Violation of the heart rhythm ventricular extrasystole. When it is necessary to do the operation. Frequent ventricular extrasystoles treatment

Ventricular extrasystole(PV), also called premature ventricular contraction, is a common form of arrhythmia. Arrhythmia is a condition characterized by a violation of the rhythm of the heart. This pathology can occur in people with or without heart disease. In this article, you will learn about the causes and symptoms of PVCs, as well as treatments.

Steps

Part 1

Remember that sometimes PVCs do not need treatment. If you are a healthy person cardiovascular pathology(hypertension, coronary artery disease, heart failure, valvular disease, etc.) and diabetes, cases of PVC do not require treatment. Most athletes have PVCs without the need for treatment.

Detection and exclusion trigger factors ZhE. Physical activity, excessive nutrition, and other factors can trigger PVC. If you are experiencing PVC symptoms, then you need to identify the leading factor in order to eliminate or reduce its impact.

• To identify factors, it is necessary to record all cases of PVC within 24 hours. Draw a table with 24 columns for each hour of the day. Record your actions in each column, also note the occurrence of PVC symptoms.
• After a few days, you will be able to independently assess the causes of PVC. Try to eliminate or reduce the impact of the provoking factor.

1. Reduce your substance use. Caffeine (coffee and tea), alcohol, smoking, amphetamines, cocaine, etc. known as PVC triggers. These substances stimulate the sympathetic nervous system, which leads to hyperexcitability, increased heart rate.

   • Avoid these substances or reduce their amount to a minimum. It may be difficult to give up everything at once, so try to reduce their number by 5-10% every week.

2. Find out if medications you take on a regular basis cause PVCs. You may be taking medications that cause PVCs without even knowing it.

   • These drugs include anti-asthma drugs (salbutamol, theophylline), nasal decongestants (pseudoephedrine), thyroxine, and other sympathomimetics. These drugs increase the work of the heart and may cause PVCs.
   • Some medications and supplements may contain ingredients that increase heart rate.
   • Talk to your doctor about all prescription and over-the-counter medications you take. The doctor may adjust the dosage of the drug or prescribe another drug without effect on the heart.

3. Reduce anxiety and stress. Feelings of anxiety and stress can stimulate the release of sympathetic hormones and neurotransmitters that excite the heart. Anxiety is a common cause of palpitations.

   • Any negative emotions and feelings.
   • Try meditation, yoga, and other similar techniques to get rid of your anxiety. Seek the help of a professional therapist to choose the best method.

4. Eliminate the cause of the PVC. PVC may be the result of some disease, such as myocardial infarction, electrolyte imbalance, etc. In this case, it is necessary to treat the underlying disease and then the symptoms of PVC will pass. In some cases, these conditions can be treated at home, but hospitalization is most often necessary.

   • hypoxia can be cured by the administration of oxygen and drugs for the treatment of lung pathology.
   • Electrolyte imbalance usually corrected intravenously or orally. Correction of electrolyte imbalance is carried out slowly, under constant control because the rapid administration of electrolyte solutions can lead to cardiac arrest and death (especially if large amounts of potassium are administered).
   • Chemical poisoning corrected with an antidote. Medical supervision is required.
   • Heart attack is a condition that requires urgent medical care and hospitalization in the cardiology department. Treatment depends on the type, severity, and duration of the attack.

5. Take medication to prevent PVCs. Beta-blockers such as propranolol may be used to suppress PVCs. They are used to treat hypertension, anxiety, and other conditions. Beta-blockers are comparatively safer than other drugs for the treatment of PVCs and arrhythmias.

   • Propranolol tablets 10-40 mg 3-4 times a day are used to relieve PVCs. Start with low doses and gradually increase the dosage until a stable result.
   • Other drugs may be used in severe cases. Antiarrhythmic drugs are used, such as amiodarone, flecainamide, propafenone, etc. These drugs should not be used without the advice of a doctor, as misuse of the drug may aggravate the arrhythmia.

6. Undergo radiofrequency catheter ablation. This procedure can be used when medical therapy is ineffective. The site that induces extrasystoles is destroyed by radio frequency energy.

   Part 2

   PVC symptoms

   1. Keep in mind that PVC symptoms may sometimes be absent. Sometimes JE does not manifest itself. This is due to very short periods extrasystoles that a person does not feel. In such cases, the identification of PVCs may only be possible with the help of an ECG during a physical examination.

      Pay attention to the sensations in the region of the heart. After each contraction, the heart must stop and expand to fill with blood. If extrasystole occurs, then after it there is a long pause. During this period, the ventricles overflow.

      • After another signal, the overstretched ventricles eject all the blood. As a result, it is thrown large quantity blood and there is a contraction, jumping of the heart.

   2. Pay attention to skipping heart beats. This condition occurs after an episode of extrasystole, which is felt as contractions, jumps of the heart. After ventricular congestion and increased contractility, the heart recovers normal rhythm, which is felt as a pause in the work of the heart.

   3. Pay attention to heartbeats. There is a subjective sensation of palpitations when PVCs are repeated more often than 10-20 seconds. The frequent contraction of the heart causes a sensation of fluttering.

      • Normally, a person does not feel a heartbeat. Irregular and abnormal rhythm is felt by a person as a heartbeat.

   4. Syncope and fainting. Sometimes extrasystoles can be group. During an extrasystole, the heart ejects a very small amount of blood. With PVCs of 3 or more, groups of extrasystoles can lead to a critical decrease in cardiac output.

      • Short cardiac output leads to a decrease in blood pressure and a decrease in blood flow in all organs. If the blood supply to the brain is reduced for at least a few seconds, then a violation of consciousness (syncope or fainting) may occur.

   Part 3

   Causes of PVC

   1. Understand that PVC can come on without any reason. PVCs can occur for no specific reason. The pacemaker of the heart is the sinoatrial node, which is located in the right atrium. The signal travels along special pathways in the ventricles, causing a contraction.

      • However, sometimes myocardial cells initiate an impulse to contract without a signal from the sinoatrial node. Occasionally, spontaneous PVC-type contractions may occur in healthy individuals.

   2. A heart attack can be caused by a PVC. A heart attack is also known as a myocardial infarction. Due to impaired blood supply, damage to the heart muscle can occur. coronary arteries deliver blood to heart cells. If one or more of these are blocked by a thrombus or plaque, ischemic necrosis and death can occur.

