Idiopathic ventricular extrasystole operation. Ventricular extrasystole, what is it? Treatment and consequences

Article publication date: 12/19/2016

Article last updated: 12/18/2018

From this article you will learn: what is ventricular extrasystole, its symptoms, types, methods of diagnosis and treatment.

With ventricular extrasystole (this is one of the types), untimely contractions of the ventricles of the heart occur - in another way, such contractions are called extrasystoles. This phenomenon does not always indicate any diseases, extrasystole sometimes occurs in completely healthy people.

If the extrasystole is not accompanied by any pathologies, does not cause inconvenience to the patient and is visible only on the ECG - no special treatment not required. In the event that ventricular extrasystole was provoked by a violation of the heart, you will need additional examination a cardiologist or arrhythmologist who will prescribe medication or surgery.

This pathology can be completely cured (if treatment is necessary) if the defect that caused it is surgically corrected - or you can achieve a lasting improvement in well-being with the help of medications.

Causes of ventricular extrasystole

The reasons for this phenomenon can be divided into two groups:

1. organic - these are pathologies of the cardiovascular system;
2. functional - stress, smoking, overuse coffee etc.

1. Organic causes

The occurrence of ventricular extrasystole is possible with such diseases:

• Ischemia (impaired blood supply) of the heart;
• cardiosclerosis;
• dystrophic changes in the heart muscle;
• myocarditis, endocarditis, pericarditis;
• myocardial infarction and postinfarction complications;
• congenital heart defects (, coarctation of the aorta, ventricular septal defects, prolapse mitral valve other);
• the presence of extra conductive bundles in the heart (Kent's bundle in WPW syndrome, James's bundle in CLC syndrome);
• arterial hypertension.

Also, untimely contractions of the ventricles appear with an overdose of cardiac glycosides, so always consult your doctor before using them.

Diseases that cause ventricular extrasystole are dangerous and require timely treatment. If untimely contractions of the ventricles were found on your ECG, be sure to undergo an additional examination to check if you have the heart pathologies listed above.

2. Functional reasons

These are stress, smoking, drinking alcohol, illegal substances, a large number of energy drinks, coffee or strong tea.

Functional ventricular extrasystole usually does not require treatment - it is enough to eliminate its cause and once again undergo a heart examination in a couple of months.

3. Idiopathic form of extrasystole

In this condition, a completely healthy person has ventricular extrasystoles, the cause of which has not been elucidated. In this case, the patient usually does not have any symptoms, so treatment is not carried out.

Classification and severity

To begin with, we suggest that you familiarize yourself with what types of ventricular extrasystoles exist:

Three scientists (Laun, Wolf and Ryan) proposed the following classification of ventricular extrasystoles (from mildest to most severe):

• 1 type. Up to 30 single extrasystoles of the ventricles per hour (up to 720 pieces per day with a Holter study). Most often, such extrasystole is functional or idiopathic in nature and does not indicate any diseases.
• 2 type. More than 30 single untimely contractions per hour. It may indicate, and may be functional. By itself, such an extrasystole is not very dangerous.
• 3 type. Polymorphic ventricular extrasystoles. May indicate the presence of additional conducting bundles in the heart.
• 4A type. Paired extrasystoles. More often they are not functional, but organic in nature.
• 4B type. Group extrasystoles (unstable). This form is due to cardiovascular disease. Dangerous development of complications.
• 5 type. Early group ventricular extrasystoles (visible on the cardiogram in the first 4/5 of the T wave). This is the most dangerous form ventricular extrasystole, as it often causes life-threatening forms of arrhythmias.

Classification of ventricular extrasystoles

Symptoms of ventricular extrasystole

Rare single extrasystoles of a functional or idiopathic nature are usually visible only on the ECG or during the daily. They do not show any symptoms, and the patient is not even aware of their presence.

Sometimes patients with functional ventricular extrasystole complain of:

• feeling as if the heart stops (this is due to the fact that an extrasystole can be followed by an extended diastole (pause) of the ventricles);
• feeling of tremors in the chest.

Immediately after exposure to cardiovascular system unfavorable factor(stress, smoking, alcohol, etc.) the following signs may appear:

• dizziness,
• pallor,
• sweating,
• feeling as if there is not enough air.

Organic ventricular extrasystole, which requires treatment, is manifested by symptoms of the underlying disease that caused them. There are also signs listed in the previous lists. They are often accompanied by bouts of squeezing pain in the chest.

Attacks of unstable paroxysmal tachycardia are manifested by the following symptoms:

• severe dizziness,
• fainting state,
• fainting
• "fading" of the heart,
• strong heartbeat.

