Ventricular extrasystole- is a premature excitation of the heart that occurs under the influence of impulses emanating from various parts of the conduction system of the ventricles. The source of ventricular extrasystole in most cases is the branches of the His bundle and Purkinje fibers.
Ventricular extrasystole is the most common heart rhythm disorder. Its frequency depends on the diagnostic method and the population of subjects. When recording an ECG in 12 leads at rest, ventricular extrasystoles are detected in approximately 5% of healthy young people, while with Holter ECG monitoring for 24 hours their frequency is 50%. Although most of them are represented by single extrasystoles, complex forms can also be detected. The prevalence of ventricular extrasystoles increases significantly in the presence of organic heart diseases, especially those accompanied by damage to the ventricular myocardium, correlating with the severity of its dysfunction. Regardless of the presence or absence of pathology of the cardiovascular system, the frequency of this rhythm disorder increases with age. A connection between the occurrence of ventricular extrasystoles and the time of day was also noted. So, in the morning they are observed more often, and at night, during sleep, less often. The results of repeated Holter ECG monitoring showed significant variability in the number of ventricular extrasystoles in 1 hour and 1 day, which significantly complicates the assessment of their prognostic value and treatment effectiveness.
Causes of ventricular extrasystoles. Ventricular extrasystole occurs both in the absence of organic heart diseases and in their presence. In the first case, it is often (but not necessarily!) associated with stress, smoking, drinking coffee and alcoholic beverages, which cause an increase in the activity of the sympathetic-adrenal system. However, in a significant proportion of healthy individuals, extrasystoles occur for no apparent reason.
Although ventricular extrasystole can develop with any organic heart disease, its most common cause is ischemic heart disease. With Holter ECG monitoring within 24 hours, it is detected in 90% of such patients. Patients with both acute coronary syndromes and chronic ischemic heart disease, especially those who have suffered a myocardial infarction, are susceptible to the occurrence of ventricular extrasystoles. Acute cardiovascular diseases, which are the most common causes of ventricular extrasystole, also include myocarditis and pericarditis, and chronic diseases include various forms of cardiomyopathies and hypertensive heart, in which its occurrence is facilitated by the development of ventricular myocardial hypertrophy and congestive heart failure. Despite the absence of the latter, ventricular extrasystoles are often found with mitral valve prolapse. Their possible causes also include iatrogenic factors such as overdose of cardiac glycosides, the use of ß-adrenergic stimulants and, in some cases, membrane-stabilizing antiarrhythmic drugs, especially in the presence of organic heart diseases.
Symptoms There are no complaints or consist of a feeling of “freezing” or “push” associated with increased post-extrasystolic contraction. Moreover, the presence of subjective sensations and their severity do not depend on the frequency and cause of extrasystoles. With frequent extrasystoles, patients with severe heart disease rarely experience weakness, dizziness, anginal pain and shortness of breath.
An objective examination occasionally reveals a pronounced presystolic pulsation of the jugular veins, which occurs when the next systole of the right atrium occurs with the tricuspid valve closed due to premature contraction of the ventricles. This pulsation is called Corrigan's venous waves.
The arterial pulse is arrhythmic, with a relatively long pause after the extraordinary pulse wave (the so-called complete compensatory pause, see below). With frequent and group extrasystoles, the impression of atrial fibrillation may be created. In some patients, a pulse deficiency is determined.
During auscultation of the heart, the sonority of the first tone may change due to asynchronous contraction of the ventricles and atria and fluctuations in the duration of the P-Q interval. Extraordinary contractions may also be accompanied by splitting of the second tone.
Main electrocardiographic signs of ventricular extrasystole are:
premature extraordinary appearance on the ECG of an altered ventricular QRS complex";
significant expansion and deformation of the extrasystolic QRS complex";
the location of the RS-T segment and the T wave of the extrasystole is discordant with the direction of the main wave of the QRS complex";
absence of a P wave before the ventricular extrasystole;
the presence in most cases of a complete compensatory pause after a ventricular extrasystole.