      • A damaged heart muscle cannot contract correctly and synchronously. As a result, the contraction signal does not properly pass through the ventricles and causes premature contraction.
      • The occurrence of PVC is most likely within a few hours after heart attack. This condition should be treated with due care as it can lead to life-threatening illnesses such as arrhythmia.

   3. Cardiomyopathy can lead to PVC. Cardiomyopathy can be dilated or hypertrophic. Cardiomyopathy is the result of long-term an existing disease hearts.

      • Common causes are hypertension, myocardial infarction, heart valve disease, alcoholism, obesity, diabetes, thyroid gland, vitamin B1 deficiency, etc. These diseases lead to the expansion of the chambers of the heart, the muscle becomes thin or thick.
      • Normally, the architecture of the heart muscle is disordered. Fibrosis in various parts heart leads to change neural pathways. This contributes to the abnormal course of the pulse and PVC.

Ventricular extrasystole- this is a premature excitation of the heart, which occurs under the influence of impulses emanating from various parts of the conduction system of the ventricles. The source of ventricular extrasystole in most cases is the branching of the His bundle and Purkinje fibers.

Ventricular extrasystole is the most common violation heart rate. Its frequency depends on the method of diagnosis and the contingent of the examined. When registering an ECG in 12 leads at rest, ventricular extrasystoles are determined in approximately 5% of healthy individuals. young age, whereas with Holter ECG monitoring for 24 hours, their frequency is 50%. Although most of them are represented by single extrasystoles, complex forms can also be detected. The prevalence of ventricular extrasystoles increases significantly in the presence of organic heart diseases, especially those accompanied by damage to the ventricular myocardium, correlating with the severity of its dysfunction. Regardless of the presence or absence of pathology of cardio-vascular system the frequency of this rhythm disturbance increases with age. The relationship of the occurrence of ventricular extrasystoles with the time of day was also noted. So, in the morning they are observed more often, and at night, during sleep, less often. The results of repeated ECG Holter monitoring showed a significant variability in the number of ventricular extrasystoles per hour and per day, which makes it difficult to assess their prognostic value and treatment effectiveness.

Causes of ventricular extrasystoles. Ventricular extrasystole occurs both in the absence of organic heart disease, and in their presence. In the first case, it is often (but not necessarily!) Associated with stress, smoking, drinking coffee and alcohol, which cause an increase in the activity of the sympathetic-adrenal system. However, in a significant proportion of healthy individuals, extrasystoles occur for no apparent reason.

Although ventricular extrasystole can develop with any organic heart disease, its most common cause is coronary artery disease. With Holter ECG monitoring for 24 hours, it is detected in 90% of such patients. The occurrence of ventricular extrasystoles affects patients with both acute coronary syndromes and chronic ischemic heart disease especially after myocardial infarction. Acute cardiovascular diseases, which are the most common causes of ventricular extrasystole, should also include myocarditis and pericarditis, and chronic - various forms of cardiomyopathy and hypertensive heart, in which its occurrence is facilitated by the development of ventricular myocardial hypertrophy and congestive heart failure. Despite the absence of the latter, ventricular extrasystoles often occur with mitral valve prolapse. To their possible reasons also include such iatrogenic factors as an overdose of cardiac glycosides, the use of ß-agonists and, in some cases, membrane-stabilizing antiarrhythmic drugs, especially in the presence of organic heart disease.

Symptoms. Complaints are absent or consist of a feeling of "fading" or "shock" associated with increased post-extrasystolic contraction. At the same time, the presence of subjective sensations and their severity do not depend on the frequency and cause of extrasystoles. With frequent extrasystoles in patients with severe heart disease, weakness, dizziness, anginal pain and lack of air are occasionally noted.

An objective examination occasionally determines a pronounced presystolic pulsation of the jugular veins, which occurs when the next systole of the right atrium occurs with a closed tricuspid valve due to premature contraction of the ventricles. This pulsation is called Corrigan's venous waves.

The arterial pulse is arrhythmic, with a relatively long pause after an extraordinary pulse wave (the so-called complete compensatory pause, see below). With frequent and group extrasystoles, an impression of the presence of atrial fibrillation may be created. Some patients have a pulse deficit.

During auscultation of the heart, the sonority of the first tone may change due to asynchronous contraction of the ventricles and atria and fluctuations in the duration P-Q interval. Extraordinary contractions may also be accompanied by a splitting of the II tone.

Main electrocardiographic signs of ventricular extrasystoles are:

premature extraordinary appearance on the ECG of an altered ventricular QRS complex";

significant expansion and deformation of the extrasystolic QRS complex";

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 absence of a P wave before the ventricular extrasystole;

the presence in most cases after a ventricular extrasystole of a complete compensatory pause.

The course and prognosis of ventricular extrasystoles depend on its form, the presence or absence of organic heart disease and the severity of ventricular myocardial dysfunction. It has been proven that in persons without structural pathology of the cardiovascular system, ventricular extrasystoles, even frequent and complex ones, do not significantly affect the prognosis. At the same time, in the presence of organic heart disease, ventricular extrasystoles can significantly increase the risk of sudden cardiac death and overall mortality, initiating persistent ventricular tachycardia and ventricular fibrillation.

Treatment and secondary prevention with ventricular extrasystole, they pursue 2 goals - to eliminate the symptoms associated with it and improve the prognosis. This takes into account the class of extrasystole, the presence of organic heart disease and its nature and severity of myocardial dysfunction, which determine the degree of risk of potentially fatal ventricular arrhythmias and sudden death.

In persons without clinical signs of organic cardiac pathology, asymptomatic ventricular extrasystole, even high grades according to V. Lown, does not require special treatment. Patients need to be explained that the arrhythmia is benign in nature, recommend a diet enriched with potassium salts, and exclude such provoking factors as smoking, drinking strong coffee and alcohol, and with hypodynamia - an increase physical activity. With these non-drug measures, treatment is also started in symptomatic cases, switching to drug therapy only if they are ineffective.

