 0 - no ventricular extrasystoles;
• 1 - less than 30 single monomorphic ventricular extrasystoles are recorded during any hour during monitoring;
• 2 - more than 30 frequent single monomorphic ventricular extrasystoles are recorded during any hour during monitoring;
• 3 - polymorphic ventricular extrasystoles are recorded;
• 4a - paired monomorphic ventricular extrasystoles;
• 4b - paired polymorphic extrasystoles;
• 5 - group polymorphic ventricular extrasystoles, as well as episodes of paroxysmal ventricular tachycardia.

Forms of ventricular extrasystole:

With asymptomatic ventricular extrasystole and no signs of organic heart disease drug therapy is usually not required. The recommendations are lifestyle modifications.

According to the prognostic classification, benign, potentially malignant and malignant ventricular extrasystoles are distinguished.

Depending on the number of sources of excitability, two forms of extrasystoles are determined:

• monotopic- 1 ectopic focus;
• polytopic- several ectopic foci.

By frequency, ventricular extrasystoles are divided into the following types:

• single- up to 5 extrasystoles per minute;
• multiple- more than 5 extrasystoles per minute;
• paired- between normal contractions of the heart there are two extrasystoles in a row;
• group- between normal heartbeats, there are several (more than two) extrasystoles in a row.

Depending on the ordering, ventricular extrasystoles are:

• disordered- there is no pattern between normal contractions and extrasystoles;
• ordered- alternation of 1, 2 or 3 normal contractions with extrasystoles.

Variants of ventricular extrasystoles:

Symptoms

Subjective complaints in patients with ventricular extrasystole are often absent, and it is detected only during an ECG - a planned prophylactic or for another reason. In some cases, ventricular extrasystole manifests itself in the form of discomfort in the region of the heart.

Ventricular extrasystole, which occurs in the absence of any heart disease, can be difficult to tolerate by the patient. It develops on the background of bradycardia and may be accompanied by a sinking heart (a feeling of cardiac arrest), followed by a series of heartbeats, separate strong beats in the chest. Such ventricular extrasystoles appear after eating, during rest, sleep, after an emotional shock. It is characteristic that during physical exertion they are absent.

Implantation of cardioverter-defibrillators is indicated for malignant ventricular extrasystole, which has a high risk of sudden cardiac death.

In patients with organic heart disease, extrasystoles, on the contrary, occur during exercise and disappear when taking horizontal position. AT this case ventricular extrasystoles appear on the background of tachycardia. They are accompanied by weakness, a feeling of lack of air, fainting, anginal pain. There is a characteristic pulsation of the veins in the neck (venous Corrigan waves).

Ventricular extrasystole against the background of vegetovascular dystonia causes complaints of irritability, fatigue, recurrent headaches, dizziness, anxiety, fear, panic attacks.

Ventricular extrasystole often occurs in women during pregnancy, along with tachycardia and painful sensations on the left side chest. In this case, the pathology, as a rule, is benign and responds well to therapy after childbirth.

Diagnostics

Diagnosis of ventricular extrasystole is based on instrumental examination data. The results of the collection of complaints (if any) and anamnesis, including family, objective examination, as well as a number of laboratory tests, are also taken into account.

The auscultatory features of ventricular extrasystoles include a change in the sonority of the 1st heart sound, splitting of the 2nd heart sound. In patients with an objective examination, a pronounced presystolic pulsation of the cervical veins is detected, after an extraordinary pulse wave arrhythmic is determined arterial pulse with a long compensatory pause.

The main methods that are used to diagnose ventricular extrasystoles include ECG, as well as Holter ECG monitoring. In this case, the following are determined: an extraordinary premature occurrence of an altered ventricular QRS complex, the absence of a P wave before an extrasystole, expansion and deformation of the extrasystolic complex, a complete compensatory pause after a ventricular extrasystole.

When conducting an electrocardiogram, single ventricular extrasystoles are determined in 5% of clinically healthy young people, and during daily ECG monitoring - in about 50% of cases.

To clarify the diagnosis, echocardiography, rhythmocardiography, sphygmography, polycardiography, transesophageal electrocardiography, magnetic resonance imaging may be required. The relationship between physical activity and the occurrence of extrasystoles is determined using the treadmill test and bicycle ergometry.

From Methods laboratory diagnostics common blood and urine tests, biochemical blood tests, determination of the level of hormones in the blood are used.

