What does single ventricular extrasystole mean. Ventricular extrasystole - how dangerous

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

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

Possible causes of ventricular extrasystole include iatrogenic factors: an overdose of cardiac glycosides, taking ß-agonists, antiarrhythmic drugs, antidepressants, diuretics, etc.

Classification of ventricular extrasystoles

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

Diagnosis of ventricular extrasystole

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

Treatment of ventricular extrasystole

Persons with asymptomatic ventricular extrasystoles without signs of organic heart disease are not shown special treatment. Patients are advised to follow a diet enriched with potassium salts, exclude provoking factors (smoking, drinking alcohol and strong coffee), and increase physical activity during physical inactivity.

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

With severe disturbances in well-being and in cases of ineffectiveness of therapy with ß-blockers and sedatives, it is possible to use antiarrhythmic drugs (procainamide mexiletine, flecainide, amiodarone, sotalol). The selection of antiarrhythmic drugs is carried out by a cardiologist under the control of ECG and Holter monitoring.

With frequent ventricular extrasystoles with an established arrhythmogenic focus and no effect of antiarrhythmic therapy, radiofrequency catheter ablation is indicated.

Forecast of ventricular extrasystole

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

In the group of arrhythmias of the extrasystolic type, ventricular extrasystole occupies one of the most important places in terms of significance for prognosis and treatment. An extraordinary contraction of the heart muscle occurs on a signal from an ectopic (additional) focus of excitation.

According to the International Classification of Diseases (ICD-10), this pathology is coded I 49.4.
The prevalence of extrasystoles among patients and healthy people was established during long-term Holter monitoring of the heart rhythm. Extrasystoles from the ventricles are detected in 40–75% of cases of examined adults.

Where is the source of extrasystoles

Ventricular extrasystoles occur in the wall of the left or right ventricle, often directly in the fibers of the conduction system. If extrasystole occurs at the end of the ventricular relaxation phase, then it coincides in time with the next atrial contraction. The atrium is not completely emptied, a reverse wave goes through the vena cava.

Usually, ventricular extrasystoles cause contraction of only the ventricles themselves and do not transmit impulses in the opposite direction to the atria. "Supraventricular" called extrasystoles from ectopic foci located above the level of the ventricles, in the atria, atrioventricular node. They can be combined with ventricular. There are no pancreatic extrasystoles.

The correct rhythm from the sinus node is maintained and broken only by compensatory pauses after extraordinary beats.

The sequence of occurrence of impulses must not be violated.

The reasons

Causes for ventricular extrasystole appear with heart disease:

• inflammatory nature (myocarditis, endocarditis, intoxication);
• myocardial ischemia (foci of cardiosclerosis, acute heart attack);
• metabolic and dystrophic changes in the muscle and conduction system (violation of the ratio of potassium-sodium electrolytes in myocytes and intercellular space);
• a sharp depletion of the energy supply of cells caused by malnutrition, lack of oxygen in acute and chronic heart failure, decompensated defects.

Ventricular extrasystoles can appear in people with a healthy cardiovascular system due to:

• irritation of the vagus nerve (with overeating, insomnia, mental work);
• increased tone of the sympathetic nerve (smoking, physical work, stress, hard work).

If there are two sources of impulse formation in the heart, then the main one is the one that is capable of a higher frequency. Therefore, most often the normal is preserved. But extrasystoles can also occur against the background of atrial fibrillation.

Types of ventricular extrasystoles

The classification of ventricular extrasystole takes into account the frequency of pathological impulses, the localization of ectopic foci.

Extrasystoles from the ventricles, as well as from other foci, can be single (one for 15-20 normal contractions) or group (3-5 ectopic contractions between normal ones).

Single extrasystole against the background of sinus rhythm

The constant repetition of extraordinary single contractions for each normal is called bigeminy, for two - trigeminy. according to the type of bigeminy or trigeminy, it refers to allorhythmias (irregular, but persistent rhythm disturbance).

Depending on the number of detected foci, extrasystoles are distinguished:

• monotopic (from one focus);
• polytopic (more than one).

By location in the ventricles, the most common are left ventricular out-of-order contractions. Right ventricular extrasystole is less common, perhaps due to the anatomical features of the vascular bed, rare ischemic lesions of the right heart.

Classification B.Lown - M.Wolf

Not all specialists use the existing classification of ventricular extrasystole according to Laun and Wolf. She offers five degrees of extrasystole in myocardial infarction according to the risk of developing fibrillation:

• degree 1 - monomorphic extraordinary contractions are recorded (no more than 30 per hour of observation);
• grade 2 - more frequent, from one focus (over 30 per hour);
• degree 3 - polytopic extrasystole;
• degree 4 - is subdivided depending on the ECG pattern of rhythm ("a" - paired and "b" - volley);
• degree 5 - the most dangerous in the prognostic sense type "R to T" was registered, which means that the extrasystole "climbed" to the previous normal contraction and is able to disrupt the rhythm.

In addition, a "zero" degree was allocated for patients without extrasystoles.

Group extrasystoles

M. Ryan's proposals for gradation (classes) supplemented the B.Lown - M.Wolf classification for patients without myocardial infarction.

In them, “gradation 1”, “gradation 2”, and “gradation 3” completely coincide with the Launian interpretation.

The rest have been changed:

• "gradation 4" - is considered in the form of paired extrasystoles in monomorphic and polymorphic variants;
• in "gradation 5" is included.

Varieties of allorhythmia

How does extrasystole feel to patients

Symptoms of ventricular extrasystoles do not differ from any extraordinary contractions of the heart. Patients complain of a feeling of "fading" of the heart, stopping, and then a strong push in the form of a blow. Some people feel this way:

• weakness,
• dizziness,
• headache.

Rarely, extrasystole is accompanied by a cough movement.

