Ventricular disease. Ventricular premature beats. 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) sections of the conduction system of the right or left ventricle.

This leads to the fact that in the whole heart or in its individual parts, in this case - in the ventricles, extraordinary contractions occur.

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. As a result, angina pectoris, atrial fibrillation, or death may occur.

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Extrasystoles can be of a different nature and symptomatology, but the most dangerous are ventricular.

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

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

If a right ventricular extrasystole or a left ventricular extrasystole has arisen 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 progression of arrhythmias.

The emergence of a pathological focus of excitation in the myocardium of the ventricles with the formation of a 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 sympatho-adrenal system leads to an increase in the appearance of extrasystoles. The physiological factors that affect this tone include the use of coffee, tea, alcohol, stress and nicotine addiction. There are a number of diseases leading to the formation of extrasystole:

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

There is a definite connection between the patient's age, time of day and the frequency of occurrence of extrasystoles. So, more often the ventricular type is present in persons over 45 years of age. Dependence on daily 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 the belonging of a pathology to one or another type, the doctor will establish the level of its danger and the method of treatment.

Into which subgroups it is customary to divide ventricular arrhythmias with extraordinary systoles:

by 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 occurrence (early, late, interpolated);
according to the pattern of contractions (disordered, ordered);
classification of ventricular extrasystoles according to Lown and Bigger.

Ordered ventricular extrasystoles form a special pattern of development, according to which their name is determined. Bigemenia is called an extraordinary contraction of the ventricles, recorded every second normal cardiac cycle, trigemenia - every third, quadrigymenia - every fourth.

In the medical community, Lown's classification of ventricular premature beats is most common.

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 to T").

The mechanism of development of extrasystoles may differ. There are two main ones - reciprocal and automatic. Reciprocal arrhythmias occur during the formation of a vicious circle of intraventricular excitation, the so-called "re-entry" mechanism. Its essence lies in disrupting the passage of a normal signal, which is associated with the presence of at least two ways of conducting an impulse. In this case, for one of them, the signal 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 increased 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 cardiovascular pathology in the history and during examination (normal ejection fraction of the left ventricle, 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 course of the disease is characterized by a moderate or low risk of sudden death. The examination reveals structural changes in the heart in the stage of compensation. Ultrasound of the heart determines a decrease in the LV ejection fraction (30-55%) and the presence of a 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 have a critical decrease in ejection fraction - less than 30%. Persistent ventricular tachycardia is also noted.

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

Clinical manifestations

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

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

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

Diagnostics

The diagnosis is based on the results of the collection of complaints, the history of the patient's development and life, the data of a comprehensive examination and additional studies. Assessing the patient's condition, the doctor pays attention to the increased pulsation of the cervical veins, changes in the pulse wave and auscultatory picture of heart sounds. From laboratory tests, a standard set is prescribed (general blood and urine tests, blood glucose and biochemical blood tests), as well as an analysis for thyroid and pituitary hormones.

To obtain an accurate formulation of the diagnosis, an obligatory criterion is the result of an ECG and daily Holter monitoring. Using these methods, it is possible to accurately establish the source of the pathological focus, the frequency of extrasystoles, the number and relationship with the load. Echo-KG is performed to identify the left ventricular ejection fraction and the presence / absence of structural changes in the heart. In case of difficulties in diagnosing the disease, it is possible to prescribe MRI, CT, angiography.

Treatment

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

Antiarrhythmic drugs are divided into 5 classes:

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

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

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

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

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Premature single cardiac contractions 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 the prognosis. In each case, the doctor decides on the treatment of cardiac arrhythmias 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 causing the premature contraction of the heart, supraventricular (supraventricular) and are distinguished. The supraventricular ones include atrial, extrasystoles from the AB junction, as well as much more rare sinus. One of the varieties of ventricular extrasystoles are stem.

With supraventricular extrasystole, drug treatment is prescribed with poor tolerance of rhythm disturbances.

Many cardiologists prefer to use long-acting selective beta-blockers in this case. These funds practically do not affect carbohydrate metabolism, blood vessels and bronchi. They work during the day, which allows you to take them once a day. The most popular drugs are metoprolol, nebivolol, or bisoprolol. In addition to them, inexpensive, but quite effective, can be prescribed.

Additionally, with fear of death, poor tolerance of interruptions, valerian, Novo-passit, Afobazol, Grandaxin, Paroxetine can be prescribed.

If ventricular premature beats

A small number of ventricular extrasystoles are 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 premature beats.

Mainly for the treatment of very frequent ventricular extrasystole, an operation is used - (cauterization) of the focus of pathological impulses. However, drugs can also be prescribed, primarily IC and III classes:

propafenone;

allapinin;

sotalol.