Ventricular extrasystole (PV) refers to varieties. It manifests itself in the form of extraordinary and premature contractions of the heart ventricles. Patients feel dizzy general weakness, sometimes pain in the region of the heart and lack of oxygen. To detect a violation, you need to go through comprehensive examination. In most situations, treatment is carried out with the help of medications. In rare cases it may. Ventricular extrasystole in children is diagnosed only in 5% of cases, but as they grow older, the probability of a violation increases to 50%. Therefore, PVC is considered a pathology of people over 45 years old. The danger lies in the likelihood of sudden cardiac arrest. PVC is also called ventricular extrasystole and ventricular arrhythmia. ICD 10 ( international classification diseases) assigned the ICD code I49.3 to this disease.

The reasons

Understanding what it is and what consequences it can lead to, it is necessary to be able to recognize the symptoms of ventricular extrasystole and be aware of the potential causes of the disorder. Changes in the rhythm of the ventricles are not always perceived as a pathological disorder. Ventricular extrasystole is considered as a deviation safe for health and life. Exists certain norm per day, at which the PVC is classified as a non-hazardous change:

• from 700 to 950 additional impulses can be in people who do not suffer from disorders of the cardiovascular system, and this is the norm;
• 960 - 1200 pulses are considered normal if the patient was diagnosed with polymorphic ventricular extrasystole, and there is no threat to life or health;
• 1200 extrasystoles or more require the intervention of specialists, since this is already a serious deviation that can lead to tachycardia and other dangerous consequences.

About 75% of the total population is included in the first two groups. Is not rare disease, which cannot be perceived as a dangerous pathology. But with a parallel flow of extrasystole with others severe violations it is better to seek advice from a cardiologist, undergo a comprehensive examination and conduct treatment, if necessary. There are heart rhythm disturbances according to the type of ventricular extrasystole, depending on the causes. It can be functional, idiopathic ventricular extrasystole or cardiac.

The cardinal reasons include:

• chronic heart failure;
• arterial hypertension;
• myocarditis;
• pericarditis;
• hypertrophic cardiomyopathy;
• dilated cardiomyopathy, etc.

There are also functional reasons or a functional type of PVC that is not associated with diseases of the cardiovascular system. These factors include:

• and tobacco products;
• sleep disorders;
• regular intake of drugs of the anesthetic group;
• violations of micro-metabolic processes in the body;
• exceeding the established dosages of drugs;
• abuse of narcotic and psychotropic drugs;
• osteochondrosis;
• infectious lesions;
• severe stress, anxiety and emotional upheaval, etc.

There are many reasons for ventricular extrasystole, but not always the violation manifests itself against the background of obvious provoking factors. There are cases when specific causes have not been identified in ventricular extrasystole. The arrhythmia was provoked by unknown factors against the background of the patient's excellent health. Therefore, everyone, even a healthy person, should have an attending physician in the cardiology department, to whom he can periodically come for preventive diagnostics.

signs

Quite often, ventricular extrasystole is detected only on the ECG, and clear signs violations are absent or weakly manifested, because of which the patient simply does not pay attention to them. Less often, the symptoms become brighter. Then PVC can be detected on the basis of the following manifestations:

• there is a feeling of failure in the work of the heart muscle;
• the heart seems to freeze or push in an enhanced mode;
• a person quickly gets tired, becomes very irritable;
• occasional headaches and dizziness;
• there is a lack of oxygen, the patient seems to be suffocating;
• feel pain in the heart and great weakness the whole organism;
• in rare cases, with this violation, the patient may faint.

During examinations, doctors observe characteristic pulsations of the veins in the neck. Pulsation can be arrhythmic, with long pauses and extraordinary impulses. But you need to make sure that the diagnosis is correct, for which instrumental diagnostic methods are used.

ZhE gradation

Although adults are more likely to have ventricular arrhythmias, children should also be tested to prevent possible complications. For a child and an adult, the same gradation of ventricular extrasystole is used. In total, there are several stages of PVC, which determine whether it is necessary to carry out treatment to eliminate it. The first stage (or 0) indicates the absence of extrasystole. The condition is normal and does not pose a danger. Therefore, they are repelled from the first class.

