Ventricular diseases. Ventricular extrasystole. Correct diagnosis of the disease

One of the common types of arrhythmic pathology is ventricular extrasystoles, when impulses are formed not in the sinus node, but in various (ectopic) parts of the conduction system of the right or left ventricle.

This leads to extraordinary contractions occurring throughout the entire heart or its individual parts, in this case the ventricles.

When ventricular extrasystoles occur, the heart is prematurely excited, it beats strongly or, conversely, freezes. Cardiac output decreases, coronary and cerebral blood flow slows down. This may result in angina, atrial fibrillation, or death.

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Extrasystoles can have different natures and symptoms, but the most dangerous are ventricular ones.

Depending on the time of formation, nature and number of extrasystoles, they are divided into 5 classes:

The most typical occurrence of pathology is in adulthood; usually extrasystoles are found in 70% of patients who have heart complaints. The disease is a sign that structural and functional changes are present in the myocardium, but often heart damage is not detected using standard instrumental methods.

If right ventricular extrasystole or left ventricular extrasystole occurs against the background of another cardiac pathology, patients should first of all resort to the prevention of the underlying disease and lead a healthy lifestyle, this will not allow the arrhythmias to progress.

The occurrence of a pathological focus of excitation in the ventricular myocardium with the formation of premature contraction of the heart is called ventricular extrasystole. They can often occur in healthy people (5% of cases).

The factors that caused the development of the disease can be of physiological and pathological origin. An increase in the tone of the sympathetic-adrenal system leads to an increase in the occurrence of extrasystoles. Physiological factors influencing this tone include the consumption of coffee, tea, alcohol, stress and nicotine addiction. There are a number of diseases that lead to the formation of extrasystole:

cardiac ischemia;
myocarditis;
cardiomyopathy;
heart failure;
pericarditis;
hypertonic disease;
osteochondrosis of the cervical spine;
prolapse of the mitral valve leaflets;
cardiopsychoneurosis.

There is a certain connection between the patient’s age, time of day and the frequency of extrasystoles. Thus, more often the ventricular type is present in people over 45 years of age. Dependence on circadian biorhythms is manifested in the registration of extraordinary heart contractions, more in the morning hours.

Ventricular extrasystole threatens the patient’s life. Its formation increases the risk of sudden cardiac arrest or ventricular fibrillation.

Classifications

There are many classifications of ventricular extrasystoles. Each of them is based on some criterion. Having determined whether the pathology belongs to one type or another, the doctor will determine the level of its danger and the method of treatment.

What subgroups are ventricular arrhythmias with extraordinary systoles usually divided into:

according to the form of rhythm disturbance (mono-, polymorphic, group);
by the number of sources (mono-, polytopic);
depending on the frequency of occurrence (rare, infrequent, moderately rare, frequent, very frequent);
by stability (stable, unstable);
from the time of appearance (early, late, interpolated);
according to the pattern of abbreviations (disordered, ordered);
classification of ventricular extrasystoles according to Lown and Bigger.

Ordered ventricular extrasystoles form a special pattern of development, which determines their name. Bigemeny is an extraordinary contraction of the ventricles, recorded every second normal cardiac cycle, trigemeny - every third, quadrigymeny - every fourth.

In the medical community, the most common classification of ventricular extrasystole according to Lown.

Its last modification was in 1975, but it still has not lost its relevance and contains the following classes:

0 (no arrhythmia);
1 (extrasystoles less than 30/hour, from one source and one form);
2 (one source and form, 30 or more extrasystoles per hour);
3 (multifocal extrasystoles);
4a (paired extrasystoles from one focus);
4b (polymorphic extrasystoles accompanied by other arrhythmias - ventricular fibrillation/flutter, tachycardia paroxysm);
5 (early extrasystoles “type R on T”).

The mechanism of development of extrasystoles may differ. There are two main ones - reciprocal and automatic. Reciprocal arrhythmias arise when a vicious circle of intraventricular excitation is formed, the so-called “re-entry” mechanism. Its essence lies in the disruption of the passage of a normal signal, which is associated with the presence of at least two paths for the impulse. In this case, the signal for one of them is delayed, which causes the formation of an extraordinary contraction. This mechanism plays a role in the formation of such arrhythmias as paroxysm of ventricular tachycardia and extrasystoles, Wolff-Parkinson-White syndrome, atrial/ventricular fibrillation. An ectopic focus of excitation can occur with increased automatism of the pacemaker cells of the heart. Arrhythmias with such a development mechanism are called automatic.

Bigger's classification provides for the formation of groups of patients according to the degree of increase in the risk of complications.

It includes the following course of extrasystole:

malignant;
potentially malignant;
benign.