A more colorful description is the "flipping" of the heart, "shocks in the chest."

Diagnostics

The use of electrocardiography (ECG) in diagnostics is of great importance, since the technique is not difficult to master, the equipment is used for removal at home, in the ambulance.

Removing an ECG takes 3-4 minutes (together with the application of electrodes). On the current record during this time, it is not always possible to “catch” extrasystoles and give them a description.

The way out is the Holter method of long-term ECG recording with subsequent interpretation of the results. The method allows you to register even single out-of-order abbreviations.

To examine healthy individuals, exercise tests are used, an ECG is done twice: first at rest, then after twenty squats. For some professions associated with high overloads, it is important to identify possible violations.

Ultrasound of the heart and blood vessels allows you to exclude various cardiac causes.

It is important for the doctor to establish the cause of the arrhythmia, therefore, the following are prescribed:

• general blood analysis;
• C-reactive protein;
• the level of globulins;
• blood for thyroid-stimulating hormones;
• electrolytes (potassium);
• cardiac enzymes (creatine phosphokinase, lactate dehydrogenase).

Idiopathic (unclear by genesis) remains extrasystole if the patient does not have any diseases and provoking factors during the examination.

Features of extrasystole in children

Arrhythmia is detected in newborn babies at the first listening. Extrasystoles from the ventricles may have congenital roots (various malformations).

Acquired ventricular extrasystole in childhood and adolescence is associated with rheumatic heart disease (after angina), infections complicated by myocarditis.

A special group of causes is a hereditary pathology of the myocardium, called arrhythmogenic ventricular dysplasia. The disease often leads to sudden death.

Extrasystole in older children is accompanied by disorders in the endocrine system, occurs when:

• drug overdose;
• in the form of a reflex from a stretched gallbladder with its dyskinesia;
• influenza intoxication, scarlet fever, measles;
• food poisoning;
• nervous and physical overload.

In 70% of cases, ventricular extrasystole is detected in a child by chance during a routine examination.

Grown up children catch interruptions in the rhythm of the heart and extraordinary tremors, complain of stabbing pains to the left of the sternum. In adolescents, there is a combination with vegetovascular dystonia.

Depending on the predominance of vagal or sympathetic nervous regulation, extrasystoles are observed:

• in the first case - against the background of bradycardia, during sleep;
• in the second - during games, along with tachycardia.

Diagnosis in childhood goes through the same stages as in adults. In treatment, more attention is paid to the daily regimen, a balanced diet, light sedatives.

Clinical examinations of children can detect early changes

Extrasystole in pregnant women

Pregnancy in a healthy woman can cause rare ventricular extrasystoles. This is more typical for the second trimester, due to the imbalance of electrolytes in the blood, the high standing of the diaphragm.

The presence of diseases of the stomach, esophagus, gallbladder in a woman causes reflex extrasystole.

For any complaints of a pregnant woman about the feeling of interruptions in the rhythm, it is necessary to conduct an examination. After all, the process of pregnancy significantly increases the load on the heart and contributes to the manifestation of latent symptoms of myocarditis.

The obstetrician-gynecologist prescribes a special diet, potassium and magnesium preparations. In most cases, no treatment is required. Persistent group extrasystole requires clarification of the cause and consultation of a cardiologist.

Treatment

Treatment of ventricular extrasystole includes all the requirements of a healthy regime and nutrition.

• stop smoking, drinking alcohol, strong coffee;
• be sure to use potassium-containing foods in the diet (jacket potatoes, raisins, dried apricots, apples);
• should refrain from lifting weights, strength training;
• if sleep suffers, then light sedatives should be taken.

Drug therapy is connected:

• with poor tolerance of arrhythmia by the patient;
• increased frequency of idiopathic (unclear) group extrasystole;
• high risk of fibrillation.

In the doctor's arsenal there are antiarrhythmic drugs of various strengths and directions. The purpose must be consistent with the main cause.

The drugs are very carefully used for a heart attack, the presence of ischemia and symptoms of heart failure, various blockades of the conduction system.

Against the background of treatment, the effectiveness is judged by repeated Holter monitoring: a positive result is a decrease in the number of extrasystoles by 70-90%.

Surgical treatments

The lack of effect of conservative therapy and the risk of fibrillation is an indication for radiofrequency ablation (rf). The procedure is performed in a cardiosurgical hospital under sterile conditions of the operating unit. Under local anesthesia, a catheter with a source of radiofrequency radiation is inserted into the patient's subclavian vein. The ectopic focus is cauterized with radio waves.

With a good "hit" in the cause of the impulses, the procedure provides an efficiency in the range of 70 - 90%.

A probe is inserted through the catheter into the heart.

The use of folk remedies

Folk remedies are used for extrasystole of a functional nature. If there are organic changes in the heart, you should consult a doctor. Some methods may be contraindicated.

Several popular recipes
At home, it is convenient and easy to brew medicinal herbs and plants in a thermos.

1. In this way, decoctions are prepared from the root of valerian, calendula, cornflower. Brew should be at the rate of 1 tablespoon of dry vegetable raw materials in 2 cups of water. Keep in a thermos for at least three hours. Can be brewed overnight. After straining, drink ¼ cup 15 minutes before meals.
2. Horsetail is brewed in the proportion of a tablespoon to 3 cups of water. Drink a spoonful up to six times a day. Helps with heart failure.
3. Alcohol tincture of hawthorn can be bought at a pharmacy. Drink 10 drops three times a day. To cook it yourself, you need 10 g of dry fruits for every 100 ml of vodka. Infuse for at least 10 days.
4. Honey recipe: mix equal volumes of squeezed radish juice and honey. Take a tablespoon three times a day.

All decoctions are stored in the refrigerator.