Course and prognosis of ventricular extrasystole depend on its form, the presence or absence of organic heart disease and the severity of ventricular myocardial dysfunction. It has been proven that in persons without structural pathology of the cardiovascular system, ventricular extrasystoles, even frequent and complex ones, do not have a significant effect on the prognosis. At the same time, in the presence of organic heart damage, ventricular extrasystoles can significantly increase the risk of sudden cardiac death and overall mortality, initiating persistent ventricular tachycardia and ventricular fibrillation.
Treatment and secondary prevention with ventricular extrasystole, two goals are pursued - to eliminate the symptoms associated with it and improve the prognosis. This takes into account the class of extrasystole, the presence of organic heart disease and its nature and severity of myocardial dysfunction, which determine the degree of risk of potentially fatal ventricular arrhythmias and sudden death.
In persons without clinical signs of organic cardiac pathology, asymptomatic ventricular extrasystole, even of high gradations according to V. Lown, does not require special treatment. Patients need to be explained that the arrhythmia is benign, recommend a diet enriched with potassium salts, and the exclusion of such provoking factors as smoking, drinking strong coffee and alcohol, and in case of physical inactivity, increase physical activity. Treatment begins with these non-drug measures in symptomatic cases, moving to drug therapy only if they are ineffective.
First-line drugs in the treatment of such patients are sedatives (herbal medicines or small doses of tranquilizers, for example diazepam 2.5-5 mg 3 times a day) and beta-blockers. In most patients, they provide a good symptomatic effect, not only due to a decrease in the number of extrasystoles, but also, independently of it, as a result of a sedative effect and a decrease in the strength of post-extrasystolic contractions. Treatment with beta-blockers begins with small doses, for example, 10-20 mg of propranolol (obzidan, anaprilin) 3 times a day, which, if necessary, are increased under heart rate control. In some patients, however, a slowdown in sinus rhythm is accompanied by an increase in the number of extrasystoles. With initial bradycardia associated with increased tone of the parasympathetic part of the autonomic nervous system, characteristic of young people, the reduction of extrasystole can be facilitated by an increase in the automaticity of the sinus node with the help of such drugs that have an anticholinergic effect, such as belladonna preparations (bellataminal tablets, bellaid, etc.) and itropium .
In relatively rare cases of ineffectiveness of sedative therapy and correction of the tone of the autonomic nervous system, with a pronounced disturbance in the well-being of patients, it is necessary to resort to tableted antiarrhythmic drugs IA (retarded form of quinidine, procainamide, disopyramide), IB (mexiletine) or 1C (flecainide, propafenone) classes. Due to the significantly higher frequency of side effects compared to beta-blockers and the favorable prognosis in such patients, the use of membrane-stabilizing agents should be avoided if possible.
ß-Adrenergic blockers and sedatives are also the drugs of choice in the treatment of symptomatic ventricular extrasystole in patients with mitral valve prolapse. As in cases of absence of organic heart disease, the use of class I antiarrhythmic drugs is justified only in cases of severe impairment of well-being.
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
The 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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Description
Ventricular extrasystole
Extrasystoles are those contractions of the heart that occur under the influence of sources other than the sinus node. In the case when “unscheduled” contractions come from fibers located in the ventricles of the heart, this phenomenon is called ventricular extrasystole. When the heart rhythm is disturbed by contractions, the rhythm of which is “set” by the fibers of the atria, this is supraventricular extrasystole. With contractions coming from different parts of the heart, polytopic ventricular extrasystole occurs.
Description:
Ventricular extrasystole is a premature excitation that occurs under the influence of impulses emanating from various parts of the conduction system of the ventricles. The source of ventricular extrasystole in most cases is the branches of the His bundle and Purkinje fibers.
Symptoms of Ventricular extrasystole:
There are no complaints or consist of a feeling of “freezing” or “push” associated with increased post-extrasystolic contraction. Moreover, the presence of subjective sensations and their severity do not depend on the frequency and cause of extrasystoles. With frequent extrasystoles, patients with severe heart disease occasionally experience weakness and dizziness. anginal pain and shortness of breath.
An objective examination occasionally reveals a pronounced presystolic pulsation of the jugular veins, which occurs when the next systole of the right atrium occurs with the tricuspid valve closed due to premature contraction of the ventricles. This pulsation is called Corrigan's venous waves.
