Ventricular extrasystoles on ecg. Extrasystoles Intercalary extrasystoles

The cardiac conduction system plays the main role in the rhythmic functioning of the heart. cardiomyocytes , organized into two nodes and a bundle: the sinoatrial node, the atrioventricular node and the atrioventricular bundle (Hiss bundle fibers and Purkinje fibers located in the ventricles). The sinus node is located in the right atrium, it is the first-order pacemaker of the heart, and an impulse is generated in it.

From it, the impulse spreads to the underlying parts of the heart: through the cardiomyocytes of the atria to the atrioventricular node, then to the atrioventricular bundle. In response to the impulse, the heart contracts in a strict order: the right atrium, the left atrium, the retention in the atrioventricular node, then the interventricular septum and the walls of the ventricles. Excitation spreads in one direction - from the atria to the ventricles, and refractoriness (the period of non-excitability of parts of the heart muscle) prevents its reverse propagation.

Excitability is the most important feature of heart cells. It ensures the movement of a depolarization wave from the sinus node to the ventricular myocardium. Various parts of the conduction system also have automaticity and are capable of generating impulses. The sinus node normally suppresses the automation of other departments, so it is the pacemaker of the heart - it is the center of first-order automation. However, for various reasons, the rhythmic functioning of the heart can be disrupted and various disorders occur. One of which is extrasystole . This is the most common heart rhythm disorder, which is diagnosed in various diseases (not only cardiac) and in healthy people.

Estracystole of the heart, what is it? Extrasystoles are called premature (extraordinary) contractions of the heart or its parts. Premature contraction is caused by a heterotropic impulse that does not originate from the sinus node, but originates in the atria, ventricles, or atrioventricular junction. If the focus of increased activity is localized in the ventricles, then premature depolarization of the ventricles occurs.

Premature ventricular depolarization, what is it? Depolarization means excitation that spreads through the heart muscle and causes the heart to contract in diastole, when the heart should relax and accept blood. This is how they arise ventricular extrasystoles And . If an ectopic focus forms in the atrium, premature depolarization of the atria occurs, which is manifested not only by atrial extrasystole, but also by sinus and paroxysmal tachycardia .

If normally, during a period of long diastole, blood manages to fill the ventricles, then with an increase in the frequency of contractions (with tachycardia) or as a result of an extraordinary contraction (with extrasystoles), the filling of the ventricles decreases and the volume of extrasystolic ejection falls below normal. Frequent extrasystoles (more than 15 per minute) lead to a noticeable decrease in minute blood volume. The earlier the extrasystole appears, the less blood volume manages to fill the ventricles and the less extrasystolic ejection. First of all, this affects coronary blood flow and cerebral circulation. Therefore, the detection of extrasystole is a reason for examination, establishing its cause and the functional state of the myocardium.

Pathogenesis

In the pathogenesis of extrasystole, three mechanisms of its development are important - increased automatism, trigger activity and re-entry of excitation (reentry). Increased automatism means the appearance of a new area of ​​excitation in the heart, which can cause an extraordinary contraction. The reason for increased automaticity is disturbances in electrolyte metabolism or.

With the reentry mechanism, the impulse moves along a closed path - the excitation wave in the myocardium returns to the place of its origin and repeats the movement again. This occurs when areas of tissue that conduct impulses slowly are adjacent to normal tissue. In this case, conditions are created for the excitation to re-enter.

With trigger activity, trace excitation develops at the beginning of the resting phase or at the end of repolarization (restoration of the original potential). This is due to disruption of transmembrane ion channels. The cause of such disorders is various disorders (electrolyte, hypoxic or mechanical).

According to another hypothesis, disruption of autonomic and endocrine regulation causes dysfunction of the sinoatrial node and simultaneously activates other centers of automaticity, and also enhances impulse transmission along the atrioventricular junction and His-Purkinje fibers. Cells located in the mitral valve leaflets, with increasing levels catecholamines form automatic impulses, which are carried out on the atrial myocardium. Cells of the atrioventricular junction also cause supraventricular arrhythmias .

Classification

Extrasystole according to localization is divided into:

• Ventricular
• Supraventricular (supraventricular).
• Extrasystole from AV connection.

By time of appearance during diastole:

• Early.
• Average.
• Late.

By form:

• Monomorphic - the shape of all extrasystoles on the ECG is the same.
• Polymorphic - changes in the shape of extrasystolic complexes.

In practical work, ventricular extrasystole is of primary importance.

Ventricular extrasystole

This type of extrasystole occurs in patients with ischemic heart disease, arterial hypertension , ventricular hypertrophy , . Often occurs when hypoxemia and increased activity sympathoadrenal system . Ventricular extrasystole is observed in 64% of patients after and is more common among men. Moreover, the prevalence of the disease increases with age. There is a connection between the occurrence of extrasystoles and the time of day - more often in the morning than during sleep.

Ventricular extrasystole: what is it, consequences

What are ventricular extrasystoles? These are extraordinary contractions that occur under the influence of impulses that come from various parts of the conduction system of the ventricles. Most often, their source is Purkinje fibers and the His bundle. In most cases, extrasystoles incorrectly alternate with normal heart contractions. The ICD-10 code for ventricular extrasystole is I49.3 and is encrypted as “Premature ventricular depolarization.” Extrasystole without specifying the location of the outgoing impulse has a code according to ICD-10 I49.4 “Other and unspecified premature depolarization.”

The danger of ventricular extrasystole for humans is its consequences - ventricular tachycardia , which can go into ventricular fibrillation (ventricular fibrillation), and this is a common cause of sudden cardiac death. Frequent extrasystoles cause insufficiency of coronary, renal and cerebral circulation.

Ventricular extrasystole is classified

By localization:

• Right ventricular.
• Left ventricular.

By number of outbreaks:

• Monotopic (there is one source of impulses).
• Polytopic ventricular extrasystole (presence of several sources of impulses).

By adhesion interval:

• Early.
• Late.
• Extrasystole R on T.

In relation to the main rhythm:

• Trigeminy.
• Bigeminy.
• Quadrohemony.
• Triplet.
• Verse.

By frequency:

• Rare - less than 5 per minute.
• Average - up to 15 per minute.
• Frequent ventricular extrasystole - more than 15 per minute.

By density:

• Single extrasystoles. Single ventricular extrasystole, what is it? This means that extrasystoles occur one at a time against the background of a normal rhythm.
• Paired - two extrasystoles follow each other.
• Group (they are also called salvo) - three or more extrasystoles that follow each other.

Three or more extrasystoles occurring in a row are called “jogs” of tachycardia or unstable tachycardia. Such episodes of tachycardia last less than 30 seconds. To designate 3-5 extrasystoles following each other, the term “group” or “volley” ES is used.

Frequent extrasystoles, paired, group and frequent “jogs” of unstable tachycardia sometimes reach the level of continuous tachycardia, with 50-90% of contractions per day being extrasystolic complexes.

Ventricular extrasystole on ECG

• There is no atrial contraction - there is no P wave on the ECG.
• The ventricular complex is changed.
• After a premature contraction there is a long pause, which after ventricular extrasystoles is the longest compared to other types of extrasystoles.

One of the most well-known classifications of ventricular arrhythmias is the classification extrasystoles according to Laun-Wolff 1971. She considers ventricular extrasystoles in patients with myocardial infarction.

Previously, it was believed that the higher the class of extrasystole, the higher the likelihood of life-threatening arrhythmias (ventricular fibrillation), but when studying this issue, this position was not justified.

Life-threatening ventricular extrasystole is always associated with cardiac pathology, so the main task is to treat the underlying disease.

Lown's classification of ventricular extrasystoles was modified in 1975 and offers a gradation of ventricular arrhythmias in patients without myocardial infarction.

An increase in the risk of sudden death is associated with an increase in the class of extrasystoles in patients with heart damage and a decrease in its pumping function. Therefore, categories of ventricular extrasystoles are distinguished:

• Benign.
• Malignant.
• Potentially malignant.

Extrasystoles in persons without heart damage are considered benign, depending on their gradation. They do not affect life prognosis. For benign ventricular extrasystole, treatment (antiarrhythmic therapy) is used only for severe symptoms.

Potentially malignant - ventricular extrasystoles with a frequency of more than 10 per minute in patients with organic heart disease and decreased contractility of the left ventricle.