1. The first class (1) speaks of arrhythmia in the amount of up to 30 extra impulses per hour. This is a common ventricular extrasystole. Refers to a normal state of health, does not pose a threat and does not need treatment.
2. Second class (2). This is a single ventricular extrasystole, manifested in the form of more than 30 extra impulses per hour. It is worth paying attention to it and adjusting your lifestyle a little. But it doesn't pose a serious threat.
3. Third class (3). Polymorphic extrasystoles, having different shapes with one ECG performed. If episodes of ventricular arrhythmia are multiple, special treatment will be required.
4. The fourth class (4a) refers to paired ventricular extrasystoles following each other.
5. The fourth class (4c) is called volley extrasystoles, manifested in the form of 3-5 extrasystoles in turn one after another.
6. Fifth grade (5). This is already ventricular tachycardia, requiring mandatory surgical intervention.

The last three classes of PVCs can lead to dangerous and serious consequences for human health, including fibrillation and tachycardia. The result of such complications is sudden cardiac arrest with all the ensuing consequences, including the death of a person. How dangerous PVC is depends on its type. To determine the nature of the lesion and the number of unnecessary contractions (impulses), it is required to conduct a comprehensive examination of the patient in cardiology department. It is dangerous to ignore the manifestations of frequent ventricular extrasystole, therefore, at the first signs or suspicions of abnormal heart function, seek help.

Treatment Methods

With ventricular extrasystole, treatment is selected individually. It is difficult to choose tactics and a scheme, since a number of factors influence this. The primary factor for the choice of treatment methods is the severity of PVC. Sometimes the patient may not receive any treatment at all. All recommendations come down to the normalization of a healthy lifestyle and the exclusion of potentially harmful provoking factors. Only in 25% of all cases of PVC there is a possibility of developing any complications that require a course of therapy. The bulk of cases of manifestation of ventricular arrhythmia falls under the conditions of the normal state, and therefore taking medication or carrying out other procedures can only harm. If the symptoms of rhythm disturbance occur periodically or are isolated, you should try to get rid of the provoking factors. The basis of therapy is to maintain optimal electrolyte balance and pressure. All patients should eat properly and saturate the body with potassium.

Treatment may be:

• medication;
• radio frequency;
• implantation.

The doctor determines how to treat the patient and what methods are best used for this. We will talk about each type of therapy separately.

Medical therapy

Doctors will first try to treat the disorder with medication. JE interacts well with many medicines. Therefore, the selected treatment regimen for the patient may include:

1. Sodium channel blockers. These are several different classes of drugs, including Quinidine, Mexiletin and Flecainide. They have their strengths and weak sides. A specific class and a representative of this segment is selected by the attending physician individually, taking into account the clinical picture of the patient. Recent studies have shown that taking these blockers is dangerous for people who have experienced ventricular extrasystole after a heart attack. This is due to an increase in deaths after the use of drugs;
2. Beta blockers. This category of drugs is relevant for patients in whom ventricular extrasystole was caused by organic heart disease.
3. Blockers calcium channel. They are prescribed in rare cases, since recent observations have shown the absence of a significant effect of these drugs on the condition of patients.

Specific drugs, the duration of the course and the number of applications are determined by the attending physician, based on the collected patient history and the results of a comprehensive examination.

This is the method surgical intervention, which is relevant in the absence of the effectiveness of medicines, individual features the patient's body or urgent need affect the current state. But RFA has a number of contraindications, which is why not every patient is allowed to undergo such an operation. This is a minimally invasive method based on the introduction of a special catheter with an electrode through the femoral artery, which destroys areas that lead to the formation of unnecessary impulses of the heart muscle. After surgery, patients recover quickly. Complications are rare, but their probability is always present.

Implantation

Implants can be installed to the patient in the most rare situations. This is relevant when detecting malignant extrasystole of the ventricles of the heart muscle, when there is a high probability of sudden death due to changes in the work of the heart. A special implant normalizes impulses and contractions. But contributes major changes into the habitual way of life. It is possible to give predictions of life with PVC only on the basis of the form of cardiac arrhythmia and the presence of organic pathologies of the heart. Functional extrasystole of the ventricles is safe for human life and health. But it is worth normalizing your lifestyle, giving up bad habits.

Adults and children are advised to periodically undergo examinations of the cardiovascular system. The ECG is a simple, fast, but informative diagnostic procedure. If you conduct an electrocardiogram once a year, you can regularly observe changes in the work of the heart muscle, note violations and respond to them in a timely manner. Preventive examinations are especially relevant for patients with a genetic predisposition to heart disease. Therefore, it is important for parents to check the health of their child, as well as to control the work of the heart muscle themselves. The earlier negative changes can be detected, the higher the probability of quickly eliminating them with minimal damage to health and family budget.

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