Rare solitary ventricular extrasystoles. What are solitary ventricular extrasystoles? How is pathology diagnosed?

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.

What it is?

Ventricular extrasystole is one of the types of arrhythmias, which are premature, out of turn, contractions of the ventricles. Ventricular extrasystole is characterized by a feeling of disturbances in the work of the heart in the form of failures, weakness, dizziness, pain of an anginal nature and lack of air.

This type of arrhythmia is established after listening to the heart, electrocardiogram and Holter monitoring. And for the treatment of extraordinary contraction of the ventricles, sedative drugs, beta-blockers and antiarrhythmic drugs are used.

Causes

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 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, normal sinus rhythm is most often maintained. But extrasystoles can also occur against the background of atrial fibrillation.

Classification

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.

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;
• Grade 5 includes ventricular tachycardia.

Symptoms

Single ventricular premature contractions are recorded in half of healthy young people during monitoring for 24 hours (ECG Holter monitoring). They don't make you feel good. Symptoms of ventricular extrasystoles appear when premature contractions begin to have a noticeable effect on the normal heart rhythm.

Ventricular extrasystole without concomitant heart disease is very poorly tolerated by the patient. This condition usually develops against the background of bradycardia (rare pulse) and is characterized by the following clinical symptoms:

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

Ventricular extrasystoles on the background organic diseases hearts are usually multiple, but the patient is asymptomatic. They develop with physical activity and pass in the supine position. Usually this type of arrhythmia develops against the background of tachycardia.

Many women during pregnancy experience tachycardia and pain in the left side of the chest. ZhES development future mother- a common occurrence. This is explained by the fact that circulatory system and the heart lies a double burden. In addition, one should take into account the physiological restructuring of the hormonal background, which affects the rhythm of impulses. Such extrasystole is not malignant and can be easily treated after childbirth.

Diagnostic methods

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

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

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

Treatment of ventricular extrasystole

With benign ventricular extrasystole, which is well tolerated by patients, drug treatment is not carried out. They recommend giving up bad habits, modifying risk factors, taking Corvalol is possible.

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

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

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

Lifestyle with ventricular extrasystoles

With ventricular extrasystole, especially caused by other heart diseases, you need to rest more, stay in the fresh air more often, observe a work and rest regime, eat right, avoid drinking coffee, alcohol, reduce or eliminate smoking.

Patients with a benign type of ventricular extrasystole do not need to limit physical activity. In the malignant type, significant stress and psycho-emotional situations that can lead to the development of an attack should be limited.

Folk methods

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

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

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

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

Consequences

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

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

1. Stable ventricular tachycardia is characterized by prolonged (more than half a minute) attacks of group ventricular extrasystoles. It, in turn, provokes the consequences shown later in this table.
2. Ventricular flutter Contraction of the ventricles with a frequency of 220 to 300 beats per minute.
3. Fibrillation (flicker) of the ventricles Chaotic contractions of the ventricles, the frequency of which reaches 450 beats per minute. The flickering ventricles are unable to pump blood, so the patient usually loses consciousness due to lack of oxygen in the brain. This condition, if left untreated, can lead to death.
4. Asystole (cardiac arrest) May occur on the background of an attack of ventricular arrhythmia or suddenly. Often, asystole inevitably leads to death, since doctors are not always able to carry out resuscitation within a few minutes after cardiac arrest.

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

Forecast

With a benign course and the absence of an underlying cardiac disease, the prognosis is favorable.

With a potentially malignant type and in the presence of organic damage the prognosis of the heart is relatively unfavorable and is determined not only by the characteristics of ventricular extrasystoles according to ECG monitoring (frequent, medium, paired, group), but also by the nature of the underlying disease and the stage of heart failure, in the later stages of which the prognosis is not favorable. In a malignant course, the prognosis is unfavorable due to a very high risk of sudden cardiac death.

The prognosis can be improved by taking antiarrhythmic drugs in combination with beta-blockers, since the combination of these drugs not only improves the quality of life, but also significantly reduces the risk of complications and death.

Disease prevention

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

Identification of the disease can occur even during a routine preventive examination, for this reason, a health check in a medical institution is a must for everyone.

Coordinated contraction of the atria, and then the ventricles, is possible with the sequential propagation of an electrical impulse along the conduction pathways of the heart. However, there are situations when the correct rhythm is broken. One of them is ventricular extrasystole - an extraordinary contraction of the ventricles under the action of an impulse that has arisen in the pathological focus.

Classification of pathology

In frequency, rare extrasystoles (up to 5 per minute) and medium frequency (5-15 per minute) differ. Frequent ventricular extrasystole is characterized by the appearance of more than 15 premature contractions per minute, tens of thousands of such extrasystoles can be recorded per day.

There are single, paired and group (3 - 4 in a row) ventricular extrasystoles (VE).

They may come from the right or left ventricle. This can be seen on the cardiogram, but clinical significance the origin of extrasystoles has no.

Depending on the focus of pathological impulses, there are:

• monotopic ventricular extrasystole (all premature contractions occur in one area of ​​​​the heart muscle);
• polytopic ventricular extrasystole (there are several areas of formation of a pathological electrical signal).

According to the form of the PVC, which is visible on the ECG, it stands out:

• monomorphic ventricular extrasystole (all pathological contractions look the same, this indicates the monotony of their origin);
• polymorphic ventricular extrasystole (the form of PVC is different, which may indicate different foci of impulse formation).

The frequency of PVCs varies. Often these are episodic contractions that occur without a definite pattern. If the extrasystolic complex is replaced by a sinus (normal) complex, and then the PVC reappears, that is, there is an alternation “through one”, this is bigeminia ventricular extrasystole. When two normal contractions are recorded, and then PVC, after which the cycle repeats - this is trigeminy.

In addition, there is a variant of parasystole, when the formation of a pathological impulse does not depend in any way on sinus contractions. The focus independently works in its own rhythm, causing regular extrasystoles. They fall into different areas. sinus rhythm, so outwardly they are quite easy to distinguish from episodic PVCs.

With the help of 24-hour ECG monitoring, 5 classes of PVCs were identified, which have different dangers for humans:

• 0: single per day;
• 1: rare ventricular premature beats, up to 30 per hour;
• 2: more than 30 per hour;
• 3: polytopic;
• 4: paired and group PVCs;
• 5: "R on T", that is, early. They are considered dangerous in relation to the occurrence of ventricular fibrillation, although this statement is now being revised.