First-line drugs in the treatment of such patients are sedatives(phytopreparations or small doses of tranquilizers, such as diazepam 2.5-5 mg 3 times a day) and ß-blockers. In most patients, they give a good symptomatic effect, not only due to a decrease in the number of extrasystoles, but also, regardless of it, as a result of a sedative effect and a decrease in the strength of post-extrasystolic contractions. Treatment with ß-blockers begins with small doses, for example, 10-20 mg of propranolol (obzidan, anaprilin) ​​3 times a day, which, if necessary, increase under the control of heart rate. In some patients, however, slowing the frequency sinus rhythm accompanied by an increase in the number of extrasystoles. With initial bradycardia associated with an increased tone of the parasympathetic part of the autonomic nervous system, characteristic of young people, the relief of extrasystole can be facilitated by an increase in the automatism of the sinus node with the help of drugs that have an anticholinergic effect, such as belladonna preparations (tablets of bellataminal, bellaida, etc.) and itropium .

In relatively rare cases ineffectiveness of sedative therapy and correction of the tone of the autonomic nervous system, with a pronounced disturbance in the well-being of patients, it is necessary to resort to tableted antiarrhythmic drugs IA (retard form of quinidine, novocainamide, disopyramide), IB (mexiletine) or 1C (flecainide, propafenone) classes. Due to the significantly higher frequency side effects compared with ß-blockers and a favorable prognosis in such patients, the appointment of membrane stabilizing agents should be avoided if possible.

ß-Adrenergic blockers and sedatives are the drugs of choice in the treatment of symptomatic ventricular extrasystoles in patients with mitral valve prolapse. As in the absence of organic heart disease, the use of class I antiarrhythmic drugs is justified only in cases of severe impairment of well-being.

Ventricular extrasystole- this is one of the types of arrhythmias, which are premature, out of turn, contractions of the ventricles. Ventricular extrasystole is characterized by a feeling of disturbances in the work of the heart in the form of failures, weakness, dizziness, pain of an anginal nature and lack of air. This type of arrhythmia is established after listening to the heart, electrocardiogram and Holter monitoring. And for the treatment of extraordinary contraction of the ventricles, sedative drugs, beta-blockers and antiarrhythmic drugs are used.

Ventricular extrasystoles account for almost 62% of all extrasystolic arrhythmias. This violation of the heart rhythm is a consequence of premature excitation of the heart muscle, which comes from the Purkinje fibers and the bundle of His.

Based on ECG results given form heart contraction, representing single extrasystoles, is determined in 5% of healthy young people, and during daily monitoring in almost half of those surveyed. In addition, this recently began to increase sharply with age.

Ventricular extrasystole causes

The etiological factors for the occurrence of this extraordinary contraction of the ventricles are both the absence of heart diseases of organic origin, and their presence. The first case is characterized stressful situations, smoking, drinking alcohol, coffee, tea, which increase the activity of adrenal and sympathetic system. But in most healthy people, extrasystoles appear for no particularly apparent reason.

However, despite the fact that the characteristic form of arrhythmic contractions occurs against the background of many cardiac lesions of an organic nature, one of the most important causes of ventricular extrasystole is still considered. When monitoring throughout the day, such arrhythmia is observed in 90% of patients.

The occurrence of ventricular contractions is influenced by the acute coronary syndromes, especially transferred . Among the common causes of ventricular extrasystole, one can distinguish both an enlarged heart, which in its development is facilitated by hypertrophy of the heart muscle, ventricles and heart failure. In addition, extrasystoles of this type of arrhythmia are often detected in the pathology of the mitral valve.

Also characteristic causes in the formation of an extraordinary contraction of the ventricles, iatrogenic factors play an important role, namely, an overdose when taking cardiac glycosides, beta-adrenergic stimulants, and sometimes membrane-stimulating antiarrhythmic drugs, especially if there are cardiac pathologies of organic origin.

Ventricular extrasystole symptoms

This form of extraordinary cardiac contraction of the ventricles can be asymptomatic or with sensations of a sinking heart or a shock as a result of an increased contraction of post-extrasystolic origin. At the same time, subjective sensations do not have a characteristic severity and are not dependent on heart rate and the cause of extrasystoles. With frequent ventricular extrasystole in patients with severe forms weakness sometimes appears in cardiac pathologies; pain, as in; may feel dizzy and not have enough air to breathe.

At the time of the examination, a pronounced presystolic pulsation of the veins in the neck is sometimes detected, which occurs during the next atrial systole on the right against the background of a closed tricuspid valve as a result of a characteristic premature contraction of the ventricles. This pulsation is called Corrigan's venous pulsation. At the same time, the pulse on the artery is practically not palpable, it has a rather long pause, which occurs after a complete pause of compensatory properties.

But the occurrence of atrial fibrillation is facilitated by frequent forms of extrasystole and group. In addition, in many patients it is difficult to determine the pulse. This is due to its deficiency. When listening to the heart, the first tone changes its sound due to the non-simultaneous contraction of the atria and ventricles, as well as fluctuations in the P-Q interval. In addition, these contractions out of turn are characterized by a splitting of the second tone.

The main ECG signs of ventricular extrasystole include the appearance of an extraordinary premature change on the electrocardiogram of the ventricular QRS complex. In addition, this complex is significantly enlarged and deformed; there is an inconsistency of the extrasystole in the location of the T-wave and the RS-T segment in relation to the main QRS complex; there is no P-wave before ventricular extrasystole, and there is also, after a characteristic extrasystole of the ventricles, an absolute pause of a compensatory nature.

Ventricular extrasystole is sometimes characterized by a different clinical course and the same prognosis, which will depend on the existing cardiac pathologies of an organic nature, the form of manifestation and the pronounced degree of violations of the ventricular heart muscle.

However, there is evidence that extraordinary cardiac contractions in the ventricles, even the most frequent and complex ones, with the absence of structural C.C.S. pathologies in patients, do not particularly affect the prognosis. given state. But with existing cardiac lesions of organic origin, these forms of arrhythmic contractions significantly increase the percentage of sudden death as a result of heart disease and mortality. general, cause a persistent manifestation of ventricular tachycardia and fibrillation.

Gradation of ventricular extrasystoles

A healthy heart works automatically, that is, at a certain moment, an excitatory impulse appears in the cardiomyocytes, which is subsequently transmitted to the myocardial heart muscle. But when various changes of a small-focal or large-focal nature occur in it, then reintroduction impulse and therefore the myocardium is subjected to repeated excitation.