Malignant are paroxysms tachycardia , periodic ventricular fibrillation due to heart disease and ventricular ejection function less than 40%. Thus, the combination of high-grade extrasystole and decreased contractility of the left ventricle increases the risk of death.

Supraventricular extrasystole

Supraventricular extrasystole: what it is, its consequences. These are premature contractions of the heart that are caused by impulses from an ectopic focus located in the atria, AV junction, or at the junction of the pulmonary veins into the atria. That is, the foci of impulses may be different, but they are located above the branches of the His bundle, above the ventricles of the heart - hence the name. Let us recall that ventricular extrasystoles originate from a focus located in the branching of the Hiss bundle. Synonym for supraventricular extrasystole - supraventricular extrasystole .

If rhythm disturbances are caused by emotions (of a vegetative nature), infections, electrolyte disorders, various stimulants, including alcohol, caffeine-containing drinks and drugs, drugs, then they are transient in nature. But supraventricular ES can also appear against the background of myocardial lesions of an inflammatory, dystrophic, ischemic or sclerotic nature. In this case, the extrasystoles will be persistent, and their frequency decreases only after treatment of the underlying disease. A healthy person also has supraventricular extrasystoles, the norm per day of which is up to 200. This norm per day is recorded only during daily ECG monitoring.

Single supraventricular extrasystole (occurs one at a time, rarely and without a system) is asymptomatic in the clinic. Frequent ES can be felt as chest discomfort, a lump in the chest, freezing, agitation followed by shortness of breath. Frequent extrasystoles can worsen a person’s quality of life.

Supraventricular extrasystoles are not associated with the risk of death, but multiple extrasystoles, group and very early (type R on T) can be a harbinger of atrial fibrillation ( atrial fibrillation ). This is the most serious consequence of supraventricular extrasystole, developing in patients with atrial dilatation. Treatment depends on the severity of ES and the patient’s complaints. If extrasystoles occur against the background of heart disease and there are echocardiographic signs of left atrium enlargement, then drug treatment is indicated. This condition is often observed in patients over 50 years of age.

Atrial extrasystole is considered as a type of supraventricular extrasystole, when the arrhythmogenic focus is located in the right or left atrium. According to Holter monitoring, atrial extrasystoles are observed in 60% of healthy individuals during the day. They are asymptomatic and do not affect the prognosis. If there are prerequisites (myocardial lesions of various origins) they can cause supraventricular tachycardia and paroxysmal supraventricular tachycardia.

Atrial extrasystole on ECG

• P waves are premature.
• Always differ in shape from the sinus P wave (deformed).
• Their polarity is changed (negative).
• The PQ interval of the extrasystole is normal or slightly prolonged.
• Incomplete compensatory pause after extrasystole.

Causes of extrasystole

Cardiac reasons:

• Cardiac ischemia . Extrasystole serves as an early manifestation of myocardial infarction, is a manifestation of cardiosclerosis, or reflects electrical instability in a post-infarction aneurysm. Supraventricular ES is also a manifestation of ischemic heart disease, but has a lesser effect on the prognosis.
• . Ventricular ES is the earliest symptom of hypertrophic cardiomyopathy and determines the prognosis. Supraventricular extrasystole not typical for this disease.
• Dysplasia connective tissue of the heart. With it, abnormal chords appear in the ventricle, extending from the wall to the interventricular septum. They are the arrhythmogenic substrate for ventricular extrasystole.
• Cardiopsychoneurosis . Rhythm and automaticity disorders in NCD are common and varied. Some patients exhibit rhythm disturbances in the form of polytopic extrasystole, paroxysmal supraventricular tachycardia and atrial flutter. Ventricular and supraventricular extrasystoles occur with the same frequency. These rhythm disturbances appear at rest or during emotional stress. The nature of the extrasystoles is benign, despite the fact that interruptions in the work of the heart and the fear of stopping it frighten many patients, and they insist on treating the arrhythmia.
• Metabolic cardiomyopathies , including alcoholic cardiomyopathy .
• , including infective endocarditis and myocarditis in autoimmune diseases. Association with infections is a characteristic feature of myocarditis. Extrasystoles appear in waves during exacerbations of myocarditis. Patients have antibodies to streptococci , tumor necrosis factor (for immune myocarditis). There is a moderate expansion of the chambers (sometimes only the atria) and a slight decrease in the ejection fraction. The only manifestation of sluggish myocarditis is extrasystoles. To clarify the diagnosis of indolent myocarditis, a myocardial biopsy is performed.
• Dilated cardiomyopathy . This disease is characterized by a combination of ventricular and supraventricular extrasystole, which turns into atrial fibrillation.
• Congenital and acquired (rheumatic). Ventricular ES appears early in aortic defects. PVCs with mitral defects indicate active rheumatic carditis. Mitral defects (especially stenosis) are characterized by the appearance in the early stages of the disease of supraventricular ES, which occurs due to overload of the right ventricle.
• Restrictive cardiomyopathy accompanied by both types of ES in combination with blockades. Amyloidosis occurs with restrictive changes and in the form of damage only to the atria with the occurrence of supraventricular ES and atrial fibrillation.
• Hypertonic disease . The severity of ventricular ES correlates with the severity of left ventricular hypertrophy. A provoking factor for ES may be the use of non-potassium-sparing diuretics. As for the supraventricular form, it is less typical.
• Mitral valve prolapse . VES often occurs with myxomatous valve degeneration, and NVES occurs against the background of severe mitral regurgitation.
• Chronic cor pulmonale . With this disease, supraventricular extrasystoles and right ventricular extrasystoles appear.
• "The Heart of an Athlete" Extrasystole and sports are quite common combinations. Various rhythm and conduction disturbances develop against the background of myocardial hypertrophy with inadequate blood supply. If a rare PVC is diagnosed for the first time and there is no heart pathology, sports of any kind are allowed. For athletes with frequent ventricular extrasystoles, radiofrequency ablation of the arrhythmia focus is recommended. After the operation, an examination is carried out 2 months later, including an ECG, ECHO-CG, Holter monitoring, and a stress test. In the absence of recurrence of extrasystole and other rhythm disturbances, all types of sports are permitted.
• Heart injuries.

Extracardiac reasons:

• Electrolyte imbalance ( hypokalemia , hypomagnesemia or hypercalcemia ). Long-term hypomagnesemia is associated with a high incidence of ventricular extrasystoles and ventricular fibrillation. Mortality increases in patients with hypomagnesemia. Magnesium preparations are used as antiarrhythmic drugs that combine the properties of class I and IV antiarrhythmic drugs. In addition, magnesium prevents the cell from losing potassium.
• Overdose cardiac glycosides (they provoke both types of extrasystoles), tricyclic antidepressants , thiazide and loop diuretics, hormonal contraceptives.
• Taking narcotic drugs.
• Use of anesthetics.
• Taking antiarrhythmic drugs IA, IC, III class.
• . In patients with ES, screening of thyroid hormones is mandatory.
• . Against the background of increased hemoglobin, the course of extrasystole improves.
• long-term non-scarring. In a greater percentage of cases, atrial extrasystole occurs, but ventricular extrasystole can also occur. Extrasystole in patients with peptic ulcers occurs more often at night and against the background bradycardia . An effective drug in this situation is.
• Infection.
• Stress.
• . In this condition, extrasystoles are accompanied by fear, panic, and increased anxiety, which are very poorly compensated by self-soothing and require drug correction. With nervousness, extrasystoles of the first two classes according to the Lown classification, therefore it is necessary to treat the neurosis, not the heart.
• Abuse of alcoholic beverages, tea, coffee, heavy smoking.

All of the above factors can be divided into three groups. There is a division of extrasystoles depending on etiological factors:

• Functional. This includes rhythm disturbances of psychogenic origin associated with chemical exposure, stress, alcohol, drugs, coffee and tea. Functional extrasystole occurs when vegetative-vascular dystonia , . There are also cases of extrasystole development in women during menstruation.
• Organic. This group of extrasystoles develops against the background of various myocardial lesions: myocarditis , cardiosclerosis , myocardial infarction , IHD, heart defects , hemochromatosis , amyloidosis , condition after surgical treatment of the heart, “athlete’s heart.”
• Toxic. They are caused by the toxic effects of certain medications, thyroid hormones during thyrotoxicosis , toxins in infectious diseases.