Modern forecasting

For 40 years of existence, the above classifications have helped to educate doctors, enter the necessary information into automatic ECG decoding programs. This is important for quickly obtaining the result of research in the absence of a specialist nearby, in the case of remote (in rural areas) examination of the patient.

To predict dangerous situations, it is important for a doctor to know:

• if a person has ventricular extrasystoles, but there is no confirmed heart disease, their frequency and localization does not matter for the prognosis;
• the risk to life is increased for patients with heart defects, organic changes in hypertension, myocardial ischemia only in the case of a decrease in the strength of the heart muscle (increasing heart failure);
• a high risk should be considered for patients after myocardial infarction in the presence of more than 10 ventricular extrasystoles per hour of observation and the detection of a reduced volume of blood ejection (common heart attack, heart failure).

The patient needs to see a doctor and be examined for any obscure interruptions in the heart rhythm.

A type of heart rhythm disorder (arrhythmia), a characteristic manifestation of which is premature and out-of-order contractions of the ventricles, is called ventricular extrasystole.

The main symptoms of pathology include sensations of malfunctions in the functioning of the heart, malaise, as well as the appearance of anginal pain, dizziness.

The diagnosis of "ventricular extrasystole" is established on the basis of electrocardiogram data, Holter monitoring and auscultation.

For the treatment of the disease, the use of sedative drugs, beta-blockers, antiarrhythmic drugs is prescribed.

Often, in order to normalize the functioning of the CCC, it is advised to use folk remedies consisting entirely of natural ingredients.

Ignoring the manifestations of the disease can lead to disastrous consequences.

Extrasystole is one of the most common types of rhythm disturbances. This type of arrhythmia can develop in absolutely any person, regardless of gender and age. Depending on the place of formation of the ectopic focus of excitation in cardiological practice, the following types of pathology are distinguished: ventricular, atrial and atrioventricular extrasystoles. The most common is ventricular.

The occurrence of ventricular extrasystole is due to premature excitation of the myocardium, which comes from the conduction system, in particular from the branches of the His bundle and Purkinje fibers.

When registering an ECG, pathology in the form of rare extrasystoles is diagnosed in approximately five percent of completely healthy people, and with daily monitoring - in more than fifty percent of the subjects.

Ventricular extrasystole is a dangerous disease that requires immediate therapy. Localization of extrasystoles - tissues of the conducting system or the wall of the ventricle (right or left).

There are actually plenty of reasons for the development of ventricular extrasystole. Functional extrasystoles develop, as a rule, due to:

• frequent stressful situations;
• abuse of products containing caffeine;
• alcohol abuse;
• chronic fatigue;
• hormonal imbalance;
• infectious pathologies;
• toxic effects;
• influence or exposure to certain medications (glucocorticoids, antidepressants, diuretics).

Organic extrasystoles occur due to:

• the presence of coronary artery disease;
• cardiovascular insufficiency;
• infectious diseases of the cardiovascular system;
• congenital or acquired malformations of the CCC;
• thyroid pathologies;
• metabolic-dystrophic disorders in the muscle;
• cell malnutrition.

In the presence of more than one source producing pulsation, the main one will be the one that is able to form a large frequency, in connection with this, the preservation of a normal sinus rhythm of the heart is often observed.

There are several classifications of extrasystoles. The generally accepted gradations include M. Ryan and B. Lown. Extrasystoles can be single and group.

The constant repetition of single contractions for each normal is called bigeminy, and for 2 - trigeminy. According to the number of additional foci, monotopic and polytopic extrasystoles are distinguished.

In addition, there are interpolated or inserted extrasystoles - premature contractions that occur during a long pause with a rare rhythm, early ones appear at the time of atrial contraction and late ones during the period of ventricular contraction.

Should know

This disease is very similar to paroxysmal tachycardia - a disorder in which the heart works uneconomically.

Moreover, this disorder is characterized by inefficient blood circulation, which can result in circulatory failure.

To distinguish one pathology from another, the patient is prescribed the necessary studies.

The disease is characterized by:

• a feeling of interruptions in the functioning of the heart;
• malaise;
• anxiety;
• panic;
• feeling of fear;
• dizziness;
• soreness in the chest;
• lack of oxygen;
• headache.

In order to establish an accurate diagnosis, as well as identify the causes of heart damage and disruption of its work, the doctor, in addition to questioning and auscultation, prescribes the following:

• load tests;
• blood sampling;
• electrophysiological research;

Extrasystole is considered idiopathic if a person during the examination did not reveal any pathologies and provoking factors.

If you experience the above symptoms, make an appointment with a cardiologist. The sooner treatment begins, the better the prognosis will be. Do not self-medicate and trust drug reviews. The tactics of extrasystole therapy can be selected exclusively by a qualified specialist.

Classification of ventricular extrasystoles according to Laun and how the disease is felt by patients

The classification of ventricular extrasystoles according to Lown is one of the generally accepted ones, but not all doctors use it.

Classification of PVC B. Lown - M. Wolf offers five stages of pathology in a heart attack according to the risk of fibrillation.

The first degree of classification of all ventricular extrasystoles according to Lown is characterized by monomorphic extraordinary contractions (no more than thirty per hour).

As for the second degree, at this stage, the frequency of contractions is recorded (more often than thirty per hour).

The third degree is characterized by polytopic extrasystole. As for the fourth, it is divided into double and salvo. Fifth degree - the most dangerous type "R to T" is recorded in terms of prognosis, which indicates the "climbing" of the extrasystole to the previous normal contraction and the ability to disturb the rhythm.

The classification of ventricular extrasystoles according to Lown offers another degree of zero, in which extrasystole is not observed.

The M.Ryan classification supplemented the previous gradation for patients without a heart attack. Points one through three are completely identical with Laun's interpretation. The rest are slightly modified.