In the heart muscle, the left ventricle is considered the most vulnerable part, since dystrophic changes and sclerotic lesions often appear here after IHD or a heart attack. That's why extraordinary extrasystoles much more often develop in the left ventricle, while the right ventricle is less susceptible to such changes. From this we can conclude that ventricular extrasystole is an extraordinary contraction of the heart, due to the ectopic impulse located in the ventricle. Therefore, the launch of re-excitation, located in the septum between the ventricles or on its wall, occurs with the help of the re-entry focus. And this means that a focus of excitation can form in any part of the left ventricle and cause ventricular extrasystole.

For prognostic evaluation of such ventricular extrasystoles, the Lown and Wolf classification is used, according to which five classes of gradations of this arrhythmia are distinguished. The first class includes a single arising ventricular extrasystole with a heart rate of less than thirty per hour. Therefore, this type of arrhythmia is considered harmless and practically the norm if a person does not have a heart pathology.

The second class includes single extrasystoles, which are also formed in the ventricles with a frequency exceeding thirty per hour. This arrhythmia is somewhat more significant, but very rarely manifests itself in any consequences.

The third class is characterized by polymorphic forms of extraordinary cardiac contraction of the ventricles, which differ in different leads of the electrocardiogram. In the case of recurring episodes of a characteristic form of arrhythmia, specialized treatment is prescribed.

In the fourth grade (A), paired heart contractions are observed, following sequentially, that is, in a row. In the fourth grade (B) - group arrhythmias, which are characterized by the repetition of three or five extrasystoles in a row in the ventricles.

And for the fifth grade are peculiar early forms arrhythmias or "R to T". In addition, from the third to the fifth grade, ventricular extrasystoles are considered a high degree of gradation, which can lead to ventricular tachycardia and ventricular fibrillation, and this can cause cardiac arrest and death.

But the significance of an extraordinary cardiac contraction of the ventricles of low gradation is determined by the presence of some symptoms that occur with these extrasystoles. Sometimes, with every second stroke, this form of arrhythmia develops, and the patient does not feel it. But when the extrasystole appears only two or three times an hour, the patient may feel very bad, up to loss of consciousness. Therefore, how a certain form of extraordinary cardiac contraction of the ventricles is life-threatening is decided strictly individually for each patient.

Ventricular extrasystole ECG

This type of arrhythmia occurs in the presence of heart diseases of an organic nature and without them. According to the daily monitoring by Holter, ventricular extrasystole is observed in 60% of the subjects. And in the absence of cardiac pathology, it does not characteristic influence for arrhythmia prognosis.

After myocardial infarction, ventricular extrasystole in its distribution is 80%. At the same time, frequent and paired extrasystoles are characterized by an increased lethal outcome. However, these forms of this arrhythmia are not significant risk factors, in contrast to low LV ejection fraction.

On the electrocardiogram, ventricular extrasystole is an extraordinary wide deformed QRS complexes that do not have previous P waves. And the interval between linked complexes can be permanent. In addition, with its varying heart rate with a common divisor, they talk about ventricular form parasystole. With this arrhythmia, extrasystoles come from the focus of excitation, which does not receive impulses from the sinus node.

Ventricular extrasystole can be manifested by single heartbeats, as well as repeated sequentially (bigeminy), every second QRS complex in the form of trigeminy or the third in the form of quadrigeminy.

Two consecutive arrhythmias are called paired, and more than three at a frequency of 100 per minute - ventricular tachycardia or an unstable form. In addition, ventricular extrasystole may have the same or different shape, that is, it is characterized by monomorphic or polymorphic extrasystole.

Basically, extraordinary impulses are not conducted into the atria and do not discharge the sinus node, so the resulting impulses are unable to excite the ventricles as a result of their refractoriness. This is what causes the occurrence of a complete compensatory pause against the background of ventricular extrasystole, that is, an interval is formed between extrasystolic R waves, before and after, equal to the RR interval. As a result of an extraordinary impulse to the atria, in the form of retrograde P waves, the sinus node may be discharged and the compensatory pause will become incomplete.

At some points, the impulse to the atria becomes blocked in the AV node, and this lengthens the PQ interval or contributes to the prolapse of the next QRS complex. This lengthening of the post-extrasystolic PQ interval is explained by the manifestation of a latent form retrograde conduction into the atrioventricular node.

In those cases when a compensatory pause is not formed after ventricular extrasystole, an interpolated or insertion form of arrhythmia appears.

Ventricular extrasystole treatment

The main goals of the treatment of ventricular extrasystoles are to reduce the discomfort caused by heart contractions and prevent paroxysms of a stable form of VT or.

In the event that it is necessary to reduce only unpleasant sensations, patients are subject to empirical treatment, which focuses on the well-being of patients. As a rule, opinions on the appointment of treatment for ventricular extrasystole that occurs without symptoms are somewhat contradictory. The use of antiarrhythmic drugs for the treatment of complex forms of arrhythmias without a characteristic symptomatic picture is possible only in the case of potential danger given condition and likely to benefit from these medicines. In addition, almost forty percent of patients, as a result of side effects of antiarrhythmic drugs, have to abandon these drugs. One of the dangers of taking antiarrhythmics is their arrhythmogenic property, observed in 10% of patients.

Basically, ventricular extrasystole in the absence of cardiac pathology of organic origin does not increase the risk of sudden death. Although with reduced LV contractility, the likelihood of developing a stable ventricular extrasystole slightly increases, and the prediction of this arrhythmia in relation to sudden onset death is insignificant.

Patients who had a myocardial infarction and were treated with encainide or flecainide had successful elimination of ventricular extrasystoles, but were accompanied by an increased mortality of almost four times in contrast to placebo. Therefore, given these data, empiric treatment antiarrhythmic drugs are not recommended.

But the indications for hospitalization are newly discovered ventricular extrasystoles and an unfavorable, according to forecasts, form of arrhythmia.

For the appointment of specialized treatment, it is necessary to take into account the gradation class of the extraordinary cardiac contraction of the ventricles, the existing cardiac pathologies, the nature of the dysfunction of the heart muscle and the severity of this disorder, which become potentially fatal for ventricular extrasystole and death.

Patients without symptomatic signs of cardiac anomaly, even with high gradations according to V. Lown, are not prescribed a specific treatment. Therefore, it is necessary to be able to explain to the patient that arrhythmia can be benign, in which a diet enriched with potassium is recommended with the exception of nicotine, alcohol, coffee and strong teas, and in cases of hypodynamia it is necessary to increase physical activity. It is from such events that they begin to treat the asymptomatic form of ventricular extrasystole. And only when they are ineffective, proceed to the appointment of medications.