The arterial pulse is arrhythmic, with a relatively long pause after the extraordinary pulse wave (the so-called complete compensatory pause, see below). With frequent and group extrasystoles, the impression of atrial fibrillation may be created. In some patients, a pulse deficiency is determined.
During auscultation of the heart, the sonority of the first tone may change due to asynchronous contraction of the ventricles and atria and fluctuations in the duration of the P-Q interval. Extraordinary contractions may also be accompanied by splitting of the second tone.
The main electrocardiographic signs of ventricular extrasystole are:
1.premature extraordinary appearance of an altered ventricular QRS complex on the ECG;
2. significant expansion and deformation of the extrasystolic QRS complex;
3. the location of the RS-T segment and the T wave of the extrasystole is discordant to the direction of the main wave of the QRS complex;
4.absence of P wave before the ventricular extrasystole;
5.the presence in most cases of a complete compensatory pause after a ventricular extrasystole.
The course and prognosis of ventricular extrasystole depend on its form, the presence or absence of organic heart disease and the severity of ventricular myocardial dysfunction. It has been proven that in persons without structural pathology of the cardiovascular system, ventricular extrasystoles, even frequent and complex ones, do not have a significant effect on the prognosis. At the same time, in the presence of organic heart damage, ventricular extrasystoles can significantly increase the risk of sudden cardiac death and overall mortality, initiating persistent ventricular tachycardia and ventricular fibrillation.
Causes of Ventricular extrasystole:
Ventricular extrasystole
What are ventricular extrasystoles?
Ventricular extrasystoles(PVC) are called premature heart contractions associated with the presence of a small lesion located in the ventricles of the heart, which has the ability to independently generate electrical impulses.
In which patients is ventricular extrasystole more common?
Ventricular extrasystole is more often recorded in males and its prevalence increases with age.
A small number of ventricular extrasystoles are common in healthy populations (up to 80%).
A marked increase in the number of ventricular extrasystoles (at least 1000-5000 extrasystoles per day) can be observed in various diseases of the cardiovascular and respiratory systems.
What factors can provoke the occurrence of ventricular extrasystole?
The occurrence of ventricular extrasystole can be facilitated by:
- Diseases of the cardiovascular system (arterial hypertension, coronary artery disease, heart failure);
- Diseases of the respiratory system;
- Electrolyte metabolism disorders (changes in the concentrations of potassium and magnesium in the blood);
- Thyroid dysfunction;
- Taking certain substances (caffeine, alcohol, amphetamines, cocaine) and smoking;
- Certain medications (digoxin, theophylline);
- Many patients do not have any provoking factors, in which case the extrasystole is called idiopathic.
What is the significance of ventricular extrasystole?
A small number of ventricular extrasystoles does not affect the prognosis and does not require treatment.
Pathological number of ventricular extrasystoles:
- May occur in patients with cardiovascular disease;
- May cause other cardiac arrhythmias (if predisposed);
- May lead to chronic heart failure in some patients.
What symptoms are characteristic of ventricular extrasystole?
In most cases, extrasystole is asymptomatic.
Some patients complain of freezing (caused by a compensatory pause) or interruptions, “tumbling” of the heart (caused by a stronger heart contraction after an extrasystole).
The presented complaints often contribute to a feeling of anxiety, which in turn stimulates the release of certain biologically active substances (adrenaline), leading to an increase in the number of extrasystoles and the severity of the heartbeat.
What diagnostic measures are appropriate in patients with ventricular extrasystole?
The main tasks when examining patients are:
- Registration of extrasystoles on ECG;
- Determining the number of extrasystoles and establishing a cause-and-effect relationship between PVCs and the patient’s complaints during ambulatory ECG monitoring;
- Exclusion of possible causes of ventricular extrasystole:
- Cardiac diseases;
- Non-cardiological diseases.
What are the basic principles of treatment for ventricular extrasystole?
Regardless of the causes of ventricular extrasystole, first of all, the doctor is obliged to explain to the patient that it is a PVC. in itself, is not a life-threatening condition. The prognosis in each specific case depends on the presence or absence of other heart diseases. effective treatment of which allows to achieve a decrease in the severity of arrhythmia symptoms, the number of extrasystoles and an increase in life expectancy.
