Ventricular extrasystole classification. What is solitary ventricular extrasystole

Ventricular extrasystole (PV) refers to varieties. It manifests itself in the form of extraordinary and premature contractions of the heart ventricles. Patients feel dizzy, general weakness, sometimes pain in the heart and lack of oxygen. To identify a violation, you need to undergo a comprehensive examination. In most situations, treatment is carried out with the help of medications. In rare cases it may. Ventricular extrasystole in children is diagnosed only in 5% of cases, but as they grow older, the probability of a violation increases to 50%. Therefore, PVC is considered a pathology of people over 45 years old. The danger lies in the likelihood of sudden cardiac arrest. PVC is also called ventricular extrasystole and ventricular arrhythmia. ICD 10 ( international classification diseases) assigned the ICD code I49.3 to this disease.

The reasons

Understanding what it is and what consequences it can lead to, it is necessary to be able to recognize the symptoms of ventricular extrasystole and be aware of the potential causes of the disorder. Changes in the rhythm of the ventricles are not always perceived as a pathological disorder. Ventricular extrasystole is considered as a deviation safe for health and life. There is a certain rate per day at which PVC is classified as a non-dangerous change:

• from 700 to 950 additional impulses can be in people who do not suffer from disorders of the cardiovascular system, and this is the norm;
• 960 - 1200 pulses are considered normal if the patient was diagnosed with polymorphic ventricular extrasystole, and there is no threat to life or health;
• 1200 extrasystoles or more require the intervention of specialists, since this is already a serious deviation that can lead to tachycardia and other dangerous consequences.

About 75% of the total population is included in the first two groups. This is not a rare disease that cannot be perceived as a dangerous pathology. But with a parallel course of extrasystole with other severe disorders, it is better to consult a cardiologist, undergo a comprehensive examination and carry out treatment, if necessary. There are heart rhythm disturbances according to the type of ventricular extrasystole, depending on the causes. It can be functional, idiopathic ventricular extrasystole or cardiac.

The cardinal reasons include:

• chronic heart failure;
• arterial hypertension;
• myocarditis;
• pericarditis;
• hypertrophic cardiomyopathy;
• dilated cardiomyopathy, etc.

There are also functional causes or a functional type of PVC, which is not associated with diseases of the cardiovascular system. These factors include:

• and tobacco products;
• sleep disorders;
• regular intake of drugs of the anesthetic group;
• violations of micro-metabolic processes in the body;
• exceeding the established dosages of drugs;
• abuse of narcotic and psychotropic drugs;
• osteochondrosis;
• infectious lesions;
• severe stress, anxiety and emotional upheaval, etc.

There are many reasons for ventricular extrasystole, but not always the violation manifests itself against the background of obvious provoking factors. There are cases when specific causes have not been identified in ventricular extrasystole. The arrhythmia was provoked by unknown factors against the background of the patient's excellent health. Therefore, everyone, even a healthy person, should have an attending physician in the cardiology department, to whom he can periodically come for preventive diagnostics.

signs

Quite often, ventricular extrasystole is detected only on the ECG, and there are no obvious signs of a violation or are weakly manifested, which is why the patient simply does not pay attention to them. Less often, the symptoms become brighter. Then PVC can be detected on the basis of the following manifestations:

• there is a feeling of failure in the work of the heart muscle;
• the heart seems to freeze or push in an enhanced mode;
• a person quickly gets tired, becomes very irritable;
• occasional headaches and dizziness;
• there is a lack of oxygen, the patient seems to be suffocating;
• there is pain in the heart and severe weakness of the whole body;
• in rare cases, with this violation, the patient may faint.

During examinations, doctors observe characteristic pulsations of the veins in 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 methods are used instrumental diagnostics.

ZhE gradation

Although adults are more likely to have ventricular arrhythmias, children should also be tested to prevent possible complications. For a child and an adult, the same gradation of ventricular extrasystole is used. In total, there are several stages of PVC, which determine whether it is necessary to carry out treatment to eliminate it. The first stage (or 0) indicates the absence of extrasystole. The condition is normal and does not pose a danger. Therefore, they are repelled from the first class.

1. The first class (1) speaks of arrhythmia in the amount of up to 30 extra impulses per hour. This is a common ventricular extrasystole. Refers to a normal state of health, does not pose a threat and does not need treatment.
2. 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 adjusting your lifestyle a little. But it doesn't pose a serious threat.
3. Third class (3). Polymorphic extrasystoles with different forms with one ECG. If episodes of ventricular arrhythmia are multiple, special treatment will be required.
4. The fourth class (4a) refers to paired ventricular extrasystoles following one after another.
5. The fourth class (4c) is called volley extrasystoles, manifested in the form of 3-5 extrasystoles in turn one after another.
6. Fifth grade (5). This is already ventricular tachycardia, requiring mandatory surgical intervention.

The last three classes of PVCs can lead to dangerous and serious consequences for human health, including fibrillation and tachycardia. The result of such complications is sudden cardiac arrest with all the ensuing consequences, including the death of a person. How dangerous PVC is depends on its type. To determine the nature of the lesion and the number of extra contractions (pulses), a comprehensive examination of the patient in the cardiology department is required. It is dangerous to ignore the manifestations of frequent ventricular extrasystole, therefore, at the first signs or suspicions of abnormal heart function, seek help.

Treatment Methods

With ventricular extrasystole, treatment is selected individually. It is difficult to choose tactics and a scheme, since a number of factors influence this. The primary factor for the choice of treatment methods is the severity of PVC. Sometimes the patient may not receive any treatment at all. All recommendations come down to the normalization of a healthy lifestyle and the exclusion of potentially harmful provoking factors. Only in 25% of all cases of PVC there is a possibility of developing any complications that require a course of therapy. The bulk of cases of manifestation of ventricular arrhythmia falls under the conditions of the normal state, and therefore taking medication or carrying out other procedures can only harm. If the symptoms of rhythm disturbance occur periodically or are isolated, you should try to get rid of the provoking factors. The basis of therapy is to maintain optimal electrolyte balance and pressure. All patients should eat properly and saturate the body with potassium.