Classes 0 and 1 are not dangerous. The rest usually appear with chronic heart disease and can cause severe arrhythmias.

Reasons for development

As with many arrhythmias, the causes of ventricular extrasystole are diverse - from harmless temporary conditions to serious illnesses.

Rare single PVCs occur in many people. They are caused by emotional stress, excessive smoking or caffeine intake, and energy drinks. Such extrasystoles also appear with neuro-circulatory dystonia.

Usually, PVCs are detected in heart disease, for example:

• ischemic disease, angina pectoris;
• myocardial infarction;
• post-infarction aneurysm (saccular protrusion of the wall) of the left ventricle;
• cardiomyopathy - dilated, restrictive, hypertrophic;
• myocardial dystrophy;
• myocarditis - viral, bacterial, allergic;
• postmyocarditis cardiosclerosis - scarring of the heart tissue after acute inflammation;
• heart defects;
• developmental anomalies, such as prolapse mitral valve;
• pericarditis;
• hypertonic disease;
• heart failure.

Reasons for the development of extrasystole in different age groups:

Violation of the rhythm "ventricular extrasystole" often appears with a toxic effect on the myocardium of various substances:

• alcohol;
• narcotic and psychotropic substances;
• cardiac glycosides;
• class 1C antiarrhythmics (etacizin, propafenone);
• means for the treatment of asthma (salbutamol, eufillin);
• thyrotoxicosis - increased secretion of thyroid hormones.

Young people have idiopathic ventricular extrasystole, usually monomorphic, monotopic, without signs of heart disease. Its reason is not clear.

Signs and symptoms

Sometimes patients do not feel PVC. However, often patients complain of a feeling of interruption.

After PVC, there is a compensatory pause, when the heart does not contract for a short time, and there is a feeling of fading. The subsequent normal sinus impulse is perceived by patients as a "blow" in the chest.

With frequent PVCs, patients complain of irregular heartbeat. Sometimes such an arrhythmia is accompanied by sudden sweating, weakness and dizziness, fainting is possible.

If these sensations arose for the first time or are poorly tolerated by the patient, you should immediately consult a doctor.

In case of heart pathology, the signs of PVC are combined with manifestations of the underlying disease - pain behind the sternum, shortness of breath, increased pressure, and so on.

Diagnosis of pathology

With PVC, the patient is first interviewed and examined. It includes:

• assessment of complaints (arrhythmia frequency, duration of existence) and medical history;
• listening chest during which signs of heart defects or cardiomyopathies can be determined;
• study of the pulse;
• pressure measurement.

Laboratory tests are assigned:

• blood tests, urine;
• biochemical analysis with the determination of the level of potassium and cholesterol;
• hormonal studies to exclude thyrotoxicosis;
• tests to exclude rheumatism and autoimmune diseases.

Signs of PVC on the cardiogram- the appearance of a premature wide irregular ventricular complex without a previous P wave. After it, a complete compensatory pause is determined - a sign that allows you to distinguish PVC from supraventricular. Compensatory pause - the distance between two contractions adjacent to the extrasystole, between which it is located. This distance is compared with the interval between the last of three consecutive normal contractions.

If the compensatory pause is greater than this interval, it is complete.

The ECG also determines the signs of the underlying disease: an increase in the left ventricle, cicatricial changes, signs of an aneurysm.

Echocardiography, or ultrasound of the heart, is needed to diagnose the underlying pathology of the heart.

Holter ECG monitoring is the main diagnostic method. It should be carried out in all persons with heart disease, especially after myocardial infarction. It is also useful to go through it for people with complaints of interruptions in the work of the heart, which are not registered on a conventional ECG.

The study reveals the number and nature of extrasystoles and classifies them into one of 5 classes, which is necessary to select the correct treatment and assess the prognosis of the disease.

Exercise tests (veloergometry or treadmill) are carried out with great care and only when there is an indication of a clear connection between arrhythmia and exercise. If this is confirmed, further treatment should be aimed at eliminating ischemia, after which the extrasystole will also disappear. In this case, the patient undergoes a study of the vessels of the heart - coronary angiography.

Treatment of ventricular extrasystole

The underlying pathology is being treated. With benign rare extrasystole, treatment is not prescribed.

For the first time, a PVC that has arisen or intensified is treated in a hospital. In the future, the cardiologist selects antiarrhythmic drugs. Often they have to be taken for life.

Usually propafenone, cordarone, sotahexal are used in combination with low doses of beta-blockers. Self-medication with these drugs is unacceptable. When choosing therapy, you need to do an ECG monthly until the condition normalizes.

With PVC, you need to rest more, be in the fresh air, eat dairy and plant foods. It is necessary to exclude the use of alcohol, coffee and smoking. Avoid emotional stress.

In rare benign PVC, there are no restrictions on physical activity in young people. In other patients, the load is determined by the underlying disease.

Surgical treatment of PVC is possible - radiofrequency ablation, that is, the destruction of the pathological focus of impulses with the help of special equipment. With an accurate determination of the source of arrhythmia, the effectiveness of this treatment method is very high.

Patient Prognosis

Rare PVCs are not dangerous to life and health.

In malignant forms (3-5 classes of extrasystole), without treatment, a serious complication can occur - ventricular fibrillation, which can cause cardiac arrest. Timely and proper treatment the main cardiac pathology and directly the arrhythmia itself significantly reduces this likelihood.

Ventricular extrasystole is a violation of the rhythm, which is manifested by a sudden contraction of the heart muscle of the ventricle. Extrasystole has different signs and principles of treatment. The prognosis is mainly determined by the severity of the underlying pathology. With frequent extrasystoles, antiarrhythmic drugs or surgery are prescribed.

Useful video

About the symptoms and causes of ventricular extrasystole and methods of its treatment, see this video:

cardiobook.com

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

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

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

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

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

The prevalence and development of the disease

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

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

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

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

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

Classification and differences of species, stages

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

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

Three types are distinguished according to the time of occurrence:

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

Ordered ventricular extrasystoles are called allorhythmia. When a heart rhythm disorder (HRC) by the type of ventricular extrasystole occurs after each normal complex, talking about bigeminy, when after two normal - o trigeminia etc.