If the treatment of the disease that caused this type of ventricular extrasystole is not started on time, life-threatening complications may appear.

Diagnostics

Most often, ventricular extrasystole is detected during a preventive medical examination during an ECG. But sometimes, if the symptoms are pronounced, the patients themselves come to the cardiologist with complaints about the heart. For an accurate diagnosis, as well as determining the primary disease that caused ventricular extrasystole, it will be necessary to undergo several procedures.

Initial inspection

If the patient himself came with complaints, the doctor will interview him to find out how severe the symptoms are. If the signs are paroxysmal in nature, the cardiologist must know how often they occur.

The doctor will also measure arterial pressure and pulse rate. At the same time, he can already notice that the heart is contracting irregularly.

After initial examination The doctor immediately prescribes an EKG. Focusing on its results, the cardiologist prescribes all other diagnostic procedures.

Electrocardiography

According to the cardiogram, doctors immediately determine the presence of ventricular extrasystoles.

Not on the cardiogram, ventricular extrasystole manifests itself as follows:

1. the presence of extraordinary ventricular QRS complexes;
2. extrasystolic QRS complexes are deformed and expanded;
3. there is no P wave before the ventricular extrasystole;
4. after an extrasystole there is a pause.

Holter examination

If pathological changes are visible on the ECG, the doctor prescribes daily ECG monitoring. It helps to find out how often the patient has extraordinary contractions of the ventricles, whether there are paired or group extrasystoles.

After a Holter examination, the doctor can already determine whether the patient needs treatment, whether extrasystole is life-threatening.

Ultrasound of the heart

It is carried out to find out which disease provoked ventricular extrasystole. It can be used to identify ischemia, congenital and acquired heart defects.

coronary angiography

This procedure evaluates the status coronary vessels that supply oxygen and nutrients to the myocardium. Angiography is prescribed if the ultrasound showed signs of coronary heart disease (CHD). After examining the coronary vessels, you can find out exactly what provoked coronary artery disease.

Blood test

It is carried out to find out the level of cholesterol in the blood and to exclude or confirm atherosclerosis, which could provoke ischemia.

EFI - electrophysiological study

It is carried out if there are signs of WPW- or CLC-syndrome on the cardiogram. Allows you to accurately determine the presence of an additional conductive bundle in the heart.

Therapy of ventricular extrasystoles

Treatment of untimely contractions of the ventricles is to get rid of the cause that provoked them, as well as stopping attacks of severe ventricular arrhythmia, if any.

Treatment of the functional form of extrasystole

If ventricular extrasystole is functional, then you can get rid of it in the following ways:

• quit bad habits;
• take medication to relieve nervous tension(valerian, sedatives or tranquilizers, depending on the severity of the anxiety);
• adjust the diet (refuse coffee, strong tea, energy drinks);
• observe the regime of sleep and rest, engage in physiotherapy exercises.

Organic Form Treatment

Treatment of the organic form of type 4 disease involves taking that helps get rid of attacks of ventricular arrhythmia. The doctor prescribes Sotalol, Amiodarone or other similar medicines.

Antiarrhythmic drugs

Also, with pathologies of types 4 and 5, the doctor may decide that it is necessary to implant a cardioverter-defibrillator. This is a special device that corrects the heart rate and stops ventricular fibrillation if it occurs.

Treatment of the underlying disease that caused ventricular extrasystole is also required. Often, various surgical procedures are used for this.

Surgical treatment of the causes of ventricular extrasystole

Consequences of ventricular extrasystole

Ventricular extrasystole 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 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:

Consequence	Description
Stable ventricular tachycardia	It 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.
ventricular flutter	Contraction of the ventricles with a frequency of 220 to 300 beats per minute.
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 state, in the absence medical care can cause death.
Asystole ()	May occur against 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.

Prognosis for pathology

With extrasystole of the ventricles of types 1 and 2, the prognosis is favorable. The disease practically does not affect the quality of life of the patient and does not cause serious consequences.

With ventricular extrasystoles of type 3 and above, the prognosis is relatively favorable. With timely detection of the disease and the beginning of therapy, you can completely get rid of the symptoms and prevent complications.

Any extrasystole is characterized by many parameters, therefore, more than 10 sections are distinguished in the complete classification of extrasystoles. In practice, only some of them are used, which best reflect the course of the disease.

Extrasystoles are classified:

1. By localization:

• Sinus.
• Atrial.
• Atrioventricular.
• Ventricular.