Treatment may be:

• medication;
• radio frequency;
• implantation.

The doctor determines how to treat the patient and what methods are best used for this. We will talk about each type of therapy separately.

Medical therapy

Doctors will first try to treat the disorder with medication. PVC interacts well with many drugs. Therefore, the selected treatment regimen for the patient may include:

1. Sodium channel blockers. These are several different classes of drugs, including Quinidine, Mexiletin and Flecainide. They have their strengths and weaknesses. A specific class and a representative of this segment is selected by the attending physician individually, taking into account the clinical picture of the patient. Recent studies have shown that taking these blockers is dangerous for people who have experienced ventricular extrasystole after a heart attack. This is due to an increase in deaths after the use of drugs;
2. Beta blockers. This category of drugs is relevant for patients in whom ventricular extrasystole was caused by organic heart disease.
3. calcium channel blockers. They are prescribed in rare cases, since recent observations have shown the absence of a significant effect of these drugs on the condition of patients.

Specific drugs, the duration of the course and the number of applications are determined by the attending physician, based on the collected patient history and the results of a comprehensive examination.

This is the method surgical intervention, which is relevant in the absence of the effectiveness of medicines, individual features the patient's body or urgent need to affect the current condition. But RFA has a number of contraindications, which is why not every patient is allowed to undergo such an operation. This is a minimally invasive method based on the introduction through femoral artery a special catheter with an electrode that destroys areas that lead to the formation of unnecessary impulses of the heart muscle. After surgery, patients recover quickly. Complications are rare, but their probability is always present.

Implantation

Implants can be installed to the patient in the most rare situations. This is relevant when detecting malignant extrasystole of the ventricles of the heart muscle, when there is a high probability of sudden death due to changes in the work of the heart. A special implant normalizes impulses and contractions. But it makes serious changes in the habitual way of life of a person. It is possible to give predictions of life with PVC only on the basis of the form of cardiac arrhythmia and the presence of organic pathologies of the heart. Functional extrasystole of the ventricles is safe for human life and health. But normalize your lifestyle, give up bad habits costs.

Adults and children are advised to periodically undergo examinations of the cardiovascular system. ECG is simple, fast, but informative diagnostic procedure. If you conduct an electrocardiogram once a year, you can regularly observe changes in the work of the heart muscle, note violations and respond to them in a timely manner. Preventive examinations are especially relevant for patients with a genetic predisposition to heart disease. Therefore, it is important for parents to check the health of their child, as well as to control the work of the heart muscle themselves. The earlier negative changes can be detected, the higher the probability of quickly eliminating them with minimal damage to health and family budget.

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And the adequate rhythm of the work of a muscular organ is a heart rate at the level of 80-90 beats per minute, uniform periods of time between each contraction. In the case of extrasystole, pathological activity of the cardiac structures is observed: the beats come earlier than they should, the heart slows down, then speeds up.

There are several varieties of the considered pathological phenomenon, depending on the localization.

Ventricular extrasystole is a violation of the heart rhythm by the type of occurrence of additional contractions outside the main activity of the organ. They are different in character, but occur in the ventricles.

This type of pathology is the most dangerous, because the ventricles are responsible for an adequate ejection of blood, tissue hypoxia sets in, the organs cannot function normally. Generalized disturbances in the operation of systems are noted.

Death due to cardiac arrest or other complications of non-cardiac origin is the most likely outcome.

Despite such a formidable genesis of the disease, single ventricular extrasystoles can occur in quite healthy people.

To understand how the disease-causing process develops, you need to refer to a brief anatomical and physiological reference. The heart and cardiac structures in general are unique in their kind.

Despite the fact that the organ is completely muscular, its cells, the so-called cardiomyocytes, are capable of spontaneous excitation or generation of an electrical impulse.

A special anatomical formation is responsible for creating the signal - the sinus node or the natural pacemaker in a different way. Normally, an electrical impulse is created here, transmitted through the bundles of His throughout the heart, then the cycle repeats. Such autonomy ensures the smooth operation of the body even in extreme cases.

Pathologies are possible in which the second, third center of the signal is formed. This not normal. In about 40% of situations, a new pacemaker develops in the ventricular region. (atria and atrioventricular node). Less often - in the ventricles themselves.

The second option is much more dangerous. As a result of pathological excitation, complete contraction does not occur, blood is not ejected to a normal degree, hence total hypoxia. Further we go, worse it becomes.

Process elimination is a big problem for cardiac surgeons. Conducted mainly surgical methods, less often medicinal. The task is to suppress pathological activity in the ventricles.

Classification

It is possible to typify a disease-causing phenomenon for various reasons. Among those with the greatest clinical significance.

Depending on the number of new foci:

• Single ventricular extrasystole (monotopic). When the impulse is produced in a single place.
• Polytopic. The reverse phenomenon. Both stomachs are involved. Much more threatening.

By frequency and number:

• Single.
• Multiple (pair, group).

If the former are found in many people (up to 80-90% in the population), the latter only in patients, and even then not always. Depends on the type of the main process. Frequent ventricular extrasystole is associated with a high risk of complications (up to 50-60%).

The origin of the phenomenon also plays an important role. So, cardiac and non-cardiac factors are distinguished (there are a few more of them, but they themselves cause the problem less often by almost half).

There are other ways to classify. But they have no clinical significance and are rather of scientific interest for specialized specialists.

Ventricular extrasystoles lead to hemodynamic disturbances in all cases, so treatment is carried out regardless of the nature of the problem.

Differentiation of the disease according to Lown

There is another way to delimit the process. There is a mixed classification, which was named after the chief of its creators.