Causes and risk factors

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

1. cardiac causes.

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

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

Symptoms

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

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

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

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

In many patients, PVC is no obvious clinical.

Diagnosis and signs on the ECG

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

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

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

ABOUT differential diagnosis different types extrasystoles are described in the video:

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

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

Therapy tactics

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

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

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

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

Rehabilitation

Rehabilitation is indicated for patients with prior infarctions and high-grade PVCs that have led to complications such as ventricular tachycardia or ventricular flutter after surgical treatment of arrhythmias.

Prognosis, complications and consequences

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

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

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

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

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What are extrasystoles and what causes them?

IN modern medicine the term extrasystole means premature contraction of the myocardium, this is when the heart is not yet filled with enough blood for its next release into the heart vessels, that is, in essence, this is a violation of cardiac activity.

Premature contractions can be either too frequent or rare. One fine day, a person suddenly feels that his heart is working intermittently. It is this feeling that has such a frightening effect on people. The disease associated with such disorders in the work of the heart is called extrasystole.

A feature of the occurrence of extrasystole is that its signs can occur in almost every person, regardless of his state of health or age. In addition, there are a number of reasons that can cause this pathology:

• the presence of heart disease - ischemia of the heart, myocardial infarction, myocarditis and cardiomyopathy, heart failure;
• diseases associated with disruption of the endocrine system - diabetes, diseases thyroid gland and adrenal glands;
• side effects with long-term use of antiarrhythmic drugs, diuretics, glycosides;
• the presence of electrolyte imbalance in the human body;
• the negative effects of toxins from the use of alcohol and tobacco products;
• oxygen starvation caused by anemia or bronchopulmonary diseases.

In the presence of the above reasons, the patient needs a thorough examination and complex treatment aimed at eliminating the root cause or stabilizing its condition.

Symptoms indicating signs of extrasystole in humans

In most cases, with a heart rhythm disorder, patients experience the following symptoms:

• jolts or sudden blows in the chest area;
• feeling of a sinking heart;
• feeling that the heart is working intermittently;
• pallor of the skin;
• feeling of fear, anxiety and anxiety;
• anginal pain;
• lack of air.

As a rule, single extrasystoles most often do not manifest themselves clinically and are found only during a medical examination.

Classification and characteristics of extrasystoles

Extrasystole can be - organic and functional. Organic includes pathology caused by heart disease - coronary artery disease, heart disease, cardiomyopathy and other heart pathologies.

Such diseases contribute to the occurrence of dystrophic processes in the myocardium, which may be the cause of the symptoms of extrasystole. Functional can manifest itself in a normal, healthy heart.

Extrasystoles are divided depending on the place of impulse formation:

• ventricular or ventricular - with the formation of an impulse in the ventricles of the heart;
• atrial or supraventricular extrasystoles - characterized by the formation of an extraordinary impulse in any of the sections of the atria, excluding the sinus node.

And there is also a classification according to the number of sudden contractions:

• single contraction;
• paired extrasystoles (couplets);
• group - three or more contractions in a row (triplets).

Extrasystole of the ventricular type

Ventricular extrasystole is one of the most common types of cardiac arrhythmias. When conducting a study using the method of monitoring heart rhythms according to Holter, the presence of arrhythmia of the ventricular type was revealed in approximately 50% of people, among whom there were quite healthy people who did not suffer from any heart diseases.

In healthy people, the appearance of ventricular extrasystoles may be due to lifestyle - a violation of the diet (overeating), insomnia, high mental or physical stress. And also their appearance is facilitated by maintaining an unhealthy lifestyle - smoking, alcohol and other bad habits.

Classification of ventricular (ventricular) extrasystoles

Extrasystole according to the ventricular type is divided into the following classes:

1. monomorphic single extrasystoles are fixed (up to 30 within an hour);
2. the appearance of more than 30 single supraventricular extrasystoles of a monomorphic type per hour;
3. when polymorphic ventricular extrasystoles are registered on the electrocardiogram;
4. subdivided depending on the presence of extraordinary paired abbreviations: monomorphic and polymorphic type;
5. registration of group premature contractions (from 3 or more within 30 seconds), the so-called early extrasystoles.

There is also a zero class, in which the complete absence of premature contractions of the ventricles of the heart is recorded on the electrocardiogram. Ventricular extrasystole of the first class, not accompanied by cardiac pathologies, belongs to the category of functional and does not require cardinal treatment.

If symptoms are found that belong to higher classes (from 2 to 5), a deeper examination of the patient is required, due to the risk of ventricular fibrillation and the onset sudden death.

Supraventricular (supraventricular) extrasystole

The occurrence of extraordinary impulses in the atria of the heart or in the atrioventricular septum between the atria or cardiac ventricles contributes to the occurrence of supraventricular extrasystole. As a result, a person has premature defective heart contractions.

The reasons why atrial extrasystoles occur, as well as the symptoms of the disease, have a general similarity with other types of cardiac arrhythmias. But unlike ventricular extrasystole, atrial arrhythmia is easier to tolerate by a person and does not pose a threat of sudden cardiac arrest.

It should be noted that in childhood supraventricular extrasystole occurs without any symptoms and complaints of poor health. This happens most often, because children, due to their age, are unable to correctly articulate their feelings. Parents need to pay attention if the baby becomes irritable and often cries.

Types of supraventricular extrasystoles

The classification of supraventricular or atrial extrasystoles is based on the following features:

• at the site of the formation of the focus - atrial or atrioventricular;
• by the number of foci - monotropic, polytropic;
• by the frequency of ineffective contractions - single, paired, multiple, group;
• in order;
• according to the time of occurrence - early, middle, late.

Statistical daily rate of extrasystoles

The quantitative rate of extrasystoles per day directly depends on a number of factors, these include:

• Age of a person - if up to 35–40 years the absence of cardiac contraction disorders is detected quite often, then in a person at an advanced age, during daily ECG monitoring, they are detected in almost all cases.
• Individual tolerance - with poor tolerance, even a single extrasystole may require human treatment. In this case, the very concept of the norm becomes relative.
• The presence of provocation of tachycardia - when extrasystole provokes the appearance of cardiac tachyarrhythmia. Regardless of the number of extraordinary contractions, this type of extrasystole requires mandatory treatment.