With benign extrasystoles, the risk of complications is extremely low. Moreover, such patients have no signs of pathology of the cardiovascular system in the anamnesis and during examination (normal left ventricular ejection fraction, no hypertrophy or cicatricial changes in the myocardium). The frequency of ventricular extrasystoles does not exceed 10 per hour and there is no clinical picture of paroxysmal ventricular tachycardia.

A potentially malignant disease is characterized by a moderate or low risk of sudden death. The examination reveals structural changes in the heart in the compensation stage. Ultrasound of the heart reveals a decrease in LV ejection fraction (30-55%) and the presence of scar or myocardial hypertrophy. Patients complain of a feeling of interruptions in the work of the heart, accompanied by short-term episodes of ventricular tachycardia (up to 30 seconds).

Malignant extrasystoles are those whose manifestation causes a disturbance in the general well-being of the patient (palpitations, fainting, signs of cardiac arrest). Patients exhibit a critical decrease in ejection fraction - less than 30%. Persistent ventricular tachycardia is also noted.

The most dangerous ventricular ecstasystoles include 3 gradations in the Lown classification - 4a, 4b and 5 classes.

Clinical manifestations

In most patients, in the absence of damage to the cardiovascular and nervous systems, extrasystole occurs hidden. There are no specific complaints inherent to the disease. Its pronounced clinical picture is usually represented by the following symptoms:

weakness;
irritability
dizziness/headaches;
feeling of discomfort in the chest (pain, tingling, heaviness);
heart sinking feeling
a push in the chest with frequent extrasystoles;
arrhythmic pulse;
feeling of pulsation in the veins of the neck;
dyspnea.

The presence of concomitant cardiac pathology aggravates the course of the disease.

Diagnostics

Making a diagnosis is based on the results of collecting complaints, the history of the patient’s development and life, data from a comprehensive examination and additional studies. Assessing the patient’s condition, the doctor pays attention to increased pulsation of the neck veins, changes in the pulse wave and auscultatory pattern of heart sounds. A standard set of laboratory tests is prescribed (general blood and urine analysis, blood glucose and biochemical blood test), as well as an analysis of thyroid and pituitary hormones.

To obtain an accurate diagnosis, the mandatory criterion is the result of an ECG and daily Holter monitoring. Using these methods, it is possible to accurately determine the source of the pathological focus, the frequency of extrasystoles, the number and relationship with the load. Echo-CG is performed to identify the left ventricular ejection fraction and the presence/absence of structural changes in the heart. If it is difficult to diagnose the disease, MRI, CT, and angiography may be prescribed.

Treatment

If there are no patient complaints, with a benign course of extrasystole, only monitoring the state of the cardiovascular system is indicated. Such patients are recommended to undergo examination 2 times a year with mandatory ECG registration. The tactics of patient management depend on the number of extrasystoles per day, the course of the disease, and the presence of concomitant pathology. The dosage of drugs is selected individually by the attending physician.

Antiarrhythmic drugs are divided into 5 classes:

1a – Na + channel blockers (“Procainamide”, “Disopyramide”);
1c – activators of K + channels (“Difenin”, “Lidocaine”);
1c – Na + channel blockers (“Flecainide”, “Propafenone”);
2 – beta-blockers (“Metaprolol”, “Propranolol”);
3 – K + channel blockers (“Amiodarone”, “Ibutilide”);
4 – Ca 2+ channel blockers (“Diltiazem”, “Verapamil”);
5 – Other drugs with antiarrhythmic effects (cardiac glycosides, calcium, magnesium preparations).

For ventricular extrasystole, class 2 drugs are widely used. They help reduce symptoms of arrhythmia and also have a positive effect on the quality of life of patients.

Scientific studies have proven that beta-adrenergic blockers improve the prognosis regarding the risk of cardiac death in patients with cardiovascular pathology.

Persistent ventricular extrasystole according to Lown, which is not amenable to drug treatment, requires surgical intervention. For the success of the operation, it is necessary to accurately know the source of pathological activity. When it is determined, patients undergo implantation of cardioverter-defibrillators or radiofrequency catheter ablation.

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Premature single heartbeats occur in both healthy people and patients with heart disease. Treatment of extrasystole with drugs is not always necessary; often it only leads to an improvement in the patient’s well-being, without affecting the course of the disease and prognosis. In each case, the question of treatment for heart rhythm disorders is decided by the doctor after an individual examination of the patient.

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Diagnosis of pathology

The classic method for recognizing arrhythmias is electrocardiography. Depending on the source of the pathological impulse that causes premature contraction of the heart, there are supraventricular (supraventricular) and. The supraventricular ones include atrial, extrasystoles from the A-V junction, as well as the much rarer sinus. One of the types of ventricular extrasystoles are stem ones.

For supraventricular extrasystole, drug treatment is prescribed if the rhythm disturbance is poorly tolerated.