Class 4 ventricular extrasystole according to Lown is considered in the form of paired extrasystoles in polymorphic and monomorphic variations. Class 5 includes ventricular tachycardia.

Ventricular extrasystole according to Lown, belonging to the first class, has no symptoms and ECG signs of organic pathology.

The remaining II-V classes are very dangerous and belong to organic extrasystoles.

Signs of ECG monitoring PVC:

• Change of the QRS complex which is shown in advance.
• There is a deformation and a strong expansion of the extrasystolic complex.
• Absence of R wave.
• The likelihood of a compensatory pause.
• There is an increase in the interval of internal deviation in the right chest leads with left ventricular extrasystole and in the left with right ventricular.

In addition to the fact that the classification of ventricular extrasystole according to Lown is distinguished, there is also a classification depending on the number of extraordinary impulses. Extrasystoles are single and paired. In addition, allorrhythmia is also distinguished - extrasystole with a strong rhythm disturbance. Since in this case there is an increasing appearance of impulses from additional foci, it is impossible to call such a rhythm completely sinus.

Allorhythmia is represented by three types of disorders: bigeminy (after one normal contraction, one extrasystole follows), trigeminy (extrasystole appears after two contractions), quadrigeminy (after four contractions).

When contacting a cardiologist, in addition to dizziness, malaise and headaches, there are complaints of a feeling of “fading or turning over” of the heart, as well as “shocks in the chest”.

Single and polytopic ventricular extrasystoles: types, forms, classes and prognostic classification

There are several forms of pathology. According to the number of sources of excitability, extrasystoles are monotopic and polytopic, according to the time of occurrence - early, interpolated and late. By frequency, group or salvo, paired, multiple and single ventricular extrasystoles are distinguished.

According to the orderliness, extrasystoles are ordered (allorythmias) and disordered.

Single ventricular extrasystoles in most cases are a variant of the norm. They can occur not only in adults, but also in children and adolescents.

Special treatment for single ventricular extrasystoles is not required. Polytopic, unlike single ventricular extrasystoles, occur 15 or even more times per minute.

With polytopic ventricular extrasystoles, the patient needs treatment. Untimely first aid is fraught with disastrous consequences. The disease can be diagnosed with the help of Holter monitoring.

Ventricular extrasystoles are also divided into benign (no damage to the myocardium, the risk of death is excluded), malignant and potentially malignant.

As for the potentially malignant extrasystole, this subspecies is accompanied by organic lesions of the heart. There is an increased risk of death due to cardiac arrest.

Extrasystoles of a malignant course are accompanied by the occurrence of serious organic lesions. The risk of stopping death is high.

Compensatory pause for extrasystole in children and pregnant women: causes, traditional and alternative treatment

An extended pause that continues from a ventricular extrasystole to a new independent contraction is called a compensatory pause for extrasystoles.

After each ventricular extrasystole, there is a complete compensatory pause. With extrasystole, it is recorded in the case when the ectopic impulse cannot be carried out retrograde through the atrioventricular node to the atria.

A compensatory pause during extrasystole completely compensates for the premature occurrence of a new impulse. A complete compensatory pause with extrasystole is characteristic of ventricular extrasystole.

Extrasystoles in children can develop due to:

• hereditary pathologies of the heart muscle;
• drug overdose;
• intoxication;
• nervous and physical overload.

Children may complain of soreness (stabbing) in the chest, extraordinary tremors.

Rare extrasystoles in the second trimester of pregnancy are a variant of the norm. This is due to an electrolyte imbalance in the blood. Diseases of the gastrointestinal tract and gallbladder can provoke the appearance of reflex extrasystole.

Treatment of pathology consists in:

• giving up bad habits - smoking and alcohol abuse;
• introducing boiled potatoes, raisins, apples, dried apricots into the diet;
• refraining from strong physical exertion;
• taking mild sedatives.

As a rule, the use of antiarrhythmic drugs is prescribed: Propranolol, Metoprolol, Lidocaine, Novocainamide, Amidaron. In case of complication of ventricular extrasystole of coronary artery disease, the use of polyunsaturated fatty acids is prescribed - agents that contribute to the nourishment of the myocardium. The use of vitamins, antihypertensive and restorative drugs is often prescribed.

In case of insufficient effectiveness of drug therapy, or in case of a malignant course of the pathology, an operation is prescribed:

• radiofrequency catheter ablation of additional lesions;
• open heart surgery, which consists in excising areas in which additional impulses occur.

With functional extrasystoles, the use of drugs from the people will be very helpful. They will help in the treatment of the disease and speed up the healing process.

1. Herbal infusion will help normalize the heart rhythm. Soak twenty grams of crushed marigold roots in four hundred milliliters of freshly boiled water. Remove the composition in heat for two hours. Drink 50 ml of drink before each sitting at the table.
2. Mix equal proportions of honey with freshly squeezed radish juice. Take a spoonful of the drug three times a day.
3. Pour ten grams of dried hawthorn fruit with high-quality vodka - 100 ml. Close the container tightly and remove the dark place for a week. Take ten drops of the filtered preparation three times a day.

Normally, the heart rate is set by a special sinoatrial node, which can be found in the right atrium. It releases a charge of electricity that causes the atria to contract. It spreads throughout the myocardium through a complex system of special cells. The frequency of contractions is normally well regulated by special nerves and humorally (by catecholamines, for example, adrenaline). So the heart adapts to the needs of the body of its owner, that is, during stress, excitement or physical activity, the frequency of contractions becomes much higher.

Extrasystoles are "wedging" of additional beats into the normal rhythm of the heart, they are extraordinary and create additional difficulties for the heart. They occur when an electrical charge is transferred from an area outside the sinoatrial node.