In the presence of the so-called early extrasystoles - on the electrocardiogram, it immediately follows the previous heartbeat, the rate per day of early atrial extrasystoles should be no more than 30–40, ventricular extrasystoles should not be in a healthy person.

Average extrasystoles appear in the middle of the heart rhythm and the normal number of extrasystoles of this type should be within 200 for the ventricular and not more than 400 for the supraventricular type.

Late extrasystoles are characterized by the appearance before the next contraction of the heart, and almost coincide with it, their rate is up to 700 per day, regardless of the type of extrasystole. It should be noted that if an extrasystole is detected in an elderly person, the norm can be doubled.

Diagnostic methods

The diagnostic methods used to determine the extrasystole of both the ventricular and atrial types are completely identical. At the initial stage, a cardiologist conducts a clinical examination and collects anamnesis of the patient.

During an external examination, the doctor listens to the chest organs, measures blood pressure- tonometry, palpation of the pulse. Based on complaints and collected information about the patient, a preliminary diagnosis is established, which serves as the basis for laboratory and instrumental studies.

Laboratory research

To exclude pathologies of the endocrine system, diseases of the joints and autoimmune diseases, the patient is prescribed general and biochemical blood tests, blood tests for hormone levels, rheumatological and immunological tests. This will reveal whether a person has diseases that can contribute to the acquisition of various heart defects.

Methods of instrumental examination of the patient

The use of modern medical equipment allows doctors to determine with high accuracy whether a patient has disturbances in the work of the heart and the type of extrasystole. The following types of studies are used for diagnostics:

• An electrocardiogram is the most common type of heart examination. It can be used to detect signs of cardiac ischemia, aneurysm or hypertrophy of various cardiac regions. But in cases of diagnosing extrasystoles with its help, it is not always possible to fix the appearance of single extrasystoles. Most often, violations are recorded during a routine medical examination.
• Holter ECG monitoring during the day is the most rational method for diagnosing extrasystole. This type of examination allows you to most accurately determine the number of premature contractions, evaluate their characteristics and the cause of the appearance. And also with the help of this device you can monitor the effectiveness of subsequent treatment.

• Echocardiography - ultrasound procedure heart, effective in detecting cardiac pathologies. During the procedure, indicators of the activity of the heart, the size of the atria and ventricles are determined.
• Coronary angiography - the procedure is used to exclude pathologies of the coronary arteries that can cause cardiac ischemia.

Do I need to treat extrasystole?

The main criterion for determining the need for treatment of extrasystole, according to experts, is the patient's individual intolerance to the symptoms of pathology. And also mandatory treatment is required when the number of extrasystoles exceeds 1200–2000 per day.

In each case, the doctor makes a decision based on the individual characteristics of the patient's health, since in some cases 200 unscheduled contractions per day can lead to a significant decrease in a person's quality of life, and in other cases he feels great at higher rates.

If the studies have shown that extrasystole can pose a threat to the patient's life (most often it concerns ventricular extrasystole) or a person has severe cardiac pathologies, treatment should be carried out immediately.

Principles of treatment of extrasystole

When confirming the diagnosis - extrasystole, the first thing to do is to reconsider your lifestyle. Eliminate bad habits - smoking, alcohol. Adjust your diet and daily routine. Long walks in the fresh air and moderate physical activity will provide significant support to the human cardiovascular system.

The main objective of drug treatment is to eliminate the symptoms of extrasystole and prevent arrhythmia. Light sedatives and β-blockers are used in the treatment.

Thanks to them, a positive effect is achieved, which is expressed in a decrease in extrasystoles and an improvement in the general well-being of the patient. In cases of ineffectiveness of such therapy, the doctor decides the advisability of using antiarrhythmic drugs.

Surgical treatment is used only in cases where the medical method of treatment does not bring a positive effect and there is a risk of fibrillation. The procedure consists of radiofrequency ablation and is performed in a hospital. A catheter with an irradiation source is inserted into the patient's subclavian vein, and with the help of radio waves, the focus of extrasystoles is cauterized.

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What is ventricular extrasystole

According to the international classification, the disease was registered according to ICD 10 under the number I-149.3 "Premature depolarization of the ventricles."

What it is? Ventricular extrasystoles (in other words, arrhythmias) appear as a result of premature contractions of the main rhythm of the ventricle. Due to such extraordinary contractions of the ventricles, the overall contraction of the heart muscle is also disturbed, which is manifested by a lack of air and a general negative state of the patient.

Note! The peculiarity of this cardiac pathology is that it can occur even in young people, and with age, the manifestations of the disease become much more frequent.

Most often, manifestations of extrasystole are observed in the morning, in the evening and at night - they decline. There are a lot of variations in the manifestations of extrasystoles (they can last both for just one hour and for a day), which greatly complicates the diagnosis of the disease and prevents treatment from being started on time.

Usually, impulses coming from the ventricles cause only the contraction of the ventricles themselves, without affecting the atria. But there is a pathology in which extrasystoles occur in the atria located above the ventricles. This condition is called supraventricular extrasystole (in other sources - supraventricular extrasystole).

Manifestations of ventricular extrasystole do not pose a significant threat to human health, but without timely treatment, the risk of premature sudden death increases, especially in the presence of concomitant cardiac pathologies.

Causes of the disease

Violation of the heart rhythm can occur due to a hereditary factor (congenital heart disease) or due to the lifestyle of the patient. Although in many young people extrasystole appears for no apparent reason.

Conventionally, the factors affecting the occurrence of the disease can be divided into several groups:

• Cardiac factor - concomitant diseases of the heart, against which extrasystole may develop: heart failure, ischemia, myocarditis, cardiomyopathy, myocardial infarction, heart disease.
• The drug factor is the uncontrolled intake of certain groups of drugs: for example, antiarrhythmic drugs, diuretics, cardiac glycosides.
• Electrolyte disturbances - a change in the body's proportions of the content of electrolytes (sodium, potassium, magnesium).
• Toxic effects - alcohol and tobacco smoking.
• Violations of the vegetative-vascular system - imbalance nervous system, which can affect the development of cardiac pathologies.
• Hormonal disorders - diseases associated with a violation of the hormonal background: diseases of the adrenal glands, diabetes mellitus, thyrotoxicosis.
• Chronic hypoxia - oxygen starvation that occurs with certain diseases: bronchial asthma, anemia, sleep apnea.