Extrasystole: a forum for people suffering from it

All of the above reasons are confirmed in the topic “extrasystole, forum”. Most often there are reviews about the appearance of extrasystoles in vegetative-vascular dystonia and neuroses. Psychological reasons for the appearance of extrasystoles are suspiciousness, fears, and anxiety. In such cases, patients turned to a psychotherapist and psychiatrist, and taking sedatives ( Vamelan , ) or long-term use of antidepressants gave a positive result.

Very often, extrasystoles were associated with a hiatal hernia. Patients noted their association with eating large amounts of food while lying or sitting. Restricting food in volume, especially at night, was effective. There are often reports that taking magnesium preparations (,) helped reduce the number of extrasystoles and they became less noticeable to patients.

Symptoms of extrasystole

Symptoms of ventricular extrasystole are more pronounced than with supraventricular extrasystole. Typical complaints are interruptions in the work of the heart, a feeling of fading or cardiac arrest, increased contraction and rapid heartbeat after a previous freezing. Some patients experience chest pain and severe fatigue. There may be pulsation of the jugular veins, which occurs in atrial systole.

Single ventricular extrasystoles - what is it and how do they manifest? This means that extrasystoles occur one at a time among normal heart contractions. Most often they do not manifest themselves and the patient does not feel them. Many patients feel interruptions in their heart function only in the first days of the appearance of extrasystoles, and then they get used to it and do not pay attention to them.

Symptoms such as “strong stroke” and “cardiac arrest” are associated with an increased stroke volume, which is ejected after the extrasystole by the first normal contraction and a long compensatory pause. Patients describe these symptoms as “heart inversion” and “freezing.”

With frequent group extrasystoles, patients feel palpitations or heart fluttering. The sensation of a wave from the heart to the head and a rush of blood to the neck are associated with blood flow from the right atrium to the veins of the neck while the atria and ventricles contract simultaneously. Pain in the heart region is rarely observed in the form of short, vague pain and is associated with irritation of receptors when the ventricles are overfilled during a compensatory pause.

Some patients develop symptoms that indicate cerebral ischemia: dizziness, nausea, unsteadiness when walking. To some extent, these symptoms may also be caused by neurotic factors, since the general symptoms of arrhythmia are a manifestation of autonomic disorders.

Tests and diagnostics

Clinical and biochemical examinations:

• Clinical blood test.
• If myocarditis is suspected, inflammatory markers (CRP level), cardiac troponins (TnI, TnT), natriuretic peptide (BNP), and cardiac autoantibodies are examined.
• Blood electrolyte levels.
• Study of thyroid hormones.

Instrumental studies

• ECG. Examples of ECG of the main types (ventricular and atrial) were given above. Atrial premature beats are more difficult to diagnose if the patient has a wide QRS complex (similar to a His bundle block), early supraventricular ES (the P wave overlaps the previous T and makes it difficult to identify the P wave), or blocked supraventricular ES (the P wave does not extend into the ventricles). Complex rhythm disturbances present even greater difficulties. For example, polytopic extrasystole . With it, extrasystoles are generated by several sources in the heart, which are localized in different areas. Extrasystoles appear on the ECG, which have different shapes, different durations of compensatory pauses, and an inconsistent pre-extrasystolic interval. If further excitation follows one path, then the extrasystoles will have the same shape - this is a polytopic monomorphic form. Polytopic polymorphic extrasystoles occur in different directions of impulses. This type of arrhythmia indicates serious myocardial damage, severe electrolyte imbalance and hormonal changes.
• Holter monitoring. Evaluates changes in heart rate per day. Repeated Holter monitoring during treatment makes it possible to evaluate its effectiveness. CM is performed in the presence of rare extrasystoles, which are not detected during a standard electrocardiographic study. The most important thing during the study is to determine the number of ES per day. No more than 30 ES per hour is allowed.
• Tests with physical activity. Treadmill test - a study with a load on a treadmill with ECG recording in real time. The subject walks along a moving walkway and the load (movement speed and elevation angle) changes every 3 minutes. Before and during the study, blood pressure and electrocardiogram are monitored. The study is stopped if the patient complains. When performing a stress test, the occurrence of paired VES at a heart rate less than 130 per minute in combination with “ischemic” ST is important. If extrasystoles occur after exercise, this indicates their ischemic etiology.
• Echocardiography. The dimensions of the chambers, structural changes of the heart are studied, the state of the myocardium and hemodynamics are assessed, signs of arrhythmogenic dysfunction and changes in hemodynamics during extrasystoles are identified.
• Magnetic resonance imaging of the heart. Examination and assessment of the function of the right and left ventricles, identification of fibrous, cicatricial changes in the myocardium, areas of edema, lipomatosis.
• Electrophysiological study (EPS). It is carried out before surgery to clarify the location of the source of pathological impulses.

Polytopic extrasystole

Treatment of extrasystole

How to treat extrasystole? First of all, you need to know that the presence of extrasystole is not an indication for prescribing antiarrhythmic drugs. Asymptomatic and low-symptomatic extrasystoles do not require treatment in the absence of cardiac pathology. This is a functional extrasystole, to which people with vegetative-vascular dystonia are prone. What should you do in this case?

Lifestyle changes are important stages in the treatment of extrasystole. The patient should lead a healthy lifestyle:

• Avoid drinking alcohol and smoking, introduce walking in the fresh air.
• Eliminate potential factors that cause arrhythmia - strong tea, coffee. If extrasystole occurs after eating, you need to observe what food it occurs after and exclude it. However, for many, extrasystoles occur after eating a large meal and drinking alcohol.
• Eliminate psycho-emotional tension and stress, which in many patients are factors that provoke the appearance of extrasystoles.
• Introduce foods rich in magnesium and potassium into your diet: raisins, cereals, citrus fruits, lettuce, persimmons, dried apricots, bran, prunes.

In such patients, echocardiography is indicated to identify structural changes and monitor left ventricular function. In all cases of rhythm disturbances, patients should be examined to exclude metabolic, hormonal, electrolyte, disturbances and sympathetic influences.

If detected thyrotoxicosis , myocarditis the underlying disease is treated. Correction of arrhythmias in case of electrolyte disorders involves the administration of potassium and magnesium supplements. If the sympathetic nervous system is predominant, beta-blockers are recommended.

Indications for the treatment of extrasystole:

• Subjective intolerance to sensations of rhythm disturbance.
• Frequent group extrasystoles that cause hemodynamic disturbances. Supraventricular ES of more than 1-1.5 thousand per day against the background of organic heart damage and atrial dilatation is considered prognostically unfavorable.
• Malignant ventricular ES with a frequency of 10-100/hour against the background of heart disease, with paroxysms of tachycardia or cardiac arrest.
• Potentially malignant - threat of development of ventricular fibrillation.
• Detection of deterioration in parameters (decreased output, dilatation of the left ventricle) during repeated echocardiography.
• Regardless of tolerance, frequent extrasystole (more than 1.5-2 thousand per day), which is combined with a decrease in myocardial contractility.

Treatment of extrasystole at home involves taking antiarrhythmic drugs. It is better to select a drug in a hospital setting, since this is done by trial and error: the patient is sequentially (3-5 days) prescribed drugs in average daily doses and their effect is assessed based on the patient’s condition and ECG data. The patient takes the selected drug at home and periodically comes for a control ECG test. It sometimes takes several weeks to evaluate the antiarrhythmic effect.

Antiarrhythmic drugs for extrasystole

Different groups of drugs are used:

• Class I - sodium channel blockers: Quinidine durules , Aymalin , Ritmilen , Pulsnorma , Ethmozin . These drugs are equally effective. In emergency situations, intravenous administration is used Novocainamide . All representatives of class I antiarrhythmic drugs increase the mortality rate of patients with organic heart disease.
• Class II - these are β-blockers, which reduce the sympathetic effect on the heart. They are most effective for arrhythmias that are associated with psycho-emotional stress and physical activity. Drugs, Korgard , Trazicore , Visken , Cordanum .
• Class III - potassium channel blockers. Drugs that increase the duration of the action potential of cardiomyocytes. (active ingredient amiodarone) and (additionally has beta-blocker properties).
• Class IV - calcium channel blockers: Falicard .