Accordingly, allocate:

• 1 type of extrasystole. Up to 30 modified contractions per hour or about 700 per day. This is normal or relatively acceptable and is not indicative of a disease or process. Against the background of the diagnosis of organic transformations, it will not be possible to identify.
• 2nd view. Over 30 extrasystoles per hour. Complex phenomenon. May be an indication of normal functional activity. Rarely, it is a symptom of heart disease. Careful monitoring of the patient is required.
• Polymorphic extrasystoles or type 3. They form in two ventricles at once, are found only on electrocardiography, usually do not make themselves felt with almost no manifestations, which makes early diagnosis difficult. He speaks of the appearance of new conducting bundles in the cardiac structures.
• 4a view. Development of paired pathological signals. According to profile studies, in about 40% of clinical situations it has a normal origin, in 60% it is pathogenic.
• 4b type. Group extrasystole or an unstable variant of ventricular paroxysmal tachycardia with an extremely unstable course (during the day there may be several attacks of 5-15 minutes or more). It is of organic origin and requires urgent diagnosis and treatment. Complications are frequent, the risks are approximately 65% ​​within 3-5 years.
• 5 view. Early extrasystoles of a group character. The most dangerous form of the pathological process. It appears on the cardiogram with clear signs, symptoms are also present. Therefore, the diagnosis is not difficult. The therapy is urgent.

Ventricular extrasystole does not always have pathological features. The ratio is 40/60 or so.

The reasons

Factors of development of the problem are diverse. In almost all situations, the disease is secondary in nature and is associated with disturbances in the operation of any system.

Common points include:

• Long-term arterial hypertension. Patients with decent experience usually suffer from extrasystole, regardless of the stage. The reason for this is the prolonged tension of the heart, the need to more actively pump blood through the body, overcoming the resistance of stenotic arteries. This is a kind of adaptive mechanism that has no compensatory value.
• Ischemic disease of the muscular organ. It develops independently or as a result of a myocardial infarction, which is somewhat more common. Another option is, again, hypertension. All the presented problems require lifelong therapy, since extrasystole occurs in 100% of these situations as the first complication.

• Congenital genetic or acquired syndromes associated with the formation of extra conductive bundles in addition to the main ones. This is a rare option, however, it is extremely difficult to fix such a problem. Minimally invasive or full surgical intervention is required.

• . The consequence of malnutrition or improper distribution of the load on the cardiac structures. It ends with a stoppage of the organ, coronary disease or severe complications. In severe cases, it requires transplantation, which in itself in developing countries is almost a sentence.

• Congenital and acquired heart defects. There are many of them. The most harmless (relatively) is an open ductus arteriosus. Therapy is surgical. There are almost no manifestations, therefore it will not work to identify the problem on your own. An electrocardiogram and long-term observation of the patient are required.

• Myocardial infarction. Acute circulatory disorders in the cardiac structures. It ends with the replacement of dead tissues with scar tissue. Associated with lifelong maintenance therapy. In the absence of help, a relapse occurs, this time fatal, with no prospects for resuscitation or restoration of life.

• Inflammatory pathologies of the heart and its structures. Myocarditis and the like. Accompanied by total destruction of the ventricles or other anatomical structures. In such a situation, extrasystoles are not so important, although they can end in stopping the work of the organ. The therapy is conservative.

Non-cardiac causes are somewhat less common: endocrine problems, diseases of the excretory, nervous systems. Functional factors can be adjusted by the patient himself:

• Abuse of coffee, tea, energy drinks.
• Prolonged uncontrolled or illiterate use of drugs to lower blood pressure, glycosides, psychotropics and the like.
• Smoking.
• Alcoholism.
• Physical inactivity.
• Obesity.
• Not proper nutrition with too much or too little salt.

The diagnosis is made by exclusion. In the absence of data for organic pathologies, they speak of an idiopathic phenomenon.

Symptoms

Violation of the heart rhythm by the type of ventricular extrasystole is not always felt. In the early stages, or with single altered contractions, there may be no signs at all or they are so meager that they do not attract attention. In other cases, the clinical picture is quite informative.

An example list of features is as follows:

• Feeling the beating of your own heart. It is found against the background of a normal heart rate or slight tachycardia.
• Pressure, burning behind the sternum.
• Dizziness. Indicates a violation of the nutrition of the brain and the entire central nervous system. It is largely due to a deficiency of cerebellar trophism.
• Paleness of the skin.
• Excessive sweating.
• Breathing problems. Tissue hypoxia explains the need for a better supply of oxygen.
• The heart skips beats or freezes, which creates a feeling that the organ has stopped working.
• Fainting states.
• Headache for no apparent reason.

Unstable bouts of up to 100-300 strokes are possible. Duration is minimal: from 5 to 30 minutes. The process is observed against the background of extrasystoles, therefore cardiac arrest is likely, if symptoms occur, it is recommended to call an ambulance medical care to address the issue of hospitalization.

Diagnostics

The examination is carried out by a cardiologist or a specialized type of surgeon, if there are suspicions of defects or other problems. Against the background of etiological factors of an extracardiac kind, consultation of other specialists is indicated.

Among the methods are:

• Oral questioning of the patient about complaints and their type. Plays the most important role in identifying the problem.
• Collection of anamnesis. Lifestyle, family medical history, bad habits, current therapy, somatic problems. Both of these studies are required to determine the vector for further diagnosis.
• Measurement of blood pressure. Also counting heart rate, better repeatedly.
• Daily Holter monitoring. Allows you to assess the state of the cardiovascular system in natural conditions for the patient. Therefore, it is better to carry out on an outpatient basis.
• Electrocardiography. Basic way early detection Problems. It allows you to see the slightest deviations from the norm with your own eyes. However, a significant qualification of doctors is required. It is impossible to decipher the result on your own.
• Echocardiography. Ultrasound technique, visualization. Necessary for the diagnosis of organic lesions of the cardiovascular system. It does not allow you to see much, therefore it is not considered universal.
• Angiography. As needed.
• Load tests. Bicycle ergometry, treadmill. With great care, since the likelihood of cardiac arrest is high.

Against the background of pathologies of a different profile, laboratory methods and other methods are used.
The study is carried out in the system, under the control of a group of doctors.