For the treatment of such patients, first-line drugs include sedatives (eg, diazepam or herbal remedies) and beta-blockers. For a significant number of patients, they provide positive effect due to reduced heart rate under the influence of sedatives and reduced strength of post-extrasystolic contraction.

As a rule, the appointment of beta-blockers begins with Propranol (Anaprilin, Obzidan) in small doses, and if necessary, they are increased, while controlling the heart rate. In a certain category of patients with ventricular extrasystole, at the moment when the rhythm frequency decreases, the number of extrasystoles increases. But if there is in the outcome, as a consequence increased tone parasympathetic division of the ANS, especially in young people, belladonna and Itropium preparations are used to stop ventricular extrasystoles.

And in very rare cases, with ineffective treatment with sedatives, as well as to correct the tone of the ANS and in case of impaired well-being, patients resort to the appointment of Disopyramide, Novocainamide, Quinidine, Mexiletine, Propavenone and Flecainide. In addition, these membrane-stabilizing agents, unlike beta-blockers, have a significant side effects, so it is advisable to avoid them in your appointments, if possible. Also sedatives and adrenoblockers are well used to treat this form of arrhythmia with characteristic symptoms on the background . And the use of first-class antiarrhythmic drugs in this case also acceptable only in case of severely disturbed well-being.

With frequent ventricular extrasystole of a monotopic form, which is resistant to drug treatment, or if it is impossible to take antiarrhythmic drugs in combination with poor prognosis or drug intolerance, intracardiac EPS and RFA of the heart are prescribed.

To date, the most common heart disease is ventricular extrasystole. It is accompanied by a violation of the rhythm and contractions of the ventricles of the heart.

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

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

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

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

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

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

Any heart disease (myocarditis, coronary artery disease, heart defects, cardiomyopathy, etc.) can cause extrasystole. In some cases, this violation of the heart rhythm appears with extracardiac diseases: systemic allergic reactions; hyperthyroidism; intoxication in infectious diseases, etc.

In addition, extrasystole can sometimes occur due to strong emotional stress and be a manifestation of viscero-visceral reflexes in diaphragmatic hernia, stomach diseases and cholecystitis. Often determine exact reason this pathology fails.

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

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

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

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

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

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

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

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

Depending on the place of occurrence, there are:

1. Left ventricular.
2. Right ventricular.

Division by the number of pathological foci of excitation:

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

Rhythm classification:

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

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

According to the results of the interpretation of Holter monitoring, several classes of extrasystoles are distinguished:

• 0 class - ES are absent;
• class 1 - single rare monotopic ES, not exceeding 30 per hour;
• class 2 - similar to class 1, but with a frequency of more than 30 per hour;
• class 3 - single polytopic ES;
• class 4A - polytopic paired ES;
• class 4B - any group ES with periods of ventricular tachycardia;
• class 5 - the appearance of early extrasystoles that occur at the moment of relaxation muscle tissue hearts. Such ES are extremely dangerous, because. may be a precursor to cardiac arrest.

This Wolf-Laun classification was developed for a more convenient assessment of the degree of risk and prognosis of the disease. 0 - 2 class practically does not pose a threat to the patient.

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

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 most early start treatment.

There are several types of classifications:

1. by ryan

   You should also be aware of the classification methods for 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.

• the 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. Source » gidmed.com»

Causes of the disease

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

1. Cardiac (cardiac) causes:

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

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

• alcohol;
• smoking.

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.

The reasons causing the development of ventricular extrasystole include:

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

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

Single ventricular premature contractions are recorded in half of healthy young people during monitoring for 24 hours (ECG Holter monitoring). They don't make you feel good.

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

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

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

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

Ventricular extrasystoles against the background of organic heart diseases, as a rule, are multiple, but for the patient they are asymptomatic. They develop with physical exertion and pass in the supine position. Usually this type of arrhythmia develops against the background of tachycardia. Source "zdorovko.info"

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

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

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

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

Depending on the number of excitation sources, there are:

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

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

Complaints are examined first. If these are similar to those described above, one should suspect or determine the presence of an organic pathology affecting the heart. It turns out the dependence of symptoms on physical activity and other provoking factors.

When listening (auscultation) of the work of the heart, tones can be weakened, deaf or pathological. This occurs in patients with hypertrophic cardiopathology or with heart defects.

The pulse is non-rhythmic, with different amplitudes. This is due to the occurrence of a compensatory pause after extrasystole. Blood pressure can be anything. With group and / or frequent ventricular ES, its decrease is possible.

To rule out pathology endocrine system tests for hormones are prescribed, biochemical parameters of blood are studied.

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

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

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

Sometimes, to provoke ventricular extrasystole and study the characteristics of the work of the heart muscle at this moment, stress ECG tests are performed. The occurrence of ES indicates the appearance of arrhythmia due to coronary pathology. Due to the fact that this study, if performed incorrectly, can be complicated by ventricular fibrillation and death, it is carried out under the supervision of a physician. Testing room in without fail must be equipped with an emergency resuscitation kit.

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

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

The diagnosis can be established on the basis of:

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

  At the same time, a diary is kept in which all the actions of the patient are recorded (rising, eating, physical activity, emotional anxiety, deterioration in well-being, going to bed, waking up at night).

  The ECG and diary data are verified, thus, non-permanent cardiac arrhythmias (associated with physical activity, food intake, stress, or nocturnal ventricular extrasystoles) are detected;

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

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

• echocardiography data - EchoCG (ultrasound examination of the heart), which allow to identify cardiac causes of ventricular extrasystole (heart disease leading to heart rhythm disturbance);
• results of stress tests - ECG recordings during and after physical activity (squats, walking on a treadmill or exercise on a stationary bike), which allow you to identify arrhythmia that occurs during exercise;
• magnetic resonance imaging (MRI) data, which is performed when echocardiography is not informative, as well as to identify diseases of other organs that can cause arrhythmias (heart rhythm disturbances).

