Stomatricular extrasystolic arrhythmia. Methods for the treatment of ventricular extrasystole

The date: 13.04.2019

Stomatricular extrasystole - This is a violation heart Rhythm (arrhythmia), which is characterized by the occurrence of additional heart pulses outside the conductive system of the heart - in the so-called ectopic foci located in the wall of the ventricles (lower hearts), which cause extraordinary, defective heart cuts.

Symptoms

No rare cases when symptoms of extrasystole are poorly pronounced and the patient does not even know about their disease, and its presence is determined only by the results of the electrocardiogram (ECG).

But most often the patient transfers the symptoms of the extrasystole is quite painful. Every extrasystole he feels like a heart impetus, after which the feeling of "failure", "fading", "turning" and even "stop" of the heart comes. Immediately after the jolts, the pulse wave falls out, an attempt to try the pulse will be unsuccessful.

Some patients note that after hitting some time there is a feeling of compression and tingling for the sternum and / or a non-stupid dull pain.

Indirect symptoms of extrasystole - dizziness, nausea, feeling of fear, fear of death, increased sweating, permanent consciousness, panic attacksAs a rule, arise after another extrasystole.

The severity of the symptoms of the extrasystole primarily depends on the contractile ability of the heart muscle, the frequency of the extrasystole, their species, causes of occurrence, as well as the individual threshold of the sick person.

Among the doctors there is an opinion that in persons with the functional reasons of the extrasystole signs of the disease appear brighter, and vice versa, if the cause of the disease is organic origin, the symptoms of extrasystolia are weakly expressed or not noticeable.

Causes

The ventricular extrasystole can develop due to organic heart diseases or wearing idiopathic character.

The most often organic base of the ventricular extrasystole is CHA; In patients with myocardial infarction, it is registered in 90-95% of cases. The development of ventricular extrasystole may be accompanied by the flow of post-infarction cardiosclerosis, myocarditis, pericarditis, arterial hypertension, dilatation or hypertrophic cardiomyopathy, chronic heart failure, pulmonary heart, prolapse mitral valve.

Etoiopathic (functional) ventricular extrasystolia can be associated with smoking, stress, consumption of caffene-containing drinks and alcohol, leading to an increase in the activity of the sympathetic and adrenal system. The ventricular extrasystolia is found in persons suffering from cervical osteochondrosis, neurocirculatory dystonia, vagotonia. With increased parasympathetic activity nervous system Stomatricular extrasystole can be observed alone and disappear during exercise. Quite often, single ventricular extrasystoles occur in healthy individuals without visible reasons.

TO possible reasons The ventricular extrasystole includes yatrogenic factors: overdose of heart glycosides, reception of ß-adrenostimulants, antiarrhythmic drugs, antidepressants, diuretics, etc.

Signs

The ventricular extrasyistol usually has the following signs:

The main feature is the prematurity of the occurrence.
Another sign is the lack of teeth of the QRs in front of the QRS complex.
Emission of ventricular complexes more than 0.12 p.
An additional feature can be considered the discordance of the ST segment and the teeth of T (directed the opposite of the main teeth of the QRS complex).

After the ventricular extrasystole, a complete compensatory pause should be complete (the sum of the intervals from the sinus complex to the extrasystole and from the extrasystole to the next sinus complex is equal to the double interval R-R) as a result of retrograde discharge by the extrasystic pulse of the sinus node. Sometimes ventricular extrasystoles can be interpolated, i.e. Inserted between two sinus complexes QRS without a compensatory pause (the discharge of the sinus node does not occur), this phenomenon is one of the main symptoms. The hidden retrograde conducting interpolated extrasystole in AV-compound causes the lengthening of the p-R interval of the subsequent sinus complex.

Diagnostics

The diagnosis can be installed on the basis of:

analysis of complaints (on the feeling of "interruptions" in the work of the heart, the hearts of the heart "outside the rhythm", shortness of breath, weakness) and anamnesis of the disease (when symptoms appeared, with their appearance, which treatment was carried out and its effectiveness, as the symptoms of the disease changed over time);
anamnesis analysis of life ( past illnesses and operations, bad habits, lifestyle, level of labor and life) and heredity (the presence of heart disease in close relatives);
general inspection, tackling of the pulse, auscultation (listening) of the heart (the doctor can identify the change in the rhythm and the frequency of heart cuts, as well as the difference between the heart rate and the pulse rate), percussion (climbing) of the heart (the doctor can identify the change in the heart boundaries caused by its disease which is the cause of ventricular extrasystole);
indicators of general and biochemical analysis of blood and urine, hormonal analysis (hormone level), which can identify extracardial (non-heart disease) causes of extrasystole;
electrocardiography data (ECG), which allow you to identify changes that are characteristic of each type of ventricular extrasystole;
eCG daily monitoring indicators (Halter monitoring) - a diagnostic procedure, which consists in carrying the patient of the ECG portable apparatus during the day. At the same time, a diary is being conducted, in which all the actions of the patient (lifting, meals, physical activity, emotional concern, deterioration of well-being, waste, awakening at night). ECG and diary data are proceedable, thus reveal non-permanent heart rate disorders (associated with exercise, meal, stress, or night ventricular extrasystoles);
electrophysiological research data (heart stimulation electrical impulses With the simultaneous entry of the ECG) - the electrode is supplied to the heart cavity by introducing a special catheter through a large blood vessel. Applied in cases if rESULTS ECG do not give unequivocal information on the form of arrhythmia, as well as to estimate the state of the conductive heart system;
echocardiography data - Echocrine ( ultrasound procedure hearts) that allow you to identify the cardiac causes of the ventricular extrasystole (heart disease, leading to heart rate impaired);
the results of the load tests - ECG records during and after physical exertion (squats, walking on a treadmill or classes on an exercise bike), - which allow you to identify arrhythmia occurring during exercise;
the data of magnetic resonance imaging (MRI), which is carried out in non-informativeness of echocardiography, as well as to identify diseases of other organs that may cause arrhythmias (heart rate disorders).

ECG

This type of arrhythmia is also found in the presence of heart diseases of an organic nature and without them. In carrying out daily monitoring of the holder, the ventricular extrasystole is noted in 60% of the surveyed. And in the absence of cardiac pathology, it does not have a characteristic impact on arrhythmia forecast.