Many cardiologists prefer to use long-acting selective beta blockers in this case. These drugs have virtually no effect on carbohydrate metabolism, blood vessels and bronchi. They act throughout the day, allowing you to take them once a day. The most popular drugs are metoprolol, nebivolol or bisoprolol. In addition to them, an inexpensive but quite effective one can be prescribed.

Additionally, if there is a fear of death or poor tolerance to interruptions, valerian, Novo-passit, Afobazol, Grandaxin, Paroxetine can be prescribed.

If ventricular extrasystole

A small number of ventricular extrasystoles is not dangerous to health. If they are not accompanied by severe heart disease, drugs for the treatment of ventricular extrasystole are not prescribed. Antiarrhythmics are used for frequent ventricular extrasystole.

Mostly for the treatment of very frequent ventricular extrasystole, surgery is used - (cauterization) of the focus of pathological impulses. However, medications can also be prescribed, primarily class IC and class III:

propafenone;

allapinin;

sotalol.

Class IC drugs are contraindicated after myocardial infarction, as well as in conditions accompanied by dilation of the left ventricular cavity, thickening of its walls, decreased ejection fraction, or signs of heart failure.

Useful video

For information on what treatment methods for extrasystoles are currently used, watch this video:

The main drugs for the treatment of extrasystole

Bisoprolol (Concor) is most often used to eliminate the supraventricular form of arrhythmia. It is a beta blocker that suppresses sensitivity corresponding heart receptors.

Beta receptors are also located in blood vessels and bronchi, but bisoprolol is a selective agent that selectively acts only on the myocardium.

If the disease is well controlled, it can be used even in patients with asthma or diabetes.

To achieve the effect, bisoprolol is used once a day. In addition to suppressing arrhythmia, it slows the pulse and prevents angina attacks. It lowers blood pressure well.

The medicine should not be used in patients with edema and shortness of breath at rest (circulatory insufficiency of classes III - IV), with a pulse at rest less than 50 - 60. It is contraindicated in atrioventricular block II - III degree, as it can increase its severity. You should not take it if the “upper” pressure is less than 100 mmHg. Art. It is also not prescribed to children under 18 years of age.

In more than 10% of patients, especially those with heart failure, the drug causes a heart rate slower than 50 beats per minute. In 1 - 10% of patients, dizziness and headache occur, which disappear with constant use of the medication. In the same percentage of cases, there is a decrease in pressure, increased shortness of breath or swelling, a feeling of cold feet, nausea, vomiting, bowel movements, and fatigue.

Sotalol also blocks beta receptors of the heart and acts on potassium receptors. This necessitates its use for the prevention of severe ventricular arrhythmias. It is used for frequent supraventricular extrasystole, 1 time per day.

Contraindications Sotalol has the same side effects as bisoprolol, but it also adds long QT syndrome and allergic rhinitis.

While taking this drug, 1 - 10% of patients experience the following undesirable effects:

dizziness, headache, weakness, irritability;

slowing or increasing heart rate, increased shortness of breath or swelling, decreased blood pressure;

chest pain;

nausea, vomiting, diarrhea.

Cordarone is usually prescribed for frequent supraventricular or ventricular extrasystole that cannot be treated with other drugs.

To develop the effect, you must constantly take the drug for at least a week, and then usually take 2-day breaks.

The drug has similar contraindications to bisoprolol, plus:

iodine intolerance and thyroid disease;

lack of potassium and magnesium in the blood;

long QT syndrome;

pregnancy, breastfeeding, childhood;

interstitial lung diseases.

More than 10% of patients who use cordarone experience nausea, vomiting, abdominal discomfort, and increased sensitivity to sunlight.

In 1 - 10% of patients, the following unpleasant effects may occur:

slow heart rate;

liver damage;

lung diseases, such as pneumonitis;

hypothyroidism;

discoloration of the skin in a grayish or bluish color;

muscle tremors and sleep disturbances;

decrease in blood pressure.

For extrasystole, antiarrhythmic drugs are used depending on the source of extraordinary contractions (according to ECG data):

supraventricular – Verapamil, Metoprolol;
ventricular – Lidocaine, Difenin.

When prescribing treatment, the presence of heart and circulatory diseases is taken into account:

blood stagnation, heart failure - Cordarone, SotaHexal;
low blood pressure – Lidocaine, Allaforte, Celanide;
angina pectoris, previous heart attack - Isoptin, Amiodarone, Atenolol;
hypertension - Anaprilin, Verapamil.

These medications are not needed in all cases of detection of extrasystoles, since in the absence of heart disease they are limited to lifestyle changes (8-hour sleep, quitting smoking, alcohol, caffeine). Indications for taking antiarrhythmic drugs are:

sensations of the patient in the form of a blow to the heart, interruptions, freezing, strong and rapid heartbeat after a pause;
general weakness, anxiety, hot flashes, shortness of breath;
circulatory disorders (more often with bigeminia - one normal beat and extrasystole) - headache, dizziness, attacks of loss of consciousness, disturbances in speech, movements and sensitivity in the limbs;
suffered severe arrhythmia, performed resuscitation (extrasystoles can provoke fibrillation);
complex forms of rhythm disturbances (for example, with QT prolongation).