Signs on the ECG

Among the characteristic moments of ventricular extrasystole on the ECG:

• Early occurrence of the QRS complex, its expansion.
• Complete compensatory pause after extrasystole.
• The appearance of interpolated, intercalated teeth on the graph (occur between full contractions).

Decoding is carried out by specialists in functional diagnostics or cardiology.

Treatment

Systemic therapy. With the use of medicines surgical techniques, lifestyle changes play some role, although this point is given less importance.

Treatment of ventricular extrasystole pass with the use of drugs:

• cardiac glycosides. Digoxin or lily of the valley tincture, but not both.
• Antiarrhythmic drugs. Amiodarone and analogues. In strictly adjusted dosages.
• calcium antagonists. Better Verapamil.

Medical therapy is not very effective, except for early stages there is no point in prescribing funds.

Maintenance therapy involves the lifelong prescription of certain pharmaceuticals, at the discretion of the specialist.

Surgical methods are much more effective in most cases, since cardiac pathologies are of organic origin.

Shunting, elimination of a congenital or acquired defect in cardiac structures, open or endoscopic surgery by resection of a fragment that generates pathological impulses. Radiofrequency ablation is possible.

The main technique is selected by a cardiac surgeon after a long, thorough examination.

Attention:

If the doctor immediately suggests an operation, there is reason to doubt his competence.

Lifestyle changes play the biggest role only in the early stages:

• Complete rejection of bad habits.
• Normalization of the diet (everything is possible, but in moderation, there are no strict restrictions).
• Full sleep for 8 hours a night.
• Physical activity. Walks or exercise therapy 2 hours a day.
• Drinking mode - 2 liters.
• Salt no more than 7 grams.

Correction is carried out under the supervision of a nutritionist and the main specialist.

Complications and likely prognosis

The consequences of ventricular extrasystole are monotonous:

• Heart failure. Requires urgent resuscitation. There are only a few minutes. AT stationary conditions more chances for recovery.
• Tachycardia. Significantly reduces the quality of life, worsens the outcome of the course of the pathological process at times.
• Ventricular arrhythmia. Joins almost instantly. Aggravates the development of the underlying disease.

All of these phenomena, one way or another, lead to the death of the patient. It's a question of time. Therefore, it is not worth delaying treatment and diagnosis.

The predictive data is something like this:

• With single extrasystoles, there are almost no risks. The probability of complications is about 2-5% for 5 years or more.
• The opposite phenomenon with group contractions is accompanied by severe problems in 65% of situations without therapy, one and a half to two times less against the background of curation.

A complete cure never occurs, but there are chances to improve the quality of life and prolong one's own existence. From a prognostic point of view, 3,4,5 types of process are the least favorable. 1 and 2 do not pose a danger to life and health.

Finally

Extrasystole of ventricular localization is a violation of the normal heart rhythm by the type of occurrence of additional, early contractions.

The systematic use of drugs, lifestyle changes, and surgical treatment are associated with a good or relatively favorable prognosis.

The more neglected the problem, the less chance of recovery. Lethal outcome is the most likely end of the process outside of medical care. Profile specialist - cardiologist.

• Classification of extrasystoles
• Treatment of ventricular extrasystole

What are solitary ventricular extrasystoles? What are their features? As you know, premature contraction of fibers in the ventricles, which does not obey the main pacemaker, which is the sinus node, is called. Of all types of arrhythmias, this option occurs most often, even if the heart muscle is absolutely healthy. It occurs in all categories of the population, can be registered in early childhood, the likelihood of occurrence increases with age.

It has been reliably established that if daily monitoring is carried out for a group of people, then half of them will experience various single excitations from different parts of the heart. Experts call them "functional". At the same time, 30% of them are supraventricular, and 60% are single extrasystoles. At the same time, 10% is accounted for by their combined appearance.

The main causes of extrasystole

Ventricular extrasystole occurs due to excitation in the myocardium, which comes mainly from the legs of the bundle of His or the Purkinje fibers located below.

The reasons for the contraction in the myocardium of the ventricles are divided into functional and organic:

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Classification of extrasystoles

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

• single (less than 5 per minute);
• frequent (6 or more per minute);
• paired (when there are two extrasystoles in a row);
• early (layering of the P wave on the T);
• late (arising in the last phase of diastole);
• insertion, or interpolated (in the middle of the interval of the main rhythm);
• monotopic and polytopic (have different foci of activity);
• monomorphic and polymorphic (different in shape);
• allorhythmic (repeated at regular intervals).

According to the localization of excitation, ventricular impulses can be right ventricular and left ventricular.

There is also a classification according to which several classes of ventricular extrasystoles are distinguished:

1. Class I - the frequency of single extrasystoles is less than 30 per hour. This condition is considered a variant of the norm.
2. Class II - the frequency is more than 30 per hour. This is a more significant indicator, but usually does not lead to serious consequences.
3. Class III - polymorphic ventricular extrasystole is observed. This is already an unfavorable symptom that requires urgent treatment.
4. IVa class - the presence of paired, following each other extrasystoles.
5. Class IVc - volley episodes of excitement, up to 6 or more in a row.
6. Class V - the appearance of early extrasystoles.

The last three types of rhythm disturbances can lead to complications such as fibrillation. The clinical significance of extrasystoles of a lower grade is determined by the presence of concomitant symptoms.

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Clinical signs of extrasystole

As a rule, the ventricular form of extrasystole is tolerated by patients much harder than the atrial or from the AV connection.

Often single ventricular extrasystoles of organic origin do not have particularly pronounced clinical signs. Pronounced complaints of patients about missed beats, fading of the heartbeat, interruptions, cardiac tremors, as a rule, occur when functional reasons, but there may be exceptions.

Indirect signs of ventricular extrasystole are expressed in general weakness, rapid fatigue, dizziness, sleep disturbance, intolerance to long-distance travel in transport.

With an organic nature, the main signs of the disease that caused such a rhythm disturbance come first.