Treatment methods for ventricular extrasystole
Due to the presence of so-called minor psychiatric pathology (primarily anxiety disorder) in many patients with PVCs accompanied by symptoms, consultation with an appropriate specialist may be required.
Currently, there is no data on the beneficial effects of antiarrhythmic drugs (with the exception of beta blockers) on the long-term prognosis in patients with PVCs, and therefore the main indication for antiarrhythmic therapy is the presence of established cause-and-effect relationship between extrasystole and symptoms, with their subjective intolerance. The most optimal means for treating extrasystole are beta blockers. The prescription of other antiarrhythmic drugs, and especially their combinations, is in most cases unjustified, especially in patients with asymptomatic extrasystole.
If antiarrhythmic therapy is ineffective or the patient does not want to receive antiarrhythmic drugs, radiofrequency catheter ablation of the arrhythmogenic focus of ventricular extrasystole is possible. This procedure is highly effective (80-90% effective) and safe in most patients.
In some patients, even in the absence of symptoms, antiarrhythmic drugs or radiofrequency ablation may be necessary. In this case, indications for intervention are determined individually.
What are ventricular extrasystoles? Ventricular or ventricular extrasystole is a violation of the rhythmic activity of the heart, which is manifested by the appearance of extraordinary, premature contractions of the ventricles. Such additional impulses arise in the foci of ectopia and provoke changes in the normal rhythm of the heart muscle.
Arrhythmia of the type ventricular extrasystole is an extremely common type of abnormal rhythmic activity of the myocardium, which occurs in every ninth inhabitant of our planet after the age of 50 years.
In children and young patients, this rhythm disorder is diagnosed much less frequently, and in most cases is associated with the presence of congenital heart defects, previous myocarditis, and the like.
Why do ventricular extrasystoles occur?
Today, experts distinguish between cardiac and extracardiac causes of ventricular extrasystole. Cardiac factors in the development of rhythm disturbances are the main causes of extraordinary contractions, which in almost 75% of cases become decisive moments in the development of the pathological process.
Among the cardiac causes of the development of the disease are:
- acute and chronic variants of the course of ischemic heart damage, but most often myocardial infarction (AMI);
- congenital and acquired heart defects;
- inflammatory diseases of the heart structures (inflammatory, infectious damage to the walls, valves, etc.);
- damage to the muscle tissue of the heart (and cardiomyodystrophy of various origins);
- heart failure.
Extracardiac causes of gastric rhythm disturbances with the appearance of ectopic foci that generate premature contractions may be as follows:
- external toxic effects on the body (the effect of large doses of alcohol, smoking, intoxication with harmful substances);
- metabolic disorders and endocrine disorders (obesity, hyperthyroidism, adrenal diseases);
- increased activity of the parasympathetic nervous system;
- overdose or long-term use of medications, namely cardiac glycosides, diuretics, antidepressants, antiarrhythmics;
- chronic starvation of the myocardium as a result of dysfunction of the respiratory system (asthma, obstructive bronchitis, apnea);
- changes in the electrolyte composition of the blood.
Sometimes it is not possible to find out the reasons for the development of ventricular extrasystoles. In such cases, it is customary to talk about such a pathological condition as idiopathic ventricular extrasystole. Quite often, single ventricular extrasystoles occur without specific reasons in absolutely healthy people.
Features of the classification of the disease
The modern classification of ventricular abnormalities allows us to distinguish six main classes of the disease.
This scheme for grading extrasystoles arising in the ventricular parts of the myocardium was proposed back in 1975 by M. Rayan, therefore in medical circles it is known as the Rayn classification.