It is also possible to consult a therapist. Source » lookmedbook.ru»

Basic principles of treatment

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

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

Currently, there are no data on the beneficial effects of antiarrhythmic drugs (with the exception of beta-blockers) on distant forecast in patients with PVC, in connection with which the main indication for antiarrhythmic therapy is the presence of an established causal relationship between extrasystole and symptoms, with their subjective intolerance.

The most optimal means for the treatment of extrasystoles are beta-blockers. The appointment of other antiarrhythmic drugs, and even more so their combinations, in most cases is unreasonable, especially in patients with asymptomatic extrasystoles.

If antiarrhythmic therapy is ineffective or the patient is unwilling to receive antiarrhythmic drugs, radiofrequency catheter ablation of the arrhythmogenic focus of ventricular extrasystole is possible. This procedure is highly effective (80-90% effective) and safe in most patients.

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

To get good therapeutic effect, it is necessary to adhere healthy regimen and nutrition.
Requirements that a patient suffering from cardiac pathology must comply with:

• give up nicotine alcoholic beverages, strong tea and coffee;
• eat food with high concentration potassium - potatoes, bananas, carrots, prunes, raisins, peanuts, walnuts, Rye bread, oat groats;
• in many cases, the doctor prescribes the drug "Panangin", which includes "heart" microelements;
• give up physical training and hard work;
• do not adhere to during treatment strict diets for weight loss;
• if the patient is facing stress or has restless and interrupted sleep, then light sedative fees(motherwort, lemon balm, peony tincture), as well as sedatives (valerian extract, Relanium).

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

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

• sodium channel blockers - Novocainamide (usually used for first aid), Giluritmal, Lidocaine;
• beta-blockers - Cordinorm, Karvedilol, Anaprilin, Atenolol;
• drugs - blockers potassium channels- "Amiodarone", "Sotalol";
• blockers calcium channels- "Amlodipine", "Verapamil", "Cinnarizine";
• if the patient's extrasystole is accompanied by high blood pressure, then antihypertensive drugs- "Enaprilin", "Captopril", "Ramipril";
• for the prevention of blood clots - "Aspirin", "Clopidogrel".

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

The operation is prescribed only in cases of ineffectiveness of drug therapy. Often this type of treatment is recommended for patients who have organic ventricular extrasystoles.

Types of cardiac surgery:

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

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

Treatment goals:

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

Indications for hospitalization:

• First identified PVC.
• Prognostically unfavorable PVC.

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

Benign ventricular extrasystole:

• poor subjective tolerance;
• frequent PVC (including idiopathic);
• Potentially malignant PVC without severe LVH (LV wall thickness less than 14 mm) of non-ischemic etiology.

Class I antiarrhythmic drugs (allapinin, propafenone, etacizin, moracizin) can be prescribed.

Phenytoin is prescribed for PVC with digoxin intoxication. Drugs are prescribed only during the period of subjective sensation of extrasystoles.

Perhaps the appointment of sedative drugs and psychotropic drugs (phenazepam, diazepam, clonazepam).

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

Contraindications to class I antiarrhythmic drugs:

• postinfarction cardiosclerosis;
• LV aneurysm;
• LV myocardial hypertrophy (wall thickness >1.4 cm);
• LV dysfunction;

In patients with reduced LV ejection fraction, the use of class I antiarrhythmic drugs, aimed only at reducing the number of PVCs, worsens the prognosis due to an increased risk of SCD.

While taking class IC antiarrhythmic drugs (encainide, flecainide, moricizin) to suppress PVCs in patients with MI, mortality significantly increased (by 2.5 times) due to the proarrhythmic effect.

The risk of proarrhythmic action also increases with severe LV myocardial hypertrophy, active myocarditis.
All class IA and C antiarrhythmic drugs should be used with caution in cases of impaired conduction in the bundle branch system and distal 1st degree AV block; in addition, they are contraindicated in prolongation of the QTc interval over 440 ms of any etiology.

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

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

β-blockers are used for primary and secondary prevention VSS, they are shown to all patients with coronary artery disease and PVC (in the absence of contraindications). Malignant and potentially malignant ventricular extrasystoles.

Amiodarone is the drug of choice.

Sotalol is prescribed when amiodarone is contraindicated or ineffective.

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

It used to be that the more common form of extrasystole in children was ventricular. But now all types of extrasystoles occur with almost the same frequency.

This is related to the fact that children's body grows rapidly, and the heart, unable to cope with such a load, "turns on" compensatory functions due to all the same extraordinary contractions. Usually, as soon as the growth of the child slows down, the disease disappears by itself.

But extrasystole cannot be ignored: it can be a sign of a serious disease of the heart, lungs or thyroid gland. Children usually make the same complaints as adults, that is, they complain of "interruptions" in the work of the heart, dizziness, weakness. Therefore, upon occurrence similar symptoms The child must be carefully examined.

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

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

Alternative methods of treatment of extrasystole

If extrasystole is not life-threatening and is not accompanied by hemodynamic disorders, you can try to defeat the disease yourself.

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

Also, for the treatment of extrasystole, you can use an infusion of medicinal herbs. It has cardiotonic, antiarrhythmic, sedative and mild sedative actions. It should be taken one tablespoon 3-4 times a day. To do this, you need hawthorn flowers, lemon balm, motherwort, common heather and hop cones.

They must be mixed in the following proportions:

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

Important! Before you start treatment with folk remedies, you need to consult with your doctor, because many herbs can cause allergic reactions. Source: sosudinfo.ru

With physiological extrasystole, which proceeds benignly, without hemodynamic disturbances, complications rarely occur. But if it proceeds malignantly, then complications are quite common. This is what is dangerous extrasystole.

Most frequent complications with extrasystole - ventricular or atrial fibrillation, paroxysmal tachycardia. These complications can threaten the life of the patient and require urgent, emergency care.

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

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

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

In other cases, the prognosis is more often favorable. Subject to all medical recommendations even in the presence of comorbidities, mortality from this disease. Source "webmedinfo.ru"
The prognosis of PVCs depends entirely on the severity of the impulse disturbance and the degree of ventricular dysfunction.

With pronounced pathological changes in the myocardium, extrasystoles can cause atrial and ventricular fibrillation, persistent tachycardia, which in the future is fraught with the development of a fatal outcome.