After the myocardial infarction suffered, ventricular extrasystolia in its distribution is 80%. At the same time, frequent and paired extrasystoles are characterized by an increased fatal outcome. However, these forms of this arrhythmia do not relate to essential risk factors in contrast to the low fraction of LV emission.

On the electrocardiogram, ventricular extrasystolia is an extraordinary wide deformed QRS complexes that have no preceding teeth of R. and the interval between the linked complexes can be constant. In addition, when it varying heart abbreviations with a common divider, they talk about the ventricular form of parasistolia. With this arrhythmia, the extrasystoles are based on the focus of the excitation, into which the pulses of the sinus node do not come.

The ventricular extrasystole can manifest themselves with single heart abbreviations, as well as repeatedly sequentially (bigemia), each second QRS complex in the form of a trigemia or third in the form of quadrgemia.

The two in a row arising arrhythmias are called pairs, and more three at a frequency of 100 per minute - ventricular tachycardia or unstable form. In addition, ventricular extrasystole may have the same or different shapeThat is, it is characterized by monomorphic or polymorphic extrasystole.

Mostly extraordinary impulses are not conducted in the atrium and do not discharge sinus knotTherefore, the emerging impulses are unable to lead to the excitation of the ventricle as a result of their refractoriness. It is precisely this that causes an occurrence against the backdrop of the ventricular extrasystolism of a complete compensatory pause, that is, an interval between the extrasystic teeth R, before and after, equal to the RR interval. As a result of an extraordinary impulse on the atrium, in the form of retrograde teeth P, the sinus node and a compensatory pause will be incomplete.

Some moments, the impulse to the atrium is subject to blocking in the AV node, and this extends the PQ interval or contributes to the fallout of the next QRS complex. This elongation of the post-extrastolic interval PQ is explained by the manifestation of a hidden form of retrograde in an atrioventricular node.

In cases where a compensatory pause is not formed after the ventricular extrasystole, the interpolated or insert form of arrhythmia appears.

Classification

Stomatic arrhythmia has its own classification. It is accepted to allocate 5 grades of extrasystole (they are not only after 24-hour surveillance, ECG):

I class - extrasystoles are not registered;
Class II - for an hour up to 30 monotopic extrasystoles;
III class - for an hour 30 and more monotopic extrasystoles were revealed, regardless of the time of day;
IV Class - not only monotoopic extrasystoles, but also political optics are recorded;
IV "A" class - on the film they are registered monotopic, but already paired extrasystoles;
IV "B" class - there are political pair extrasystoles;
V Class - group political ventricular extrasystoles are recorded on the film. Within 30 seconds, they can be up to five in a row.

Stomatricular arrhythmias of class I are referred to physiological. They are not dangerous for the life and health of the patient. But the extrasystoles with II according to V class are accompanied by persistent impairment of hemodynamics and can lead to ventricular fibrillation and even to the death of the patient.

Treatment

The main objectives of the treatment of ventricular extrasystole are to reduce easy sensationscaused by cardiac abbreviations and prevent paroxysms of a steady form of railway or ventricular fibrillation.

In the event that it is necessary to reduce only the unpleasant sensations, patients are subject to empirical treatment, which is focused on the well-being of patients. As a rule, opinions on the appointment of the treatment of ventricular extrasystole, which flows without symptoms, is somewhat disgraced. The use of antiarrhythmic drugs for therapy of complex forms of arrhythmias without a characteristic symptomatic picture can only be possible in the case of the potential hazard of this state and the probable benefit from these medicines. In addition, almost forty percentages of patients as a result of the side effects of antiarrhythmic drugs, it is necessary to abandon these funds. One of the dangers of antiarrhythmics reception is their arrhythmogenic property observed in 10% of patients.

Basically, ventricular extrasystolia in the absence of cardiac pathology of organic origin does not increase the risk of education sudden death. Although, with a reduced reduction of the LV, the likelihood of the formation of stable ventricular extrasystolism is somewhat increasing, and the prediction of this arrhythmia in relation to sudden death of a minor.

In patients who suffered a myocardial infarction and received treatment in the form of an eninca or freakinide, a successful elimination of ventricular extrasystole was noted, but was accompanied by increased mortality almost four times unlike placebo reception. Therefore, given these data, the empirical treatment with antiarrhythmic drugs is not recommended.

But testimony for hospitalization are first discovered ventricular extrasystoles and unfavorable, according to forecasts, form of arrhythmia.

For destination specialized treatment Be sure to take into account the gradation class of an extraordinary heart rate of ventricles, which are available heart disease, the nature of the dysfunction of the heart muscle and the severity of this violation, which become potentially fatal for ventricular extrasystole and fatal outcome.

Patients without the presence of symptomatic signs of cardiac anomaly, even at high gradations according to V. Lown, do not prescribe a certain treatment. Therefore, it is necessary to be able to explain to the patient that arrhythmia can be benign, in which a diet is recommended to be enriched with potassium with the exception of nicotine, alcohol, coffee and strong tea varieties, and in cases of hypodine, it is necessary to increase physical activity. It is from such events that the asymptomatic shape of the ventricular extrasystole is beginning to be treated. And only if they find out ineffective, proceed to the appointment of drugs.

For the treatment of such patients, the preparations of the first row include the means of sedative action (for example, diazepams or phytopreparations) and beta-adrenoblays. For a significant number of patients, they have a positive effect due to reduced heart abbreviations under the influence of sedative preparations and reduced post-extrepassistolic reduction forces.

As a rule, the purpose of beta-adrenoblockers starts from propranola (anaprilin, sumsioned) in small doses, and if necessary, they increase by controlling the frequency of heart abbreviations. In some category of patients with ventricular extrasystolia, at the moment when the rhythm frequency decreases, the number of extrasystole is increasing. But in the presence of bradycardia in the outcome, as a result increased tone The parasympathetic department of VNS, especially in young people, is used to relieve ventricular extrasystolic drugs of beautification and hatropium.

And in very rare cases, with ineffective treatment with sedative preparations, as well as to adjust the tone of the NAS and, with the disturbed health of the patients, they resort to the purpose of dyspeyramide, novocainamide, quinidine, mexyleletina, suspension and frecking. In addition, these membrane-stabilizing agents, in contrast to beta-adrenobloclars, have significance side phenomena, so they are desirable to avoid in their appointments, if possible. Also sedatives and adrenobloclars are well used to treat this form of arrhythmias with characteristic symptoms on the background of the mitral valve prolapse. And the use of first-class antiarrhythmic drugs in this case is also acceptable only with highly disturbed well-being.

