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

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

TO possible reasons ventricular premature beats include iatrogenic factors: overdose of cardiac glycosides, intake of ß-adrenostimulants, antiarrhythmic drugs, antidepressants, diuretics, etc.

Classification of ventricular extrasystoles

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

Diagnostics of the ventricular extrasystole

The main methods for detecting ventricular extrasystoles are ECG and Holter ECG monitoring. On the electrocardiogram, an extraordinary premature appearance of the altered ventricular QRS complex, deformation and expansion of the extrasystolic complex is recorded (more than 0.12 sec.); absence of P wave before extrasystole; full 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 disease. Patients are advised to follow a diet enriched with potassium salts, exclude provoking factors (smoking, drinking alcohol and strong coffee), and increase physical activity in case of physical inactivity.

In other cases, the goal of therapy is to eliminate symptoms associated with ventricular extrasystole, and to prevent life threatening arrhythmias. Treatment begins with the appointment of sedatives (phytopreparations 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. With existing bradycardia, relief of ventricular extrasystole can be achieved by prescribing anticholinergic drugs (belladonna alkaloids + phenobarbital, ergotoxin + belladonna extract, etc.).

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

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

Prognosis of ventricular extrasystole

The course of ventricular extrasystole depends on its form, the presence of organic heart disease and hemodynamic disturbances. Functional ventricular premature beats are not life threatening. Meanwhile, ventricular extrasystole, which develops against the background of organic heart damage, significantly increases the risk of sudden cardiac death due to the development of ventricular tachycardia and ventricular fibrillation.

Extraordinary contractions of the heart are called extrasystole. Depending on the localization of the focus of excitation, several forms of pathology are distinguished. Ventricular premature beats are considered clinically unfavorable, which will be discussed in detail.

Cardiovascular diseases are among the top five diseases leading to disability. The most popular is extrasystole, since it occurs in 70% of people. It can be determined at any age; there is also no connection between pathology and gender and constitutional features.

The predisposing factors for the development of extrasystole include arterial hypertension, coronary heart disease, heart defects, lack of potassium and magnesium in the blood, as well as gender and age.

Extrasystoles are usually divided into two large groups: atrial and ventricular. The second type is characterized by an unfavorable clinical course, therefore, it is worth knowing why ventricular premature beats are dangerous and what treatment options are offered by modern medicine.

Description of ventricular premature beats

The term "ventricular premature beats" (VES) means a pathological process that occurs in the left or right ventricle and causes a premature contraction of the corresponding parts of the heart.

There are three mechanisms for the development of the disease: violation of automatism, trigger activity, circular passage of the excitation wave (ri-entry).

Violation of automatism carried out in the direction of increasing heart rate. This is due to the subthreshold potential of the pathological focus located in the ventricles. Under the influence of a normal rhythm, it passes into the threshold one, as a result of which a premature contraction occurs. A similar developmental mechanism is characteristic of arrhythmias developing against the background of myocardial ischemia, electrolyte dysfunctions, and an excess of catecholamines.

Trigger Activity - represents the emergence of an extraordinary impulse under the influence of post-depolarization, which is associated with the previous action potential. Distinguish between early (formed during repolarization) and late (formed after repolarization) trigger activity. It is associated with those extrasystoles that appear with bradycardia, myocardial ischemia, electrolyte disorders, intoxication with certain drugs (for example, digitalis).

Circular passage of an excitation wave (ri-entry) is formed with various organic disorders, when the myocardium becomes heterogeneous, which interferes with the normal passage of the impulse. In the area of ​​the scar or ischemia, areas are formed with an unequal conducting and restoring speed. As a result, both single ventricular extrasystoles and paroxysmal attacks of tachycardia appear.

Symptoms of ventricular premature beats

In most cases, there are no complaints. To a lesser extent, the following symptoms appear:

• uneven heartbeat;
• weakness and dizziness;
• lack of air;
• chest pain in an atypical location;
• the pulsation can be very pronounced, therefore it is felt by the patient.