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

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

In order to prevent complications, it is important to contact a specialist (cardiologist) in time. Properly prescribed treatment and the implementation of all recommendations are the key to a quick recovery. Source "zdorovko.info"

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

Identification of the disease can occur even with a planned preventive examination, for this reason, a health check in medical institution is a must for everyone. Source"gidmed.com"

Prevention of extrasystole, like any other heart rhythm disorder, consists in the prevention and treatment of the pathology of the cardiovascular system - arterial hypertension, coronary heart disease, chronic heart failure, etc.

Prevention measures:

1. Stress avoidance

   If the extrasystole was caused emotional tension or the work of the patient implies constant stress. You should have a series of sessions with a psychologist. With the help of a specialist, you can learn various techniques self-control and self-training. To provide sedative effect the doctor may prescribe appropriate drugs (motherwort tincture, corvalol, etc.)

2. Taking vitamins

   One of the traditional preventive measures with extrasystole is the intake of vitamins and minerals containing potassium. Recovery normal level potassium in the body, the attending physician can also prescribe not only the intake of potassium-containing drugs, but also the observance of a certain diet. Potassium is rich in apples, bananas, zucchini, dried apricots, pumpkin, etc.

3. Dieting

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

4. Treatment of current diseases

   Can lead to cardiac arrhythmias a large number of diseases. Among them are pathologies gastrointestinal tract and spine. Timely diagnosis and competent treatment of osteochondrosis can prevent the appearance of extrasystole.

   Physicians often recommend to their patients morning exercises, breathing exercises and massages. In some cases, when diagnosing arrhythmias, antiarrhythmic drugs (for example, Kordaron, Propafenone, etc.) are indicated under medical supervision. Source "propanorm.ru"

To prevent recurrence, it is necessary to select a quality drug therapy and take it daily. It is important to modify risk factors, stop smoking and drugs, limit the intake of alcoholic beverages, carefully use medications, not exceeding the allowed dosages.

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

Extrasystoles (extrasystoles): causes, signs and symptoms, therapy, prognosis

Today great amount people suffering from diseases of the heart and cardiovascular system. And not last place in this list is extrasystole. Extrasystole is a type in which extraordinary contractions occur either of the whole heart or a certain part of it. People suffering similar ailment, usually complain of a “hit” from the inside to the chest, a short-term fading of the heart (usually for a few seconds), and then it starts working again as usual.

The most common heart rhythm disorder is ventricular extrasystole. Patients suffering from this disease need adequate antiarrhythmic therapy and should be under the constant supervision of an arrhythmologist.

Symptoms

Symptoms of extrasystole, regardless of the causes of the disease, are not always pronounced. Most often, patients complain about:

• Malfunctions in the work of the heart (there may be a feeling that the heart seems to be turning over in the chest);
• Weakness, discomfort;
• increased sweating;
• "Tides" of heat;
• lack of air;
• Irritability, feeling of fear and anxiety;
• Dizziness. Frequent extrasystoles may be accompanied by dizziness. This occurs due to a decrease in the volume of blood ejected by the heart muscle and, as a result, oxygen starvation in brain cells.

Extrasystole may be a sign of other diseases. For example, extrasystole is caused by a violation of the autonomic regulation of the heart muscle, increased activity parasympathetic nervous system, and therefore can occur both during physical exertion and in a calm state. It is accompanied precisely by symptoms of a disorder of the nervous system, that is, anxiety, fear, irritability.

The extrasystole that occurs with is due to the fact that, with a disease, compression of nerve endings and blood vessels occurs between the vertebral discs.

In pregnant women, the appearance of extrasystoles is also often recorded. Usually, extrasystoles during pregnancy occur with overwork or, as well as if the woman had problems with the thyroid gland, cardiovascular and broncho-pulmonary systems. If the pregnant woman feels well and does not show any complaints, then in this case no treatment is required.

Extrasystole after eating is also not uncommon. It is functional and usually does not require treatment. Such extrasystole is associated with the parasympathetic nervous system and occurs if a person, after eating food, takes a horizontal position. After eating, the heart rate decreases, and the heart begins to turn on its compensatory capabilities. This happens just due to unnecessary, extraordinary heartbeats.

Organic and functional extrasystoles

Extrasystoles are divided into organic and functional. With organic extrasystole, the patient, being in a supine position, feels better than in a standing position. With functional extrasystole, the opposite is true. The causes of extrasystole are different and very diverse.

Causes of functional extrasystoles:

1. stressful situations;
2. Excessive consumption of caffeine and alcoholic beverages;
3. Overwork;
4. Smoking;
5. menstruation (in women);
6. Infectious diseases accompanied by high fever;
7. VSD (vegetative-vascular dystonia).

Causes of organic extrasystoles:

1. (IHD is the most common disease leading to heart rhythm failures);
2. Chronic cardiovascular insufficiency;
3. infectious diseases of the heart;
4. Some species (may be acquired and congenital);
5. Thyroid disorders (such as thyrotoxicosis).

Supraventricular extrasystole

Supraventricular extrasystole is a type of arrhythmia in which a violation of the heart rhythm occurs not in the conduction heart system, but in the atria or in the atrioventricular septum. As a result of such a violation, additional heart contractions appear (they are caused by extraordinary, incomplete contractions). This type of arrhythmia is also known as supraventricular extrasystole.

Symptoms of supraventricular extrasystole: shortness of breath, feeling of lack of air, heart failure, dizziness.

Classification of supraventricular extrasystoles

By localization:

• Atrial (the focus is localized in the atrial region);
• Atrioventricular (the location of the focus is in the septum that separates the ventricles from the atria);

According to the number of foci:

• One focus (monotopic extrasystole);
• Two or more foci (polytopic extrasystole);

By time of occurrence:

• Early (formed during atrial contraction);
• Interpolated (localization point - on the border between ventricular and atrial contractions);
• Late (may occur with contraction of the ventricles or with complete relaxation of the heart muscle - during diastole).

By frequency (per minute):

• Single (five or less extrasystoles);
• Multiple (more than five);
• Group (several in a row);
• Paired - (two at a time).

Ventricular extrasystole

The most common type of arrhythmia is ventricular extrasystole. In this case, a violation of the heart rhythm is formed in the conduction system of the ventricles. Allocate right ventricular extrasystole and left ventricular.

There are many reasons for the occurrence of ventricular arrhythmias. These include diseases of the heart and cardiovascular system, post-infarction, ( chronic type), IBS, . Ventricular extrasystole can also occur with osteochondrosis of the spine (most often cervical) and with vegetative-vascular dystonia.