With frequent ventricular extrasystole of a monotopic form, which is resistant to drug treatment, or in case of the impossibility of receiving antiarrhythmic action drugs in combination with poor prediction or intolerance to drugs, an intracardiac efi and rchu of the heart are prescribed.

By type of biheminia

Stomatricular Bigemin suggests that the body of intoxication is expressed in the body, which is a consequence of taking drugs against vintage.

Often this kind of arrhythmia is found in patients who are in diseases of cardio-vascular system Admitted adrenaline, Novocainamide, County and Novocaine. In addition, this form can be a consequence of the use of certain types of anesthesia, for example, chloroform or cyclopropane.

Sometimes this pathology develops due to electrical stimulation of the heart. Other reasons for the development of such a condition can be distinguished:

severe poisoning of phosporganic substances with acutely occurring intoxication;
electrolyte violations in myocardium;
coronaryography;
heart probing;

All reasons are combined by changes occurring in the heart muscle and having organic origins. Even seemingly insignificant disorders in myocardium are able to lead to the emergence of an ectopic excitation focus, especially if they are combined with some factors of a functional nature.

In children

The causes of the extrasystole are different, but in the overwhelming majority of cases these are neurogenic disorders, extracardial origin. Under the action of a parasympathetic system, the permeability of membranes, the level of intra and extracellular potassium and sodium is changing, the intensity of transmembrane ion currents changes, which is due to disorders of excitability, automatism, conductivity with the emergence of extrasystole. An important pre-exposition factor in the genesis of extraceseistric arrhythmia is often the migration of the rhythm between the sinus and atrocadic assemblies - a consequence of Vagotonia, less often into intoxication with organic heart pathology.

Extrasystolia can be the result of an increased automatism of some cells of the conductor system outside the sinus node.

Another variety of extrasystole - ventricular - for a long time was considered the most frequent view Rhythm violations in children. BUT B. recent times It was established that many extrasystoles that were previously accepted for ventricular, in reality, are in fact submitted by the Aberran QRS complex. In healthy children, one is often found single-meal, as a rule, right-handed extrasystoles. This extrasystole is based on vegetative dystonia.

Ventricular extrasystoles are separated depending on the localization on the right-handhold (most often in children from the separation department) and left-deceased. In the frequency of occurrence of ventricular extrasystole are divided as follows: less than 30 per hour, 30-100 per hour, 100-600 per hour, more than 600 per hour (or up to 5 per minute), 5-10 per minute, more than 10 per minute; or up to 15,000 in 24 hours and more than 15,000 in 24 hours. ventricular extrasystoles with frequency of occurrence of more than 5 per minute (according to ECG) or more than 300 per hour (according to Halter monitoring) are considered frequent. In terms of assessing the probability of developing secondary arrhythmogenic changes in myocardium in children, it is customary to be a ventricular extrasystolism with a frequency of registration according to Holter monitoring of more than 15,000 per day.

The morphology is distinguished by monomorphic ventricular extrasystoles (one morphology of the ventricular complex) and polymorphic (more than one morphology of the ventricular complex); in the density of extrasystole - single ventricular extrasystoles and paired (paired); on frequency - sporadic and regular; By the time of emergence and degree of prematurity - early, late and interpolated. Taking into account the circadian representation of ventricular extrasystoles classified on day, night and mixed.

In most cases, idiopathic ventricular extrasystole proceeds asymptomatic. About 15% of older children with frequent ventricular extrasystole describe "interruptions" or "failures", "missed blows" in the heart rhythm. Among other symptoms are complaints of asthenovegetative nature, reflecting the dysfunction of the sympathetic or parasympathetic department of the vegetative nervous system (fast fatigue, sleep disorders, headaches, sudden attacks of weakness, dizziness, poor transportation of transport, cardilation). With ventricular extrasystole, developed against the background of organic heart pathology, the severity of clinical symptoms depends on the underlying disease. The electrocardiographic criteria of the ventricular extrasystole - the presence of premature cuts of ventricles with a deformed wide QRS complex (more than 60 ms in children under 1 year, more than 90 ms in children from 1 year to 3 years, more than 100 ms in children 3-10 years old, more than 120 ms Children over 10 years old), sharply different in morphology from the main sinus rhythm. The P teeth are absent or inverted and recorded after the ventricular complex, the ST segment and the teeth g are discordant to the extracesestolic complex QRS, possibly the presence of drain complexes. The ventricular complexes can be almost uncovered or expanded slightly with ventricular extrasystole from the base of the highly located rear-line branching of the left leg of the Gis beam or involving the macro-re-entry on the legs of the Gis beam.

The topical non-invasive diagnosis of ventricular extrasystole according to ECG data is carried out on the basis of a number of algorithms. The right-handed extrasystoles are characterized by the morphology of the ventricular complex by the type of blockade of the left leg of the beam of Gis, left-deudes - by type of blockade of the right leg of the beam of Gis. This rule has exceptions due to the fact that ECG data reflect more subepicardial electrophysiological processes, and extrasystoles emanating from zones located endocardially can change their morphology. Overcoming the considerable distance from endocardium to epicarde. The most unfavorable loads (sympathose-dependent), as well as early and ultra-obsteen ventricular extrasystoles, superimposed on the descending knee of the teeth, its vertex or ascending knee, sometimes at the end of the ST segment of the preceding normal QRS complex.

Idiopathic

Idiopathic ventricular extrasystole must be accompanied by the control of the state of central hemodynamics. Its change in the form of a decrease in the fraction of emissions and the increase in dilatation of the heart cavities is the basis for the appointment of interventional treatment.

Single

Single ventricular extrasystole (or, as it is also called, rare) - 5 and less extrasystole occurs within a minute. May proceed asymptomatic.

Under the ventricular extrasystole is meant one of the types of heart rate disorders, which is characterized by extraordinary abbreviations of the myocardium of ventricles. Such pathology, in contrast to hydrodynricular tachycardia, is usually associated not with functional violations of the regulation of cardiac activity, but with some organic changes in myocardium.