Supraventricular extrasystole occurs in two cases. Either if some area of ​​the atrium depolarizes ahead of time, or if this extraordinary impulse is sent by the atrioventricular node. In 60% of healthy people, single extrasystoles "come" from the atrium are observed. However, they are also typical of some conditions, such as heart attack, and mitral valve anomalies. They can provoke uncontrolled contraction - fibrillation, and therefore extrasystoles cannot be ignored. Alcohol along with caffeine will exacerbate the problem.

Ventricular extrasystole occurs in people of any age. This is not uncommon at all. If you record an ECG for 24 hours, then in 63% of absolutely cardiologically healthy single ventricular extrasystoles are detected. However, they are found in large numbers in people with abnormal heart structure. This often happens after a heart attack.

In children, ventricular extrasystole occurs about as often as atrial, usually regular low-intensity exercise is enough for it to stop manifesting itself. Only in the case of an abnormal structure of the atrium, it can cause atrial fibrillation.

As for the heart, which has the correct structure, it must be said that ventricular extrasystole is not dangerous. However, if they begin to appear more often during exercise, this is a bad symptom.

If structural abnormalities are detected, it is imperative to visit a cardiologist. Otherwise, the situation can become life-threatening.

Risk factors for extrasystoles include hypertension, advanced age, ventricular hypertrophy, heart attack, cardiomyopathy, calcium, magnesium, and potassium deficiencies, amphetamines, tricyclic antidepressants, and digoxin, alcohol abuse, stress, caffeine, and infection.

Usually patients complain of a strong heartbeat. Ventricular extrasystole is manifested by extraordinary contractions after a normal beat and is accompanied by a feeling of "stopping" the heart. This is a strange sensation, unusual for a person, which is why it is noted as a symptom. Some people are very worried about this.

Usually at rest the condition worsens, and under load it goes away on its own. However, if they become stronger under load, then this is not a good symptom.

Other symptoms include fainting, weakness, and a chronic cough that cannot be explained by other causes.

For those who suspect anomalies in the structure of the heart, echocardiography and ultrasound are prescribed. The composition of the blood and the amount of thyroid hormones are checked, as well as the sufficiency of electrolytes (calcium, magnesium, potassium) in the blood. Tests are often carried out in the form of forced physical activity: the frequency of extrasystoles is checked during exercise and at rest.

In most cases, extrasystoles are not a cause for alarm, but if you suspect them in yourself, go to a doctor you trust. Constant anxiety kills more people than extrasystoles.

Newspaper "Medicine and Pharmacy News" 22 (302) 2009

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Extrasystole: clinical significance, diagnosis and treatment

Authors: V.A. Bobrov, I.V. Davydova, Department of Cardiology and Functional Diagnostics, NMAPE named after A.I. P.L. Shupyk, Kyiv

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Abstract

Extrasystole is undoubtedly the most common form of heart rhythm disturbance. An extrasystole is a premature contraction that is directly related to the previous contraction of the main rhythm. There is another option for premature contractions - parasystole. Premature parasystolic complexes are not associated with previous contractions and do not depend on the main rhythm. The clinical significance, prognosis and therapeutic measures for extra- and parasystole are the same, therefore, in further discussion of the problem, we will use the term "extrasystole" to refer to any premature contractions, regardless of their mechanism.

Based on the data of numerous studies using long-term ECG monitoring, it has been established that extrasystoles occur in all people - both in patients and in healthy people. At the same time, in healthy individuals, in most cases, rare single extrasystoles are recorded, polymorphic ventricular extrasystoles (PV) are detected less often, and even more rarely - group ventricular extrasystoles. Sometimes people without signs of any disease of the cardiovascular system have a very large number of extrasystoles, frequent group extrasystoles, or even episodes of ventricular tachycardia (VT). In these cases, the term "idiopathic arrhythmias" (or "primary electrical heart disease") is used.

Usually, extrasystoles are felt by the patient as a strong cardiac impulse with a failure or fading after it. Some extrasystoles may occur unnoticed by the patient. When probing the pulse in such patients, the loss of a pulse wave can be determined.

Any structural heart disease can cause extrasystole. Especially often it is detected in patients with acute myocardial infarction and coronary heart disease. In addition, extrasystole can also occur with other myocardial injuries, including subclinical ones.

The most common causes and factors associated with extrasystole:

1. Diseases of the myocardium, endocardium and coronary vessels of the heart.

2. Electrolyte imbalance, violation of acid-base balance.

3. Hypoxia.

4. Traumatic influences.

5. Violation of autonomic regulation.

6. Pathological reflexes caused by diseases of the digestive system; dystrophic changes in the cervical and thoracic spine; diseases of the bronchi and lungs, especially accompanied by a debilitating cough; BPH.

7. Diagnostic procedures.

8. Various allergic reactions.

9. Pharmacodynamic and toxic effects of drugs.

Classification of extrasystoles

1) by localization - atrial, from the atrioventricular (AV) connection, ventricular;

2) according to the time of appearance in diastole - early, middle, late;

3) by frequency - rare (less than 30 per hour) and frequent (more than 30 per hour);

4) by density - single and double;

5) by frequency - sporadic and allorhythmic (bigeminy, trigeminy, etc.);

6) for conducting extrasystoles - polymorphic.

In Ukraine, when interpreting the data of Holter ECG monitoring (HM ECG) in patients with ventricular arrhythmias, the classification of B. Lown and M. Wolf (1971) is traditionally used:

- Rare single monomorphic extrasystoles - less than 30 per hour.

- Frequent extrasystoles - more than 30 per hour.

- Polymorphic extrasystoles.

- Repeated forms of extrasystoles: 4A - paired, 4B - group (including episodes of ventricular tachycardia).

- Early ventricular extrasystoles (type "R on T").