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

Useful video

For information on what methods of treating extrasystoles are used at the moment, see this video:

The main drugs for the treatment of extrasystole

Bisoprolol (concor) is most often used to eliminate the supraventricular form of arrhythmia. It belongs to beta-blockers that suppress sensitivity corresponding receptors of the heart.

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

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

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

The medicine should not be used in patients with edema and dyspnea at rest (circulatory insufficiency of III - IV classes), and the pulse at rest is less than 50 - 60. It is contraindicated in atrioventricular block II - III degree, as it can increase its severity. Do not take it if the "upper" pressure is less than 100 mm Hg. Art. Also, it is not assigned to children under 18 years of age.

In more than 10% of patients, especially those with heart failure, the drug causes a slowdown in the pulse rate of less than 50 per minute. In 1 - 10% of patients, dizziness and headache occur, which pass against the background of constant medication. In the same percentage of cases, there is a decrease in pressure, increased shortness of breath or edema, a feeling of cold feet, nausea, vomiting, stool disturbances, fatigue.

Sotalol also blocks beta-receptors of the heart, acts on potassium receptors. This leads to its use for the prevention of severe ventricular arrhythmias. It is used for frequent supraventricular extrasystole, once a day.

Contraindications in sotalol the same as in bisoprolol, however, a long QT syndrome and allergic rhinitis are also added.

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

dizziness, headache, weakness, irritability;

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

chest pain;

nausea, vomiting, diarrhea.

Cordaron is usually prescribed for frequent supraventricular or ventricular premature beats that cannot be treated by other means.

For the development of the effect, it is necessary to constantly take the drug for at least a week, and then usually take 2-day breaks.

The drug has similar contraindications with bisoprolol, plus:

iodine intolerance and thyroid disease;

lack of potassium and magnesium in the blood;

long QT syndrome;

pregnancy, breastfeeding, childhood;

interstitial lung disease.

More than 10% of patients when using cordarone experience nausea, vomiting, discomfort in the abdomen, increased sensitivity to sunlight.

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

slowing down the pulse;

liver damage;

lung diseases such as pneumonitis;

hypothyroidism;

staining the skin in a grayish or bluish color;

muscle tremors and sleep disturbances;

decrease in blood pressure.

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

supraventricular - Verapamil, Metoprolol;
ventricular - Lidocaine, Diphenin.

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

stagnation of blood, heart failure - Cordaron, SotaGeksal;
low blood pressure - Lidocaine, Allaforte, Celanide;
angina pectoris, 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:

the patient's sensations in the form of a blow to the heart area, interruptions, fading, strong and frequent heartbeat after a pause;
general weakness, anxiety, hot flashes, shortness of breath;
circulatory disorders (more often with bigeminy - one normal blow and extrasystole) - headache, dizziness, bouts of loss of consciousness, impaired speech, movement and sensitivity in the limbs;
suffered severe arrhythmia, resuscitation performed (extrasystoles can provoke fibrillation);
complex forms of rhythm disturbances (for example, with prolonged QT).

Pills for extrasystole of the heart

The appointment of pills for extrasystole of the heart is carried out depending on the 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 drugs are recommended:

calming action - Valerian, Novo-Passit;
improving metabolism in the heart muscle - Riboxin, Kratal, Preductal, Actovegin, Mildronat;
containing potassium and magnesium - Asparkam, Magnikum, Kalipoz prolongatum;
omega-3 fatty acids - Omacor, Doppelhertz Omega 3.

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

Rhythm disturbances can also be caused by:

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

Therefore, the success of the treatment of this form of arrhythmia depends on the detection and elimination of the main cause.

Look at 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, heart attack;
rhythm disturbance against the background of stress, panic attacks, thyrotoxicosis, adrenal diseases.

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

If necessary, the dosage can be doubled or a combination of a beta-blocker and Sotalol, Amiodarone can be prescribed. If the patient has bronchial asthma, Prinzmetal angina pectoris, then Isoptin or Diakordin are recommended. When extrasystoles occur at rest, Zelenin and Belloid drops are used at night. Teopek has proven itself 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, Etatsizin are used. In most patients without heart damage, significant relief can be achieved with tranquilizers and antidepressants.

What is taken with ventricular extrasystole

For extrasystoles that occur in the ventricles, take sedatives, antiarrhythmic drugs, or a combination of 2 drugs. In asymptomatic cases, medication is not 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 often becomes a tranquilizer. It is of plant origin - extract of valerian, hawthorn, motherwort, Fitosed, Persen, Novo-Passit. For neuroses and vegetative-vascular dystonia with a crisis course, synthetic agents are also used - Afobazol, Clonazepam or Bellataminal.