The basis of pathogenesis is the violation of the electrical homogeneity of myocardium due to inflammatory diseases or scar changes (for example, after a myocardial infarction suffered). As a result, a focus of high automatic and excitability, which generates, appears in the heart muscle of the ventricles, which generates nervous impulsepassing through the conductive system and causing an extraordinary reduction in myocardium.

Classification

There are several options for classifying ventricular extrasystole. The need to know all kinds of division of them into groups is due to differences in symptoms, a forecast and an embodiment of pathology.

One of the most important criteria in the classification of such extrasystole - frequency of extrasystole. Under the extrasystole (ES) understand a single extraordinary reduction. Thus, allocate:

Rare (up to 5 per minute).
Less rare (medium frequency EC). Their number can reach 16 per minute.
Frequent (more than 16 for one minute).

An equally important embodiment of ES by groups is the density of their occurrence. Sometimes it is called "location density on ECG."

Single extrasystoles.
Paired (two ES, following each other).
Group (three or more).

Depending on the places of origin Allocate:

Legal deud.
Right-handed.

Division by the number of pathological foci of excitation:

Monotopic (one hearth).
Polytopic (several excitation foci, which can be arranged both in one ventricle and both in both).

Classification by rhythmity:

Allritemic - periodic extrasystoles. In this case, instead of each second, third, fourth, etc. Normal abbreviation occurs ventricular extrasystole:
- bigemia - Each second reduction is an extrasystole;
- trigemia - every third;
- quadrgemia - every third and t.
Sporadic - not regular, independent heart rhythm, extrasystoles.

According to the results of the interpretation of Holter monitoring, several grades of extrasystole:

0 class - ES are missing;
class 1 - single rare monotopic ES, not exceeding 30 per hour;
class 2 - in the same way as class 1, but with a frequency of more than 30 for an hour;
class 3 - single political et;
class 4a - political pair ES;
class 4b - any group EC with ventricular tachycardia periods;
class 5 - the appearance of early extrasystoles arising at the time of relaxation muscular fabric Hearts. Such ES is extremely dangerous, because May be predecessors of the heart stop.

This classification of Wolf-lane is designed for a more convenient assessment of the degree of risk and the forecast of the disease. 0 - 2 Class practically does not carry a threat to the patient.

When choosing a method of treatment, doctors rely mainly on classification depending on the degree of benignness of extrasystole. It is distinguished by a benign, potentially malignant and malignant current.

Causes of ventricular extrasystole

Despite the fact that the change in the functional properties of myocardium is mainly considered as prerequisites for the development of superstricular extrasystole, such deviations can sometimes contribute to the occurrence and ventricular ES. In rare cases, large doses of nicotine, caffeine or emotional stress can still cause single ventricular extraxyitols. This can be observed with IRC (vegetual-vascular dystonia).

The main cause of the development of ventricular extrasystole is organic lesions of the heart muscle. More than half of the cases, pathology develops against the background of ischemic heart disease (IBS). Any lesions, such as myocardial infarction, post-infarction state, various cardiomyopathy, arterial hypertension and malformations are the cause of ventricular ES.

In some cases, the disease develops against the background of chronic thyrotoxicosis, in which myocardium is exposed toxic action Hormones thyroid gland. Action on the heart muscle of some antiarrhythmics, cardiac glycosides and preparations used for treatment pulmonary disease (Berodual, Salbutamol, Eufillin) also contribute to the emergence of ES.

Symptoms of pathology

There are no cases when the ventricular extrasystolia is not feels subjectively. However, almost always the main complaint of patients is the feeling of interruptions in the work of the heart, the feeling of fear or the "lump of the throat" with the fading of the heart. With group ES, a feeling of rapid heartbeat is possible, which is often accompanied by sharp dizziness and weakness. If at the time of the rhythm violation, the pump function of the heart muscle is significantly disturbed, then fainting up to a long loss of consciousness.

In the event that such complaints are worried for the first time and accompanied by an increase in heart rate (heart rate) more than 120 per minute, it is necessary to urgently contact the medical institution or call ambulance.

Any concomitant heart damage can add to the symptoms of ventricular extrasystole painful feelings Behind the sternum or attacks of shortness of breath. This is often found in chronic heart failure (CHF) and IBS.

Group or political frequency ventricular ES can lead to ventricular fibrillation. In this case, in addition to the loss of consciousness in the patient, the respiratory development can occur with the development of clinical death.

Diagnosis of ventricular extrasystole

To determine this type of extrasystole, there are enough three main types of diagnostics: survey and examination of the patient, some laboratory and instrumental types of research.

At the beginning, complaints are studied. In the event of similarities such as described above, it is necessary to suspect or determine the presence of organic pathology affecting the heart. It turns out the dependence of symptoms from exercise and other provoking factors.

When listening to (auscultation) of the work of the heart, the tones may be weakened, deaf or pathological. This is found in patients with hypertrophic cardiopathology or with heart defects.

The pulse is nehydramine, with a different amplitude. This is explained by the emergence of a compensatory pause after the extrasystole. Arterial pressure Maybe anyone. With group and / or frequent ventricular ESs, it is possible to reduce it.

In order to exclude pathology endocrine system Analyzes for hormones are assigned, biochemical blood biochemical indicators are being studied.

Among tool Research The main electrocardiography and Halter monitoring are the main. Interpretizing ECG results can be detected by an extended modified ventricular QRS complex, before which there is no atrial P-prong. This speaks about the reduction of ventricles, which does not occur atrial abbreviations. After this deformed extrasystole, a pause is observed, followed by a normal sequential reduction in cardiac cameras.

At echocardiography, signs of ischemia or left ventricular hypertrophy are determined only in the presence of a concomitant lesion of myocardium.

In cases of the main disease, signs of myocardial ischemia, left ventricular aneurysms, left ventricle hypertrophy or other heart chambers and other violations are detected.

Sometimes for provoking ventricular extrasystole and studying the characteristics of the heart muscle at this point, loaded samples are carried out. The emergence of ES testifies to the appearance of arrhythmia due to coronary pathology. Due to the fact that this study may be complicated by fibrillation of ventricles and death, it is carried out under the control of the doctor. Cabinet for testing in obligatory must be equipped with a set for emergency hold Resuscitation events.