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Correct diagnosis of the disease

For the correct diagnosis of the disease, it is necessary to take into account the main complaints that the patient makes, to conduct a complete check of the state of the autonomic and central nervous system. An important role in this is played by a complete examination of the work of the heart and blood vessels. Specialists count the number of emerging ventricular extrasystoles per 100 normal heartbeats. Individuals are those whose frequency is less than 10%.

It is imperative for such a pathology to conduct a study using an ECG, which must be done in dynamics.

Conducting daily monitoring allows you to get the most objective picture of the disease. Bicycle ergometry allows differentiation between idiopathic ventricular extrasystoles (they pass under load) and ectopic foci arising from organic changes in the heart muscle.

Cardiac pathology, expressed in excessive premature excitation of tissues under the influence of passing nerve impulses that come from various parts of the conduction system of the ventricles of the heart, ventricular extrasystole brings significant discomfort to the patient's life and can have a number of unpleasant consequences in the absence of appropriate treatment.

This condition, according to the medical statistics of cardiac pathologies, should be considered the most common: it is most often diagnosed in people of a fairly young age (about 5% of cases of pathologies in the work of the heart).

What it is?

A feature of this cardiac pathology is its risk of occurrence even at a young age, while the frequency of manifestations of this type of extrasystole increases with age. The most common are isolated cases of extrasystole; however, particularly complex variants of the disease are also identified, in which a repeated rise in excitation of ventricular tissues is diagnosed.

Morning hours should be considered the most favorable for the manifestation of ventricular extrasystole, and a significant number of variants of this condition makes it difficult to identify the disease and determine the most correct system for its treatment. Ventricular extrasystole is an extraordinary contraction of the ventricle, which subjectively manifests itself as an untimely contraction of the heart muscle, there is a lack of air.

• During pregnancy, single ventricular extrasystoles can occur, since at this time a significant load is placed on the woman's body, and the general hormonal background also changes, which can also lead to some interruptions in the work of the heart. Any complaints of an unstable heart rhythm should be the reason for a full examination of the pregnant woman.
• The detection of this cardiac pathology is usually carried out already in the neonatal period, and it can be caused by a hereditary factor or congenital anomalies in the development of the heart.
• At a later age in children, this condition occurs with nervous or physical excessive stress, with food or drug poisoning. Most often, ventricular extrasystole in a child is detected by chance, during the next preventive examination. An older child may already complain of discomfort in the heart and interruptions in heart rate.

In terms of its manifestations and impact on the patient's life, ventricular extrasystole does not pose a significant threat to human health, however, without the necessary treatment, a significant increase in the risk of sudden death is likely, this becomes especially true in the presence of any other cardiac pathologies.

You will learn about what a single ventricular extrasystole is, idiopathic, rare and frequent, as well as its other types, in the next section.

The following video will tell you more about such a pathology as ventricular extrasystole:

Classification

When this pathological condition of the cardiac system is detected, today the disease is classified depending on the degree of its development and the symptoms that appear. And according to the data obtained during the daily ECG, it is customary to classify ventricular extrasystoles into the following classes:

• 0 class corresponds to a state in which there are no manifestations of this state;
• Class 1 is characterized by the detection of no more than 30 cases of single extrasystoles of the ventricle of the heart during any hour during the day. They have a pronounced monomorphic character;
• class 2 - a condition in which more than 30 single frequent monomorphic ventricular extrasystoles are detected during a daily ECG;
• Class 3 can be established with frequent polymorphic ventricular extrasystoles;
• class 4a is characterized by the detection of repeated (paired, one after the other) extrasystoles of a monomorphic nature during the daily ECG;
• 4b class - a condition in which paired polymorphic extrasystoles of the ventricle are recorded;
• class 5 is characterized by the detection of volley (or group) polymorphic extrasystoles of the ventricle.

The first class can be considered as having no external and organic manifestations, therefore it does not have a negative impact on both the patient's condition and health in general. And from the 2nd to the 5th class, extrasystoles already carry a certain danger for deepening the existing organic lesions: if the patient already has lesions of the cardiac system of any nature, then the development of extrasystoles exacerbates the impact on the state of health of pathological conditions.

Classes 2-5 are characterized by an increased risk of sudden death from coronary heart failure. Therefore, when diagnosing this pathological condition, it is imperative to conduct a complete examination of the cardiac system and conduct appropriate treatment.

About the violation of the heart rhythm by the type of ventricular extrasystole, the next section will tell in more detail.

By type of main characteristics

Depending on the main characteristics, which usually include heart rate and the location of the manifestations of this pathology, the following types of this pathological condition should be distinguished:

• single, or single extrasystoles of the ventricles, are extraordinary contractions of the muscles of the ventricle, which are observed infrequently, after about 25-30 normal contractions of the heart;
• group contractions of the ventricle are 3-5 contractions of an ectopic nature between normal heart rhythms;
• bigeminia - this condition is characterized by the repetition of one-time contractions for each normal heart rhythm;
• if an extraordinary contraction is observed after every third contraction, then trigymenia occurs.

Depending on the meta-detection of extrasystoles, monotopic and polytopic ventricular extrasystoles should be distinguished. There are also two varieties, depending on the place of diagnosis of extrasystoles:

1. right ventricular - this species less common, probably due to the peculiarities anatomical structure hearts;
2. left ventricular - occurs most often.

Due to the possibility of early diagnosis of the presence of extraordinary ventricular contractions, the earliest possible start of treatment is possible.

by ryan

You should also be aware of the methods for classifying this pathological condition, depending on the method of their diagnosis; for example, classification by ryan allows you to divide the manifestations of pathology into classes:

• 0 class is not observed, does not have visible symptoms and is not detected during daily ECG;
• ventricular extrasystole 1 gradation according to ryan is characterized by the detection of infrequent monotopic contractions;
• Grade 2 has frequent monotopic abbreviations;
• for the third class according to this classification, polytopic contractions of the ventricle of the heart are characteristic;
• ventricular extrasystole 3 gradation according to ryan - these are multiple paired polymorphic contractions that are repeated at a certain frequency;
• for class 4a, monomorphic paired contractions of the ventricle should be considered characteristic;
• 4b class should be characterized by paired polymorphic abbreviations;
• in the fifth grade of pathology, development is observed ventricular tachycardia.