Atrial extrasystole may have congenital roots. A newborn child is examined for the presence of arrhythmias already at the first listening.

Acquired extrasystole in children and adolescents is usually associated with past infections and cardiac pathologies that have arisen against their background.

Violations in the endocrine system caused by an overdose of drugs, infectious intoxication (with measles, influenza, scarlet fever) can cause extrasystole in a child, food poisoning, physical or nervous overload.

In older children (teenagers), interruptions in heart rate may occur against the background of vegetative-vascular dystonia.

Note! Often the cause of ventricular extrasystole remains unclear. In this case, doctors diagnose the idiopathic form of the disease.

In pregnant women, cardiac arrhythmia can be recorded in the second semester, which is associated with a high standing of the diaphragm and an imbalance in the blood of electrolytes. The very process of pregnancy increases the load on the heart and can cause symptoms of extrasystoles. Extrasystole during pregnancy does not require special treatment - it will be enough to establish nutrition and daily routine, additional intake of magnesium and potassium preparations is possible.

Types and symptoms of ventricular extrasystole

Most often, ventricular extrasystole is asymptomatic, and the disease can be detected using medical diagnostics, which allows you to accurately determine the type of pathology by the type and form of manifestations.

Types of extrasystoles:

• According to the number of detected foci:

1. monotopic (one source of cardiac impulses);
2. polytopic (several foci).

• Location of discovery:

1. right ventricular (impulses are supplied by the right ventricle);
2. left ventricular (most common).

• By time of occurrence:

1. late (occurring during the contraction of the ventricles or in the phase of complete cardiac relaxation);
2. interpolated (occurring between contractions of the ventricles and atria);
3. early (attacks of extrasystole occur during atrial contraction).

• By frequency of occurrence:

1. single (up to five contractions per minute);
2. multiple or frequent extrasystole (more than five contractions per minute);
3. steam room (two extrasystoles occur between normal contractions);
4. group (between normal contractions there are several extrasysitol in a row).

• By repetition frequency:

1. disordered (there is no pattern between normal contractions and extrasystoles);
2. bigeminia (for each normal heartbeat, a one-time contraction of the ventricles occurs);
3. trigiminia (alternation of extrasystoles every three normal contractions).

Important! Symptoms of extrasystole of the ventricles are similar to the manifestations of normal arrhythmia.

Patients complain of a feeling of "shocks in the heart", "fading" of the heart, followed by a strong shock in the form of a blow.

Main clinical manifestations:

• uneven heart rate;
• Lack of air;
• Unexpected dizziness (may result in fainting).

At the same time, the patient may feel severe fatigue, weakness, headache, increased irritability.

Diagnosis and treatment

Diagnosis of ventricular extrasystole is carried out mainly by the ECG method. Extrasystole on the ECG is determined within 3-4 minutes, using this method, you can take readings at home (the equipment is available on ambulances).

Note! A more accurate diagnostic method is the Holter technique, which records readings over a longer period of time, which makes it possible to detect even single ventricular contractions.

Additionally, during an examination in a hospital, the doctor may prescribe a general and biochemical analysis of blood and urine, ultrasound, MRI, polycardiography, etc.

Treatment of extrasystole of the heart is aimed at eliminating clinical manifestations diseases and improved cardiac monitoring. In this case, a variety of extrasystole, the presence of additional cardiac pathology and manifestations of myocardial dysfunction disorder are necessarily taken into account.

Depending on the type, form and degree of the disease, a method is chosen how to treat extrasystole.

General therapy

In the absence of pronounced clinical symptoms and violations of the cardiac and endocrine system, atrial extrasystole does not require treatment, it is enough just to follow the general recommendations of the doctor:

Rest more, observe the daily routine:

• Adjust the diet (more - vegetables and herbs, less - spicy, fried, canned food).
• Take regular walks outdoors.
• Avoid emotional upheavals, stress, psycho-emotional and physical overload.

Additionally, sedatives may be prescribed.

Medical therapy

Drug treatment is connected in case of poor tolerance of the patient to manifestations of extrasystole, with high risk complications, with an unexplained (idiopathic) nature of the disease.

The purpose of drugs depends on the cause of extrasystole:

• Sedatives containing a small dose of tranquilizers, or adrenoblockers.
• Antiarrhythmic drugs or anticholinergics to normalize the heart rhythm. Supraventricular extrasystole is stopped by taking calcium antagonists, beta-blockers, first-class antiarrhythmic drugs.
• Omega-3 preparations - with a combination of extrasystole of the ventricles with coronary heart disease, hypoxia.
• Vitamins and general strengthening preparations.

When choosing a drug, the effectiveness of this group of drugs for a certain type of extrasystole, the presence of contraindications and side effects are taken into account.

Surgical intervention

This type of therapy is used when conservative methods of treatment are ineffective and when the disease takes a life-threatening course.

Types of surgery:

• Catheter ablation with radio frequencies - a catheter is inserted into the atrial cavity through a blood vessel, at the end of which an electrode is placed that cauterizes the focus of the pathology.
• Open heart surgery, in which the areas of the heart where impulses originate are cut.

ethnoscience

Treatment with folk remedies is used with a zero (mild) form of the disease, in the absence of severe clinical manifestations and the absence of pathologies.

Mainly used folk remedies that have a sedative and relaxing effect:

• Decoctions of cornflower, valerian root, calendula. Any of the decoctions is brewed in the same way: a tablespoon of raw materials is poured with two glasses of boiling water. The product is left overnight in a thermos. Drink 15 minutes before meals - a quarter cup.
• A tablespoon of horsetail is poured into three cups of boiling water. The remedy is infused and drunk in a tablespoon during the day (up to 5-6 times a day).
• Mix radish juice and honey in equal proportions. Take before meals - a tablespoon of funds.

In children, the diagnosis of ventricular extrasystole is similar to adults. In therapeutic therapy, more attention is paid to a balanced diet, daily routine, and the use of weak sedatives.

Timely diagnostic methods and the subsequent correctly selected course of treatment can cure the disease without complications. Dangerous consequences can occur against the background of the patient's comorbidities - ischemic disease, hypertension, heart attack.