Tablets for cardiac extrasystole

The prescription of tablets for cardiac extrasystole is carried out depending on ECG data and blood tests, since this is not a separate disease, but only a symptom. If the examination does not reveal diseases of the cardiovascular system, then the following medications are recommended:

calming effect - Valerian, Novo-Passit;
improving metabolism in the heart muscle - Riboxin, Kratal, Preductal, Actovegin, Mildronate;
containing potassium and magnesium - Asparkam, Magnicum, Kalipoz prolongatum;
omega-3 fatty acids – Omacor, Doppelherz Omega 3.

If hypertension, angina pectoris, inflammation (myocarditis, endocarditis) are detected, then all efforts should be directed towards treating the underlying disease. As the condition of the myocardium and blood vessels improves, extrasystoles will also disappear.

Rhythm disturbances can also be caused by:

cough;
lack of potassium;
osteochondrosis;
damage to the digestive system;
dysfunction of the thyroid gland, reproductive glands, adrenal glands;
taking medications;
smoking, alcoholism.

Therefore, the success of treating this form of arrhythmia depends on identifying and eliminating the main cause.

Watch the video about the causes of arrhythmia:

Medicines for supraventricular extrasystole

Supraventricular extrasystole is treated with beta-blockers for:

rapid heart rate (tachycardia);
attacks of angina pectoris, previous heart attack;
rhythm disturbances due to stress, panic attacks, thyrotoxicosis, adrenal diseases.

Anaprilin 30 mg,
Atenolol 25-50 mg,
Betaloc 50 mg,
Bisoprolol 5 mg,
Nebil 5 mg.

If necessary, the dosage can be increased by 2 times or a combination of a beta blocker and Sotalol, Amiodarone can be prescribed. If the patient has bronchial asthma or Prinzmetal's angina, then Isoptin or Diacordin are recommended. If extrasystoles occur at rest, Zelenin and Belloid drops are used at night. Teopek has worked well in low doses - 50 mg after lunch and before bed.

If supraventricular arrhythmia appears against the background of myocardial diseases, there is a risk of circulatory disorders, then Propanorm and Etatsizin are used. In most patients without heart damage, significant relief can be achieved with tranquilizers and antidepressants.

What to take for ventricular extrasystole

For extrasystoles that occur in the ventricles, take sedatives, antiarrhythmic drugs or a combination of 2 drugs. In asymptomatic cases, no medication is required. For single extrasystoles, diet, lifestyle changes, physical activity, sedatives and beta-blockers are recommended.

Drug of choice

The drug of choice for ventricular extrasystole is often a tranquilizer. It can be of plant origin - extract of valerian, hawthorn, motherwort, Fitosed, Persen, Novo-Passit. For neuroses and vegetative-vascular dystonia with a crisis course, synthetic drugs are also used - Afobazol, Clonazepam or Bellataminal.

How to treat single

a diet rich in foods with potassium - dried apricots, baked potatoes, mushrooms, nuts, legumes, dried fruits, seaweed;
cessation of smoking, abuse of coffee, diuretics, laxatives, alcohol;
dosed physical activity - swimming, walking, light running (in the absence of contraindications);
soothing - peony tincture, Corvalol phyto, Valocordin.
beta blockers - Atenolol, Anaprilin.

Frequent extrasystole

For the treatment of frequent ventricular extrasystole, the following is used:

It is possible to reduce the risk of complications during ventricular extrasystole in patients with heart disease with medications that affect:

blood clotting – Cardiomagnyl, Plavix;
cholesterol level – Vasilip, Zocor;
blood pressure – Prestarium, Enalapril;
metabolic processes in the heart muscle - Preductal, Espa-lipon.

How to relieve an attack: first aid for extrasystole

To relieve an attack of extrasystole, use the following first aid measures:

sit the patient in a comfortable position;
ensure the supply of fresh air;
give water with 20 drops of a soothing tincture (motherwort, hawthorn, mint, valerian, peony) or Corvalol to drink;
Place a Validol tablet under your tongue.

If the attack is accompanied by panic, trembling of the hands, strong and rapid heartbeat, then breathing into a paper bag or tightly closed palms helps (there should be no gap between them and the face).

Treatment of cardiac extrasystole with drugs

Medicines for the treatment of cardiac extrasystole are prescribed for frequent, dangerous forms, poor tolerance of arrhythmia, myocardial diseases, and the most common drugs are Anaprilin, Corvalol, Isoptin.