How to treat solitary

a diet rich in foods with potassium - dried apricots, baked potatoes, mushrooms, nuts, legumes, dried fruits, seaweed;
quitting smoking, coffee abuse, 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 premature beats are used:

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

blood clotting - Cardiomagnet, Plavix;
cholesterol level - Vasilip, Zokor;
blood pressure - Prestarium, Enalapril;
metabolic processes in the heart muscle - Preductal, Espalipon.

How to relieve an attack: first aid for extrasystole

To relieve an attack of extrasystole, the following first aid means are used:

to seat the patient in a comfortable position;
ensure the supply of fresh air;
give water to drink with 20 drops of a sedative tincture (motherwort, hawthorn, mint, valerian, peony) or Corvalola;
put a Validol tablet under the tongue.

If the attack is accompanied by panic, trembling 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 extrasystole of the heart with drugs

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

Anaprilin

Anaprilin for extrasystole helps reduce the effect of adrenaline and other stress hormones on the heart. It is effective for rhythm disturbances arising from emotional overstrain, heavy physical exertion.

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

Corvalol

Corvalol with 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 the initial tachycardia). The drug can be prescribed only to patients without myocardial diseases - with neuroses, vegetative-vascular dystonia. The 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 and high blood pressure, frequent 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 pectoris of rest and tension (variant) with resistance to nitrates.

Is it possible to cure extrasystole completely

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

It is important to take into account that all medications, without exception, 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 the period of treatment, ECG monitoring is important.

How to get rid of extrasystole forever

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

make lifestyle changes - sleep for at least 8 hours, refusal from night and shift work, 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, potassium-eliminating diuretics, laxatives);
undergo 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 required, and, if necessary, an examination by a neurologist or endocrinologist.

Forecast

Supraventricular extrasystoles are not life threatening. However, they can be the first symptoms of trouble from the myocardium or other organs. Therefore, when supraventricular extrasystole is detected, a cardiologist's consultation is required, and, if necessary, further examination.

If, according to daily monitoring, the number of ventricular premature contractions was 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 should realize how important a healthy lifestyle is for him. He needs to be given information about changing factors

risk of heart disease in the future:

quitting alcohol abuse and smoking;

regular moderate physical activity;

control, if any;

normalization of weight;

elimination of snoring and sleep apnea;

restoration of 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 EKG, complete blood count and biochemistry. Once a year, you should undergo daily ECG monitoring and control of thyroid hormones.

Every patient with ventricular extrasystoles should also 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 does not receive medication, it is still necessary to visit a doctor, since this rhythm disturbance can be an early symptom of heart disease.

In addition, visits to patients receiving antiarrhythmics are mandatory. All these people should be seen by a cardiologist 2 times a year.

When extrasystole appears, it is not always necessary to treat it. Usually it is 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. The drugs used for the treatment of extrasystoles have a number of serious contraindications and undesirable effects. They can be taken only after examination and as directed by a doctor.

Causes of ventricular premature beats

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

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

1. Organic causes

The occurrence of ventricular extrasystole is possible with such diseases:

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

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

Diseases that cause ventricular premature beats are dangerous and require timely treatment. If your ECG revealed untimely ventricular contractions, be sure to undergo additional examination to check if you have the above cardiac pathologies.

2. Functional reasons

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

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

3. Idiopathic form of extrasystole

In this condition, a completely healthy person has ventricular extrasystoles, the cause of which is not clear. In this case, the patient is usually not bothered by any symptoms, so no treatment is given.

Classification and severity

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

Three scientists (Lown, Wolf and Ryan) have proposed the following classification of ventricular premature beats (from mild to most severe):

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

Classification of ventricular premature beats

Symptoms of ventricular premature beats

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

Sometimes patients with functional ventricular extrasystole complain of:

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

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

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

Organic ventricular premature beats, which require treatment, are 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
light-headedness
fainting
"Sinking" of the heart,
strong heartbeat.

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

Diagnostics

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

Initial inspection

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

Also, the doctor will immediately measure blood pressure and pulse rate. At the same time, he can already notice that the heart is contracting irregularly.

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

Electrocardiography

On the cardiogram, doctors immediately determine the presence of ventricular extrasystoles.

Not a cardiogram, ventricular extrasystole is manifested as follows:

the presence of extraordinary ventricular QRS complexes;
extrasystolic QRS complexes are deformed and expanded;
there is no P wave in front of 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 has extraordinary ventricular contractions, whether there are paired or group extrasystoles.