2. Time of appearance in diastole:

• Early.
• Medium.
• Late.

3. By frequency:

• Rare (up to 5 / min).
• Medium (6-15/min).
• Frequent (more than 15/min).

4. By density:

• Single.
• Paired.

5. By frequency:

• Sporadic (random).
• Allorhythmic - systematic - bigeminy, trigeminy, etc.

6. For carrying out:

• Re-entry of an impulse by the re-entry mechanism.
• Blockade of conduction.
• Supernormal performance.

7. By etiology:

• Organic.
• Toxic.
• Functional.

8. By the number of sources:

• Monotopic.
• Polytopic.

Sometimes there is a so-called interpolated ventricular extrasystole- it is characterized by the absence of a compensatory pause, that is, a period after extrasystole, when the heart restores its electrophysiological state.

The classification of extrasystole according to Laun and its modification Ryan.

Laun's classification of extrasystole

Creating a classification of ventricular extrasystoles according to Laun - important step in the history of arrhythmology. Using the classification in clinical practice, the doctor can adequately assess the severity of the disease in each patient. The fact is that PVC is a common pathology and occurs in more than 50% of people. In some of them, the disease has a benign course and does not threaten the state of health, but others suffer from a malignant form, and this requires treatment and constant monitoring of the patient. The main function of ventricular extrasystoles is the classification according to Lown - to distinguish malignant from benign pathology.

Ventricular extrasystole gradation according to Lown includes five classes:

1. Monomorphic ventricular extrasystole with a frequency of less than 30 per hour.

2. Monomorphic PVC with a frequency of more than 30 per hour.

3. Polytopic ventricular extrasystole.

• Paired ZhES.
• 3 or more PVCs in a row - ventricular tachycardia.

5. PVC type R to T. ES is assigned the fifth class when the R wave falls on the first 4/5 of the T wave.

ZHES classification according to Laun used by cardiologists, cardiac surgeons and other medical specialties for many years. Appeared in 1971 thanks to the work of B. Lown and M. Wolf, the classification, as it seemed then, would become a reliable support for doctors in the diagnosis and treatment of PVCs. And so it happened: until now, several decades later, doctors are guided mainly by this classification and its modified version by M. Ryan. Since that time, researchers have not been able to create a more practical and informative gradation of PVCs.

However, attempts to introduce something new have been made repeatedly. For example, the already mentioned modification by M. Ryan, as well as the classification of extrasystoles by frequency and form from R. J. Myerburg.

Classification of extrasystole according to Ryan

The modification made changes to the 4A, 4B and 5 class of ventricular extrasystoles according to Lown. The complete classification looks like this.

1. Ventricular extrasystole 1 gradation according to Ryan - monotopic, rare - with a frequency of less than 30 per hour.

2. Ventricular extrasystole 2 gradations according to Ryan - monotopic, frequent - with a frequency of more than 30 per hour.

3. Ventricular extrasystole 3 gradation according to Ryan - polytopic PVC.

4. The fourth class is divided into two subclasses:

• Ventricular extrasystole 4a gradation according to Ryan - monomorphic paired PVCs.
• Ventricular extrasystole 4b gradation according to Ryan - paired polytopic extrasystole.

5. Ventricular extrasystole 5 gradation according to Ryan - ventricular tachycardia - three or more PVCs in a row.

Ventricular extrasystole - classification according to R. J. Myerburg

Classification according to Myerburg divides ventricular arrhythmias depending on the form and frequency of PVCs.

Frequency division:

1. Rare - less than one EC per hour.
2. Infrequent - from one to nine ES per hour.
3. Moderate frequency - from 10 to 30 per hour.
4. Frequent ES - from 31 to 60 per hour.
5. Very frequent - more than 60 per hour.

Division by shape:

1. Single, monotopic.
2. Solitary, polytopic.
3. Double.
4. Ventricular tachycardia lasting less than 30 seconds.
5. Ventricular tachycardia lasting more than 30 seconds.
6. R. J. Meyerburg published his classification in 1984, 13 years later than B. Lown. It is also actively used, but significantly less than those described above.

Classification of extrasystole according to J. T. Bigger

By itself, the diagnosis of PVC does not say anything about the patient's condition. Much more important is information about concomitant pathology and organic changes in the heart. To assess the likelihood of complications, J. T. Bigger proposed his own version of the classification, on the basis of which it is possible to draw a conclusion about the malignancy of the course.