Ventricular arrhythmia has its own classification. It is customary to distinguish 5 classes of extrasystoles (they are placed only after a 24-hour observation, according to the ECG):

• Class I - extrasystoles are not registered;
• Class II - up to 30 monotopic extrasystoles were recorded per hour;
• Class III - 30 or more monotopic extrasystoles were detected per hour, regardless of the time of day;
• Class IV - not only monotopic extrasystoles are recorded, but also polytopic ones;
• IV "a" class - monotopic, but already paired extrasystoles are registered on the film;
• IV "b" class - there are polytopic paired extrasystoles;
• Class V - group polytopic ventricular extrasystoles are recorded on the film. Within 30 seconds there can be up to five in a row.

Class I ventricular arrhythmias are classified as physiological. They are not dangerous to the life and health of the patient. But extrasystoles from class II to class V are accompanied by persistent hemodynamic disorders and can lead to and even death of the patient.

Varieties of ventricular extrasystoles

1. A single ventricular extrasystole (or, as it is also called, rare) - within a minute there are 5 or less extrasystoles. May be asymptomatic;
2. Average extrasystole - up to 15 per minute;
3. Frequent ventricular extrasystole - more than 15 extrasystoles within a minute.

The more extrasystoles occur in one minute, the stronger the pulse becomes, the patient begins to feel worse. And this means that if treatment is not required with single extrasystoles, then with frequent ones, the patient's condition worsens significantly and he simply needs treatment.

The following subspecies of arrhythmia are also distinguished:

• Ventricular arrhythmias occurring benignly. There are no signs of damage to the heart muscle, and there is practically no risk of sudden;
• Potentially malignant extrasystole. In this case, there are already any organic lesions of the heart and hemodynamic disorders. The risk is rising sudden stop hearts.
• Arrhythmia of malignant type. In view of the serious organic lesions cardiac tissue and persistent hemodynamic disturbances, there are numerous extrasystoles. High risk of mortality.

Symptoms

Right ventricular extrasystole in its own way clinical signs resembles and occurs in the right ventricle, and the left ventricular - respectively, vice versa. Symptoms of ventricular extrasystole are practically no different from atrial extrasystole, unless the cause is VVD (weakness, irritability may occur, the patient notes fatigue).

Diagnostics

most popular and accessible way diagnosis is an ECG. Methods such as bicycle ergometry and the trimedyl test are also widely used. With their help, you can determine whether extrasystole is associated with physical activity.

What does extrasystole look like on an ECG?

If the patient has complaints related to the work of the heart, it must be sent to the ECG. An electrocardiogram will help identify all types of extrasystoles. The film will reflect premature extraordinary contractions of the myocardium with alternating normal, correct contractions. If there are several such extraordinary contractions, this will indicate double or even group extrasystoles. And if the extrasystoles are early, they can be layered on the top of the tooth of the previous complex, its deformation and expansion are possible.

The most common is ventricular extrasystole on the ECG

Holter monitoring

Extrasystole can not always be detected on the ECG. This is due to the fact that this study is carried out quickly enough (about 5 minutes), and single extrasystoles may simply not get on the film. In this case, other types of diagnostics are used. One of the methods is It is carried out during the day, in the patient's usual motor activity, after which the doctor determines whether any heart rhythm disturbances have occurred during this time and how dangerous they are for the patient's life.

Video: lesson on arrhythmias and extrasystoles

Treatment

Before starting treatment, you must always consult with your doctor. In no case should you self-medicate, since arrhythmia - serious illness, which may lead to various complications. The doctor will conduct the necessary examination, measure arterial pressure, prescribe additional methods of examination and, if necessary, prescribe appropriate medications. Remember: only a specialist should prescribe treatment for extrasystole of the heart!

With inefficiency conservative therapy, Maybe surgical intervention- installation of an artificial pacemaker. It will prevent the occurrence of arrhythmia and significantly improve the quality of life of the patient. In the absence of positive dynamics after antiarrhythmic therapy, patients may be prescribed.

Video: therapy of tachyarrhythmias and supraventricular extrasystoles

Alternative methods of treatment of extrasystole

If extrasystole is not life-threatening and is not accompanied by hemodynamic disorders, you can try to defeat the disease yourself. For example, when taking diuretics, potassium and magnesium are excreted from the patient's body. In this case, it is recommended to eat foods containing these minerals (but only in the absence of kidney disease) - dried apricots, raisins, potatoes, bananas, pumpkin, chocolate.

Also, for the treatment of extrasystole, you can use an infusion of medicinal herbs. It has cardiotonic, antiarrhythmic, sedative and mild sedative effects. It should be taken one tablespoon 3-4 times a day. To do this, you need hawthorn flowers, lemon balm, motherwort, common heather and hop cones. They must be mixed in the following proportions:

1. 5 parts of lemon balm and motherwort;
2. 4 parts heather;
3. 3 parts hawthorn;
4. 2 parts hops.

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

Extrasystole in children

It used to be that the more common form of extrasystole in children was ventricular. But now all types of extrasystoles occur with almost the same frequency. This is due to the fact that the child's body grows rapidly, and the heart, unable to cope with such a load, "turns on" compensatory functions due to all the same extraordinary contractions. Usually, as soon as the growth of the child slows down, the disease disappears by itself.

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

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

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

Complications

With physiological extrasystole, which proceeds benignly, without hemodynamic disturbances, complications rarely occur. But if it proceeds malignantly, then complications are quite common. This is what is dangerous extrasystole.

The most common complications with extrasystoles are ventricular or atrial fibrillation,. These complications can threaten the life of the patient and require urgent, emergency care.

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

Extrasystole can be accompanied not only by tachycardia, but also by bradycardia. The heart rate in this case does not increase, but, on the contrary, decreases (there can be up to 30 beats per minute or less). This is no less dangerous for the life of the patient, since bradycardia is disturbed and the risk of heart block is high.

Finally

If symptoms of extrasystole are detected, you should immediately consult a doctor, and it is better to immediately consult a cardiologist. Do not leave the disease unattended, because, not dangerous at first glance, it can lead to very sad consequences.. And in no case do not self-medicate without consulting a specialist - this will not lead to anything good.

Take care of your health and take care of yourself and your loved ones!