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

Ultrasound of the heart

It is carried out to find out what disease triggered the ventricular extrasystole. With its help, it is possible 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 the ultrasound showed signs of coronary artery disease (IHD). After examining the coronary vessels, you can find out exactly what triggered the coronary heart disease.

Blood test

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

EFI - electrophysiological study

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

Ventricular extrasystole therapy

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

Treatment of the functional form of extrasystole

If the 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 the diet (give up coffee, strong tea, energy drinks);
to observe the regime of sleep and rest, to engage in physiotherapy exercises.

Organic form treatment

Treatment of the organic form of type 4 disease provides for receptions that help get rid of attacks of ventricular arrhythmias. The doctor prescribes Sotalol, Amiodarone, or other similar medications.

Antiarrhythmic drugs

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

It also requires treatment of the underlying disease that caused the ventricular premature beats. Various surgical procedures are often used for this.

Surgical treatment of the causes of ventricular extrasystole

Consequences of ventricular extrasystole

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

If the patient has polymorphic 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. It, in turn, provokes the consequences shown further in this table.
Ventricular flutter	Contraction of the ventricles with a frequency of 220 to 300 beats per minute.
Fibrillation (fibrillation) of the ventricles	Chaotic ventricular contractions, the frequency of which reaches 450 beats per minute. Flickering ventricles are unable to pump blood, so the patient usually faints due to lack of oxygen in the brain. This condition, in the absence of medical care, can provoke death.
Asystole ()	It may occur against the background of an attack of ventricular arrhythmia or suddenly. Often, asystole inevitably leads to death, since doctors are far from always able to perform resuscitation actions within a few minutes after cardiac arrest.

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

Prognosis for pathology

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

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

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

If any pathological process (inflammation, necrosis, scarring) occurs in the heart muscle of the ventricles, this can create electrical inhomogeneity (heterogeneity) of the muscle cells of the ventricles. The mechanism of re-entry of the excitation wave develops, that is, if there is some block in the path of the impulse, electrically neutral scar tissue, for example, the impulse cannot be bypassed, and the muscle cells located up to the block level are re-stimulated. 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 (atrio-ventricular) junction and in the ventricles. The latter option is called ventricular premature beats.

Ventricular extrasystole is one of the rhythm disturbances, 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. According to the density of the 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 the ECG, but this division does not have much significance.
4. By the nature of the location of the focus of excitation
- monotopic extrasystoles coming from the same focus
- polytopic, emanating from the foci located in different parts of the myocardium of the ventricles
5. By the shape of the ventricular complexes
- monomorphic extrasystoles, having the same shape during the recording of one cardiogram
- polymorphic, having a different shape
6. By rhythm
- periodic (allorhythmic) extrasystoles - an extraordinary contraction of the ventricles occurs at regular intervals, for example, every second normal complex "falls out", instead of which there is an extrasystole - bigemenia, every third - trigeminia, every fourth - quadrimenia
- non-periodic (sporadic) extrasystoles occur irregularly, regardless of the leading heart rate.
7. Depending on the results of daily monitoring, extrasystoles are classified according to the criteria developed by Lown and Wolf. There are five classes of extrasystoles:
- grade 0 - extrasystoles not registered during the day
- Grade 1 - rare, up to 30 per hour, monomorphic, monotopic extrasystoles are noted
- Grade 2 - frequent, more than 30 per hour, single, monomorphic, monotopic extrasystoles
- Grade 3 - single polytopic extrasystoles are registered
- 4A class - paired polytopic extrasystoles
- Grade 4B - volley extrasystoles (more than three in a row at once) and runs of ventricular tachycardia
- Grade 5 - early and very early extrasystoles, type "R to T" on the ECG, arising in the early, initial phase of ventricular diastole, when muscle tissue relaxation is observed. These extrasystoles can lead to ventricular fibrillation and asystole (cardiac arrest).

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

Causes of ventricular premature beats

Ventricular extrasystole can develop with 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 damage to the heart. This group of reasons includes:
- ischemic heart disease, more than 60% of ventricular premature beats are caused by this disease
- acute myocardial infarction
- postinfarction cardiosclerosis
- postinfarction left ventricular aneurysm
- cardiomyopathy
- myocardial dystrophy
- myocarditis
- postmyocarditis 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, 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 premature beats

Sometimes the extrasystole is not felt by the patient in any way. But in most cases, the main manifestation of the disease is the sensation of interruptions in the work of the heart. Patients describe a kind of "somersault", "overturning" of the heart, followed by a feeling of heart sinking due to a compensatory pause after extrasystole, then a sensation of a jolt in the heart rhythm caused by an increased contraction of the ventricular myocardium after a pause. In cases of frequent extrasystoles or episodes of ventricular tachycardia, a sensation of a 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 have arisen suddenly or for the first time in their life, require urgent medical attention, therefore 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 coronary artery disease, shortness of breath and edema with heart failure, etc.