It was assumed that high gradations of extrasystoles (classes 3-5) are the most dangerous. However, in further studies it was found that the clinical and prognostic value of extrasystole (and parasystole) is almost entirely determined by the nature of the underlying disease, the degree of organic heart damage and the functional state of the myocardium. In persons without signs of organic heart disease, the presence of extrasystole (regardless of frequency and nature) does not affect the prognosis and does not pose a danger to life. In patients with severe organic myocardial damage, especially in the presence of post-infarction cardiosclerosis or signs of heart failure (HF), the detection of frequent group ventricular extrasystole may be an additional prognostically unfavorable sign. But even in these cases, extrasystoles do not have independent prognostic value, but are a reflection of myocardial damage and left ventricular dysfunction. This classification was created to systematize ventricular arrhythmias in patients with acute myocardial infarction (MI), but it does not meet the needs of risk stratification and the choice of differentiated treatment tactics in post-infarction patients. In more detail, variants of ventricular arrhythmias are displayed in the classification of R. Myerburg (1984), which is convenient to use when interpreting the results of HM ECG.

When conducting daily ECG monitoring, the statistical norm of extrasystoles is considered to be approximately 200 supraventricular extrasystoles and up to 200 ventricular extrasystoles per day. Extrasystoles can be single or paired. Three or more extrasystoles in a row are called tachycardia ("jogging" tachycardia, "short episodes of unstable tachycardia"). Unsustained tachycardia refers to episodes of tachycardia lasting less than 30 seconds. Sometimes, to designate 3-5 extrasystoles in a row, the definition of “group”, or “volley”, extrasystoles is used. Very frequent extrasystoles, especially paired and recurrent "jogging" of unstable tachycardia, can reach the degree of continuously recurrent tachycardia, in which from 50 to 90% of contractions during the day are ectopic complexes, and sinus contractions are recorded as single complexes or short short-term episodes of sinus rhythm .

From a practical point of view, the “prognostic” classification of ventricular arrhythmias proposed in 1983 by J. Bigger is very interesting:

— Safe arrhythmias- any extrasystoles and episodes of unstable ventricular tachycardia that do not cause hemodynamic disturbances in persons without signs of organic heart damage.

— Potentially dangerous arrhythmias- ventricular arrhythmias that do not cause hemodynamic disturbances in persons with organic heart disease.

— life-threatening arrhythmias("malignant" arrhythmias) - episodes of sustained ventricular tachycardia, ventricular arrhythmias accompanied by hemodynamic disturbances, or ventricular fibrillation (VF). Patients with life-threatening ventricular arrhythmias usually have significant organic heart disease (or "electrical heart disease" such as long QT syndrome, Brugada syndrome).

However, as noted, ventricular extrasystole has no independent prognostic value. By themselves, extrasystoles are safe in most cases. Extrasystole is even called a "cosmetic" arrhythmia, emphasizing its safety. Even “jogging” of unstable ventricular tachycardia is also referred to as “cosmetic” arrhythmias and is called “enthusiastic escape rhythms”.

The detection of extrasystole (as well as any other variant of rhythm disturbances) is the reason for an examination aimed primarily at identifying a possible cause of arrhythmia, heart disease or extracardiac pathology and determining the functional state of the myocardium.

Is it always necessary to treat extrasystolic arrhythmia?

Asymptomatic or asymptomatic extrasystoles, if no heart disease is detected after examination of the patient, do not require special treatment. It is necessary to explain to the patient that the so-called benign oligosymptomatic extrasystole is safe, and taking antiarrhythmic drugs can be accompanied by unpleasant side effects or even cause dangerous complications. First of all, it is necessary to eliminate all potentially arrhythmogenic factors: alcohol, smoking, strong tea, coffee, taking sympathomimetic drugs, psychoemotional stress. You should immediately begin to observe all the rules of a healthy lifestyle. Such patients are shown dispensary observation with echocardiography approximately 2 times a year to identify possible structural changes and deterioration of the functional state of the left ventricle. So, in one of the studies, during long-term follow-up of 540 patients with idiopathic frequent extrasystole (more than 350 extrasystoles per hour and more than 5000 per day), an increase in heart cavities (arrhythmogenic cardiomyopathy) was found in 20% of patients. Moreover, more often an increase in the cavities of the heart was noted in the presence of atrial extrasystole.

If during the examination it turns out that extrasystoles are associated with some other disease (diseases of the gastrointestinal tract, endocrine diseases, inflammatory diseases of the heart muscle), the underlying disease is treated.

Extrasystole caused by disorders of the nervous system, psycho-emotional overload, is treated with sedative preparations (strawberry, lemon balm, motherwort, peony tincture) or sedatives (relanium, rudotel). If extrasystoles occur during treatment with cardiac glycosides, cardiac glycosides are canceled. If during HM ECG the number of extrasystoles exceeds 200 and the patient has complaints or there is a heart disease, treatment is prescribed.

Indications for the treatment of extrasystole:

1) very frequent, as a rule, group extrasystoles, causing hemodynamic disturbances;

2) severe subjective intolerance to the sensation of interruptions in the work of the heart;

3) detection during repeated echocardiographic examination of deterioration in the functional state of the myocardium and structural changes (decrease in ejection fraction, dilatation of the left ventricle).

General principles for the treatment of arrhythmias:

- In most cases, arrhythmia is a consequence of the underlying disease (secondary), so the treatment of the underlying disease can contribute to the treatment of rhythm disturbances. For example, thyrotoxicosis with atrial fibrillation or coronary heart disease with ventricular extrasystoles.

- Most arrhythmias are accompanied by psychosomatic disorders that require psychocorrection. In case of insufficiency of non-drug measures, alprazolam and modern antidepressants are most effective.