According to Laun

The following features are characteristic for the classification of ventricular extrasystole according to Lown:

• the zero class has no pronounced manifestations and is not diagnosed during the daily ECG;
• for the first class, infrequent monotypic contractions with a repetition frequency within 30/60 contractions should be considered characteristic;
• the second class is distinguished by pronounced frequent contractions with a monotopic character;
• with the development of pathology up to the third class, polymorphic contractions of the ventricle are observed;
• 4a class - manifestation of paired contractions;
• 4b class is characterized by the occurrence of ventricular tachycardia;
• for the fourth class with this variant of the classification, the manifestation of early PVCs, which occur in the first 4/5 of the T wave, is characteristic).

These two classification options are most often used today and allow the most complete characterization of the patient's condition.

Causes of ventricular extrasystole

Most common causes The occurrence and further development of this pathological contraction of the ventricle are organic lesions of the cardiac system, which are idiopathic in nature. The reasons causing the development of ventricular extrasystole include:

• myocardial infarction - in this case, about 95% of cases of extrasystoles are detected;
• postinfarction cardiosclerosis;
• prolapse mitral valve;
• arterial hypertension;
• pericarditis;
• heart failure.

Symptoms of the disease

The most commonly reported manifestations of this condition include:

• noticeable disruptions in the work of the heart,
• lack of air
• uneven heart rhythm.

You may also experience:

• fainting
• sudden dizziness, which can be quite severe and prolonged.

Increased irritability, rapid onset of fatigue even with a slight load, headache, localized in different parts of the head - all these manifestations are also characteristic of ventricular extrasystole.

Diagnostic methods

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

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

A specialist will tell you more about the diagnosis of ventricular extrasystole in the following video:

Treatment

Depending on the symptoms and the stage of development of the disease, treatment is prescribed that restores the normal functioning of the cardiac system.

Therapeutic

In the absence of objective signs of ventricular extrasystole, treatment is not required for patients. To the recommendations in given state should include a diet that is rich in potassium salts, as well as an increase in the level of activity with a sedentary lifestyle.

You should also completely exclude provoking factors, which include smoking and excessive alcohol consumption, as well as drinking strong tea and coffee.

Medicinal

The doctor may prescribe a number of sedative drugs, which include small doses of tranquilizers, as well as adrenoblockers. This approach allows to reduce the frequency of extraordinary contractions of the ventricle and thus improve general state sick.

Anticholinergic drugs allow you to quickly restore the heart rhythm and normalize the condition with existing bradycardia. In the absence of a pronounced positive effect, antiarrhythmic drugs can be prescribed.

Surgical intervention

In especially severe cases, radiofrequency ablation with a catheter is indicated. This operation is performed in a hospital side in conditions of absolute sterility.

Traditional medicine methods

This method of treatment does not always bring tangible results, and drugs traditional medicine can be prescribed for the zero class of the disease and in the absence of pronounced manifestations.

Also can be used folk remedies, which have a relaxing and sedative effect.

A well-known doctor will tell you more about diagnostic methods and methods of treating ventricular extrasystole in the following video:

Disease prevention

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

Complications

In the presence of any heart disease, extrasystole can become dangerous disease, because in some cases it can lead to unexpected cardiac arrest. Also, extrasystole of the ventricle entails a deepening of already existing diseases of the cardiac system.

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Ventricular extrasystole (PV) is difficult to treat. Panangin is generally a dummy. BetalocZOK is a beta-blocker, they sometimes reduce ES, but not always. You have made sure that Betaloc Zok does not give any effect and its further use is not justified. In general, this is a very benign form of arrhythmia and it is not necessary to treat it at all.

When to Use the 24 Hour Holter
monitoring, 80 percent of healthy men or women are found
ventricular extrasystoles (VE). There is
an age-related increase in the prevalence of PVCs in healthy individuals and in cardiac patients. ZhE
prevalent in a wide range of populations. This includes people without organic
heart disease and patients with any form of heart disease, regardless of
seriousness.

ZhE
do not cause any sensations in the vast majority of patients, although some
patients may be disturbed by fading, arrhythmias, a feeling of cardiac arrest due to
compensatory pauses or dizziness. PVCs rarely cause problems
hemodynamics, except when they appear in patients with reduced left ventricular function or when
they are parallel with bradycardia.

ZhE
have variable predictive value. They usually have no
predictive value, but may be associated with an increased risk of long-term
ventricular tachyarrhythmias and sudden cardiac death (SCD) in
heart patients.

Not
no evidence that PVC suppression (even in patients with heart disease)
may extend life expectancy or reduce the risk of adverse
arrhythmic event.

ZhE
usually diagnosed during auscultation or routine
electrocardiographic registration. AT
these cases are usually ignored,
because the signs are usually trivial and there is no evidence that
suppression (even in patients with heart disease) may prolong the duration
life or reduce the risk of an adverse arrhythmic event.

Clear guidelines for
there is no ventricular extrasystole in big sport. I took directions from the last
American edition of UpToDate (2010).

"Ventricular extrasystole (PV)
is a common finding in athletes of all age groups and is detected as
against the background of organic heart disease, and without them. Their presence, regardless of frequency, not is a risk factor for sustained ventricular
tachyarrhythmias or sudden death, but their predictive value is based on
associations with major organic heart disease.

non-invasive
assessment includes 12 ECG leads and, in selected athletes, 24 hours
outpatient Holter monitoring to assess the frequency and complexity of PVCs. organic
heart disease is detected by echocardiography. Increasing the frequency and
the complexity of PVC during exercise, which is revealed using
stress test may require a tolerance reassessment even if there are no
evidence for organic heart disease. So
Thus, in fact, those who have
organic changes in the heart with echocardiography and those who have an increase in PVC during
physical stress. Athletes with PVCs who do not have organic
heart disease does not seem to have an increased risk of cardiovascular
events. In one of
recent publications, 70 athletes had PVCs with a frequency of 2000 or more
per day. They were suspended from physical training for three months. 16 of them have 70
PVCs disappeared completely, in 34 the number of PVCs decreased to 500 or less, and in 20
there were no changes. All were admitted to competitions and for 8 years of observation
one had no cardiovascular events.”