The emergence of the last symptom complex is associated with an increase in the force of contraction that appears after extrasystole. Therefore, it is felt not as an extraordinary contraction, but rather as a “sinking heart”. Some symptoms of ventricular extrasystole are due to the underlying pathology that caused the development of a rhythm disturbance.

Corrigan's Venous Waves- pathological pulsation that occurs with a premature contraction of the ventricles against the background of a closed tricuspid valve and systole of the right atrium. It manifests itself as a pulsation of the cervical veins, which is so pronounced that it can be noticed during an objective examination of the patient.

When measuring blood pressure, arrhythmic cardiac activity is determined. In some cases, a pulse deficit is established. Sometimes extrasystoles occur so often that an erroneous diagnosis can be made in the form.

Causes of ventricular premature beats

Consider non-cardiac and cardiac factors in the onset of pathology.

Noncardiac causes associated to a greater extent with electrolyte disturbances, often found during a lack of potassium, magnesium and excess calcium concentration in the blood. The latter violation is more related to malignant processes flowing in skeletal system, hyperparathyroidism, Paget's disease, treatment with calcium preparations (which is observed in the treatment of peptic ulcer disease).

Stressful situations, unhealthy diet, disturbance of sleep and rest, intake of harmful substances (toxic, alcoholic, narcotic) have a negative effect on the cardiac system. Sometimes after surgical intervention, anesthesia or postponed hypoxia, ventricular extrasystole also develops.

Cardiac factors associated with various pathological conditions of cardio-vascular system. First of all, the ventricular myocardium suffers in heart attacks and ischemic heart disease. Have a negative effect on the structure muscle tissue heart defects (prolapse mitral valve), cardiomyopathy and myocarditis. Against the background of a slow and rapid heart rate, extraordinary ventricular contractions often occur.

Types of ventricular extrasystole

During the study of ventricular extrasystole as a pathology, different classifications and characteristics. On their basis, diagnoses are made and further treatment is carried out.

Single and polytopic ventricular extrasystoles

Extrasystoles formed by premature ventricular contractions differ in their characteristics:

• the frequency of display on the ECG divides extrasystoles into single, multiple, paired and group;
• the time of occurrence of extrasystoles can characterize them as early, late and interpolated;
• the number of pathological foci is different, therefore, polytopic (more than 15 times per minute) and monotopic extrasystoles are distinguished;
• the orderliness of extrasystoles is considered if they are evenly found on the ECG, and there is also a disordered extrasystole.

The course of ventricular extrasystole

In most cases, there are benign leaking VEBs. If they are present, organic changes are not detected in the heart, the patient may not present complaints or they are insignificant. In this case, the prognosis is favorable, so you should not worry if this disease is dangerous, ventricular extrasystole.

With a potentially malignant extrasystole of the ventricles, organic changes in the structure of the heart are determined. Most of them are associated with cardiac pathology - heart attack, coronary artery disease, cardiomyopathies. In this case, the likelihood of premature termination of cardiac activity increases.

The malignant course of ventricular extrasystole is extremely dangerous for the patient's life. Cardiac arrest may develop in the absence of medical care - death... Malignancy is due to the presence of serious organic disorders.

Classification of ventricular extrasystoles

The Lown and Ryan classifications were previously often used in medical practice... They include five grades, from the mildest 0 to the most severe 5, characterized by organic changes in the tissues of the heart. The first three classes are practically the same in their properties in both classifications:

0 - no ventricular premature beats;

1 - extrasystoles are monotypic, appear infrequently, no more than 30 per hour;

2 - extrasystoles are monotypic, occur often, more than 30 per hour;

3 - polytypic extrasystoles are determined

4а - paired extrasystoles;

4b - ventricular tachycardia with the occurrence of VES from 3 or more;

5 - there are early ventricular extrasystoles.

According to Ryan, classes are described differently:

4a - monomorphic extrasystoles follow in pairs;

4b - polymorphic extrasystoles are arranged in pairs;

5 - ventricular tachycardia with the development of VES from 3 or more.

V modern medicine another division of ventricular premature beats is widespread, according to Myerburg from 1984. It is based on monomorphic and polymorphic ventricular extrasystoles that occur in a single variant.