Anaprilin

Anaprilin during extrasystole helps reduce the effect of adrenaline and other stress hormones on the heart. It is effective for rhythm disturbances that occur during emotional stress and heavy physical exertion.

The negative effect of the drug manifests itself in extrasystoles that appear after meals, at night, and at rest. The dose is selected individually, but it is not recommended to slow the pulse to 50 beats per minute, and for elderly patients the lower limit is 55.

Corvalol

Corvalol during extrasystole acts due to a general calming effect; it does not have a specific antiarrhythmic effect on the heart. The reaction to stress factors decreases, the heart rate normalizes (with initial tachycardia). The drug can only be prescribed to patients without myocardial diseases - with neuroses, vegetative-vascular dystonia. Use is contraindicated in patients with:

damage to the kidneys, liver;
low blood pressure;
severe attacks of angina pectoris;
myocardial infarction;
heart failure.

Isoptin

The medication is prescribed for extrasystoles, high blood pressure, and rapid pulse. It is indicated for patients who cannot use beta-blockers (bronchial asthma, fluctuations in blood sugar in diabetes, a tendency to allergic reactions). It can be recommended for patients with angina at rest and exertion (variant) with resistance to nitrates.

Is it possible to cure extrasystole completely?

Since extrasystoles have a reason for their appearance, they can be cured completely if it is detected and eliminated. Drugs for arrhythmia cannot completely eliminate arrhythmia, but only eliminate the manifestations for the period of use.

It is important to take into account that without exception, all medications that normalize the frequency of heart contractions have serious side effects. Therefore, they are used only according to strict indications and in doses prescribed by a cardiologist. During treatment, ECG monitoring is important.

How to get rid of extrasystole forever

To get rid of extrasystole forever, patients without heart disease need to:

make lifestyle changes - sleep at least 8 hours, stop working at night and shift work, and smoking;
avoid physical, mental and emotional overload;
stop drinking coffee, energy drinks and alcohol;
reduce the use of drugs that can disrupt the heart rhythm (vasoconstrictor nasal drops with constant use, tonics, psychotropic drugs, potassium-removing diuretics, laxatives);
complete a full course of treatment for the disease that caused the extrasystole;
At least 2 times a year, a complete examination by a cardiologist is necessary, and, if necessary, an examination by a neurologist or endocrinologist.

Forecast

Supraventricular extrasystoles are not life-threatening. However, they may be the first symptoms of trouble in the myocardium or other organs. Therefore, if supraventricular extrasystole is detected, consultation with a cardiologist is required, and, if necessary, further examination.

If, according to daily monitoring, the number of ventricular premature contractions is 25% or more of the total number of heartbeats, such a load will ultimately lead to a weakening of the heart muscle. In this case, drug therapy is prescribed to prevent heart failure even in the absence of severe heart disease.

Prevention

A patient with supraventricular extrasystole must realize how important a healthy lifestyle is for him. He needs to be given information about changing factors

future risk of heart disease:

cessation of alcohol abuse and smoking;

regular moderate physical activity;

control, if any;

weight normalization;

elimination of snoring and sleep apnea;

restoring the balance of hormones and salts in the blood.

If a patient with supraventricular extrasystole regularly takes antiarrhythmic drugs, he should visit a cardiologist 2 times a year. During the visit, the doctor gives a referral for an ECG, general blood test and biochemistry. Once a year you should undergo daily ECG monitoring and control of thyroid hormones.

Every patient with ventricular extrasystoles should be observed by a cardiologist. The only exceptions are those patients in whom frequent extrasystole was completely eliminated using radiofrequency ablation.

If the patient does not have heart disease and is not receiving medication, it is still necessary to visit a doctor, since this rhythm disorder may be an early symptom of heart disease.

In addition, visits are required for patients receiving antiarrhythmics. All these people should be seen by a cardiologist twice a year.

When extrasystole occurs, it is not always necessary to treat it. It is usually not hazardous to health. Often it is enough to normalize sleep, nutrition, eliminate stress, give up caffeine and bad habits, and the rhythm disturbance will stop. Drugs used to treat extrasystoles have a number of serious contraindications and undesirable effects. They can be taken only after examination and as prescribed by a doctor.

Causes of ventricular extrasystole

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

organic – these are pathologies of the cardiovascular system;
functional – stress, smoking, excessive coffee consumption, etc.

1. Organic reasons

The occurrence of ventricular extrasystole is possible with the following diseases:

Ischemia (impaired blood supply) of the heart;
cardiosclerosis;
dystrophic changes in the heart muscle;
myocarditis, endocarditis, pericarditis;
myocardial infarction and post-infarction complications;
congenital heart defects (patent ductus arteriosus, coarctation of the aorta, ventricular septal defects, and others);
the presence of extra conduction bundles in the heart (bundle of Kent in WPW syndrome, bundle of James in CLC syndrome);
arterial hypertension.