In the classification of J. T. Bigger, PVC is evaluated according to a number of criteria:

• clinical manifestations;
• PVC frequency;
• the presence of a scar or signs of hypertrophy;
• the presence of persistent (lasting more than 30 seconds) or unstable (less than 30 seconds) tachycardia;
• ejection fraction of the left ventricle;
• structural changes in the heart;
• influence on hemodynamics.

Malignant is considered to be PVC with pronounced clinical manifestations(palpitations, syncope), the presence of scarring, hypertrophy or other structural lesions, a significantly reduced left ventricular ejection fraction (less than 30%), a high frequency of PVCs, with the presence of persistent or non-persistent ventricular tachycardia, a slight or pronounced effect on hemodynamics.

Potentially malignant PVC: symptomatic is weak, occurs against the background of scars, hypertrophy or other structural changes, accompanied by a slightly reduced left ventricular ejection fraction (30-55%). The frequency of PVCs can be high or moderate, ventricular tachycardia is either unstable or absent, hemodynamics suffers slightly.

Benign PVC: clinically not manifested, there are no structural pathologies in the heart, the ejection fraction is preserved (more than 55%), the frequency of ES is low, ventricular tachycardia is not recorded, hemodynamics does not suffer.

The extrasystole criteria of the J. T. Bigger classification give an idea of ​​the risk of developing sudden death- the most formidable complication of ventricular tachycardia. So, with a benign course, the risk of sudden death is considered very low, with a potentially malignant one - low or moderate, and malignant course ZhES is accompanied high risk of sudden death.

Sudden death refers to the transition of the PVC into ventricular tachycardia and then into atrial fibrillation. With the development of atrial fibrillation, a person goes into a state of clinical death. If you don't start within a few minutes resuscitation(best - defibrillation with an automatic defibrillator), clinical death will be replaced by a biological one and it will become impossible to bring a person back to life.

Ventricular extrasystoles are characterized by the premature appearance of a widened and deformed QRS complex.

Unlike an atrial extrasystole, there is always a compensatory pause before the ventricular extrasystole.

Ventricular extrasystole is a frequent violation of the heart rhythm. It can be observed both in healthy people, without any other symptoms, and in people with a diseased heart.

Ventricular extrasystole- frequent heart rhythm disturbances that can occur in healthy people without any other symptoms, but more often in people with various diseases heart, in particular coronary artery disease, heart defects, cardiomyopathies, myocarditis. The cause of ventricular extrasystole is an ectopic focus of excitation in the RV or LV.

Under ventricular extrasystole understand the premature contraction of the ventricles caused by the focus of excitation, which is located in the ventricles themselves. With the help of electrocardiography, ventricular extrasystole is easier to recognize than supraventricular (atrial extrasystole). Ventricular extrasystoles are characterized by premature widened (more than 0.11 s) and deformed QRS complexes, which in their configuration resemble the blockade of the PG stem.

So, when it occurs extrasystoles in the right ventricle (RV), it is excited earlier than the left ventricle (LV), therefore, a wide QRS complex is not recorded, resembling LBBB in configuration, since LV excitation occurs with a delay. If the center of extrasystole is located in the left ventricle, then the configuration of the QRS complex resembles the blockade of RBBB.

Ventricular extrasystole. Scheme.
a Left ventricular extrasystole with a compensatory pause (picture of RBBB blockade).
b Right ventricular extrasystole with compensatory pause (pattern of LBBB).

Ventricular extrasystole:
a Ventricular extrasystole in the form of bigeminy. fixed coupled ventricular extrasystoles.
b Interpolated and non-interpolated ventricular extrasystoles.
The last three ventricular extrasystoles are not interpolated, there is a compensatory pause.
c Heterotopic multiple ventricular extrasystoles.
d Group ventricular extrasystoles with the phenomenon of "R on T" (x).

Clinical Significance ventricular extrasystole depends on how often extrasystoles appear and whether they are single, paired or group. A group is understood as several extrasystoles following one after another. Further, the configuration of extrasystoles should also be taken into account. If the extrasystoles have the same configuration, then they come from the same focus and are called monomorphic or monotopic, but if the extrasystoles are different in configuration, then we are talking about polymorphic or polytopic extrasystoles.

At ventricular extrasystole, Unlike atrial extrasystole, there is always a compensatory pause. This means that the total duration of 2 contractions (before and after the extrasystole) is equal to twice the RR interval of normal contractions. The RR interval is understood, as mentioned earlier in the chapter on atrial extrasystoles, the distance from one R wave to the adjacent R wave.

The compensatory pause is explained as follows: the excitability of the sinus node and the atria during ventricular extrasystole is not disturbed. Since excitation from the sinus node reaches the ventricles in the absolute refractory period associated with extrasystole, excitation of the ventricles is impossible. Only when the next wave of excitation arrives from the sinus node, normal contraction of the ventricles is possible.