There is another consideration. Since your PVCs are monoform, in all likelihood they come from one local limited area of ​​the myocardium. If you conduct an EFI - an electrophysiological study, then this area can be clearly defined. And then local cauterization (RFA - radiofrequency ablation) can, by causing destruction of this area of ​​the myocardium, stop all these PVCs. Although this is not always possible.

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Ventricular extrasystole - what is it?

Ventricular extrasystole is one of the types of cardiac arrhythmias. 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 certainty 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 extrasystole. The first type of pathology is corrected by antiarrhythmic therapy, and the second is a consequence of heart disease and is considered as a cardiac pathology (requires treatment of the underlying disease).

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

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

Pericarditis and myocarditis.

Arterial hypertension.

Chronic heart failure.

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 vagus nerve with sleep problems or due to intense 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 during physical exertion, 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 of headache, dizziness - 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 extrasystole, so it is used by cardiologists at the present 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.

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Treatment of ventricular extrasystole

Treatment of ventricular extrasystole is a rather difficult 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 heart disease, 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: stress, alcohol consumption, smoking, etc. Therapy should be aimed at maintaining a 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 of the clinical picture. Besides, clinical researches made it possible to find out that the use of these drugs in patients with myocardial infarction leads 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).

The appointment of calcium channel blockers is not excluded, 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 for ventricular arrhythmia 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 the 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 the control of x-ray equipment. 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.

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Causes of ventricular extrasystole

Ventricular extrasystole can develop under the following conditions and diseases:

1. functional reasons. Often the appearance of single rare extrasystoles on the ECG is recorded in healthy individuals without any heart disease. Emotional stress, vegetative - vascular dystonia, drinking coffee, energy drinks in large quantities, smoking a large number of cigarettes can lead to this.
2. Organic heart disease. This group of reasons includes:
— ischemic disease heart, more than 60% of ventricular extrasystole is due to this disease
- acute myocardial infarction
- postinfarction cardiosclerosis
- post-infarction aneurysm of the left ventricle
– cardiomyopathy
- myocardial dystrophy
- myocarditis
- postmyocardial cardiosclerosis
- congenital and acquired heart defects
- minor anomalies in the development of the heart, in particular, mitral valve prolapse
- pericarditis
- arterial hypertension
- chronic heart failure
3. Toxic effect on the heart muscle. It develops when the body is intoxicated with alcohol, narcotic substances, drugs - cardiac glycosides, drugs used in the treatment bronchial asthma(eufillin, salbutamol, berodual), class 1 C antiarrhythmic drugs (propafenone, ethmozine). Also, extrasystole can develop with thyrotoxicosis, when the body is intoxicated with hormones. thyroid gland and their cardiotoxic effects.

Symptoms of ventricular extrasystole

Sometimes extrasystole is not felt by the patient. But in most cases, the main manifestation of the disease are sensations of interruptions in the work of the heart. Patients describe, as it were, a “somersault”, “turning over” of the heart, then a feeling of fading of the heart follows, due to a compensatory pause after an extrasystole, then a sensation of a push in the heart rhythm is possible, caused by an increased contraction of the ventricular myocardium after a pause. In cases of frequent extrasystoles or episodes of ventricular tachycardia, a feeling of rapid heartbeat is possible. Sometimes such manifestations are accompanied by weakness, dizziness, sweating, anxiety. In cases of frequent extrasystole, loss of consciousness is possible.

Complaints that are poorly tolerated by the patient, which arose suddenly or for the first time in life, require an urgent visit to the doctor, so it is necessary to call ambulance, especially if the pulse is more than a hundred beats per minute.

In the presence of an organic lesion of the heart, the symptoms of extrasystole itself are supplemented by manifestations of the underlying disease - pain in the heart with coronary artery disease, shortness of breath and edema in heart failure, etc.

In the event of ventricular fibrillation, clinical death occurs.

Diagnosis of extrasystole

For the diagnosis of ventricular extrasystole, the following methods are used:

1. Questioning and clinical examination of the patient.
- evaluation of complaints and anamnesis (history of the disease) suggests a diagnosis, especially if there is an indication of an organic pathology of the heart in a patient. It turns out the frequency of interruptions in the heart, subjective sensations, connection with the load.

- auscultation (listening) of organs chest. When listening to the heart, weakened heart tones, pathological murmurs (with heart defects, hypertrophic cardiomyopathy) can be determined.

- when probing the pulse, an arrhythmic pulse of different amplitude is recorded - before the extrasystole, the contraction of the heart sets a small amplitude of the pulse wave, after the extrasystole - a large amplitude due to an increase in the blood filling of the ventricle during a compensatory pause.

- tonometry (blood pressure measurement). Blood pressure may be lowered in healthy individuals with signs of vegetative-vascular dystonia, in patients with dilated cardiomyopathy, in advanced heart failure or with aortic valve defects, and may also be elevated or remain normal.

2. Laboratory methods examinations. Appointed general analyzes blood and urine tests, biochemical blood tests, hormonal tests, immunological and rheumatological tests, if necessary, check the level of cholesterol in the blood, exclude endocrine pathology, autoimmune diseases or rheumatism, leading to the development of acquired heart defects.

3. Instrumental Methods examinations.
- ECG does not always allow you to register extrasystoles, if we are talking about healthy people without organic heart disease. Often extrasystoles are recorded accidentally in the process scheduled examination without complaints of interruptions in the heartbeat.
ECG - signs of extrasystoles: an expanded, deformed ventricular QRS complex that appears prematurely; there is no P wave in front of it, reflecting atrial contraction; the complex is longer than 0.12 s, after which there is a complete compensatory pause due to the electrical non-excitability of the ventricles after extrasystole.