Coronaryography is carried out to eliminate the coronary genesis of extrasystole.

Treatment of the disease

At the heart of the treatment of ventricular extrasystole lies timely therapy of the disease, against the background of which the violation of heart rhythm is developing.

In case of benign extrasystole, there is usually no organic lesion of myocardium and more often asymptomatic. With this variant of the disease, treatment is not assigned. Antiarrhythmic drugs may be assigned if the attacks are subjectively poorly tolerated by the patient.

With potentially malignant flowarising against the background of any organic heart pathology, there are medium-frequent or frequent ES. Sometimes there are "jogging" of ventricular tachycardia (group ventricular extrasystoles). In this case, the risk of sudden cardiac death appears. To reduce the likelihood of death and relieving the manifestations of the disease, treatment is prescribed.

Malignant extrasystolism of ventricular genesis implies the presence of vital dangerous symptoms In addition to the main manifestations of the disease. These include loss of consciousness, stop the heart. Due to the very high risk of cardiac death, integrated therapy is appointed.

Any frequent suddenly emerging ventricular extrasystolia, regardless of the presence of such a history of emergency testimony For the introduction of antiarrhythmic drugs and hospitalization in the hospital.

When selecting drugs, an individual approach to determining the dosage and the study of all sorts of tests to eliminate contraindications to receiving antiarrhythmics is necessary. Dose medicinal substances Gradually increases before the emergence of a stable effect. The sharp abolition of the drug is unacceptable. The adequacy of treatment is estimated using Halter monitoring.

Almost all antiarrhythmic drugs have a side-term action effect - can cause arrhythmia. To reduce the likelihood of the development of complications, all antiarrhythmics (ethazin, propanorm, sotalol, amiodarons) are prescribed with beta-blockers (propranolol, metoprolol, bisoprolol). The dosage of the latter should be minimal.

Patients suffering from myocardians or a history of myocardial infarction is advisable to apply as an anhyrhythmic agents amiodarone or cordaron. Other preparations from this group may trigger arrhythmia in this case. To increase blood circulation and improve the properties of myocardium in order to prevent ventricular extrasystoles, appropriate:

antiagregants (cardiomagnet, aspirin);
aCE inhibitors (Enalapril, Perindopril);
nitrates with extended action (cardicet, nitrolong);
calcium channel blockers (diltiazem, verapamil);
complex vitamins and substances that improve myocardial metabolism (Panangin, Magnevit, Actovegin).

Lifestyle and prevention of ventricular extrasystoles

Full rest and moderate work.
Walks in the open air.
Balanced diet.
The exclusion of tobacco reception, alcohol.
Reducing the amount of caffeine consumed.
Avoiding stressful situations and increased emotional loads.

All of the above concerns people suffering from malignant scratchyistol. With benign, such restrictions do not have justifications.

Complications and forecast

Complications mainly occur with malignant versions with frequent attacks. These include ventricular tachycardia with blood circulation deficiency, trembling / ventricular fibrillation, leading to a complete stop of cardiac activity.

In other cases, the forecast is more likely favorable. In compliance with all therapeutic recommendations, even in the presence of concomitant diseases, mortality from this disease is significantly reduced.

Stomatricular extrasystole (HE) refers to varieties. Manifests itself in the form of extraordinary and premature cuts of cardiac ventricles. Patients feel dizziness, general weakness, sometimes pain in the heart area and the lack of oxygen. To identify violation, you need to undergo a comprehensive examination. In most situations, treatment is carried out using medicines. In rare cases can. The ventricular extrasystolia in children is diagnosed only in 5% of cases, but as the probability of violation increases to 50%. Because the HE is considered the pathology of people from 45 years. The danger lies in the probability of a sudden stop of the heart. HE is also called ventricular extrasystole and ventricular arrhythmia. MKB 10 ( international Classification Diseases) awarded this disease code on I49.3.

Stomatricular extrasystole requires treatment.

Causes

Understanding what it is, and what consequences can lead, it is necessary to be able to recognize the symptoms of the extrasystole of ventricles and to know about the potential causes of violation. Changes in the rhythm of ventricles are not always perceived as pathological violation. The ventricular extrasystole is considered as a safe deviation for health and life. There is a definite norm per day, in which the HE is classified as a non-hazardous change:

from 700 to 950 additional pulses may be in people who do not suffer from the violation of the cardiovascular system, and this is the norm;
960 - 1200 pulses are considered normal indicatorif the patient was diagnosed with polymorphic ventricular extrasystole, and no threats for life or health;
1200 extrasystole and more require specialist intervention, as it is already serious deviationcapable of leading tachycardia and other dangerous consequences.

About 75% of the total population are included in the first two groups. Is not rare diseasewhich can not be perceived as dangerous pathology. But with a parallel course of extrasystole with other pronounced violations, it is better to seek advice with the cardiologist, to complete a comprehensive examination and conduct treatment if there is a need for it. There are violation of the rhythm of the heart according to the type of ventricular extrasystole, depending on the causes of the occurrence. It can be a functional, idiopathic ventricular extrasystole or cardiac.

Cardial reasons include:

chronic heart failure;
arterial hypertension;
myocardits;
pericarditis;
hypertrophic cardiomyopathy;
dilatation cardiomyopathy, etc.

There are functional causes or functional type of HE, which is not associated with diseases of the cardiovascular system. To such factors include:

and tobacco products;
sleep disorders;
regular reception of drugs of the anesthetic group;
disorders of micro exchange processes in the body;
excess prescribed drug dosages;
abuse of narcotic and psychotropic means;
osteochondrosis;
infectious lesions;
strong stress, experiences and emotional shocks, etc.

In the ventricular extrasystole cause a lot, but not always the violation is manifested against the background of obvious provoking factors. There are cases where the ventricular extrasystole has no concrete causes. Arrhythmia provoked unknown factors against the background of an excellent patient's health. Because everyone, even a healthy person, should have a doctor at the department of cardiology, to which he will be able to periodically come for preventive diagnosis.