A decade earlier, the scientist Lown proposed his vision of the gradation of extrasystoles of ventricular origin, according to which extraordinary contractions were divided into six phased types, which have their own quantitative and morphological characteristics. In fact, the Ryan classification is an improved version of the Lown classification of ventricular extrasystoles:
| Gradation | Lown classification | Rayn classification |
| 0 class | No manifestations of ventricular extrasystole | |
| 1 class | Monotopic rare extrasystole (no more than 30 episodes per hour) | |
| 2nd grade | Monotopic frequent ventricular extrasystole (more than 30 extraordinary contractions per hour) | |
| 3rd grade | Polytopic ventricular extrasystoles | |
| 4a class | Paired ventricular extrasystole | Monomorphic paired ventricular extrasystoles |
| 4b class | Paired polymorphic ventricular extrasystoles | |
| 5th grade | Early ventricular extrasystoles (R on T, where the extraordinary contraction occurs in the first 4/5 of the t wave) | Ventricular tachycardia in the amount of 3 or more ventricular extrasystoles occurring in a row |
Depending on the number of foci of excitation, it is customary to distinguish:
- monotopic extrasystole – characterized by the presence of one focus of ectopia;
- polytopic extrasystole - extraordinary contractions are generated from two or more ectopic foci.
According to the frequency of occurrence, ventricular extrasystoles are divided into the following types:
- single or isolated (a single ventricular extrasystole is characterized by the appearance of premature contractions in an amount of no more than five over 60 seconds);
- multiple (five or more extraordinary contractions/60 seconds);
- paired (the appearance of two extrasystoles in a row between regular heart contractions);
- group (when several subsequent extrasystoles are diagnosed between normal contractions).
Based on the localization of foci of pathological impulse generation, the following are distinguished:
- right ventricular extrasystole;
- left ventricular extrasystole;
- combined form of the disease.
According to the time of occurrence of premature impulses:
- early ventricular extrasystoles, which occur during contraction of the atrial parts;
- interpolated ventricular extrasystoles occurring between contractions of the atria and ventricles;
- late ventricular extrasystoles are generated in diastole or during ventricular contraction.
Clinical picture of the disease
Heart rhythm disturbances such as ventricular extrasystole in practice are manifested by the following symptoms:
- with ventricular extrasystole, patients experience a feeling of interruptions in cardiac activity, the appearance of an irregular beat and a feeling of revolutions;
- extraordinary contractions of the myocardium are accompanied by weakness and general malaise, as well as anxiety and dizziness;
- Often patients with extrasystole complain of the development of shortness of breath or a sharp feeling of lack of air;
- in this pathological condition, there is a feeling of fear of death, panic attacks, anxiety and many other disorders of the psycho-emotional sphere;
- fainting conditions are possible.
Often ventricular extrasystole occurs without visible subjective manifestations, therefore, such patients have no complaints in principle, and the disease is diagnosed exclusively by electrocardiographic examination. Symptoms of ventricular extrasystole with frequent episodes of extraordinary contractions, which occur mainly against the background of heart diseases of organic origin (the so-called organics), can be accompanied by cardiac pain, severe shortness of breath and weakness, as well as loss of consciousness and nausea.
Ventricular extrasystole in children is a fairly common phenomenon, which is recorded in most cases in combination with congenital defects, myocarditis, etc. The severity of manifestations in a child depends on factors such as the age of the young patient, the type and form of the pathological process, as well as the timeliness of diagnosis of rhythm disturbances and the causes of its occurrence.
Objectively, in a patient with diagnosed extrasystole of ventricular origin, the following are determined:
- pronounced pulsation of the veins of the neck;
- arrhythmia of arterial pulse;
- change in sonority of the first tone and bifurcation of the second tone;
- after an extraordinary reduction.
Basic diagnostic methods
The main methods for determining ventricular extrasystoles are electrocardiography and Holter 24-hour ECG monitoring.
Very often, ECG signs of ventricular extrasystole are the only symptom of the disease, especially if we are talking about single extraordinary contractions.
As a rule, during an electrocardiographic study, the following signs of extraordinary contractions of the heart of ventricular origin are diagnosed:
- widened and altered QRS complex;
- deformed extrasystolic complex (more than 0.12 seconds);
- absence of P wave before extrasystole;
- characteristic compensatory pause after each ventricular extrasystole.
Ventricular extrasystole is detected on an ECG in almost 90% of cases. To clarify the diagnosis and more detailed study of the nature of the disease, the doctor may decide on the need to prescribe daily ECG Holter monitoring.