Extrasystoles on the ECG according to the type of trigemenia.

In cases of the presence of the underlying disease, the ECG reveals signs of myocardial ischemia, left ventricular aneurysm, left ventricular hypertrophy or other heart chambers, and other disorders.

- echocardiography (ultrasound of the heart) reveals the main pathology, if any - heart defects, cardiomyopathies, myocardial hypertrophy, zones of reduced or absent contraction during myocardial ischemia, ventricular aneurysm, etc. The study evaluates cardiac performance indicators (ejection fraction, blood pressure chambers of the heart) and the size of the atria and ventricles.

- Holter ECG monitoring should be carried out for all persons with cardiac pathology, especially for patients who have had a myocardial infarction to register extrasystoles that are not subjectively felt, palpitations and interruptions in the heart, not confirmed by a single cardiogram, as well as to detect other rhythm and conduction disturbances. It is an important study in therapeutic and prognostic terms for patients with frequent ventricular extrasystole, since treatment and prognosis depend on the class of extrasystole. Allows you to evaluate the nature of extrasystole before the start of treatment and monitor the effectiveness of therapy in the future.

- samples with physical activity(treadmill test) should be carried out very carefully and only in cases where the appearance of palpitations has a clear relationship with the load, since in most cases this relationship indicates the coronarogenic nature of extrasystole (caused by impaired patency coronary arteries and myocardial ischemia). If in the process of recording an ECG after walking on a treadmill, extrasystole with signs of myocardial ischemia is confirmed, then it is quite possible that after the treatment of ischemia, the prerequisites for the occurrence of frequent extrasystole will be eliminated.
The study should be carried out with caution, since the load can provoke ventricular tachycardia or ventricular fibrillation. Therefore, in the study room, there must be a set for cardiopulmonary resuscitation.

- coronary angiography - allows you to exclude the pathology of the coronary arteries, causing myocardial ischemia and the coronary nature of ventricular extrasystole.

Treatment for ventricular extrasystoles

Treatment of extrasystole is aimed at treating the underlying disease, which is its cause, and at stopping attacks of extrasystole. In order to determine the need for certain drugs, a classification of extrasystole has been developed depending on the benign course.

Benign ventricular extrasystole, as a rule, is observed in the absence of organic damage to the heart and is characterized by the presence of rare or moderate frequency of extrasystoles, asymptomatic course, or mild subjective manifestations. The risk of sudden cardiac death is extremely low. Therapy in such cases may not be prescribed. In case of poor tolerance of symptoms, antiarrhythmic drugs are prescribed.

A potentially malignant course occurs with extrasystoles against the background of the underlying cardiac disease, characterized by frequent or moderate extrasystoles, the absence or presence of symptoms, their good or poor tolerance. The risk of sudden cardiac death is significant, as unstable ventricular tachycardia is recorded. Therapy in such cases is indicated to relieve symptoms and reduce mortality.

Malignant ventricular extrasystole differs from potentially malignant one in that, in addition to the main symptoms, there are indications in the anamnesis of syncope(fainting) and/or cardiac arrest (experienced through resuscitation). The risk of cardiac death is very high, therapy is aimed at reducing the risk.

Frequent ventricular extrasystole, which appeared for the first time in life or already occurring earlier, but at the moment has developed suddenly, is an indication for hospitalization and intravenous administration drugs.

The selection of drugs for treatment should be carefully carried out by the attending physician in a clinic or hospital, with a mandatory analysis possible contraindications and selection of an individual dose. The beginning of therapy should be with a gradual increase in dose, abrupt withdrawal of drugs is unacceptable. The duration of therapy is set individually, in cases of a potentially malignant course, careful withdrawal of drugs should be secured by Holter ECG monitoring to confirm the effectiveness of therapy. In a malignant course, therapy continues for a long time, possibly for life.

Antiarrhythmic drugs have a proarrhythmic effect as side effects, that is, they themselves can cause rhythm disturbances. Therefore, their use in its pure form is not recommended, their joint appointment with beta-blockers is justified, which reduces the risk of sudden cardiac death. Of the antiarrhythmics, it is preferable to prescribe propanorm, ethacizine, allapinin, amiodarone, cordarone, sotalol in combination with low doses of beta-blockers (propranolol, bisoprolol, etc.).

Persons who have had an acute myocardial infarction and with myocarditis in acute stage, the appointment of amiodarone or cordarone is indicated, since other antiarrhythmics with acute pathology heart muscle can cause other rhythm disturbances. In addition to these drugs, nitrates (nitroglycerin, kardiket, nitrosorbide) are prescribed for organic heart diseases, ACE inhibitors(enalapril, lisinopril, perindopril), calcium channel blockers (verapamil, diltiazem), antiplatelet agents (aspirin), drugs that improve the nutrition of the heart muscle (panangin, magnerot, vitamins and antioxidants - actovegin, mexidol).

The therapy is carried out under ECG control once every two to three days during the stay in the hospital and once every 4 to 6 weeks in the clinic thereafter.

Lifestyle with ventricular extrasystoles

With ventricular extrasystoles, especially those caused by other heart diseases, you need to rest more, stay in the fresh air more often, observe the regime of work and rest, eat right, avoid drinking coffee, alcohol, reduce or eliminate smoking.
Patients with a benign type of ventricular extrasystole do not need to limit physical activity. In the malignant type, significant stress and psycho-emotional situations that can lead to the development of an attack should be limited.

Complications

Complications with a benign type of ventricular extrasystole, as a rule, do not develop. Terrible complications in the malignant type are sustained ventricular tachycardia, which can turn into flutter or ventricular fibrillation, and then lead to asystole, that is, to cardiac arrest and sudden cardiac death.

Forecast

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

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

Therapist Sazykina O.Yu.

Rapid heartbeat after eating causes Breathing exercises for cardiac arrhythmias