Signs

Quite often discover the ventricular extrasystolism only on the ECG, and there are no obvious signs of violation or weakly manifest themselves, because of which the patient simply does not pay attention to them. Less often symptoms becomes brighter. Then the HE manage to detect on the basis of the following manifestations:

there is a sense of failures in the work of the heart muscle;
the heart seems to freeze or pushes in reinforced mode;
man is quickly tired, becomes very irritable;
periodically arise headaches and dizziness;
there is a shortage of oxygen, the patient is as if choking;
it feels pain in the heart and the strong weakness of the whole organism;
in rare cases, in this case, the patient's violation may faint.

During surveys, the doctors observe the characteristic ripples of the veins on the neck. Pulsation can be arrhythmic, with long pauses and extraordinary impulses. But you need to make sure that the diagnosis is correct, for which the methods of instrumental diagnostics are used.

Graduation HE

Although adult people have probability of ventricular arrhythmia above, it is necessary to check for both children in order to prevent possible complications. For a child and an adult, the same gradation of ventricular extrasystole is used. There are several stages of HE, which determine whether treatment should be carried out to eliminate it. The first stage (or 0) indicates the absence of extrasystole. The state is normal and danger does not represent. Therefore, repel from the first class.

The first class (1) speaks arrhythmia in an amount of up to 30 extra impulses per hour. This is a frequent ventricular extrasystole. Refers to the normal state of health, does not carry threats and does not need treatment.
Second class (2). This is a single ventricular extrasystole, manifested in the form of more than 30 extra impulses per hour. It is worth paying attention to it and correctly adjust the lifestyle. But there is no serious threat.
Third class (3). Polymorphic extrasistols having different forms at one ECG. If the episodes of ventricular arrhythmia multiple, it will be necessary to carry out special treatment.
The fourth grade (4a) refers to pair ventricular extrasystoles, following each other.
The fourth grade (4B) is called vollean extrasystoles that are manifested in the form of 3 - 5 extrasystole alternately after each other.
Fifth grade (5). This is already ventricular tachycardia, requiring compulsory operational intervention.

The last three classes of HE are able to lead to dangerous and serious consequences for human health, including fibrillation and tachycardia. The result of such complications is sudden stop Hearts with all the ensuing consequences, including the death of a person. The way how dangerous HE is directly dependent on its type. To determine the nature of the defeat and the number of unnecessary abbreviations (impulses), a comprehensive examination of the patient in the cardiology department is required. Ignore the manifestations of frequent ventricular extrasystolia is dangerous, because at the very first signs or suspicions wrong work Hearts contact for help.

Treatment methods

With ventricular extrasystole, treatment is selected individually. Tactics and the scheme is difficult to choose, because a number of factors affect this. The priority factor for the choice of treatment methods is the degree of severity of the HE. Sometimes the patient may not be prescribed any treatment at all. All recommendations are reduced to the normalization of a healthy lifestyle and the exclusion of potentially harmful provoking factors. Only in 25% of all cases of HE is the likelihood of the development of any complications that require the appointment of the course of therapy. The bulk of cases of the manifestation of ventricular arrhythmia falls under the conditions normal stateTherefore, the reception of drugs or conducting other procedures can only harm. If the symptoms of the rhythm disorder are occurring periodically or are isolated, you need to try to get rid of provoking factors. The basis of therapy is to maintain optimal electrolyte balance and pressure. All patients should be powered correctly and saturate the body by Kali.

Treatment can be:

drug;
radio frequency;
implantation.

The doctor defines how to treat the patient and what methods it is better to use. About each type of therapy Talk separately.

Medical therapy

First, doctors will try to cure violation with medicines. HE well interacts with many drugs. Therefore, the selected pattern of therapy for the patient may include:

Sodium channel blockers. These are somewhat different in the class of drugs, including "County", "Mexylene" and "Flearinide". They have their own strong and weak sides. A specific class and representative of this segment is selected by the attending physician individually, taking into account the clinical picture of the patient. Recently conducted studies have shown that the reception of these blockers is dangerous for people who have faced the ventricular extrasystole after the suffered infarction. This is explained by an increase in deaths after the use of drugs;
Beta blockers. This category of drugs is relevant for patients who have extrasystolis of ventricles caused by organic heart disease.
Blockers calcium Canal. They are prescribed in rare cases, since the latest observations showed the absence of a significant effect of these drugs on the state of patients.

Specific preparations, the duration of the course and the number of applications determines the attending physician, based on the collected history of the patient and the results of a comprehensive survey.

This is a method of surgical intervention, which is relevant in the absence of effectiveness of medicines, individual features The patient's body or emergency need to influence the current state. But RCH has a number of contraindications, which is why such an operation is allowed not to be carried out. This is a minimally invasive method based on the introduction through the femoral artery of a special catheter with an electrode, which destroys areas leading to the formation of unnecessary pulses of the heart muscle. After the operation, patients are rapidly restored. Complications are rare, but their probability is always present.

Implantation

Installing implants to the patient can in the rarest situations. This is relevant in the detection of malignant extrasystole of the ventricles of the heart muscle, when the likelihood of sudden death is high due to changes in the work of the heart. Special implant normalizes pulses and abbreviations. But makes serious changes to the usual way of life of a person. It is possible to give forecasts of life with ZE only on the basis of the form of the heart rate impaired and the presence of organic pathologies of the heart. Functional extrasystole of ventricles is safe for the life and human health. But normalize your lifestyle, refuse harmful habits worth it.

Adults and children are recommended to periodically pass the cardiovascular surveys. ECG is simple, fast but informative diagnostic procedure. If you carry out an electrocardiogram once a year, you can regularly observe changes in the work of the heart muscle, mark violations and respond to them in a timely manner. Preventive examinations Especially relevant for patients with genetic predisposition to heart disease. Therefore, it is important for parents to check the state of the health of their child, as well as to control the work of the heart muscle themselves. The earlier it is possible to detect negative changes, the higher the probability to quickly eliminate them with minimal damage to health and family budget.

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Premature single heart cuts are found like healthy peopleand in patients with heart disease. The treatment of extrasystole drugs is not always necessarily, it often leads only to improving the health of the patient without affecting the course of the disease and the forecast. In each case, the question of the therapy of heart rate violations is solved by a doctor after an individual examination of the patient.

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Diagnosis of pathology

The classic method of recognition of arrhythmia - electrocardiography. Depending on the source of the pathological pulse, which causes a premature reduction in the heart, distinguishes the superthodesic (sugarynaricular) and. Nessrudskos include atrial, extrasystoles from A-in connections, as well as significantly more rare sinus. One of the varieties of ventricular extrasystoles are stem.