To prevent ventricular extrasystole, it is enough to lead a healthy lifestyle, avoid stress and regularly undergo preventive examinations.

Pulse is normal in an adult

What are ventricular extrasystoles? Ventricular or ventricular extrasystole is a violation of the rhythmic activity of the heart, which is manifested by the appearance of extraordinary, premature contractions of the ventricles. Such additional impulses arise in the foci of ectopy and provoke changes in the normal rhythm of the heart muscle.

Arrhythmia of the type of ventricular extrasystole is an extremely common type of abnormal rhythmic activity of the myocardium, which occurs in every ninth inhabitant of our planet over the age of 50 years.

In children and young patients, this rhythm disturbance is diagnosed much less frequently, and in most cases is associated with the presence of congenital heart defects, myocarditis, and the like.

Why do ventricular extrasystoles occur?

Today, experts distinguish cardiac and non-cardiac causes of ventricular extrasystoles. Cardiac factors in the development of rhythm disturbances are the main causes of extraordinary contractions, which in almost 75% of cases become decisive moments in the development of the pathological process.

Among the cardiac causes of the development of the disease are:

• acute and chronic variants of the course of ischemic heart disease, but most often myocardial infarction (AMI);
• congenital and acquired in the process of life heart defects;
• inflammatory diseases of the structures of the heart (inflammatory, infectious lesions of the walls, valves, etc.);
• damage to the muscle tissue of the heart (and cardiomyodystrophy of various origins);
• heart failure.

Non-cardiac reasons for the development of gastric arrhythmias with the occurrence of ectopic foci that generate premature contractions can be as follows:

• external toxic effect on the body (the effect of large doses of alcohol, smoking, intoxication with harmful substances);
• metabolic disorders and endocrine disorders (obesity, hyperthyroidism, adrenal diseases);
• increased activity of the parasympathetic nervous system;
• overdose or long-term use drugs, namely cardiac glycosides, diuretics, antidepressants, antiarrhythmic drugs;
• chronic myocardial starvation as a result of dysfunction of the respiratory system (asthma, obstructive bronchitis, apnea);
• changes in the electrolyte composition of the blood.

Sometimes it is not possible to find out the reasons for the development of ventricular extrasystoles. In such cases, it is customary to speak of such pathological condition like idiopathic ventricular extrasystole. Quite often, single ventricular extrasystoles occur without specific reasons in absolutely healthy people.

Features of the classification of the disease

The modern classification of ventricular unscheduled contortions allows us to distinguish six main classes of the disease.

This scheme for grading extrasystoles that occur in the ventricular sections of the myocardium was proposed back in 1975 by M. Ryan, therefore, in medical circles it is known as the Rayn classification.

A decade earlier, the scientist Lown proposed his vision of the gradation of extrasystoles of ventricular origin, according to which extraordinary contractions were divided into six phased types, which are characterized by their own quantitative and morphological characteristics. In fact, the Ryan classification is an improved version of Lown's listing of ventricular extrasystoles:

Depending on the number of foci of excitation, it is customary to distinguish:

• monotopic extrasystole - the presence of one focus of ectopia is characteristic;
• polytopic extrasystole - extraordinary contractions are generated from two or more ectopic foci.

According to the frequency of occurrence, ventricular extrasystoles are divided into the following types:

• single or single (single ventricular extrasystole is characterized by the appearance of premature contractions in an amount of not more than five for 60 seconds);
• multiple (five or more extraordinary contractions / 60 seconds);
• paired (the appearance of two extrasystoles in a row between regular heartbeats);
• group (when several subsequent extrasystoles are diagnosed between normal contractions).

According to the localization of foci of pathological generation of impulses, there are:

• right ventricular extrasystole;
• left ventricular extrasystole;
• combined form of the disease.

According to the time of occurrence of premature impulses:

• early ventricular extrasystoles that occur during contraction of the atrial parts;
• interpolated ventricular extrasystoles that occur between atrial and ventricular contractions;
• late ventricular extrasystoles, generated in diastole or during ventricular contraction.

The clinical picture of the disease

Violation of the heart rhythm according to the type of ventricular extrasystole in practice is manifested by the following symptoms:

• with ventricular extrasystole, patients experience a feeling of interruptions in cardiac activity, the appearance of an arrhythmic beat and a sense of upheaval;
• extraordinary myocardial contractions are accompanied by weakness and general malaise, as well as anxiety and dizziness;
• often patients with extrasystole complain of the development of shortness of breath or a sharp feeling of lack of air;
• in this pathological condition, there is a feeling of fear of death, panic attacks, anxiety and many other disorders of the psycho-emotional sphere;
• possible fainting.

Often ventricular extrasystole occurs without visible subjective manifestations, therefore, such patients have no complaints in principle, and the disease is diagnosed exclusively by electrocardiographic examination. Symptoms of ventricular extrasystole with frequent episodes of extraordinary contractions, which occur mainly against the background of heart diseases of organic origin (the so-called organic), may be accompanied by cardiac pain, severe shortness of breath and weakness, as well as loss of consciousness and nausea.

Ventricular extrasystole in children is a fairly common occurrence, which is recorded in most cases in combination with congenital malformations, myocarditis and. The severity of manifestations in a child depends on such factors as the age of a small patient, the type and form of the pathological process, as well as the timeliness of diagnosing rhythm disturbances and the causes of its occurrence.

Objectively, in a patient with a diagnosed extrasystole of ventricular origin, the following are determined:

• pronounced pulsation of the veins of the neck;
• arrhythmia of the arterial pulse;
• change in the sonority of the first tone and bifurcation of the second tone;
• after an emergency reduction.

Basic diagnostic methods

The main methods for determining ventricular extrasystoles are electrocardiography and Holter daily ECG monitoring.

Very often, ECG signs of ventricular extrasystole are the only symptom of the disease, especially when it comes to single extraordinary contractions.

As a rule, during an electrocardiographic study, the following signs of extraordinary contractions of the heart of ventricular origin are diagnosed:

• extended and altered QRS complex;
• deformed extrasystolic complex (more than 0.12 seconds);
• absence of P wave before extrasystole;
• characteristic compensatory pause after each ventricular extrasystole.

Ventricular extrasystole on the ECG is determined in almost 90% of cases. To clarify the diagnosis and a more detailed study of the nature of the disease, the doctor may decide on the need for daily Holter ECG monitoring.