At ventricular extrasystole due to the pathological propagation of the excitation wave, a secondary violation of repolarization also appears in the form of depression of the ST segment and a negative T wave.

For treatment of ventricular extrasystoles the doctor has various antiarrhythmic drugs at his disposal, for example, beta-adrenergic receptor blockers and propafenone (prescribed only with severe clinical symptoms). Due to the arrhythmogenic effect inherent in all antiarrhythmic drugs (the frequency of cardiac arrhythmias caused by them is on average 10%), the attitude towards them is currently more restrained and they are prescribed with more caution.

Features of the ECG with ventricular extrasystoles:
Premature appearance of the QRS complex
Broadening of the QRS complex, the configuration of which resembles the blockade of the corresponding PG leg
The presence of a compensatory pause
Sometimes seen in healthy people, but more common in people with heart disease
Treatment is indicated only when clinical symptoms. Prescribe beta-adrenergic receptor blockers, propafenone, amiodarone

Ventricular extrasystole.
Premature appearance of a widened and deformed QRS complex; every second ventricular contraction is an extrasystole (VES),
That's why this violation heart rhythm is called ventricular bigeminy.
Multiple ventricular extrasystoles in myocardial infarction (MI) of lower localization.
Frequent quadrigeminia. On normal complexes, signs of myocardial infarction (MI) of the lower localization (x) are visible.

ECG training video for extrasystole and its types

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A common symptom for all extrasystoles: the premature appearance of an extrasystolic complex.

ECG signs atrial extrasystole:

- premature appearance of the P wave and the QRST complex following it;

- deformation and change in the polarity of the P wave of the extrasystole;

- the presence of an unchanged extrasystolic ventricular QRS complex;

- the presence of a compensatory pause is the distance from the extrasystole to the PQRST cycle of the main rhythm following it.

At extrasystoles from the AV junction the impulse that occurs in the AV junction propagates in two directions: from top to bottom along the conduction system to the ventricles (in this regard, the ventricular extrasystole complex does not differ from ventricular complexes of sinus origin) and from bottom to top along the AV node and atria.

ECG signs extrasystoles from the AV junction:

- premature appearance on the ECG of an unchanged ventricular QRST complex;

- a negative P wave after an extrasystolic QRS complex (if the ectopic impulse reaches the ventricles faster than the atria) or the absence of a P wave (with simultaneous excitation of the atria and ventricles (fusion of P and QRS).

ECG signs ventricular extrasystoles:

- premature extraordinary appearance on the ECG of a modified extended and deformed ventricular QRS complex;

- the absence of a P wave in front of the ventricular extrasystole;

- the presence of a compensatory pause.

Treatment. Treatment is carried out with subjective intolerance to the feeling of interruptions in the work of the heart, deterioration of the patient's well-being, signs of hemodynamic disturbances, very frequent, group extrasystoles.

Exclusion of external arrhythmogenic factors (strong tea, coffee, alcohol, smoking) is required.

Medical therapy:

- With atrial extrasystoles, novocainamide, beta-blockers in combination with sedatives (corvalol, valerian, motherwort), verapamil, etatsizin are effective.

- With ventricular extrasystoles - amiodarone, novocainamide, etatsizin. For urgent relief of ventricular extrasystoles (for example, with myocardial infarction), lidocaine is administered intravenously.

Paroxysmal tachycardias .

Paroxysmal tachycardia is an attack of increased heart rate (heart rate more than 140-220 per minute), lasting from several seconds to several hours, with a sudden onset (the patient feels it as a "push" in the heart) and ending.

Rhythm is subject to sinus node, and the focus of automatism outside the sinus node.

Depending on the source of the rhythm, paroxysmal tachycardias are:

1) supraventricular (supraventricular) - can occur not only in heart pathology, but also in healthy individuals:

a) atrial;

b) atrioventricular;

2) ventricular - only with severe pathology of the heart.

All variants of paroxysmal tachycardia significantly impair hemodynamics: diastolic filling of the ventricles, coronary blood flow decreases, stroke volume (SV) decreases, which can lead to acute left ventricular failure. Hemodynamic disturbances are the greater, the higher the heart rate.

Clinical picture of paroxysmal tachycardia.

During an attack, patients may experience palpitations, shortness of breath, pain in the region of the heart, dizziness, and general weakness. On examination, swelling of the cervical veins, restlessness, pallor are noted. skin, it is almost impossible to count the pulse during an attack, blood pressure decreases.