Extrasyistole options from AV node.
a) the prong P merged with the QRS complex,
b) the changed tooth P is visible after the QRS complex

All of them have specific ECG signs, allowing in most cases to confidently distinguish them from each other. But on the usual ECG of the rest registered within a few seconds, the rhythm disorders are often not detected.

Stomatricular extrasyistol

Therefore, the main method of extrasystole diagnosis is daily. Special equipment allows you to record all the electrical activity of the heart per day, diagnose the type of extrasystole, their number, time distribution, connection with load, sleep, drug intake and other important characteristics. Only then should be prescribed drugs for the treatment of the extrasystole of the heart.

Tredmil test or cybergometry

An additional method to help determine the connection of arrhythmias with a load is a Tredmil test or. This is a view physical activity (Accordingly, walking along a moving track or imitation of cycling), accompanied by a constant ECG control.

When appearance large number The extrasystole during the load or at the rest of the functional diagnostic doctor reflects this in conclusion according to the test results with the load.

It goes into the past method of rhythmocardiography as not found reasonable application in the clinic. However, in many medical institutions It is used and also allows you to detect extrasystoles.

Only after receiving the complete characteristics of the extrasystole, the doctor begins treatment.

Treatment

Approaches to the therapy of religious and ventricular extrasystoles are somewhat different. It depends on efficiency different groups Antiarrhythmic drugs and the benefits of elimination of provoking factors of rhythm disorders.

Lifestyle

With any form of extrasystole, the patient is recommended:

elimination of emotional stress factors;

exception of excessive physical exertion;

rejection of poisoning substances - nicotine, stimulants, alcoholic beverages;

reduction of caffeine consumption;

increasing the content in the diet of products rich in potassium.

If the Neckwarce is extrasystole

Usually this type of rhythm disorder flows almost without symptoms. Sometimes there is a feeling of heartbeat or interruptions in the work of the heart. It is not dangerous and has no clinical value. It is not necessary to treat them, except in cases where they precede the development of hydrodynricular tachyrhythmias or. In this case, the choice of the drug depends on the conducted arrhythmia.

In the rustic lap extrasystolia, treatment with drugs is prescribed with poor tolerability of rhythm disorders.

Many cardiologists prefer to use in this case selective beta blockers of extended action. These funds practically do not affect carbohydrate metabolism, vessels and bronchi. They act during the day, which allows them to take them once a day. Most popular means - metoprolol, nebivolol or bisoprolol. In addition to them, it can be appointed inexpensive, but quite effective.

Additionally, at the fear of death, Valerian, Novo-Passit, Afobazol, Grandaxin, Paroksetin can be appointed bad tolerance of interruptions.

If ventricular extrasystole

Small amount of ventricular extrasystole is not dangerous to health. If they are not accompanied by severe heart disease, preparations for the treatment of ventricular extrasystole are not prescribed. Antiarrhythmics are used with frequent ventricular extrasystole.

Mostly for the treatment of very frequent ventricular extrasystole, the operation is used - (cavity) of the focus of pathological impulse. However, drugs, primarily IC and III classes, can be appointed:

conpaphenon;

allapinin;

satolol.

The Class IC drugs are contraindicated after the myocardial infarction, as well as under states accompanied by the expansion of the left ventricular cavity, thickening its walls, decrease the ejection fraction or signs of heart failure.

Useful video

What methods of treating extrasystoles are applied at the moment, see this video:

Basic preparations for the treatment of extrasystole

Bisoprolol (Concorp) is most often used to eliminate arrhythmatic form of arrhythmia. It refers to beta-blockers overwhelming sensitivity
Appropriate heart receptors. Beta receptors are also located in vessels and bronchi, but bisoprolol is a selective agent, selectively acting only on myocardium.

With good control of the disease, it can be used even in patients with asthma or diabetes.

To achieve the effect of bisoprolol used 1 time per day. In addition to the suppression of arrhythmia, it slows down the pulse and prevents angina attacks. It well reduces blood pressure.

Medicine should not be used In patients with eductions and shortness of breath (blood circulation deficiency of III - IV classes), with and pulse at one time less than 50 - 60. It is contraindicated in atrioventricular blockade II - III degreeSince it is able to strengthen its severity. Do not take it if the "upper" pressure is less than 100 mm Hg. Art. He is also not prescribed to children under 18.

More than 10% of patients, especially having heart failure, the drug causes a slowdown of the pulse less than 50 per minute. In 1 - 10% of patients there are dizziness and headache passing against the background of constant medication. In the same percentage of cases there is a decrease in pressure, strengthening of shortness of breath or edema, a feeling of cooling stop, nausea, vomiting, stool disorders, fatigue.

Satolol also blocks the BET-receptors of the heart, acts on potassium receptors. This determines its use for the prevention of heavy ventricular arrhythmias. It is used with frequent sufficientaricular extrasystole, 1 time per day.

Contraindications Sololol has the same as in bisoprolol, but even the elongated Qt syndrome and allergic rhinitis is added.

Against the background of taking this drug, 1 - 10% of patients occur such unwanted effects:

dizziness, headache, weakness, irritability;

slowdown or cheating of the pulse, strengthening shortness of breath or edema, pressure reduction;

chest pain;

nausea, vomiting, diarrhea.

Currron is usually prescribed with frequent sufficientlynivicular or ventricular extrasystole, which cannot be treated with other means. For the development of the effect, it is necessary to constantly take the drug for at least a week, and then usually make 2 days of breaks.

The drug has similar contraindications with bisoprolol, plus:

the intolerance to the iodine and the disease of the thyroid gland;

lack of potassium and magnesium blood;

the elongated Qt syndrome;

pregnancy, breastfeeding, children's age;

interstitial lung diseases.

More than 10% of patients with the use of cordaron occur nausea, vomiting, unpleasant sensations in the abdomen, increased sensitivity to the sun rays.

In 1 - 10% of patients such unpleasant effects may appear:

slow pulse;

liver damage;

lung diseases, for example, pneumonite;

hypothyroidism;

coloring of the skin in a grayish or bluish color;

muscle tremor and sleep disorders;

reduced blood pressure.