In accordance with the new frequency classification, VEBs are divided into five classes: 1 - these are rare extrasystoles, 2 - infrequent extraordinary contractions, 3 - moderately frequent extrasystoles, 4 - frequent premature contractions, 5 - very frequent.

According to the characteristics of rhythm disturbances, ventricular extrasystoles are divided into types: A - monomorphic in a single amount, B - polymorphic in a single number, C - paired, D - unstable in their dynamics, E - stable.

Complications of ventricular premature beats

Basically, there is an aggravation of the underlying disease, against the background of which VES developed. The following complications and consequences also occur:

• the anatomical configuration of the ventricle changes;
• the transition of extrasystole to fibrillation, which is dangerous with a high risk of death;
• possibly the development of heart failure, which is most often found in polytopic, multiple extrasystoles.
• the most formidable complication is sudden cardiac arrest.

Diagnostics of the ventricular extrasystole

It begins with listening to the patient's complaints, an objective examination, listening to the activity of the heart. Further, the doctor appoints instrumental research... The main diagnostic method is electrocardiography.

ECG signs of ventricular premature beats:

• the QRS complex appears prematurely;
• in its shape and size, the extraordinary QRS complex differs from others, normal;
• there is no P wave in front of the QRS complex formed by the extrasystole;
• after an irregular QRS complex, a compensatory pause is always noted - an elongated segment of the isoline located between the extraordinary and normal contractions.

Holter ECG monitoring- often prescribed for patients with severe left ventricular insufficiency or with their unstable occurrence. In the course of the study, it is possible to determine rare extrasystoles - up to 10 per minute and frequent - more than 10 per minute.

EFI, or electrophysiological study, shown to two groups of patients. First, there are no structural changes in the heart, but correction of drug treatment is necessary. The second - organic violations are present, for risk assessment sudden death carry out diagnostics.

Signal-averaged ECG - new method, which is promising in terms of identifying patients with a high likelihood of severe forms ZhES. Also helps in identifying unstable ventricular tachycardia.

Treatment of ventricular extrasystole

Before starting therapy, the following situations are assessed:

• manifestations of ventricular premature beats;
• factors provoking the development of the disease, which may be associated with structural disorders, the presence ischemic disease heart, left ventricular dysfunction.
• undesirable conditions in the form of proarrhythmic effects that can complicate the course of the disease.

Depending on the course, form and severity of VES, treatment is carried out in the following areas:

1. Single, monomorphic, so-called "simple" extrasystoles, which do not cause hemodynamic disturbances, do not require specific treatment... It is enough to debug the daily regimen and nutrition, to treat the underlying ailment that could cause VES.
2. Unstable VES, the appearance of paired, polytopic, frequent extrasystoles lead to a violation of hemodynamics, therefore, antiarrhythmic drugs are prescribed to reduce the risk of ventricular fibrillation and cardiac arrest. Basically, they start with beta-blockers, if necessary, statins and aspirin are prescribed. In parallel, drugs are used to treat the underlying disease that caused extrasystole.
3. Malignant VES often requires the appointment of highly effective drugs - amiodarone, sotapol and the like, which have a good arrhythmogenic effect. If necessary, they are combined with maintenance doses of beta-blockers and ACE inhibitors.

Surgical treatment is indicated if ineffective drug therapy... Depending on the situation, destruction of the pathological focus of excitation, implantation of a cardioverter-defibrillator or an anti-tachycardic device may be prescribed.

Secondary prevention of ventricular premature beats

To prevent the development of VES, you should first of all follow the doctor's recommendations, which mainly consist in taking medications on time and observing a sleep and rest regimen. It is also important to eat well and eliminate bad habits. If physical inactivity is observed, you need to increase physical activity according to the capabilities of the body.

Video: Treatment of ventricular extrasystole

Ventricular extrasystoles (VES) are extraordinary contractions of the heart that occur under the influence of premature impulses that originate from the intraventricular conduction system.

Under the influence of an impulse that has arisen in the trunk of the bundle of His, its legs, branching of the legs or Purkinje fibers, the myocardium of one of the ventricles contracts, and then the second ventricle, without a previous atrial contraction. This explains the main electrocardiographic signs of VES: premature dilated and deformed ventricular complex and the absence of a previous normal P wave, indicating a contraction of the atria.