Diagnosis of supraventricular paroxysmal tachycardia .

ECG signs:

Ventricular extrasystole: causes, signs, treatment

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

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

In this article, we will consider the causes of ventricular extrasystole, its symptoms and signs, and talk about the principles of diagnosis and treatment of this pathology.

Causes

Ventricular extrasystole can be observed in healthy people, especially when daily monitoring electrocardiogram (Holter-ECG). Functional PVCs are more common in people younger than 50 years of age. It can be provoked by physical or emotional fatigue, stress, hypothermia or overheating, acute infectious diseases, taking stimulants (caffeine, alcohol, tannin, nicotine) or certain medicines.

Functional PVCs are quite often detected with increased activity vagus nerve. In this case, they are accompanied by a rare pulse, increased salivation, cold wet extremities, arterial hypotension.

Functional PVCs do not have a pathological course. With the elimination of provoking factors, they most often go away on their own.

In other cases, ventricular extrasystole is due to organic heart disease. For its occurrence, even against the background of heart disease, additional exposure to toxic, mechanical or autonomic factors is often required.

Often PVCs accompany chronic ischemic disease heart (angina pectoris). With daily ECG monitoring, they occur in almost 100% of these patients. Arterial hypertension, heart defects, myocarditis. heart failure and myocardial infarction are also often accompanied by ventricular extrasystoles.

This symptom is observed in patients with chronic diseases lungs, with alcoholic cardiomyopathy. rheumatism. There is extrasystole of reflex origin associated with diseases of the organs abdominal cavity: cholecystitis, peptic ulcer stomach and duodenum, pancreatitis, colitis.

Another common cause ventricular extrasystole is a metabolic disorder in the myocardium, especially associated with the loss of potassium cells. These diseases include pheochromocytoma (a hormone-producing tumor of the adrenal gland) and hyperthyroidism. PVCs can occur in the third trimester of pregnancy.

Drugs that can cause ventricular arrhythmias include primarily cardiac glycosides. They also occur with the use of sympathomimetics, tricyclic antidepressants, quinidine, anesthetics.

Most often, PVCs are recorded in patients with serious ECG changes at rest: signs of left ventricular hypertrophy. myocardial ischemia, rhythm and conduction disturbances. The frequency of this symptom increases with age, it is more common in men.

Clinical signs

With a certain degree of conditionality, one can speak of different symptoms with functional and "organic" PVCs. Extrasystoles in the absence serious illnesses hearts are usually solitary, but poorly tolerated by patients. They may be accompanied by a feeling of fading, interruptions in the work of the heart, individual strong beats in the chest. These extrasystoles often appear at rest, in the supine position or during emotional stress. physical stress or even a simple transition from horizontal to vertical position leads to their disappearance. They often occur against the background of a rare pulse (bradycardia).

Organic PVCs are often multiple, but patients usually do not notice them. They appear during physical exertion and pass at rest, in the supine position. In many cases, these PVCs are accompanied by rapid heartbeat (tachycardia).

Diagnostics

main methods instrumental diagnostics ventricular extrasystoles are ECG at rest and 24-hour Holter ECG monitoring.

Signs of PVC on the ECG:

Interpolated PVCs are distinguished, in which the extrasystolic complex is, as it were, inserted between two normal contractions without a compensatory pause.

If PVCs come from one pathological focus and have the same shape, they are called monomorphic. Polymorphic PVCs originating from different ectopic foci have different shape and a different coupling interval (distance from the previous contraction to the R wave of the extrasystole). Polymorphic PVCs are associated with severe heart disease and a more serious prognosis.

In a separate group, early PVCs ("R on T") are distinguished. The criterion of prematurity is the shortening of the interval between the end of the T wave of the sinus contraction and the beginning of the extrasystole complex. There are also late PVCs that occur at the end of diastole, which may be preceded by a normal sinus P wave, superimposed on the beginning of the extrasystolic complex.

ZhES are single, paired, group. Quite often they form episodes of allorhythmia: bigeminy, trigeminy, quadrigeminy. With bigeminy, PVC is recorded through each normal sinus complex, with trigeminy, PVC is every third complex, and so on.

With daily monitoring of the ECG, the number and morphology of extrasystoles, their distribution during the day, dependence on load, sleep, and medication are specified. This important information helps to determine the prognosis, clarify the diagnosis and prescribe treatment.

The most dangerous in terms of prognosis are frequent, polymorphic and polytopic, paired and group PVCs, as well as early extrasystoles.