Forecast

Supported extrasystoles do not threaten life. However, they may be the first symptoms of disadvantaged by myocardium or other organs. Therefore, when revealing the remanthortic extrasistoly, consultation of the cardiologist is required, and if necessary, a further examination.

If according to daily monitoring, the number of ventricular premature abbreviations was 25% or more of total Heartbeats, such a load will eventually result in the weakening of the heart muscle. In this case medical therapy It is prescribed for the prevention of heart failure, even in the absence of severe heart disease.

Prevention

Patient with Norse Strength Extrasystole must realize how important it is for him. healthy image Life. He needs to give information about changing factors

risk of heart disease in the future:

refusal of alcohol and smoking abuse;

regular moderate physical activity;

control if they are;

weight normalization;

elimination of snoring and sleep apnea;

restoration of the balance of hormones and salts in the blood.

If the patient with the suprazdroke extrasistoline regularly takes antiarrhythmic drugs, it should attend a cardiologist 2 times a year. During the visit, the doctor gives the ECG direction, a general blood test and biochemistry. Once a year, the daily monitoring of the ECG and control of the hormones of the thyroid gland should be carried out.

Cardiologist should be observed and every patient with ventricular extrasystoles. The exception is only those patients who have frequent extrasystole It was completely eliminated with radio frequency ablation.

If the patient has no heart disease, and it does not get medicine, to visit the doctor is still necessary, as this rhythm violation can be early symptom Cardiac pathology.

In addition, the visits of patients receiving antiarrhythmics are required. All these people should be observed at the Cardiologist 2 times a year.

With the emergence of extrasystole, it is not always necessary to treat it. Usually it is not dangerous to health. It is often enough to normalize sleep, nutrition, eliminate stress, refuse caffeine and bad habits, - and the rhythm disturbance will stop. Preparations used for extrasystole therapy have a number of serious contraindications and unwanted effects. You can take them only after examination and to appoint a doctor.

Clinical signs

With a certain part of the convention, we can talk about different symptoms with functional and "organic" HSP. Extrasyistols in the absence severe diseases Hearts are usually single, but poorly transferred to patients. They may be accompanied by a feeling of fading, interruptions in the work of the heart, some strong blows in the chest. These extrasystoles more often appear at rest, in the position lying or with an emotional load. Physical stress or even a simple transition from horizontal in vertical position leads to their disappearance. They often arise against the background of a rare pulse (bradycardia).

Organic ZHES are often multiple, but patients usually do not notice them. They appear during exercise and pass alone, in the lying position. In many cases, such HCPs are accompanied by frequent heartbeat (tachycardia).

Diagnostics

The main methods of instrumental diagnosis of ventricular extrasystole are ECGs alone and daily monitoring of the ECG on Holter.

Signs of HSP on ECG:

premature advanced and deformed ventricular complex;
the discordance (multidirectionality) of the ST and Tooth segment of the extrasystole and the main teeth of the QRS complex;
the absence in front of the ZHES of the PC;
the presence of a complete compensatory pause (not always).

Interpolated HCPs are isolated, in which the extracestolic complex is inserted between two normal abbreviations without a compensatory pause.

If the HSPs come from one pathological focus and have the same shape, they are called monomorphic. Polymorphic ZES, energized from different ectopic foci, have a different shape and a distinguished clutch interval (the distance from the preceding reduction to the trace R extrasystole). Polymorphic WES are associated with severe heart damage and a more serious forecast.
In a separate group, the early HSES is allocated ("R per T"). The criterion of prematureness is the shortening of the interval between the end of the teeth of the sinus reduction and the beginning of the extrasystole complex. There are also late HSS, arising at the end of the diastole, which can precede the normal sinus teeth P, superimposed on the beginning of the extracestolic complex.

ZHES are single, pair, group. Quite often, they form the episodes of allritemia: bigemia, trigemia, quadrgemia. When bigemia through each normal sinus complex is registered with ZHES, with the Trigem region ZHES is every third complex and so on.

With daily monitoring ECG, the amount and morphology of extrasystole is specified, their distribution during the day, dependence on load, sleep, drug intake. This important information Helps determine the forecast, clarify the diagnosis and assign treatment.

The most dangerous in terms of forecast is frequent, polymorphic and political, steaming and group HSES, as well as early extrasystoles.

Differential diagnosis of ventricular extrasystolia is carried out with supertrocheumatic extrasystoles, a complete blockade of the Gis beam legs, expressing ventricular abbreviations.

When the ventricular extrasystole is detected, the patient must be examined by a cardiologist. Additionally, general and biochemical blood tests can be assigned, an electrocardiographic sample with dosage exercise, echocardiography.

Treatment

Treatment of ventricular extrasystole depends on its causes. With functional JES, it is recommended to normalize the day mode, reduce the use of stimulants, reduce emotional loads. A diet is assigned enriched with potassium or preparations with the content of this trace element (Panangin).
With rare extrasystoles special antiarrhythmic treatment Not appointed. Prescribed vegetable sedatives (Valerian, dyeing) in combination with beta adrenoblockers. In the SSS against the background of Vagotonia, sympathomimetics and cholinolithic agents are effective, for example, "Bellataminal".
With the organic nature of extrasystole treatment depends on the amount of extrasystole. If there are few of them, ethmosine, etcizin or allypinin can be used. The use of these drugs is limited due to the possibility of their arrogan action.

If the extrasystole occurs in the acute period of myocardial infarction, it can be stopped using lidocaine or trimecain.

The main preparation for suppressing the ventricular extrasystole is currently considered to be Cordaron (amiodar). It is prescribed according to a scheme with a gradual decline in dosage. In the treatment of cordarone, it is necessary to periodically control the function of the liver, thyroid gland, external breathing and the level of electrolytes in the blood, as well as to undergo an inspection at the oculist.

In some cases, resistant ventricular extrasystole from a well-known ectopic focus is well treated with a radio frequency ablation operation. During such interference, cells producing pathological impulses are destroyed.

The presence of ventricular extrasystole, especially its heavy forms, worsens the forecast in individuals with organic heart disease. On the other hand, the functional WSS does not most often affect the quality of life and the prognosis in patients.

Video course "ECG for everyone", lesson 4 - "Disturbance of the rhythm of the heart: sinus Arrhythmia, extrasystolia "(ZHES - from 20:14)