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, anginal pain 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 ventricular contraction, sedative drugs, beta-blockers and antiarrhythmics are used.

Causes

The reasons for ventricular premature beats appear with heart disease:

• inflammatory nature (myocarditis, endocarditis, intoxication);
• myocardial ischemia (foci of cardiosclerosis, acute infarction);
• metabolic-dystrophic changes in the muscle and the conducting 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 occur in people with a healthy cardiovascular system due to:

• irritations 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 high frequency. Therefore, most often the sinus rhythm remains normal. But extrasystoles can also occur against the background of atrial fibrillation.

Classification

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

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

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

M. Ryan's suggestions 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.

Others changed:

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

Symptoms

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

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, individual 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);
• with physical activity, the violation is practically not manifested.

Ventricular extrasystoles against the background of organic heart diseases, as a rule, are multiple in nature, but for the patient they are asymptomatic. They develop with exertion and pass while lying down. Usually, this type of arrhythmia develops against the background of tachycardia.

Many women experience tachycardia and pain in the left side of the chest during pregnancy. The development of VES in future mother- the phenomenon is not uncommon. This is due to the fact that on circulatory system and the heart is double burdened. In addition, physiological restructuring should be considered. hormonal background affecting the rhythm of the impulses. Such extrasystole is not malignant and after childbirth is easily treatable.

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 ventricular contractions, allowing for frequency and sequence heart rate.
2. The bicycle ergometry method makes it possible to identify the dependence of the manifestations of ventricular extrasystoles on the load received, and also to classify the disease, which greatly facilitates the preparation of a program for its treatment.
3. As diagnostic methods also can be used polycardography, PPECG, sphygmography and other methods.

Extrasystole may not always be detected on an ECG. This is due to the fact that this study is carried out quickly enough (about 5 minutes), and single extrasystoles may simply not get on the film. In this case, other types of diagnostics are used. One of the techniques is Holter monitoring. It is carried out during the day, in the usual motor activity the patient, 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 the patient, drug treatment not carried out. Recommend refusal bad habits, modification of risk factors, it is possible to take Corvalol.

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

1. Propafenone is a class I antiarrhythmic; it is used in case of a benign course. Contraindicated in LV aneurysm, severe heart failure.
2. Bisoprolol - an adrenergic blocker, prevents ventricular fibrillation, hardens the heart rate. Contraindicated in patients with bronchial asthma.
3. Cordaron is the drug of choice for malignant and prognostically unfavorable PVCs. Reduces rates of cardiac mortality.

Surgical treatment is carried out with frequent ventricular extrasystoles, which do not respond well drug treatment... An electrophysiological study is performed to establish the exact location of the focus and its radiofrequency ablation.

Lifestyle with ventricular premature beats

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

Patients with a benign type of ventricular premature beats do not need to restrict physical activity. In the malignant type, significant loads and psychoemotional situations that can lead to the development of an attack should be limited.

Traditional methods

If extrasystole is not life-threatening and is not accompanied by hemodynamic disturbances, 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. This will require 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 pieces of heather;
• 3 parts of hawthorn;
• 2 parts hops.

Important! Before starting treatment folk remedies, it is necessary to consult with your doctor, because many herbs can cause allergic reactions.

Effects

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

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

1. Stable ventricular tachycardia Characterized by prolonged (more than half a minute) attacks of group ventricular extrasystoles. It, in turn, provokes the consequences shown further in this table.
2. Ventricular flutter The contraction of the ventricles at a frequency of 220 to 300 beats per minute.
3. Fibrillation (flickering) of the ventricles Chaotic contractions of the ventricles, the frequency of which reaches 450 beats per minute. Flickering ventricles are unable to pump blood, so the patient usually faints due to lack of oxygen in the brain. This condition, in the absence of medical care, can provoke death.
4. Asystole (cardiac arrest) May occur during an attack ventricular arrhythmias either suddenly. Often, asystole inevitably leads to death, since doctors are far from always able to perform resuscitation actions within a few minutes after cardiac arrest.