• If patients of the first group are not bothered by extrasystoles, they are limited to general recommendations and explanations about the non-hazardous nature of such disorders. If people in this group have more than 1000 extrasystoles per day or significantly less, but with poor tolerance, or if the patients are over 50 years old, then treatment is necessary. Calcium antagonists (,) or β-blockers are prescribed. These groups of drugs are effective for NZHES. Begin treatment with half doses and, if necessary, gradually increase. One of the β-blocker drugs is prescribed: , . If extrasystoles appear at the same time, use a single dose of the drug at this time. Verapamil is recommended for a combination of extrasystoles and bronchial asthma. If there is no effect from these drugs, they switch to half doses of class I drugs (,). If they are ineffective, they switch to or Sotalol .
• Treatment of patients in group 2 is carried out according to the same scheme, but in larger doses. Complex treatment also includes: If you need to quickly achieve an effect, amiodarone is prescribed without testing other drugs.
• Patients of the 3rd group begin treatment with amiodarone 400-600 mg per day, Sotalola or Propafenone . Patients in this group need to take medications constantly. ACE inhibitors are also used.
• For patients with NVES due to bradycardia, it is recommended to prescribe Rhythmodan , Quinidine-durules or Allapinina . Additionally, you can prescribe drugs that increase heart rate: Teopek (theophylline), Nifedipine . If ES occurs against the background of nocturnal bradycardia, the drugs are taken at night.

Patients of the first and second groups after 2-3 weeks of taking the drug can reduce the dosage and completely stop the drug. The drug is also discontinued in case of undulating course of supraventricular ES during periods of remission. If pacemakers reappear, medications are resumed.

Extrasystoles caused by electrolyte imbalance

The antiarrhythmic activity of magnesium preparations is due to the fact that it is a calcium antagonist, and also has a membrane-stabilizing property, which class I antiarrhythmics have (prevents the loss of potassium), in addition, it suppresses sympathetic influences.

The antiarrhythmic effect of magnesium appears after 3 weeks and reduces the number of ventricular extrasystoles by 12%, and the total number by 60-70%. In cardiological practice, it is used, which contains magnesium and orotic acid. It is involved in metabolism and promotes cell growth. The usual regimen for taking the drug: 1st week, 2 tablets 3 times a day, and then 1 tablet 3 times. The drug can be used for a long time, it is well tolerated and does not cause side effects. In patients with this, stool returns to normal.

Other groups of drugs are used as auxiliary:

• Antihypoxants. Promotes better absorption of oxygen by the body and increases resistance to. Among the antihypoxic drugs used in cardiology.
• Antioxidants. They interrupt the reactions of free radical oxidation of lipids, destroy peroxide molecules, and compact membrane structures. Among the drugs, and are widely used.
• Cytoprotectors. Reception reduces the frequency of extrasystoles and episodes of ischemic ST depression. Available on the Russian market, Trimetazid , .

The doctors

Medicines

• Antiarrhythmic drugs: , , Aymalin , Ritmilen , Pulsnorma , Ethmozin .
• Beta blockers: Korgard , Trazicore , Visken , Cordanum .
• Magnesium and potassium preparations: , .
• Antioxidants and cytoprotectors: Trimetazid , .

Procedures and operations

The lack of effectiveness of conservative treatment is an indication for surgical techniques. How to get rid of extrasystole forever? An option for radical treatment of extrasystole is radiofrequency ablation of the ectopic focus. It is recommended in all cases of ES with a frequency of 10 thousand per day or more.

Radiofrequency ablation for supraventricular tachycardia is a first-line treatment method. For arrhythmogenic dysplasia of the right ventricle, surgical intervention should be early, since with the relief of arrhythmia, fatty degeneration of the myocardium stops. If the operation is not performed on time, in the later stages only heart transplantation is possible. The need to prescribe antiarrhythmic drugs after ablation may remain, but their effectiveness becomes higher than before surgery. In some cases, patients are able to wean off medications after ablation after 4-12 months.

To identify arrhythmogenic foci during surgery, an electrophysiological study is performed. Under local anesthesia, the main vessels are catheterized. Then catheters (for diagnostics) and an ablation electrode (to cauterize the lesion) are inserted into the heart. The procedure is often painless, but sometimes the patient feels discomfort in the heart area. General anesthesia is used for ablation of complex arrhythmias, which include ventricular arrhythmias and atrial fibrillation.

If there is a high risk of threatening rhythm disturbances (ventricular tachycardia or ventricular fibrillation), patients are implanted with a cardioverter-defibrillator. In case of extrasystole in patients with bradycardia, a permanent pacemaker is implanted.

Treatment of extrasystole with folk remedies

Treatment with folk remedies can only be used in combination with medication. Plants, vegetables and fruits that have a sedative, anti-sclerotic effect, contain potassium and magnesium, and reduce blood clotting will be useful. It can be serviceberry, raspberries, yarrow flowers, hawthorn fruits, currants, apricots, nuts, dried apricots, raisins, plums, cucumbers, watermelon, grapes, melon, cabbage, potatoes, parsley, vegetable tops, beans, beets, apples, valerian root , lemon balm herb.

Herbal diuretics: cornflower flowers, corn silk, bearberry leaf, lingonberry and birch leaves. Replenishment of potassium losses: birch leaves, parsley and hernia grass, apricot, quince, peach juice.

The following herbs are toxic and should be used with caution. However, this is not necessary, since official preparations are prepared on their basis:

• aconite herb (preparation);
• cinchona bark ( Quinidine sulfate );
• Rauwolfia serpentine roots (preparation Aymalin ).

Extrasystole in children

The appearance of extrasystoles in children is a consequence of:

• myocardial hypoxia;
• hormonal and electrolyte imbalance;
• neurovegetative disorders;
• inflammatory myocardial damage;
• anatomical damage to the myocardium;
• occur without obvious causes (idiopathic, found in most pediatric cases).

The incidence of idiopathic extrasystole depends on age. Single ventricular extrasystoles are detected in 23% of healthy newborns. The frequency of occurrence decreases to 10% in preschool children and schoolchildren, then increases again to the original figures in adolescents.

Left ventricular extrasystole often has a benign course in children and resolves independently with age. The course of right ventricular extrasystole is also favorable, but may be a consequence of arrhythmogenic dysplasia of the right ventricle.

Extrasystole in children in 80% develops against the background of neurovegetative disorders. They may not feel them or complain of “fading” of the heart and unpleasant sensations. By nature, extrasystoles are most often single and inconsistent. They are recorded mostly in a lying position, and decrease in a standing position or after exercise. Frequent and group extrasystoles and their combination with other changes on the ECG have more serious causes and a not very favorable prognosis. But in this case, the autonomic nervous system is also of great importance. Children with extrasystole do not require emergency treatment.

The decision to start treatment is made in children with frequent ventricular extrasystole. It depends on the concomitant pathology of the heart, the age of the child and hemodynamic disorders that cause extrasystoles. But in any case, the underlying disease is treated.

• Idiopathic PVCs, given their benign course, most often do not require treatment.
• In children with rare extrasystoles and good tolerance, only a comprehensive examination is performed.
• Children with frequent asymptomatic ventricular extrasystoles with normal myocardial contractile function are also not treated with medication. In some cases with frequent or polymorphic extrasystole, beta blockers or calcium channel blockers are prescribed, but their constant use is not recommended.
• With frequent ventricular ectopy, the presence of complaints and the development of arrhythmogenic myocardial dysfunction, the issue of prescribing beta blockers or ablation .
• In case of frequent or polymorphic ventricular extrasystoles and the ineffectiveness of beta blockers/calcium channel blockers, class I or III antiarrhythmic drugs are used.

Extrasystole during pregnancy

During pregnancy, one of the most common cardiac arrhythmias is extrasystole. In half of pregnant women it occurs without changes in the heart, endocrine system or gastrointestinal tract. During pregnancy, a change in the function of the thyroid gland occurs, so this reason is first ruled out. Among other causes of extrasystole in pregnant women, the following should be noted:

• changes in hemodynamics that occurred during this physiological period in women;
• electrolyte imbalance ( hypomagnesemia And hypokalemia );
• hormonal changes (increased levels);
• cardiopsychoneurosis;
• previously rescheduled myocarditis ;
• cardiomyopathy ;
• heart defects;
• emotional arousal;
• abuse of coffee and strong tea;
• drinking alcohol and smoking;
• abuse of spicy foods;
• binge eating.