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

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

2. Functional reasons

These include stress, smoking, drinking alcohol, illicit substances, large amounts of energy drinks, coffee or strong tea.

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

3. Idiopathic form of extrasystole

In this condition, a completely healthy person experiences ventricular extrasystoles, the cause of which is not clear. In this case, the patient is usually not bothered by any symptoms, so treatment is not carried out.

Classification and severity

To begin with, we invite you to familiarize yourself with what types of ventricular extrasystoles exist:

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

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

Classification of ventricular extrasystole

Symptoms of ventricular extrasystole

Rare single extrasystoles of a functional or idiopathic nature are usually visible only on an ECG or with a 24-hour test. They do not manifest any symptoms, and the patient does not even suspect their presence.

Sometimes patients with functional ventricular extrasystole complain of:

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

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

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

Organic ventricular extrasystole, which requires treatment, is manifested by symptoms of the underlying disease that caused them. The signs listed in the previous lists are also observed. These are often accompanied by attacks of compressive chest pain.

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

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

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

Diagnostics

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

Initial examination

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

The doctor will also immediately measure your blood pressure and pulse rate. At the same time, he can already notice that the heart is beating irregularly.

After the initial examination, the doctor immediately prescribes an ECG. Based on its results, the cardiologist prescribes all other diagnostic procedures.

Electrocardiography

Using a cardiogram, doctors immediately determine the presence of ventricular extrasystoles.

In a cardiogram, ventricular extrasystole manifests itself as follows:

presence of extraordinary ventricular QRS complexes;
extrasystolic QRS complexes are deformed and widened;
there is no P wave before the ventricular extrasystole;
after the extrasystole there is a pause.

Holter examination

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

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

Ultrasound of the heart

It is carried out to find out what disease provoked the ventricular extrasystole. It can be used to identify dystrophic changes in the myocardium, ischemia, congenital and acquired heart defects.

Coronary angiography

This procedure allows you to assess the condition of the coronary vessels, which supply oxygen and nutrients to the myocardium. Angiography is prescribed if ultrasound reveals signs of coronary heart disease (CHD). By examining the coronary vessels, you can find out exactly what caused the ischemic heart disease.

Blood analysis

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

EPI – electrophysiological study

It is carried out if the cardiogram shows signs of WPW or CLC syndrome. Allows you to accurately determine the presence of an additional conduction bundle in the heart.

Therapy for ventricular extrasystole

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

Treatment of the functional form of extrasystole

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

quit bad habits;
take medications to relieve nervous tension (valerian, sedatives or tranquilizers, depending on the severity of anxiety);
adjust your diet (give up coffee, strong tea, energy drinks);
observe a sleep and rest schedule, engage in physical therapy.

Treatment of organic form

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

Antiarrhythmic drugs

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

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

Surgical treatment of the causes of ventricular extrasystole

Consequences of ventricular extrasystole

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

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

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

To avoid life-threatening consequences, do not delay starting treatment if you are diagnosed with ventricular extrasystole.

Prognosis for pathology

With ventricular extrasystole of types 1 and 2, the prognosis is favorable. The disease has virtually no effect on the patient’s quality of life and does not cause severe consequences.

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

Contraction of the ventricles of the heart, along with the atria, is carried out by conducting electrical impulses through the conduction system, which includes the sinoatrial and atrioventricular nodes, the His bundle and Purkinje fibers. The fibers transmit signals to the muscle cells of the ventricles, which directly eject blood from the heart into large vessels (aorta and pulmonary artery). In a normally functioning heart, the atria contract synchronously with the ventricles, providing the correct rhythm of contractions with a frequency of 60 - 80 beats per minute.

If any pathological process occurs in the cardiac muscle of the ventricles (inflammation, necrosis, scarring), this can create electrical inhomogeneity (heterogeneity) of the muscle cells of the ventricles. A mechanism for re-entry of the excitation wave develops, that is, if there is some kind of block in the path of the impulse, electrically neutral scar tissue, for example, the impulse cannot bypass it, and re-stimulation of the muscle cells located up to the level of the block occurs. Thus, a heterotopic (located in the wrong place) focus of excitation in the ventricles arises, causing their extraordinary contraction, called extrasystole. Extrasystole can occur in the atria, atrioventricular (atrial-ventricular) junction and in the ventricles. The latter option is called ventricular extrasystole.