To avoid life-threatening consequences, do not postpone starting treatment if you have ventricular premature beats.

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 heart damage, the prognosis is relatively unfavorable and is determined not only by the characteristics of ventricular extrasystoles by 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 poor due to the 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.

Prevention of ailment

• maintaining a more active and mobile lifestyle;
• quitting bad habits, including smoking, overuse alcohol and strong coffee;
• regular medical examinations.

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

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

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

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

Symptoms

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

• Disruptions in the work of the heart (there may be a feeling that the heart is turning over in the chest);
• Weakness, discomfort;
• Excessive sweating;
• Hot flashes;
• Lack of air;
• Irritability, feelings of fear and anxiety;
• Dizziness. Frequent extrasystoles may be accompanied by dizziness... This occurs due to a decrease in the volume of blood emitted by the heart muscle and, as a consequence, oxygen starvation in the brain cells.

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

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

In pregnant women, the appearance of extrasystoles is also quite often recorded. Usually, extrasystoles during pregnancy occur with overwork or, as well as if a woman had problems with the thyroid gland, cardiovascular and broncho-pulmonary systems. If the pregnant woman feels well and does not present any complaints, then in this case, treatment is not required.

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

Organic and functional extrasystoles

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

The causes of functional extrasystoles:

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

The causes of organic extrasystoles:

1. (IHD is the most frequent illness leading to heart rate irregularities);
2. Chronic cardiovascular failure;
3. Infectious heart disease;
4. Some types (can be acquired and congenital);
5. Diseases thyroid gland(such as thyrotoxicosis).

Supraventricular premature beats

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

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

Classification of supraventricular extrasystoles

By localization:

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

By the number of foci:

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

By the time of occurrence:

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

By frequency (one minute):

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

Ventricular premature beats

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

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

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

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

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

Varieties of ventricular extrasystoles

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

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

The following subtypes of arrhythmia are also distinguished:

• Benign ventricular arrhythmias. There are no signs of damage to the heart muscle, and there is little or no risk of sudden;
• Potentially malignant extrasystole. In this case, there are already any organic lesions of the heart and hemodynamic disturbances. Risk increases sudden stop hearts.
• Malignant arrhythmia. In view of serious organic lesions of the heart tissue and persistent hemodynamic disturbances, there are numerous extrasystoles. High risk of mortality.

Symptoms

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

Diagnostics

The most popular and in an accessible way diagnosis is - ECG. Also, techniques such as bicycle ergometry and trimedil test are widely used. With their help, you can determine whether extrasystole is associated with physical activity.

What does extrasystole look like on an ECG?

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

The most common is ventricular premature beats on the ECG

Holter monitoring

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

Video: lesson on arrhythmias and extrasystoles

Treatment

Before starting treatment, it is imperative to consult a doctor. In no case should you self-medicate, since arrhythmia is serious illness which can lead to various complications. The doctor will conduct the necessary examination, measure blood pressure, will prescribe additional examination methods and, if necessary, prescribe the appropriate medications. Remember: treatment of extrasystole of the heart should be prescribed only by a specialist!

With inefficiency conservative therapy, Maybe surgery- installation of an artificial pacemaker. It will prevent the occurrence of arrhythmias and significantly improve the patient's quality of life. In the absence of positive dynamics after antiarrhythmic therapy, patients can be prescribed.

Video: therapy of tachyarrhythmias and supraventricular extrasystoles

Traditional methods of treating extrasystole

If extrasystole is not life-threatening and is not accompanied by hemodynamic disturbances, 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. This will require hawthorn flowers, lemon balm, motherwort, common heather and hop cones. They must be mixed in the following proportions:

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

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

Extrasystole in children

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

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

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

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

Complications

With physiological extrasystole, which is benign, without hemodynamic disturbances, complications rarely occur. But if it is malignant, then complications are quite common. This is precisely what extrasystole is dangerous for.

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

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

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

Finally

If symptoms of extrasystole are detected, you must immediately consult a doctor, and it is better to immediately see a cardiologist. You should not ignore the disease, because, at first glance, it is harmless can lead to very sad consequences... And in any case, do not self-medicate without consulting a specialist - this will not lead to anything good.