Most often in women during this period, supraventricular extrasystoles (67%), then follow ventricular (up to 59%). Supraventricular ES is a common finding during routine routine examination and is recorded in healthy women. They are characterized by provoking factors such as stress, infection, overwork, smoking, abuse of caffeine-containing products and products that cause gas formation.

Ventricular extrasystoles either appear for the first time, or their frequency increases in pathological pregnancies and in normal pregnancies.

If the arrhythmia is not a threat to the woman’s life, then the prescription of antiarrhythmic drugs is avoided. Asymptomatic extrasystoles do not need correction with medications, and treatment begins with the elimination of provoking factors (emotional and physical stress, smoking, drinking coffee and alcohol).

If there is still a need to prescribe medications, then the treatment approaches are the same as for non-pregnant women. In this case, the possible effect of the drug on the fetus, the course of pregnancy and childbirth is strictly taken into account.

The drugs of choice during pregnancy are calcium channel blockers ( Verapamil ) and beta blockers ( Bisoprolol , Egilok , Propranolol ). The later medications are prescribed, the lower the risk of their effect on the condition of the fetus and the course of pregnancy. Thus, there are reports of a slowdown in fetal development when taking Atenolol And Propranolol in the first trimester, and their administration in the second trimester is considered safe. Most often pregnant women with frequent ventricular extrasystole are prescribed Bisoprolol . This drug did not have a teratogenic effect in animal studies.

Diet

The nutrition of patients depends on the underlying disease against which extrasystole developed.

• For all diseases of the cardiovascular system, the basic rule is to limit animal fats and salt. You can use Diet for cardiac arrhythmias or Diet for heart failure .
• For thyrotoxicosis, it is indicated for patients.
• If the cause of extrasystoles was anemia -.

In all cases, it is recommended to eat in small portions, since a large amount of food consumed can become a provoking factor. The last meal should be the lightest and 3 hours before bedtime. Secondly, caffeine-containing foods that increase gas formation (legumes, large amounts of bread and pastries, grapes, raisins, carbonated drinks, kvass), alcohol, and spicy foods are excluded from the diet. Each patient, observing his condition, can determine those foods that cause ES in him.

Nutrition should be rational and balanced in essential nutrients. Taking into account cardiovascular pathology, vegetables and fruits should prevail in the diet. It is also useful to include foods rich in magnesium (sesame, poppy seeds, cashews, almonds, hazelnuts, buckwheat and oatmeal, brown rice, beets) and potassium (apricots, peaches, dried apricots, a moderate amount of raisins) to prevent bloating - nuts , spinach, sun-dried tomatoes, prunes, honey, bee bread, potatoes, watermelons, bananas, melon, beef, fish.

Prevention

The main method of prevention is timely treatment of cardiovascular diseases. For patients with cardiac pathology, regular monitoring is important (with mandatory ECG and Holter monitoring stress test). In this case, it is necessary to determine the influence of the autonomic nervous system on the cardiovascular system, assess the psycho-emotional state, working conditions and bad habits.

Consequences and complications

In addition to unpleasant subjective sensations, after an extrasystole there is an unstable restoration of the function of the sinus node, and the extrasystoles themselves can cause hemodynamic disturbances. These disorders depend on the degree of premature extrasystoles, their location and frequency, and most importantly, on the condition of the heart. A short R-R interval does not provide high-quality blood filling in diastole.

With very early ventricular ES, the blood volume and the force of ventricular contraction are so small that the blood ejection is very small (systoles become ineffective). Frequent extrasystoles significantly reduce cardiac output, coronary and cerebral blood flow, and the pulse often drops (pulse deficiency). In patients with ischemic heart disease, during double ES occurs angina pectoris . Patients with atherosclerosis cerebral vessels may complain of severe weakness and dizziness. With rare extrasystoles, very noticeable changes in the volume of blood ejection do not occur.

The main consequences of ventricular extrasystole can be identified:

• Severe left ventricular hypertrophy.
• Significant decrease in left ventricular ejection fraction.
• Risk of progression to flutter or ventricular fibrillation.
• The main complication of malignant ventricular ES is sudden death.

Consequences of supraventricular extrasystole:

• Enlargement of the cavities of the heart (arrhythmogenic cardiomyopathy develops).
• Development of supraventricular tachycardia. It is characterized by rapid cardiac activity (during an attack, the heart rate reaches 220-250 beats per minute), which suddenly begins and stops.
• Development of atrial fibrillation (synonymous with atrial fibrillation). This is a chaotic and frequent contraction of the atria. During an attack, heart rate increases significantly. The occurrence of atrial fibrillation is a criterion for the malignancy of supraventricular extrasystole.

Forecast

Extrasystoles are safe in most cases, and their prognostic value is completely determined by the degree of heart damage and the condition of the myocardium. In the absence of myocardial damage and normal LV function (if the ejection fraction is 50% or more), extrasystole does not pose a threat to the patient’s life and does not affect the prognosis, since the likelihood of developing fatal arrhythmias is extremely low.

Such arrhythmias are classified as idiopathic. With organic damage to the myocardium, extrasystole is considered an unfavorable sign. Ventricular extrasystoles, if diagnosed with coronary artery disease, are associated with a risk of death. High gradations of extrasystoles are the most dangerous. Patients with potentially malignant ES require treatment to reduce mortality. Polytopic PVC has a worse prognosis than single monotopic PVC. Rare ES do not increase the risk of death.

List of sources

• Diagnosis and treatment of atrial fibrillation. Recommendations of RKO, VNOA, ASSH, 2012 // Russian Journal of Cardiology. 2013. No. 4. P. 5–100.
• Lyusov V.A., Kolpakov E.V. Cardiac arrhythmias. Therapeutic and surgical aspects. – M.: GEOTAR-Media, 2009. – 400 p.
• Shpak L.V. Heart rhythm and conduction disorders, their diagnosis and treatment: A guide for doctors. – Tver, 2009. – 387 p.
• Standard ECG parameters in children and adolescents / Ed. Shkolnikova M. A., Miklashevich I. M., Kalinina L. A. M., 2010. 232 p.
• Shevchenko N.M. Cardiology // MIA. – Moscow 2004 – 540 p. 7. Chazov E.I., Bogolyubov V.M. Heart rhythm disturbances // M.: Medicine, 1972.

Heart rhythm disturbances, which manifest themselves in extraordinary contractions, can be caused by many reasons. Most often they are heart diseases: myocarditis, inflammatory processes and ischemia. The reasons may be external influences, electrolyte imbalances, coffee addiction and sports activities.

Detection of extrasystole on an ECG raises questions: what is it and when does it occur? Scientists and doctors have so far answered these questions unequivocally. The problem with extrasystoles is the influence of the vagus nerve, which blocks the work of the rhythm-forming sinus node. Recent studies show that an unusual type of heart rhythm disorder occurs in apparently healthy people and is recorded in 70–80% of patients in the second half of life.

Formation of heart rhythm

The heart rhythm is formed thanks to the sinus atrial node. It is located at the border of the confluence of the superior vena cava with the right atrium and sets the rhythm from 60 to 100. The atrioventricular or atrioventricular node is located a little further, acting as a filter for impulses, providing a delay so that the atrium and ventricles can contract.

The entire mechanical conduction system of the heart is associated with electrical excitation, a current that covers the muscle and makes it possible to contract effectively. Normally, the heart contracts sequentially: first the atrium, then the ventricles.

With extrasystole, the heart rhythm malfunctions. Rhythm disturbances come in a variety of forms. The most difficult thing is when ventricular extrasystoles occur, causing a high rhythm frequency. Then the person may die suddenly. But there are situations when the ventricles in the heart contract at the wrong time. Such conditions are called extrasystole. A heart that contracts irregularly gets tired. This causes heart failure.

Reasons for violations

Extrasystole is not without reason. Rhythm pathologies are promoted by social factors and diseases:

• hypertonic disease;
• ischemic syndrome;
• cardiosclerosis;
• myocarditis;
• gastrointestinal diseases;

• osteochondrosis;
• diseases of the nervous system;
• thyroid disorders (hyperthyroidism);
• diabetes;
• smoking;
• alcohol;
• obesity.

An overdose of glycosides in the heart is also caused by excessive consumption of caffeine-containing drinks, sports activities, and stress factors. The pathology becomes dangerous when the number of extrasystoles exceeds 10 within an hour.