Ventricular extrasystole is one of the rhythm disorders characterized by premature, extraordinary contractions of the ventricles. The following types are distinguished:

1. By frequency:
- rare (less than 5 per minute),
- medium frequency (6 – 15 per minute),
- frequent (more than 15 per minute).
2. Based on the density of location on the cardiogram, single and paired (two contractions in a row) extrasystoles are distinguished.
3. By localization - right - and left ventricular extrasystoles, which can be distinguished on an ECG, but this division is not particularly important.
4. According to the nature of the location of the source of excitation
- monotopic extrasystoles emanating from the same focus
- polytopic, emanating from foci located in different parts of the ventricular myocardium
5. According to the shape of the ventricular complexes
- monomorphic extrasystoles, having the same shape throughout the recording of one cardiogram
- polymorphic, having different shapes
6. By rhythm
- periodic (allorhythmic) extrasystoles - extraordinary contraction of the ventricles occurs with periodicity, for example, every second normal complex “falls out”, instead of which an extrasystole occurs - bigemeny, every third - trigeminy, every fourth - quadrimeny
- non-periodic (sporadic) extrasystoles occur irregularly, regardless of the leading heart rhythm.
7. Depending on the results of 24-hour monitoring, extrasystoles are classified according to the criteria developed by Laun and Wolf. There are five classes of extrasystoles:
- 0 class – extrasystoles were not registered during the day
- Class 1 – rare, up to 30 per hour, monomorphic, monotopic extrasystoles are noted
- Class 2 – frequent, more than 30 per hour, single, monomorphic, monotopic extrasystoles
- Class 3 – single polytopic extrasystoles are recorded
- 4A class – paired polytopic extrasystoles
- Class 4B – volley extrasystoles (more than three in a row at once) and jogging ventricular tachycardia
- Class 5 – early and very early extrasystoles, type “R on T” according to ECG, occurring in the early, initial phase of ventricular diastole, when relaxation of muscle tissue is observed. Such extrasystoles can lead to ventricular fibrillation and asystole (cardiac arrest).

This classification is important in prognostic terms, since classes 0 - 1 do not pose a threat to life and health, and classes 2 - 5, as a rule, arise against the background of organic lesions of the heart and have a tendency to a malignant course, that is, they can lead to sudden cardiac arrest. of death.

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. This can be caused by emotional stress, vegetative-vascular dystonia, drinking coffee, energy drinks in large quantities, and smoking a large number of cigarettes.
2. Organic heart damage. This group of reasons includes:
- coronary heart disease, more than 60% of ventricular extrasystoles are caused by this disease
- acute myocardial infarction
- post-infarction cardiosclerosis
- post-infarction left ventricular aneurysm
- cardiomyopathy
- myocardial dystrophy
- myocarditis
- postmyocardial cardiosclerosis
- congenital and acquired heart defects
- minor anomalies of heart development, 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, drugs, drugs - cardiac glycosides, drugs used in the treatment of bronchial asthma (aminophylline, salbutamol, berodual), class 1 C antiarrhythmic drugs (propafenone, etmozin). Also, extrasystole can develop with thyrotoxicosis, when the body is intoxicated with thyroid hormones and their cardiotoxic effect.

Symptoms of ventricular extrasystole

Sometimes the extrasystole is not felt at all by the patient. But in most cases, the main manifestation of the disease is a feeling of interruptions in the functioning of the heart. Patients describe a kind of “somersault”, “turning over” of the heart, followed by a feeling of cardiac arrest caused by a compensatory pause after an extrasystole, then perhaps a sensation of a push in the heart rhythm caused by increased contraction of the ventricular myocardium after the pause. In cases of frequent extrasystoles or episodes of ventricular tachycardia, a feeling of rapid heartbeat may occur. Sometimes such manifestations are accompanied by weakness, dizziness, sweating, and anxiety. In cases of frequent extrasystole, loss of consciousness is possible.

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

In the presence of organic damage to the heart, the symptoms of extrasystole itself are supplemented by manifestations of the underlying disease - pain in the heart with ischemic heart disease, shortness of breath and edema with heart failure, etc.

If ventricular fibrillation develops, clinical death occurs.

Diagnosis of extrasystole

The following methods are used to diagnose ventricular extrasystole:

1. Interview and clinical examination of the patient.
- assessment of complaints and anamnesis (history of the disease) allows us to suggest a diagnosis, especially if there is an indication of organic heart pathology in the patient. The frequency of occurrence of heart failure, subjective sensations, and the relationship with workload are determined.

Auscultation (listening) of the chest organs. When listening to the heart, weakened heart sounds and pathological murmurs can be detected (with heart defects, hypertrophic cardiomyopathy).

When palpating the pulse, an irregular pulse of different amplitudes is recorded - before the extrasystole, the contraction of the heart sets a small amplitude for the pulse wave, after the extrasystole - a large amplitude due to an increase in the blood filling of the ventricle during the compensatory pause.

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

2. Laboratory examination methods. General blood and urine tests, biochemical blood tests, hormonal studies, immunological and rheumatological tests are prescribed, if necessary, to check the level of cholesterol in the blood, to exclude endocrine pathology, autoimmune diseases or rheumatism, leading to the development of acquired heart defects.