The consequences of the disease can be as follows:

• sudden cardiac death as a result of an attack of ventricular tachycardia or ventricular fibrillation;
• development of heart failure;
• the appearance of symptoms;
• change in the configuration or structure of the ventricular part of the myocardium.

As you can see, the consequences of ventricular extrasystole can be very dangerous for normal human life. That is why doctors recommend that all potential patients apply for medical care and periodically undergo an examination by a cardiologist for the purpose of early diagnosis of possible rhythm disturbances.

Content

One of the most common heart rhythm disorders (HRDs) is extrasystole, i.e. extraordinary ("inserted") contraction of the myocardium of the ventricles. According to statistics, more than 40% of people over the age of 40 suffer from such a cardiac pathology. In addition, with instrumental studies of the heart, ECG registration of ventricular extrasystole is detected in healthy individuals under 30 years of age in 10-15% of cases and is considered a variant of the physiological norm.

What is ventricular extrasystole

The phenomenon of ventricular extrasystole (PVC) is an extraordinary single contraction of the myocardium that occurs under the influence of premature electrical impulses that come from the wall of the chambers of the right or left ventricle, as well as the nerve fibers of the conduction system of the heart (His bundle, Purkinje fibers). As a rule, extrasystoles that occur during PVCs negatively affect only the ventricular rhythm, without disturbing the work of the upper heart.

Classification

The standard classification according to Lown was created on the basis of the results of a daily Holter ECG observation. It distinguishes 6 classes of ventricular extrasystole:

1. 0 class. On the ECG, there is no frequent ventricular extrasystole, the patient does not observe any changes in the work of the heart or morphological changes.
2. 1 class. During one hour of observation, less than 25-30 single monomorphic (monotopic, identical) ventricular pathological contractions were registered.
3. Grade 2 Within an hour of the study, more than 30 single monomorphic or 10-15 paired extrasystoles were recorded.
4. Grade 3 During the first 15 minutes, at least 10 paired, polymorphic (polytopic, heterogeneous) extrasystoles are recorded. Quite often this class is combined with atrial fibrillation.
5. 4a class. For an hour, monomorphic paired ventricular extrasystoles were recorded;
6. 4b class. During the entire time of the study, polymorphic paired ventricular extraordinary contractions are recorded.
7. Grade 5 Fixed group or volley (3-5 in a row for 20-30 minutes) polymorphic contractions.

Frequent ventricular extrasystole class 1 does not manifest itself symptomatically, is not accompanied by serious pathological changes hemodynamics, therefore it is considered a variant of the physiological (functional) norm. Extraordinary contractions of classes 2-5 are combined with a high risk of developing atrial fibrillation, sudden cardiac arrest and death. According to the clinical classification of ventricular arrhythmias (according to Mayerburg), there are:

1. Extrasystoles of a benign, functional course. They are characterized by the absence of clear clinical symptoms of organic pathology of the myocardium and any objective signs of left ventricular dysfunction. The function of the ventricular node is preserved and the risk of cardiac arrest is minimal.
2. Ventricular arrhythmias of a potentially malignant course. They are characterized by the presence of extraordinary contractions against the background of morphological lesions of the heart muscle, a decrease in cardiac output by 20-30%. Accompanied by a high risk of sudden cardiac arrest, gradation to a malignant course is characteristic.
3. Arrhythmias of a malignant course. They are characterized by the presence of ventricular extraordinary contractions against the background of severe organic lesions of the myocardium, accompanied by the maximum risk of sudden cardiac arrest.

Reasons for ventricular extrasystole

The appearance of extraordinary contractions of the ventricles is due to organic pathologies of the myocardium, the use of drugs. In addition, extrasystole is a frequent complication of other systemic lesions: endocrine diseases, malignant tumors. Some of the most common causes of PVCs are:

• ischemic disease;
• cardiosclerosis;
• myocardial infarction;
• myocarditis;
• arterial hypertension;
• cor pulmonale;
• chronic heart failure;
• mitral valve prolapse;
• uncontrolled intake of M-anticholinergics, sympathomimetics, diuretics, cardiac glycosides, etc.

Functional or idiopathic ventricular arrhythmia is associated with smoking, stress, drinking large amounts of caffeinated drinks and alcohol, which lead to an increase in the activity of the autonomic nervous system. Often, extrasystole occurs in patients who suffer from cervical osteochondrosis.

Symptoms of frequent ventricular extrasystoles

Single premature contractions of the myocardium are recorded in many healthy young people in the process of monitoring the work of the heart throughout the day (Holter ECG monitoring). They do not have a negative impact on well-being, a person does not notice their presence in any way. Symptoms of extraordinary contractions appear when hemodynamics are disturbed due to extrasystoles.

Ventricular arrhythmia without morphological lesions of the myocardium is difficult for the patient to tolerate, there are attacks of suffocation, panic. This condition, as a rule, develops against the background of bradycardia, it is characterized by the following clinical manifestations:

• feeling of sudden cardiac arrest;
• separate strong blows in the chest;
• deterioration after eating;
• disruption of the heart in the morning after waking up, emotional outburst or during physical activity.

Extraordinary contractions of the ventricular myocardium against the background of morphological disorders of the heart, as a rule, are of a multiple (polymorphic) nature, but for the patient they often occur without clinical manifestations. Symptoms develop with significant physical exertion, disappear in the supine or sitting position. This type of right ventricular or left ventricular arrhythmia develops against the background of tachycardia and is characterized by:

• suffocation;
• feeling of panic, fear;
• dizziness;
• darkening in the eyes;
• loss of consciousness.

Diagnostics

The main method for diagnosing frequent ventricular extrasystole is to record an electrocardiogram at rest and a daily Holter monitor. The daily study of the ECG helps to determine the number, morphology of pathological contractions, how they are distributed throughout the day, depending on various factors and conditions of the body (period of sleep, wakefulness, use of drugs). In addition, if necessary, the patient is additionally prescribed:

• electrophysiological study of the myocardium by stimulating the heart muscle electrical impulses with simultaneous observation of the result on the ECG;
• echocardiography or ultrasound (ultrasound) - determination of the morphological cause of arrhythmia, which, as a rule, is associated with impaired hemodynamics;
• laboratory tests to determine the fast phase protein, electrolytes, the level of pituitary, adrenal and thyroid hormones, the amount of globulins.