There are congenital extrasystoles, when in the conduction system, in addition to the sinoatrial and ventricular nodes, an additional impulse path appears - a circular one. In this situation, the impulse spins the movement in the heart between the atrioventricular node and a circle of repetition occurs, giving a high heart rate and the development of tachyarrhythmia.

Symptoms

Detection of rhythm disturbances and extrasystoles occurs through monitoring. The detected extrasystoles on the ECG, in most cases, do not manifest themselves externally to the patient, but critical conditions arise when for every complete sinus contraction there is one defective one. Thus, in the absence of a mechanical response, the release of blood into the heart is halved, the pulse slows down to 25–30. The person may lose consciousness.

Usually, single extrasystoles do not cause symptoms. With frequent exposure to the pumping function of the main muscle and consecutive impulses, the main symptom is observed - a feeling of a strong blow, freezing, and trembling of the heart. For people who do not suffer from heart disease, extrasystole is not dangerous. Deterioration of the condition during extrasystole is determined based on the following symptoms:

• Anxious dream. The patient often wakes up in the middle of the night.
• Loss of performance. Fatigue occurs quickly.
• Attacks of weakness.
• Motion sickness or seasickness.
• Dizziness with increased exertion.
• Lack of air.
• Anxiety due to nervous tension. Symptoms that accompany anxiety occur: hyperhidrosis, pallor, tremor.

With developing extrasystole, blood circulation is disrupted, which, in turn, affects the functioning of the brain, liver and kidneys. Interruptions of blood supply to the heart and brain lead to fainting, angina, paresis and speech impairment.

In patients who have had a heart attack or have heart failure, extrasystole provokes dangerous complications that threaten sudden death.

Diagnosis based on ECG data and types

The category of patients with symptoms of extrasystole requires a thorough study of the rhythm. A cardiogram is one of the main methods for diagnosing ventricular extrasystoles. The electrocardiography method makes it possible to take a detailed approach to the manifestation of disorders in the heart and identify the types of extrasystoles.

Usually, when atrial pathology appears in the cardiogram against the background of sinus rhythm, QRS complexes with changes in the P wave and prematurely occurring QRS complexes are found. After it, a compensatory pause occurs, which means atrial extrasystole.

Supraventricular extrasystoles

Nodal contractions occur in the atrioventricular node. Such changes are called supraventricular extrasystoles. They are divided into:

• upper node;
• mid-nodal;
• inferior nodes.

Supernodal extrasystole on the ECG is characterized by the fact that the P waves before the premature QRS complex arise with a negative phase. After the QRS complex, an incomplete compensatory pause occurs.

If the extrasystoles are located in the middle part of the atrioventricular node, then the QRS complex does not change, and there is, as a rule, no P wave. It is buried in a complex in the form of various notches, so it seems that the QRS is without a P wave.

If extrasystoles follow in the lower part of the node after excitation of the QRS complex, on the ST segment, on the T wave or after it, such contractions are defined as lower node extrasystoles.

Ventricular extrasystole

When abnormal electrical activity occurs from the His bundle, extrasystole is called ventricular. Ventricular extrasystoles differ from supraventricular extrasystoles in that they are not similar to the QRS complex of the normal cardiac cycle. Their indicator is widened high teeth. Ventricular extrasystoles are characterized by the fact that the P wave is not fixed in front of them; he is buried in the QRS complex. Ventricular extrasystole occurs prematurely and after it a complete compensatory pause is recorded.

If supraventricular or ventricular contractions occur at the site of the normal cardiac cycle, they do not have a compensatory pause and are called late extrasystoles.

Based on the number of foci of excitation in the heart, monotopic and polytopic extrasystoles are distinguished. With monotopic extrasystole, the impulses come from one area, with polytopic extrasystole - from two or more foci.

Patients with registered polytopic ventricular extrasystoles, as well as frequent, early and group untimely contractions of the heart, require emergency assistance to eliminate arrhythmia.

Patients whose heart suffers significantly after a heart attack and has frequent ventricular extrasystoles may undergo an electrophysiological study to assess the risk of sudden death. The need for such research does not always arise.

Treatment

If a person’s heart is healthy, if arrhythmias are detected, it is necessary first of all to extinguish the degree of excitation:

• reduce the impact of stress;
• reduce the number of cigarettes smoked;
• stop drinking alcohol;
• Avoid over-the-counter medications.

If the condition worsens and the symptoms of extrasystole increase, complex therapy based on drugs is used.

Drug therapy

Drug therapy is prescribed only in cases where the symptoms are severe or a dangerous type of extrasystole is identified. To begin with, beta blockers are prescribed. Effective and harmless drugs block adrenergic receptors and affect the functioning of the nervous system, restoring the correct rhythm. However, many with detected extrasystole refuse to take them due to a possible side effect - drowsiness. Beta blockers are contraindicated in individuals with bradycardia. In this case, anticholinergics are prescribed.

Antiarrhythmic drugs are required by injection to stop an attack of extrasystole or to maintain the correct rhythm in the heart. Some drugs that suppress ventricular activity may increase the risk of arrhythmia, so they are prescribed with great caution after serious examinations.

If extrasystole occurs due to emotional stress and neurosis, treatment is carried out with the help of sedatives. Along with sedatives, acupuncture, acupressure and physiotherapy methods are widely used. Such extrasystole is not dangerous.

In children

If single ventricular extrasystoles are detected in children, the doctor will recommend adhering to a proper lifestyle and diet. Treatment is replaced by annual monitoring under the supervision of a cardiologist.

In cases of extrasystole, when a positive result is not observed, there is a need to take drugs with an antiarrhythmic effect. Then the patient is subject to hospitalization and constant monitoring using an ECG in a hospital setting.

With the onset of menopause, women and after 40 years of age, men need to maintain heart function and avoid the main risk factors:

• smoking;
• excess body weight;
• sedentary lifestyle;
• depression;
• drinking strong tea and coffee.

This is a basic list of measures to maintain heart rate and health. In terms of sports and physical education, intensity loads are relevant. Walking, jogging, swimming, spinning or cycling are good.

Nutrition

With extrasystole, emphasis also needs to be placed on nutrition. If a person has any heart problems in the form of high cholesterol, metabolic disorders, high sugar, then food that is good for the heart is needed:

• lean meat;
• fatty fish;
• unrefined oils that help regulate cholesterol levels;
• a daily portion of raw vegetables and fruits with a high potassium content (bananas, jacket potatoes, parsley, raisins, dried apricots);
• nuts;
• bran or whole grain bread.

Tea and coffee contain substances that increase vascular tone and increase heart rate, so you should not abuse these products. Coffee lovers don't have to give up their favorite drink completely. You just need to limit your consumption of brewed coffee to 1-2 cups. The soluble analog contains more caffeine. Black tea increases heart rate more than coffee, so green tea is the most preferred one here.

Special Moves

To activate the vagus nerve in the heart during extrasystole or high contraction frequency, special techniques are used:

• Breathing technique is held, with deep inhalation and exhalation.
• Valsalva maneuvers. The nose is pinched, the stomach is strained. The person remains in this position for 15 seconds and can restore the rhythm.
• Applying pressure on the eyeballs with your fingers for 20 seconds (the method is contraindicated for those who have eye pathologies).
• Sit or lie down if you feel dizzy and have a fast heartbeat.
• 10 drops of Valocordin.
• Chermak-Hering test. The area of ​​the carotid artery is pressed with two fingers. The method effectively relieves atrial supraventricular tachycardia, but this is not recommended for older people.

Arrhythmia occurs only under one condition - when premature electrical activity appears in the atrium or ventricle. Without extrasystole, tachycardia does not start. Extrasystole occurs at a later age and is recurrent. After the first episode of arrhythmia, you must definitely see a doctor - a cardiologist or arrhythmologist.

– this is a variant of cardiac arrhythmia, characterized by extraordinary contractions of the entire heart or its individual parts (extrasystoles). It manifests itself as a feeling of a strong heartbeat, a feeling of a sinking heart, anxiety, and lack of air. Diagnosed based on the results of ECG, Holter monitoring, and stress cardio tests. Treatment includes eliminating the root cause, drug correction of heart rhythm; in some forms of extrasystole, radiofrequency ablation of arrhythmogenic zones is indicated.