The differential diagnosis of ventricular extrasystole is carried out with supraventricular extrasystoles, complete blockade of the legs of the His bundle, slipping ventricular contractions.

If ventricular extrasystole is detected, the patient should be examined by a cardiologist. Additionally, general and biochemical analyzes blood, electrocardiographic test with dosed physical activity, echocardiography.

Treatment

Treatment of ventricular extrasystole depends on its causes. With functional PVCs, it is recommended to normalize the daily routine, reduce the use of stimulants, and reduce emotional stress. A diet enriched with potassium is prescribed, or preparations containing this trace element ("Panangin").

With rare extrasystoles, special antiarrhythmic treatment not assigned. Assign herbal sedatives (valerian, motherwort) in combination with beta-blockers. With HS against the background of vagotonia, sympathomimetics and anticholinergics, for example, Bellataminal, are effective.

With the organic nature of extrasystole, treatment depends on the number of extrasystoles. If there are few, ethmosine, ethacizine, or allapinin may be used. The use of these drugs is limited due to the possibility of their arrhythmogenic effect.

If extrasystole occurs in acute period myocardial infarction, it can be stopped with lidocaine or trimecaine.

Cordarone (amiodarone) is currently considered the main drug for suppressing ventricular extrasystoles. It is prescribed according to the scheme with a gradual decrease in dosage. When treating with cordarone, it is necessary to periodically monitor liver function, thyroid gland, external respiration and the level of electrolytes in the blood, as well as undergo an examination by an ophthalmologist.

In some cases, persistent ventricular premature beats from a known ectopic lesion are well treated with radiofrequency ablation surgery. During such an intervention, cells that produce pathological impulses are destroyed.

The presence of ventricular extrasystole, especially its severe forms worsens the prognosis in patients with organic heart disease. On the other hand, functional PVCs most often do not affect the quality of life and prognosis in patients.

Video course "ECG is within the power of everyone", lesson 4 - "Heart rhythm disorders: sinus arrhythmias, extrasystole "(ZHES - from 20:14)

is one of the types of violations heart rate. Pathology manifests itself in extraordinary, premature contractions of the ventricles of the heart. At the same time, the patient himself at such moments experiences dizziness, weakness, pain in the heart, a feeling of lack of air. To detect the disease, a comprehensive cardiological examination is necessary. Treatment is most often medical.

Extrasystolic arrhythmias, which include ventricular extrasystole, are the most common cardiac arrhythmias. They are diagnosed at any age and differ depending on the location of the focus of excitation. It is ventricular extrasystole that occurs more often than others and is diagnosed in approximately 62% of cases.

During the ECG, single ventricular extrasystoles are recorded on average in 5% of young healthy people. With age, this figure increases to 50%. Therefore, it can be said with confidence that ventricular extrasystole is a heart rhythm disorder, which is typical for patients older than 45-50 years.

There are two types of cardiac arrhythmias: benign and life-threatening (malignant) ventricular extrasystoles. The first type of pathology is corrected by antiarrhythmic therapy, and the second is a consequence and is considered as a cardiac pathology (requires treatment of the underlying disease).

Main danger of such cardiac arrhythmias lies in the fact that they can provoke ventricular fibrillation and lead to sudden cardiac death.

Causes of ventricular extrasystole

The causes of ventricular extrasystole are mainly due to organic diseases of the heart muscle, however, in some cases etiological factor pathology remains unclear.

So, we can distinguish the following cardiac causes leading to ventricular extrasystole:

Postinfarction cardiosclerosis. So, people who have had a heart attack suffer from ventricular extrasystole in 95% of cases.

Arterial hypertension.

Pulmonary heart.

Dilated cardiomyopathy.

Hypertrophic cardiomyopathy.

Causes unrelated to heart disease include:

Violations of the microexchange of elements in the body, manifested in hypomagnesemia and potassium, as well as in hypercalcemia.

Taking medications in high doses. Particularly dangerous in this regard are tricyclic antidepressants, diuretics, Amitriptyline, Fluoxetine, etc.

The use of narcotic and psychotropic drugs, including caffeine, cocaine, amphetamine, alcohol.

The use of anesthetic drugs.

Irritation of the vagus nerve due to sleep problems or due to strenuous mental work.

• Cervical osteochondrosis.

  Vagotonia and neurocirculatory dystonia.

  Infectious diseases.

  Frequent stress, expressed emotional upheaval.

It has been established that in people with increased activity of the parasympathetic nervous system, ventricular extrasystole occurs during rest, and when physical activity, on the contrary, it may disappear. It is not excluded the appearance of heart rhythm disturbances in people without any diseases, that is, against the background of absolute health.