Ventricular extrasystole on ECG

The main methods for diagnosing cardiac arrhythmias are electrocardiography and monitoring of the work of the myocardium (impulses of the conduction system) according to Holter. Ventricular extrasystole when deciphering the studies performed is manifested by the following features:

• expansion of the QRS complex;
• absence of a P wave;
• extraordinary premature appearance of an altered QRS complex;
• complete compensatory pause after a pathological QRS complex;
• T wave deformity (rare);
• extension of the ST segment.

Treatment of ventricular extrasystole

In order to achieve the desired effect in the treatment of extrasystole, it is necessary to prescribe a set of therapeutic measures:

• The ban on the use of alcoholic beverages, strong tea, coffee, smoking.
• Recommendations to adhere to the basic principles of proper nutrition and increase the proportion of foods with a large amount of potassium (potatoes, seafood, beef, etc.) and other necessary trace elements in the diet for normal heart function.
• Refusal of heavy physical exertion.
• If the patient often experiences stress, insomnia, then it is recommended to use mild sedatives. herbal preparations(motherwort, lemon balm, peony tincture) or sedatives (valerian tincture).
• If indicated, the patient is referred for surgical treatment.
• Antiarrhythmic drugs are prescribed.
• The use of medicines that support the work of the heart, vitamin and mineral complexes is recommended.

Medical therapy

The scheme of drug treatment is prescribed individually, it depends entirely on the type of pathology and cause, the frequency of arrhythmias, the presence of other concomitant systemic chronic diseases. Antiarrhythmic drugs that are used for the pharmacological treatment of PVCs fall into the following categories:

• blockers of sodium, calcium and potassium channels (Novocainamide);
• beta-blockers (Concor-Cor);
• antihypertensive drugs (Anaprilin);
• thrombolytics (Aspirin).

Standard pharmacological therapy includes the use of the following pharmacological drugs:

1. Cordinorm. medicinal product based on the substance bisoprolol, which has antiarrhythmic and hypotensive effects. It is prescribed for the treatment of cardiac arrhythmias. The advantage of the drug is its rapid action and versatility for use, and the disadvantage is the high likelihood of side effects.
2. Aspirin. Tablets containing acetylsalicylic acid. The drug improves blood circulation in the myocardium, has a vasodilating effect. Aspirin is indicated for coronary heart disease, myocardial infarction. The advantage of the drug is the versatility of its use, and the disadvantage is the frequent development of allergic reactions.
3. Novocainamide. medication, active substance of which is procainamide. The drug significantly reduces the excitability of the heart muscle and suppresses pathological ectopic foci of excitation. A medication is prescribed for various cardiac arrhythmias. The advantage of the drug is considered to be a quick effect, and the disadvantage is the need to accurately calculate the dosage to prevent the development of side effects.

It is recommended that a control electrocardiogram be made after 2-3 months for a patient who started drug treatment. If extraordinary heart contractions become rare or disappear, then the therapeutic course is gradually canceled under the supervision of a doctor. In cases where, during treatment, the result has not changed or improved slightly, then the medication is continued unchanged for several more months. With a malignant course of the disease, medications are taken by the patient for life.

Surgical intervention

The indication for surgical treatment of arrhythmia is the ineffectiveness of drug therapy. As a rule, this type of elimination of the pathology is recommended for those patients who have an organic heart lesion in combination with impaired hemodynamics. There are the following types of surgery:

• Radiofrequency ablation (RFA). During the procedure, the surgeon inserts a small catheter into the heart cavity through a large vessel and, using radio waves, cauterizes problem areas of the myocardium. For the convenience of finding the affected area, electrophysiological monitoring is used. The effectiveness of RFA, according to statistics, is 75-90%. The operation is contraindicated in the elderly (over 75 years).
• Installing a pacemaker. This device is a small box that is equipped with electronics and a battery that has a lifespan of 8 to 10 years. Electrodes depart from the pacemaker, which the doctor attaches to the ventricle or atrium during surgery. They send impulses that cause the heart muscle to contract. Such an electronic device helps the patient get rid of various rhythm disturbances and return to a full life. Among the disadvantages of installing a pacemaker, the need to replace it is highlighted.

Folk remedies

Recipes traditional medicine are used to treat extrasystole of a functional type. If there are serious organic changes in the myocardium, you should consult a cardiologist, as some non-traditional methods of treatment have contraindications for use. Remember that the use of folk remedies will not replace full-fledged drug therapy or surgery. At home, you can prepare the following folk remedies for the treatment of arrhythmias:

1. A decoction of valerian root, calendula and cornflower. It is necessary to take 1 tbsp. all ingredients, mix, pour water and bring to a boil, then cool. Strain and take half a glass in the morning and evening for 10-12 days. Use with caution in people prone to allergies.
2. Infusion of horsetail. Dry grass horsetail in the amount of 2 tbsp. it is necessary to brew three cups of boiling water and soak for 6 hours. Take the remedy 5-6 times a day, 1 tsp for a month. It is not recommended to use the infusion for patients who suffer from chronic renal failure.
3. Radish juice with honey. Raw radish must be grated and squeezed through gauze. Add 1 tbsp to the resulting juice. honey. Take 2 tsp. three times a day for a week.

Forecast and prevention of frequent ventricular extrasystoles

The prognosis of the course of ventricular extrasystole depends on its form, the presence of morphological pathology of the heart tissues or hemodynamic disorders. Functional idiopathic and single extraordinary contractions of the myocardium do not pose a threat to the health or life of the patient. Extrasystole, which develops against the background of organic heart disease, if untreated, significantly increases the risk of developing organ failure, sudden death due to the development of tachycardia, atrial and supraventricular arrhythmias, fibrillation.

To prevent the development of frequent extraordinary contractions of the myocardium of the lower part of the heart, the following measures are recommended:

1. If you have a genetic predisposition to heart disease, you should start seeing a cardiologist as early as possible.
2. Apply with caution medicines that affect the heart rate and electrolyte composition of the blood (diuretics, glycosides).
3. In the presence of endocrine pathologies ( diabetes, hyperfunction of the adrenal glands or thyroid gland) should be examined for the development of cardiac pathologies.
4. Quit smoking, drinking alcohol.

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Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.