ICD-10

I49.1 I49.2 I49.3

General information

Extrasystole is premature depolarization of the atria, ventricles, or atrioventricular junction, leading to premature contraction of the heart. Single episodic extrasystoles can occur even in practically healthy people. According to electrocardiographic studies, extrasystole is recorded in 70-80% of patients over 50 years of age. A decrease in cardiac output during extrasystole entails a decrease in coronary and cerebral blood flow and can lead to the development of angina pectoris and transient cerebrovascular accidents (fainting, paresis, etc.). Extrasystole increases the risk of developing atrial fibrillation and sudden cardiac death.

Causes of extrasystole

Functional extrasystole, which develops in practically healthy people for no apparent reason, is considered idiopathic. Functional extrasystoles include:

• rhythm disturbances of neurogenic (psychogenic) origin associated with food (drinking strong tea and coffee), chemical factors, stress, alcohol intake, smoking, drug use, etc.;
• extrasystole in patients with vegetative dystonia, neuroses, osteochondrosis of the cervical spine, etc.;
• arrhythmia in healthy, well-trained athletes;
• extrasystole during menstruation in women.

Extrasystole of an organic nature occurs in case of myocardial damage due to:

• IHD, cardiosclerosis, myocardial infarction,
• pericarditis, myocarditis,
• chronic circulatory failure, cor pulmonale,
• sarcoidosis, amyloidosis, hemochromatosis,
• cardiac operations,
• In some athletes, the cause of extrasystole may be myocardial dystrophy caused by physical overstrain (the so-called “athlete’s heart”).

Toxic extrasystoles develop when:

• feverish conditions,
• proarrhythmic side effect of certain drugs (aminophylline, caffeine, novodrin, ephedrine, tricyclic antidepressants, glucocorticoids, neostigmine, sympatholytics, diuretics, digitalis drugs, etc.).

The development of extrasystole is caused by a violation of the ratio of sodium, potassium, magnesium and calcium ions in myocardial cells, which negatively affects the conduction system of the heart. Physical activity can provoke extrasystoles associated with metabolic and cardiac disorders, and suppress extrasystoles caused by autonomic dysregulation.

Pathogenesis

The occurrence of extrasystole is explained by the appearance of ectopic foci of increased activity localized outside the sinus node (in the atria, atrioventricular node or ventricles). Extraordinary impulses arising in them spread throughout the heart muscle, causing premature contractions of the heart in the diastole phase. Ectopic complexes can form in any part of the conduction system.

The volume of extrasystolic blood ejection is lower than normal, so frequent (more than 6-8 per minute) extrasystoles can lead to a noticeable decrease in the minute volume of blood circulation. The earlier the extrasystole develops, the less blood volume accompanies the extrasystolic ejection. This, first of all, affects coronary blood flow and can significantly complicate the course of existing cardiac pathology.

Different types of extrasystoles have different clinical significance and prognostic characteristics. The most dangerous are ventricular extrasystoles that develop against the background of organic heart damage.

Classification

According to the etiological factor, extrasystoles of functional, organic and toxic origin are distinguished. According to the place of formation of ectopic foci of excitation, the following are distinguished:

• atrioventricular (from the atrioventricular junction - 2%),
• atrial extrasystoles (25%) and various combinations of them (10.2%).
• in extremely rare cases, extraordinary impulses come from the physiological pacemaker - the sinoatrial node (0.2% of cases).

Sometimes the functioning of the focus of ectopic rhythm is observed regardless of the main (sinus), while two rhythms are observed simultaneously - extrasystolic and sinus. This phenomenon is called parasystole. Extrasystoles that follow two in a row are called paired, more than two are called group (or salvo). There are:

• bigeminy- rhythm with alternation of normal systole and extrasystole,
• trigemyny– alternation of two normal systoles with an extrasystole,
• quadrigymenia- the following extrasystole after every third normal contraction.

Regularly recurring bigeminy, trigeminy and quadrigymeny are called allorhythmia. Based on the time of occurrence of an extraordinary impulse in diastole, early extrasystole is distinguished, recorded on the ECG simultaneously with the T wave or no later than 0.05 seconds after the end of the previous cycle; middle - 0.45-0.50 s after the T wave; late extrasystole developing before the next P wave of normal contraction.

According to the frequency of occurrence of extrasystoles, rare (less than 5 per minute), medium (6-15 per minute), and frequent (more than 15 per minute) extrasystoles are distinguished. According to the number of ectopic foci of excitation, extrasystoles are monotopic (with one foci) and polytopic (with several foci of excitation).

Symptoms of extrasystole

Subjective sensations during extrasystole are not always expressed. The tolerance of extrasystoles is more severe in people suffering from vegetative-vascular dystonia; patients with organic heart damage, on the contrary, can tolerate estrasystole much easier. More often, patients feel extrasystole as a blow, a push of the heart into the chest from the inside, caused by vigorous contraction of the ventricles after a compensatory pause.

Also noted are “tumbling or turning over” of the heart, interruptions and freezing in its work. Functional extrasystole is accompanied by hot flashes, discomfort, weakness, anxiety, sweating, and lack of air.

Frequent extrasystoles, which are early and group in nature, cause a decrease in cardiac output, and, consequently, a decrease in coronary, cerebral and renal circulation by 8-25%. Patients with signs of cerebral atherosclerosis experience dizziness, and transient forms of cerebral circulatory disorders (fainting, aphasia, paresis) may develop; in patients with coronary artery disease - angina attacks.

Complications

Group extrasystoles can transform into more dangerous rhythm disturbances: atrial - into atrial flutter, ventricular - into paroxysmal tachycardia. In patients with atrial overload or dilatation, extrasystole can develop into atrial fibrillation.

Frequent extrasystoles cause chronic insufficiency of coronary, cerebral, and renal circulation. The most dangerous are ventricular extrasystoles due to the possible development of ventricular fibrillation and sudden death.

Diagnostics

History and objective examination

The main objective method for diagnosing extrasystole is an ECG study, however, it is possible to suspect the presence of this type of arrhythmia during a physical examination and analysis of the patient’s complaints. When talking with the patient, the circumstances of the occurrence of arrhythmia are clarified (emotional or physical stress, in a calm state, during sleep, etc.), the frequency of episodes of extrasystole, and the effect of taking medications. Particular attention is paid to the history of past diseases that can lead to organic heart damage or their possible undiagnosed manifestations.

During the examination, it is necessary to find out the etiology of extrasystoles, since extrasystoles with organic heart damage require different treatment tactics than functional or toxic ones. When palpating the pulse on the radial artery, an extrasystole is defined as a prematurely occurring pulse wave followed by a pause or as an episode of pulse loss, which indicates insufficient diastolic filling of the ventricles.

When auscultating the heart during extrasystole, premature I and II sounds are heard above the apex of the heart, while the I tone is strengthened due to low filling of the ventricles, and the II sound is weakened as a result of a small ejection of blood into the pulmonary artery and aorta.

Instrumental diagnostics

The diagnosis of extrasystole is confirmed after an ECG in standard leads and daily ECG monitoring. Often, using these methods, extrasystole is diagnosed in the absence of patient complaints. Electrocardiographic manifestations of extrasystole are:

• premature occurrence of the P wave or QRST complex; indicating a shortening of the pre-extrasystolic coupling interval: with atrial extrasystoles, the distance between the P wave of the main rhythm and the P wave of the extrasystoles; with ventricular and atrioventricular extrasystoles - between the QRS complex of the main rhythm and the QRS complex of the extrasystoles;
• significant deformation, expansion and high amplitude of the extrasystolic QRS complex during ventricular extrasystole;
• absence of the P wave before the ventricular extrasystole;
• following a complete compensatory pause after a ventricular extrasystole.

Holter ECG monitoring is a long-term (over 24-48 hours) ECG recording using a portable device attached to the patient’s body. Registration of ECG indicators is accompanied by keeping a diary of the patient’s activity, where he notes all his sensations and actions. Holter ECG monitoring is performed for all patients with cardiac pathology, regardless of the presence of complaints indicating extrasystole and its detection with a standard ECG.

Forecast

The prognostic assessment of extrasystole depends on the presence of organic heart damage and the degree of ventricular dysfunction. The most serious concerns are caused by extrasystoles that develop against the background of acute myocardial infarction, cardiomyopathy, and myocarditis. With pronounced morphological changes in the myocardium, extrasystoles can turn into atrial or ventricular fibrillation. In the absence of structural damage to the heart, extrasystole does not significantly affect the prognosis.