Signs of ventricular extrasystole may often be absent altogether, although in some cases patients present with the following complaints:

The appearance of a feeling of interruptions in the work of the heart. Sometimes there may be a fading or a feeling of increased “push”.

Fatigue, excessive irritability, episodes - all these signs may indicate ventricular extrasystole if it occurs against the background of vegetative-vascular dystonia.

The feeling that a person is suffocating due to lack of air often appears when the heart rhythm is disturbed against the background of cardiopathologies. Perhaps the appearance of heart pain, feelings of weakness. In some cases, fainting occurs.

During the examination, the doctor may notice a characteristic pulsation of the veins in the neck, which in cardiology terminology is called venous Corrigan waves. The pulse is arrhythmic, with long pauses and extraordinary waves. To verify the presence of cardiac arrhythmias, it is necessary to conduct instrumental diagnostics. First of all, this is an ECG and a Holter ECG.

Gradation of ventricular extrasystole according to ryan

Gradation of ventricular extrasystole according to ryan is one of the options for classifying cardiac arrhythmias. This is enough Full description extrasystoles, so it is used by cardiologists on currently time, although it was last modified in 1975.

So, the following stages of ventricular extrasystoles are distinguished:

O - there is no extrasystole.

1 - the number of extrasystoles does not exceed 30 episodes in 60 minutes (rare ventricular arrhythmia).

2 - the number of extrasystoles exceeds 30 episodes in 60 minutes.

3 - the presence of multifocal extrasystoles.

4a - the presence of paired monotropic extrasystoles.

4b - polymorphic ventricular extrasystoles with flickering and ventricular flutter.

5 - ventricular tachycardia with three or more ventricular extrasystoles.

Treatment of ventricular extrasystole

Treatment of ventricular extrasystole is sufficient challenging task. The tactics of therapy should be determined by many factors, and first of all, the severity of extrasystole. In addition, if a person does not have any significant diseases heart, and extrasystole objectively does not manifest itself in any way, then treatment is not carried out at all.

If the symptoms of heart rhythm disturbances still periodically disturb a person, then it is recommended that he avoid aggravating factors as much as possible, including: drinking alcohol, smoking, etc. Therapy should be aimed at maintaining normal electrolyte balance, it is equally important to control the level of blood pressure.

In addition, all patients, without exception, are recommended to adhere to a dietary diet that will be additionally enriched with potassium salts. Equally important is the fight against physical inactivity, which involves an adequate increase in physical activity.

Antiarrhythmic therapy

Ventricular extrasystole responds well to a large number of drugs, including:

Fast sodium channel blockers. This includes several classes of drugs. Class 1A includes Disopyramide, Quinidine, Procainamide. Class 1B includes Mexiletin. Class 1C includes Flecainide, Propafenone. Each class of drugs has its own advantages and disadvantages and should be selected by a doctor, based on the characteristics clinical picture. Moreover, clinical researches made it possible to find out that the use of these drugs in patients who have undergone lead to an increase in mortality.

Beta-blocker drugs. They are prescribed to patients who have organic diseases of the heart muscle.

Such medicines, as Amiodarone and Sotalol are prescribed only in extreme cases, when there are life threatening arrhythmias. Although sometimes doctors replace drugs with beta-blockers with Amiodarone (if the patient has an individual intolerance).

It is not excluded the appointment of blockers calcium channels however, recent data indicate that they do not play any significant role in the treatment of ventricular premature beats.

Radiofrequency ablation (RFA) for extrasystoles

RFA as a treatment method ventricular disorder rhythm is not recommended for every patient. There are certain indications for which this type of therapeutic effect is prescribed. It is recommended to patients who are not helped by drug correction, but at the same time, extrasystole is monomorphic, happens quite often and worries the patient with severe symptoms. RFA is also recommended for those groups of patients who refuse medical correction for a long time.

RFA involves a minimally invasive surgical intervention under X-ray control. This is a low-risk catheter operation that restores the heart rhythm well.

Implantation of cardioverter-defibrillators

The installation of implants is resorted to only if patients have a malignant ventricular extrasystole, which carries a high risk of sudden cardiac death.

The prognosis of ventricular extrasystole depends on what form of cardiac arrhythmia is diagnosed in the patient, whether there is an organic pathology of the heart and hemodynamic disturbances. If we are talking about functional extrasystole, then it does not pose any threat to human life. However, in the presence of lesions of the heart muscle, the risk of sudden death increases significantly.