- Metabolic therapy can achieve some success in the treatment of arrhythmias. However, first-generation drugs (riboxin, inosie, potassium orotate) are extremely ineffective. Modern drugs are more preferable (neoton, espalipon, trimetazidine, magnerot, solcoseryl, actovegin).

Drug treatment of extrasystole

Indications for the appointment of antiarrhythmic drugs (AAP) in extrasystolic arrhythmia are the following clinical situations:

1) progressive course of heart disease with a significant increase in the number of extrasystoles;

2) frequent, polytopic, paired, group and early ("R on T") ventricular extrasystoles, threatened in the future by the occurrence of paroxysmal ventricular tachycardia or ventricular fibrillation; 3) allorhythmia (bi-, tri-, quadrigeminia), short "runs" of atrial tachycardia, which are accompanied by signs of heart failure; 4) extrasystolic arrhythmia against the background of diseases that are accompanied by an increased risk of life-threatening arrhythmias (mitral valve prolapse, long QT syndrome, etc.); 5) the occurrence or increase in the frequency of extrasystoles during attacks of angina pectoris or acute MI; 6) preservation of PVC after the end of the attack of VT and VF; 7) extrasystoles against the background of abnormal conduction pathways (WPW and CLC syndromes).

Usually, treatment begins with the number of extrasystoles from 700 per day. The appointment of drugs occurs with the obligatory consideration of the types of extrasystoles and heart rate. The selection of antiarrhythmic drugs is made individually and only by a doctor. After the appointment of the drug, treatment is monitored using Holter monitoring. The best results are achieved with Holter monitoring once a month, but in practice this is hardly achievable. If the effect of the drug is good, the extrasystoles disappear or are significantly reduced and this effect persists for up to two months, the drug can be discontinued. But at the same time, the dose of the drug is gradually reduced for a long time, since the abrupt withdrawal of treatment leads to the recurrence of extrasystoles.

Treatment of extrasystole in selected clinical situations

Treatment of extrasystole is carried out by trial and error, sequentially (for 3-4 days) evaluating the effect of taking antiarrhythmic drugs in average daily doses (taking into account contraindications), choosing the most suitable for this patient. It may take several weeks or even months to evaluate the antiarrhythmic effect of amiodarone (the use of higher doses of amiodarone, for example, 1200 mg / day, can reduce this period to several days).

Antiarrhythmic drugs (AAP) do not cure arrhythmia, but only eliminate it for the period of taking the drugs. At the same time, adverse reactions and complications associated with taking almost all drugs can be much more unpleasant and dangerous than extrasystole. Thus, the presence of extrasystole in itself (regardless of frequency and gradation) is not an indication for the appointment of AARP.

In any case, treatment of extrasystole with antiarrhythmic drugs does not improve the prognosis. Several large controlled clinical trials have found a marked increase in overall mortality and sudden death (2-3 times or more) in patients with organic heart disease while taking class I AARP, despite the effective elimination of extrasystoles and episodes of ventricular tachycardia. The best-known study, which first revealed a discrepancy between the clinical efficacy of drugs and their effect on prognosis, is the CAST study. In the CAST study (Study of the suppression of cardiac arrhythmias) in patients with a myocardial infarction, against the background of effective elimination of ventricular premature beats with class IC drugs (flecainide, encainide and moracizin), a significant increase in total mortality by 2.5 times and the frequency of sudden death by 3.6 times compared with patients taking placebo. The results of the study made it necessary to reconsider the tactics of treating not only patients with rhythm disturbances, but also cardiac patients in general. The CAST study is one of the pillars in the development of evidence-based medicine. Only against the background of taking β-blockers and amiodarone was a decrease in mortality in patients with postinfarction cardiosclerosis, heart failure or resuscitated patients. However, the positive effect of amiodarone and especially β-blockers did not depend on the antiarrhythmic effect of these drugs.

Most often, supraventricular extrasystole does not require specialized treatment. The main indications for antiarrhythmic therapy are hemodynamic significance and subjective intolerance. In the second case, one should remember about tranquilizers and antidepressants. Arrhythmia against the background of their intake will not disappear, but the patient's attitude towards it will change significantly.

For the treatment of symptomatic, including group, supraventricular extrasystoles in patients with structural heart disease without signs of heart failure, treatment begins with calcium antagonists (verapamil, diltiazem) or β-blockers (propranolol, metoprolol, bisoprolol, betaxolol). In the absence of the effect of these drugs, class I drugs or a combination of AARP with a different mechanism of action are prescribed. The following combinations of AARP have been most approved: disopyramide + β-blocker; propafenone + β-blocker; drug class IA or IB + verapamil. Amiodarone is considered as a reserve drug in situations where its appointment is justified, taking into account group extrasystole and associated severe clinical symptoms. In the acute period of MI, special treatment for supraventricular extrasystole is usually not indicated.

Potentially "malignant" ventricular arrhythmias occur in the setting of a structural heart disease, such as CAD, or after a prior MI. With this in mind, patients primarily require adequate treatment of the underlying disease. For this purpose, standard risk factors (hypertension, smoking, hypercholesterolemia, diabetes mellitus) are corrected, drugs are prescribed that have been proven effective in patients with coronary artery disease (aspirin, β-blockers, statins) and in HF (ACE inhibitors, β-blockers, aldosterone antagonists). ).

Selection of drug therapy is carried out individually. If the patient has coronary artery disease, class I drugs (except propafenone) should not be used. If there are indications for the appointment of AARP in patients with organic heart disease, β-blockers, amiodarone and sotalol are used. The effectiveness of amiodarone in suppressing ventricular extrasystoles is 90-95%, sotalol - 75%, drugs of the IC class - from 75 to 80%.

In patients without signs of organic heart disease, in addition to these drugs, class I AAs are used: ethacizin, allapinin, propafenone, kinidine durules. Etatsizin is prescribed 50 mg 3 times a day, allapinin - 25 mg 3 times a day, propafenone - 150 mg 3 times a day, quinidine durules - 200 mg 2-3 times a day.