The malignant course of supraventricular extrasystoles can lead to the development of atrial fibrillation, ventricular extrasystoles - to persistent ventricular tachycardia, ventricular fibrillation and sudden death. The course of functional extrasystoles is usually benign.

Prevention

In a broad sense, the prevention of extrasystole involves the prevention of pathological conditions and diseases underlying its development: ischemic heart disease, cardiomyopathies, myocarditis, myocardial dystrophy, etc., as well as the prevention of their exacerbations. It is recommended to exclude drug, food, and chemical intoxications that provoke extrasystole.

For patients with asymptomatic ventricular extrasystole and without signs of cardiac pathology, a diet enriched with magnesium and potassium salts, cessation of smoking, drinking alcohol and strong coffee, and moderate physical activity are recommended.

– a type of cardiac arrhythmia 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, and lack of air. The diagnosis of ventricular extrasystole is established on the basis of data from cardiac auscultation, ECG, and Holter monitoring. In the treatment of ventricular extrasystole, sedatives, ß-blockers, and antiarrhythmic drugs are used.

General information

Extrasystolic arrhythmias (extrasystoles) are the most common type of rhythm disturbances, occurring in different age groups. Taking into account the place of formation of the ectopic focus of excitation in cardiology, ventricular, atrioventricular and atrial extrasystoles are distinguished; Of these, ventricular ones are the most common (about 62%).

Ventricular extrasystole is caused by premature excitation of the myocardium in relation to the leading rhythm, emanating from the conduction system of the ventricles, mainly the branches of the His bundle and Purkinje fibers. When recording an ECG, ventricular extrasystoles in the form of single extrasystoles are detected in approximately 5% of healthy young people, and with 24-hour ECG monitoring - in 50% of subjects. The prevalence of ventricular extrasystole increases with age.

Causes

Ventricular extrasystole can develop in connection with organic heart diseases or be idiopathic in nature.

Most often, the organic basis of ventricular extrasystole is ischemic heart disease; in patients with myocardial infarction it is recorded in 90-95% of cases. The development of ventricular extrasystole may be accompanied by the course of post-infarction cardiosclerosis, myocarditis, pericarditis, arterial hypertension, dilated or hypertrophic cardiomyopathy, chronic heart failure (CHF), cor pulmonale, mitral valve prolapse.

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

Possible causes of ventricular extrasystole include iatrogenic factors: overdose of cardiac glycosides, use of ß-adrenergic stimulants, antiarrhythmic drugs, antidepressants, diuretics, etc.

Classification

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

Diagnostics

The main methods for detecting ventricular extrasystole are ECG and Holter ECG monitoring. The electrocardiogram records the 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

Special treatment is not indicated for persons with asymptomatic ventricular extrasystole without signs of organic heart pathology. Patients are recommended to follow a diet enriched with potassium salts, eliminate 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 symptoms associated with ventricular extrasystole and prevent life-threatening arrhythmias. Treatment begins with the prescription of sedatives (herbal medicines or small doses of tranquilizers) and ß-blockers (anaprilin, obzidan). In most cases, these measures manage to achieve a good symptomatic effect, expressed in a decrease in the number of ventricular extrasystoles and the strength of post-extrasystolic contractions. In case of existing bradycardia, relief of ventricular extrasystole can be achieved by prescribing anticholinergic drugs (belladonna alkaloids + phenobarbital, ergotoxin + belladonna extract, etc.).

In case of severe health problems and in cases of ineffectiveness of therapy with beta-blockers and sedatives, it is possible to use antiarrhythmic drugs (procainamide mexiletine, flecainide, amiodarone, sotalol). The selection of antiarrhythmic drugs is made by a cardiologist under the control of ECG and Holter monitoring.

With frequent ventricular extrasystole with an established arrhythmogenic focus and lack of effect from antiarrhythmic therapy, radiofrequency catheter ablation is indicated.

Forecast

The course of ventricular extrasystole depends on its form, the presence of organic heart pathology and hemodynamic disorders. Functional ventricular extrasystoles do not pose a threat to life. Meanwhile, ventricular extrasystole, developing 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.

Extrasystole is an extraordinary cardiac contraction that is caused by an ectopic focus of automatism. Now we are talking about ventricular extrasystole (VC), which means that such an ectopic focus can be any part of the myocardium in the right or left ventricles, as well as the bundle branches (after their branching).

If you wish, you can learn to determine from which exact place the extrasystole originated, but this does not have much practical significance in the tactics of drug treatment. Such an in-depth understanding is important if invasive treatment - ablation - is planned. It will be enough for therapists to simply learn to distinguish ventricular extrasytolia from supranatural one and this will already be enough.

And so, the main signs of ventricular extrasystole are:

1. Appearance premature QRST complex (before the next normal ventricular complex should have appeared). This is a very important rule that “newbies” often forget!

2. There is no P wave before the extrasystolic QRS complex, and the extrasystolic QRS complex itself is significantly widened (more than 0.11-0.12 s) and deformed, usually like a right or left bundle branch block (we’ll talk about blocks in the relevant sections).

In general, the appearance of ventricular extrasystole is very typical: such a large, ugly, “squiggle” among normal, familiar, narrow complexes. It immediately catches your eye and will definitely distract you from the correct plan for interpreting the ECG - do not give in to temptation.

Terminology:

Monotopic extrasystole- originating from the same source of excitation (determined by the R interval or the beginning of extrasystoles, only if there are several extrasystoles on the recording).

Monomorphic extrasystole- the complexes are identical in shape (determined by eye).

Interpolated (inserted) extrasystole- without a compensatory pause after itself (more on this later).

Bigeminy- they talk about bigeminy when every second ( -bi

Trigeminy— they talk about trigemy when every third ( -three) the complex on the ECG is extrasystolic.

Quadrigeminy- they talk about trigemy when every fourth ( -quadra) the complex on the ECG is extrasystolic.

Allorhythmia- common name for bigeminy, trigeminy, quadrigeminy, etc.

Paired ventricular extrasystoles or couplet- two extrasystoles in a row.

Volvo ventricular extrasytolia- three ventricular extrasystoles in a row. If there are 4 or more extrasystoles in a row, then this is called ventricular tachycardia.

Let's look at examples

ECG No. 1

The first two complexes are of sinus origin, the third complex arose prematurely (i.e., it is an extrasystole). In addition, it is deformed and widened. After the extrasystole there is a compensatory pause - in this case, complete, since the interval between two normal complexes (2 and 4), between which the extrasystole is located, is equal to two normal RR intervals.

* The extrasytolic complex resembles a block of the left bundle branch (we'll talk about this later), which means this is a ventricular extrasystole from the right ventricle. The topic of extrasystoles has no clinical significance, but many functionalists like to clarify. There is also an opinion that left ventricular extrasystoles are more dangerous than right ventricular extrasystoles - but this is not so.

ECG No. 2

The first three complexes are of sinus origin, the fourth complex arose prematurely, it is deformed and widened. After the extrasystole there follows a compensatory pause - complete, since the interval between two normal complexes (3 and 5) is equal to two normal RR intervals.

The extrasytolic complex resembles a right bundle branch block (we'll talk about this later), which means it's a ventricular extrasystole from the left ventricle.

ECG No. 3

I think you are already able to notice the extrasystole, and you also noticed that there is no compensatory pause after it, it seems to be inserted between two normal QRS complexes. This is what an interpolated or intercalated ventricular extrasystole looks like.

ECG No. 4

Every second complex is an extrasystole, which means we are talking about ventricular bigeminy. The red segments mark the so-called coupling interval (ideally, it is measured a little differently, but for simplicity it is depicted like this), it is the same for all extrasystoles, which means the extrasystoles are monotopic (come from the same focus of automatism). The shape or appearance of the extrasystoles are also the same, which means the extrasystoles monomorphic.

ECG No. 5

Pay attention to the recording speed, it is 25 mm/s! On an ECG there is ventricular trigeminy; it is not always possible to simply see trigeminy on a shorter recording.

ECG No. 6

On the ECG we see deformed premature extrasystolic complexes (3 and 4) following in a row.

In general, we have examined the most common types of ventricular extrasystoles, I think now you will not have any special problems recognizing them. Now we will read the theory for supraventricular extrasystole and then we will complete the task for extrasystole.