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

Your doctor said that you have extrasystole or parasystole, and you have no idea what it is. We hope that after reading this article, you will find answers to many of your questions.

This type of rhythm disturbance is very common. Moreover, it is very difficult to meet a person who has never felt "interruptions" in the work of the heart in his life.

What is extrasystole and parasystole?

Extrasystole is called an extraordinary or premature contraction of the heart or its parts in relation to the main rhythm. This occurs as a result of the formation of an additional excitation pulse. The extrasystole follows the normal contraction of the heart at a certain fixed distance, which is even called the coupling interval. Unlike extrasystoles, parasystoles do not have a strictly fixed interval of adhesion with the preceding sinus complex (Fig. 1).

Rice. 1 Parasystole

This is due to the fact that the parasystolic focus has its own rhythm, independent of the main one.

The sensations of extrasystoles and parasystoles do not differ in any way. Moreover, it is possible to distinguish between these two types of heart rhythm disturbances only with the help of the electrocardiography method. Most researchers believe that extrasystole and parasystole are varieties of the same rhythm disturbance, and we think the same way. Therefore, the distinction between extrasystoles and parasystoles is only of academic interest, and their manifestation and treatment are the same. Often they just use general term- "premature contractions". And, since the term extrasystole is used by doctors much more often than parasystole, this is what we will use.

Extrasystole and parasystole are varieties of the same rhythm disturbance .

If we assume that a new focus of excitation has appeared in the heart for some reason (we will talk about them a little later), which forms its own impulses, then a premature contraction of the heart or its parts, that is, extrasystole, may occur. This additional (extraordinary) impulse can occur in different parts of the heart, depending on the location of the focus of excitation and, accordingly, extrasystoles will differ from each other. They also differ in frequency, density, periodicity, and cause of occurrence.

Varieties of extrasystole

1. Depending on the location of the focus of excitation, extrasystoles are divided into ventricular and supraventricular.

Among the supraventricular extrasystoles, the atrial and AV-nodal are separately distinguished.

Ventricular extrasystoles: classification

In the heart muscle, the most vulnerable part is the left ventricle. This is where change most often occurs dystrophic, as well as sclerosis against the background of ischemia or after a heart attack. Therefore, the potential for ventricular extrasystoles to appear is most likely in the left ventricle, while the right one is less susceptible to these changes.

Ventricular extrasystole: foci of occurrence

The term ventricular extrasystole means the appearance of an extraordinary contraction of the heart under the action of an ectopic impulse located in the ventricle. This means that re-excitation starts the re-entry focus located in the interventricular septum or its wall. Therefore, in fact, this means that an ectopic focus of excitation can form in any part of the left ventricle, which will lead to extrasystole.

Depending on where the focus of excitation is located in the left ventricle, extrasystoles are not classified, since this has no clinical significance. As an exception, this can be distinguished only by cardiac surgeons who can perform surgery, eliminating large-focal cardiosclerosis, preventing the circulation of the impulse through the re-entry mechanism.

Characteristics of the classification of ventricular extrasystoles

Unlike supraventricular, ventricular premature beats are more difficult to treat. And if in the diagnosis it is worth resorting to the same approaches as in the recognition of supraventricular extrasystoles, then the therapy here differs radically.

Ventricular extrasystoles differ from supraventricular ones, first of all, by the location of the ectopic focus of repeated impulse input. In the first case, it is located in the left ventricle, and therefore the appearance of the P wave in the extrasystolic contraction is not noted on the ECG. At the same time, it is expanded, that is, it lasts more than 0.12 seconds, and is also deformed. All this is noticeable by the location of the QRS complex on the cardiogram.

From the muscular region of the heart, the contraction spreads to the rest of the organ, causing contraction. In this case, excitement is extraordinary, but the myocardium responds to it by contraction. Simply put, this impulse conduction defect periodically causes the ventricles to contract during their diastole. On the ECG, this is recognized as a new QRS complex located at a distance from the previous one, less than the normal RR interval between two normal beats.