3. Instrumental examination methods.
- An ECG does not always allow you to register extrasystoles when we are talking about healthy people without organic heart pathology. Often, extrasystoles are recorded accidentally during a routine examination without complaints of heartbeat interruptions.
ECG – signs of extrasystoles: dilated, deformed ventricular QRS complex, appearing prematurely; there is no P wave in front of it, reflecting atrial contraction; the complex lasts longer than 0.12 s, after which a complete compensatory pause is observed, due to the electrical non-excitability of the ventricles after the extrasystole.

Extrasystoles on the ECG according to the type of trigemeny.

In cases of the presence of an underlying disease, the ECG reveals signs of myocardial ischemia, left ventricular aneurysm, hypertrophy of the left ventricle or other chambers of the heart, 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, pressure in 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 patients who have suffered a myocardial infarction to register extrasystole that is not subjectively felt, palpitations and heart failures that are not confirmed by a single cardiogram, as well as to identify 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 treatment and monitor the effectiveness of therapy in the future.

Tests with physical stress (treadmill test) should be carried out very carefully and only in cases where the occurrence of palpitations has a clear connection with the load, since in most cases this connection indicates the coronarogenic nature of extrasystole (caused by impaired patency of the coronary arteries and myocardial ischemia). If, during the recording of an ECG after walking on a treadmill, extrasystole with signs of myocardial ischemia is confirmed, then it is quite possible that after treatment of ischemia has begun, 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, the examination room must have a cardiopulmonary resuscitation kit.

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

Treatment for ventricular extrasystole

Treatment of extrasystole is aimed at treating the underlying disease that 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 nature of the 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 medium-frequency extrasystoles, an 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 tolerability of symptoms, antiarrhythmic drugs are prescribed.

Potentially malignant course occurs during extrasystoles against the background of an underlying cardiac disease, characterized by frequent or medium-frequency extrasystoles, the absence or presence of symptoms, good or poor tolerance. The risk of sudden cardiac death is significant, as unsustained ventricular tachycardia is recorded. Therapy in such cases is indicated to relieve symptoms and reduce mortality.

Malignant ventricular extrasystole It differs from potentially malignant in that, in addition to the main symptoms, there is a history of syncope (fainting) and/or cardiac arrest (survived due to resuscitation). The risk of cardiac death is very high, therapy is aimed at reducing the risk.

Frequent ventricular extrasystole, appearing for the first time in life or already occurring earlier, but now developing suddenly, is an indication for hospitalization and intravenous administration of 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 of possible contraindications and selection of an individual dose. The initiation of therapy should be with a gradual increase in dose; abrupt withdrawal of drugs is unacceptable. The duration of therapy is determined individually; in cases of a potentially malignant course, careful drug withdrawal should be supported by Holter ECG monitoring to confirm the effectiveness of therapy. In case of 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 pure form is not recommended; their joint administration with beta-blockers is justified, which reduces the risk of sudden cardiac death. Of the antiarrhythmics, it is preferable to prescribe propanorm, etatsizin, allapinin, amiodarone, cordarone, sotalol in combination with low doses of beta blockers (propranolol, bisoprolol, etc.).

Persons who have suffered an acute myocardial infarction and with myocarditis in the acute stage are advised to prescribe amiodarone or cordarone, since other antiarrhythmics in acute pathology of the heart muscle can cause other rhythm disturbances. In addition to these drugs, for organic heart diseases, nitrates (nitroglycerin, cardiket, nitrosorbide), ACE inhibitors (enalapril, lisinopril, perindopril), calcium channel blockers (verapamil, diltiazem), antiplatelet agents (aspirin), drugs that improve the nutrition of the heart muscle (panangin) are prescribed , Magnerot, vitamins and antioxidants – Actovegin, Mexidol).

Therapy is carried out under ECG monitoring once every two to three days during a hospital stay and once every 4 to 6 weeks in the clinic thereafter.

Lifestyle with ventricular extrasystole

With ventricular extrasystole, especially caused by other heart diseases, you need to rest more, spend more time in the fresh air, observe a work-rest schedule, eat right, avoid drinking coffee, alcohol, reduce or eliminate tobacco smoking.
Patients with a benign type of ventricular extrasystole do not need to limit physical activity. With 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. Formidable complications in the malignant type are sustained ventricular tachycardia, which can develop into flutter or ventricular fibrillation, and then lead to asystole, that is, 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 damage to the heart, the prognosis is relatively unfavorable and is determined not only by the characteristics of ventricular extrasystoles according to ECG monitoring (frequent, average, 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 . With a malignant course, the prognosis is unfavorable due to the very high risk of sudden cardiac death.

Taking antiarrhythmic drugs in combination with beta blockers can improve the prognosis, since the combination of these drugs not only improves the quality of life, but also significantly reduces the risk of complications and death.

General practitioner Sazykina O.Yu.