The consequences of the disease may be as follows:
- sudden cardiac death as a result of an attack of ventricular tachycardia or ventricular fibrillation;
- development of heart failure;
- the appearance of symptoms;
- change in the configuration or structure of the ventricular part of the myocardium.
As we see, the consequences of ventricular extrasystole can be very dangerous for normal human life. That is why doctors recommend that all potential patients seek medical help in a timely manner and undergo periodic examinations by a cardiologist for the purpose of early diagnosis of possible rhythm disturbances.
- Classification of extrasystoles
- Treatment of ventricular extrasystole
What are single ventricular extrasystoles? What are their features? As is known, premature contraction of fibers in the ventricles, which does not obey the main pacemaker, which is the sinus node, is called. Of all types of arrhythmias, this option occurs most often, even under conditions of absolute health of the heart muscle. It occurs in all categories of the population, can be registered in early childhood, and the likelihood of occurrence increases with age.
It has been reliably established that if daily monitoring is carried out on a group of people, then half of them will experience various single excitations from different parts of the heart. Experts call them “functional”. Moreover, 30% of them are supraventricular, and 60% are single extrasystoles. Moreover, 10% is due to their combined appearance.
The main reasons for the appearance of extrasystole
Ventricular extrasystole occurs due to excitation in the myocardium, which comes mainly from the branches of the His bundle or the Purkinje fibers located below.
The reasons why contraction occurs in the ventricular myocardium are divided into functional and organic:
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Classification of extrasystoles
According to the frequency of occurrence, extrasystoles are divided into:
- single (less than 5 per minute);
- frequent (6 or more per minute);
- paired (when there are two extrasystoles in a row);
- early (layering of the P wave on the T wave);
- late (occurring in the last phase of diastole);
- interpolated, or interpolated (in the middle of the interval of the main rhythm);
- monotopic and polytopic (have different centers of activity);
- monomorphic and polymorphic (different in shape);
- allorhythmic (repeated at certain intervals).
According to the location of excitation, ventricular impulses can be right ventricular and left ventricular.
There is also a classification according to which several classes of ventricular extrasystoles are distinguished:
- Class I - frequency of single extrasystoles less than 30 per hour. This condition is considered a variant of the norm.
- Class II - frequency is more than 30 per hour. This is a more significant indicator, but usually does not lead to serious consequences.
- Class III - polymorphic ventricular extrasystole is observed. This is already an unfavorable sign that requires urgent treatment.
- Class IVa - the presence of paired, successive extrasystoles.
- Class IV - volley episodes of excitement, up to 6 or more in a row.
- Class V - the appearance of early extrasystoles.
The last three types of rhythm disturbances can lead to complications such as fibrillation. The clinical significance of extrasystoles of a lower grade is determined by the presence of concomitant symptoms.
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Clinical signs of extrasystole
As a rule, the ventricular form of extrasystole is tolerated by patients much more severely than the atrial form or from the AV junction.
Often single ventricular extrasystoles of organic origin do not have particularly pronounced clinical signs. Pronounced complaints of patients about missed beats, subsidence of the heartbeat, interruptions, cardiac tremors, as a rule, arise for functional reasons, but there may be exceptions.
Indirect signs of ventricular extrasystole are expressed in general weakness, rapid fatigue, dizziness, sleep disturbance, and intolerance to long trips in transport.
With an organic nature, the main signs of the disease that caused the occurrence of such a rhythm disturbance come first.
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Correct diagnosis of the disease
To correctly diagnose the disease, it is necessary to take into account the main complaints that the patient presents and conduct a full check of the state of the autonomic and central nervous systems. A complete examination of the functioning of the heart and blood vessels also plays an important role in this. Experts calculate the number of ventricular extrasystoles occurring per 100 normal heartbeats. Those whose frequency is less than 10% are considered isolated.
In case of such a pathology, it is necessary to conduct a study using an ECG, which must be done over time.
Carrying out daily monitoring allows you to get the most objective picture of the disease. Bicycle ergometry makes it possible to differentiate between idiopathic ventricular extrasystoles (they go away with exercise) and ectopic foci that arise due to organic changes in the heart muscle.
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