In the case of development of ventricular fibrillation, clinical death occurs.

Diagnosis of extrasystole

To diagnose ventricular extrasystole, the following methods are used:

1. Interview and clinical examination of the patient.
- assessment of complaints and anamnesis (history of the disease) suggests a diagnosis, especially if there is an indication of an organic pathology of the patient's heart. The frequency of interruptions in the heart, subjective sensations, and the relationship with the load are determined.

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

When probing the pulse, an irregular pulse of different amplitude 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 a compensatory pause.

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

2. Laboratory methods of examination. 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.
- ECG does not always allow registering extrasystoles, when it comes to healthy people without organic pathology of the heart. Often extrasystoles are recorded by chance during a routine examination without complaints of interruptions in the heartbeat.
ECG - signs of extrasystoles: an expanded, deformed ventricular QRS complex, appearing prematurely; there is no P wave in front of it, reflecting the contraction of the atria; the complex is longer than 0.12 s, after which there is a complete compensatory pause due to electrical non-excitability of the ventricles after extrasystole.

Extrasystoles on the ECG by the type of trigemenia.

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

- echocardiography (ultrasound of the heart) reveals the underlying pathology, if any - heart defects, cardiomyopathy, myocardial hypertrophy, zones of reduced or absent contraction in myocardial ischemia, ventricular aneurysm, etc. 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 myocardial infarction to register extrasystole, not subjectively felt, palpitations and heart failure, not confirmed by a single cardiogram, as well as to detect other rhythm and conduction disturbances. It is an important research in the therapeutic and prognostic terms for patients with frequent ventricular extrasystole, since the treatment and prognosis depend on the class of extrasystole. Allows you to assess the nature of extrasystole before starting treatment and monitor the effectiveness of therapy in the future.

Exercise tests (treadmill test) should be carried out very carefully and only in cases where the appearance of heartbeat attacks has a clear connection with exercise, since in most cases this connection indicates the coronary character of extrasystole (caused by impaired coronary artery patency 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 has begun, the prerequisites for the occurrence of frequent extrasystoles will be eliminated.
The study should be carried out with caution, since the load can provoke ventricular tachycardia or ventricular fibrillation. Therefore, the study room must have 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 premature beats.

Treatment for ventricular extrasystole

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

Benign ventricular premature beats, 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 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.

Potentially malignant course occurs with extrasystoles against the background of an underlying cardiac disease, characterized by frequent or medium frequency extrasystoles, absence or presence of symptoms, good or poor tolerance. The risk of sudden cardiac death is significant, since unstable ventricular tachycardia is recorded. Therapy in such cases is indicated for the purpose of relieving symptoms and reducing mortality.

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

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

The selection of drugs for treatment should be carefully carried out by the attending physician in the clinic or hospital, with the obligatory analysis of possible contraindications and the selection of an individual dose. The beginning of therapy should be with a gradual increase in the 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 reinforced by Holter ECG monitoring to confirm the effectiveness of therapy. With a malignant course, therapy lasts a long time, possibly lifelong.

Antiarrhythmic drugs have a proarrhythmic effect as side effects, that is, they themselves are capable of causing rhythm disturbances. Therefore, their use in their 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, etacizin, 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 the acute stage are shown the appointment of 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 , magnerot, vitamins and antioxidants - actovegin, mexidol).

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

Lifestyle with ventricular premature beats

With ventricular extrasystole, especially caused by other heart diseases, you need to rest more, stay in the fresh air more often, observe a work and rest regimen, eat right, exclude the use of coffee, alcohol, reduce or eliminate tobacco smoking.
Patients with a benign type of ventricular premature beats do not need to restrict physical activity. With a malignant type, significant loads and psycho-emotional situations that can lead to the development of an attack should be limited.

Complications

Complications with a benign type of ventricular premature beats, as a rule, do not develop. Formidable complications in the malignant type are persistent 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 damage, the prognosis is relatively unfavorable and is determined not only by the characteristics of ventricular extrasystoles by ECG monitoring (frequent, medium, paired, group), but also by the nature of the underlying disease and the stage of heart failure, in the later stages of which the prognosis is not favorable ... In a malignant course, the prognosis is poor due to the very high risk of sudden cardiac death.

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

Physician therapist Sazykina O.Yu.