Some controversy exists regarding the use of amiodarone. On the one hand, some cardiologists prescribe amiodarone last - only in the absence of the effect of other drugs (believing that amiodarone quite often causes side effects and requires a long "saturation period"). On the other hand, it may be more rational to start the selection of therapy with amiodarone as the most effective and convenient drug to take. Amiodarone at low maintenance doses (100-200 mg daily) rarely causes serious side effects or complications and is rather safer and better tolerated than most other antiarrhythmic drugs. In any case, in the presence of organic heart disease, the choice is small: β-blockers, amiodarone or sotalol. If there is no effect from taking amiodarone (after a "saturation period" - at least 600-1000 mg / day for 10 days), you can continue taking it at a maintenance dose - 0.2 g / day and, if necessary, evaluate the effect of sequential addition class IC drugs (etacizin, propafenone, allapinin) in half doses.

In patients with extrasystole against the background of bradycardia, the selection of treatment begins with the appointment of drugs that accelerate the heart rate: you can try taking pindolol (visken), eufillin (teopec) or class I drugs (etatsizin, allapinin, quinidine durules). The appointment of anticholinergic drugs such as belladonna or sympathomimetics is less effective and is accompanied by numerous side effects.

In case of ineffectiveness of monotherapy, the effect of combinations of various AARPs in reduced doses is evaluated. Combinations of AARP with β-blockers or amiodarone are especially popular. There is evidence that the simultaneous appointment of β-blockers (and amiodarone) neutralizes the increased risk from taking any antiarrhythmic drugs. In the CAST study, there was no increase in mortality in patients with myocardial infarction who, along with class IC drugs, took β-blockers. Moreover, a 33% reduction in arrhythmic death was found! Against the background of taking this combination, an even greater decrease in mortality was observed than with each drug separately.

If the heart rate exceeds 70-80 beats / min at rest and the P-Q interval is within 0.2 s, then there is no problem with the simultaneous administration of amiodarone and β-blockers. In the case of bradycardia or AV blockade of I-II degree, the appointment of amiodarone, β-blockers and their combination requires the implantation of a pacemaker operating in DDD mode (DDDR). There are reports of an increase in the effectiveness of antiarrhythmic therapy when AARP is combined with ACE inhibitors, angiotensin receptor blockers, statins, and omega-3 unsaturated fatty acid preparations.

In patients with heart failure, a marked decrease in the number of extrasystoles may occur while taking ACE inhibitors and aldosterone antagonists.

It should be noted that 24-hour ECG monitoring to assess the effectiveness of antiarrhythmic therapy has lost its significance, since the degree of suppression of extrasystoles does not affect the prognosis. In the CAST study, a pronounced increase in mortality was noted against the background of achieving all the criteria for a complete antiarrhythmic effect: a decrease in the total number of extrasystoles by more than 50%, paired extrasystoles by at least 90%, and the complete elimination of episodes of ventricular tachycardia. The main criterion for the effectiveness of treatment is the improvement of well-being. This usually coincides with a decrease in the number of extrasystoles, and determining the degree of suppression of extrasystoles is not important.

In general, the sequence of selection of AARP in patients with organic heart disease in the treatment of recurrent arrhythmias, including extrasystole, can be represented as follows:

- β-blocker, amiodarone or sotalol;

- amiodarone + β-blocker.

Combinations of drugs:

- β-blocker + class I drug;

- amiodarone + class IC drug;

- sotalol + class IC drug;

- amiodarone + β-blocker + class IC drug.

In patients without signs of organic heart disease, you can use any drugs in any order or use the scheme proposed for patients with organic heart disease.

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Ventricular extrasystole

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 heart rhythm disorder. Its frequency depends on the method of diagnosis and the contingent of the examined. When recording an ECG in 12 leads at rest, ventricular extrasystoles are determined in approximately 5% of healthy young people, while 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 the cardiovascular 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. Patients with both acute coronary syndromes and chronic ischemic heart disease, especially those who have had myocardial infarction, are susceptible to the occurrence of ventricular extrasystoles. 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. Their possible causes 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 I tone may change due to asynchronous contraction of the ventricles and atria and fluctuations in the duration of the 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 QRS' extrasystolic complex;

the location of the RS-T segment and the T wave of the extrasystole is discordant to the direction of the main wave 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 arrhythmia is benign, recommend a diet enriched with potassium salts, and exclude such provoking factors as smoking, drinking strong coffee and alcohol, and with physical inactivity - increased 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, the slowing of the sinus rate is 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 of 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 of 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 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, taking stimulants (caffeine, alcohol, tannin, nicotine) or certain medications.

Functional PVCs are often found with increased vagal activity. 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 vegetative 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 extrasystoles.

This symptom is observed in patients with chronic lung diseases, with rheumatism. There is extrasystole of reflex origin associated with diseases of the abdominal organs: cholecystitis, gastric ulcer and duodenal ulcer, pancreatitis, colitis.
Another common cause of 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 conventionality, we can talk about different symptoms in functional and "organic" PVCs. Extrasystoles in the absence of severe heart disease are usually isolated, 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 tension or even a simple transition from a horizontal to a vertical position leads to their disappearance. 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

The main methods of instrumental diagnosis of ventricular extrasystole 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 monitoring of the ECG, 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 dosed physical activity, and echocardiography can be prescribed.

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, and 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 herbal sedatives (valerian, motherwort) in combination with beta-blockers. With HS against the background of vagotonia, sympathomimetics and anticholinergics, for example, Bellataminal, are effective.
With the organic nature of extrasystoles, 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 the function of the liver, 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 people 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" (PVC - from 20:14)