However, after repeated contraction, the ventricular myocardium cannot contract again in response to a new normal impulse that enters the atypical cardiomyocyte conduction system. The muscles are in a period of relative refractoriness, and therefore the ECG records the loss of the QRS complex in the area where it should have been normal.

The prolapse of a new QRS complex is called a compensatory pause. During this period, the heart cannot contract, which is explained by electrophysiological processes in the myocardium. In this case, ventricular extrasystoles lead to complete compensatory pauses, while with supraventricular they are not observed. A complete compensatory pause can be recognized by the time interval in which the heart did not contract, despite the passage of an impulse through atypical cardiomyocytes.

If the pause size is approximately equal to the normal RR interval, then the compensatory pause will be complete. However, if the interval is slightly less than the normal RR interval, then we are talking about an incomplete compensatory pause. At the same time, symptomatically, it looks like this:

• The patient feels a strong contraction of the heart, which leads to an increase in pressure in the neck and a sensation of a high pulse wave in the region of the jugular notch of the sternum.
• Then in the period compensatory pause the heart does not contract, and the patient feels as if the heart stops beating.

It is important to understand that the more often this symptom appears, the less pleasant moments in the situation itself. The extrasystoles themselves can be benign, that is, they do not originate from altered areas of the myocardium. Therefore, they should not be treated, since they do not lead to significant violations in the work of the heart. If ventricular extrasystoles begin to affect normal hemodynamics, then you should take care of adequate diagnosis and competent treatment.

Classification of ventricular extrasystoles

All ventricular extrasystoles are divided into several types. Depending on the frequency of repetitions, they are divided into:

• Single ventricular extrasystoles;
• Frequent;
• Paired or group.

By the site from which they originated:

Is ventricular premature beats dangerous?

Ventricular extrasystole is a premature excitation of the heart, which occurs under the influence of impulses emanating from different parts of the ventricular conduction system. Ventricular premature beats are considered the most common heart rhythm disorder. Its frequency depends on the method of diagnosis, as well as the contingent of the surveyed. Many are worried about the question of danger this disease hearts for life. To answer the question "Is ventricular premature beats dangerous for humans?" it is necessary to conduct an electrocardiogram of the heart and daily monitoring.

Is ventricular extrasystole dangerous?

After the necessary studies (analyzes, ECG, 24-hour maneuvering), the following data will be obtained. What types of rhythm disturbances were registered in a day; how many episodes different kind violations have been identified.

But in the absence this method diagnostics, only a short recording of ECG studies can sometimes also make some conclusions.

To date, there are several classifications of arrhythmias precisely according to the danger to life. There are five classes of ventricular extrasystoles according to the Lown and Wolf classification.

Class 1 - these are ventricular single extrasystoles, which have a frequency of less than 30 per hour. As a rule, this arrhythmia is not dangerous for the patient's life and is considered the norm for a healthy person.

Class 2 - these are single ventricular extrasystoles, the frequency of which is more than 30 per hour. This arrhythmia more significant for health, but despite this, to any serious negative consequences rarely leads.

Class 3 are polymorphic extrasystoles, in other words, those that have different shape in one ECG lead. In the presence of multiple episodes of this type of arrhythmia, special specific treatment is required.

Class 4a includes paired ventricular extrasystoles that follow one after another in a row.

Class 4c includes volley ventricular extrasystoles - these are from 3 to 5 ventricular extrasystoles in a row.

Class 5 is early ventricular premature beats or "R to T".

Grades 4a, 4b, 5 are high-grade extrasystoles, in other words, those that can start ventricular tachycardia or ventricular fibrillation, and this is already very dangerous for the patient's life, will lead to cardiac arrest, as a rule, with all of this ensuing consequences.

In addition, the significance of arrhythmias in medicine of a lower class is revealed by the presence of symptoms that have arisen against the background of such extrasystoles. It also happens that every second stroke in a patient is an extrasystole, but he does not even feel it, it also happens that an extrasystole appears up to 3 times an hour, and the patient almost loses consciousness. It can be concluded that in each a separate case the danger of ventricular extrasystole for the patient's life is identified individually.