Extrasystole - what is it, causes and methods of treatment. What are extrasystoles, symptoms and treatment of extrasystole Symptoms of extrasystole of the heart
Symptoms and treatment
What is supraventricular extrasystole? We will analyze the causes of occurrence, diagnosis and treatment methods in the article by Dr. Kolesnichenko Irina Vyacheslavovna, a cardiologist with 23 years of experience.
Publication date August 30, 2019Updated October 04, 2019
Definition of illness. Causes of the disease
Normally, the heart works in an orderly manner. The rhythm of the heart sets the sinus node, which generates electrical impulses. Under their influence, the atria contract first, then the ventricles. Sometimes the rhythm of the heart is disturbed and premature excitation and contraction of the heart or its departments occurs, which is called extrasystole.
Supraventricular (supraventricular) extrasystole (SVE)) are extraordinary premature contractions of the heart from impulses from the upper or lower atria, or from the atrioventricular junction (AV junction), which lies between the atria and ventricles of the heart .
The causes of extrasystole can be cardiac and extracardiac. Cardiac associated with diseases of cardio-vascular system(organic extrasystole). Non-cardiac causes associated with diseases of other organs and systems, as well as with the action of certain factors (functional extrasystole). In some cases, supraventricular extrasystole is not associated with problems of the heart or other organs and the action of provoking factors. In this case, idiopathic extrasystole is diagnosed.
Organic extrasystole occurs with heart diseases: coronary heart disease (CHD), and with thickening of the wall of the left ventricle, cardiomyopathies, heart defects, and prolapse (flexion) mitral valve and other diseases of the cardiovascular system.
Causes functional extrasystole:
- electrolyte imbalance: a decrease or increase in the concentration of potassium, calcium and sodium in the blood, a decrease in magnesium;
- various kinds of intoxication, including infectious diseases;
- diseases accompanied by oxygen starvation of tissues: anemia, broncho-pulmonary diseases;
- restructuring and disease endocrine system: decrease or increase in the hormonal activity of the adrenal glands and thyroid gland, diabetes mellitus, formation / imbalance / extinction of ovarian function (onset of menstruation, menopause), pregnancy;
- imbalance of the autonomic nervous system: autonomic influences in diseases of the gastrointestinal tract.
- smoking, stress, drinking a large amount of caffeinated or alcoholic beverages, leading to an increase in the activity of the sympathetic-adrenal system and the accumulation of catecholamines (adrenaline, norepinephrine, etc.), which sharply increase myocardial excitability. In this case, there is a clear connection with the provoking factor, but there are no organic changes in the heart muscle.
It is very important to identify the etiological factor that caused supraventricular extrasystole: the recommended treatment will depend on this.
If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of supraventricular extrasystole
It is not difficult to suspect supraventricular extrasystole in a patient if it is felt. Most often, patients complain about feeling of interruptions in the work of the heart: premature contractions, pauses, fading. If the arrhythmia occurs at night, the patient may wake up and feel anxious. Less often, patients are disturbed by attacks of frequent non-rhythmic heartbeats, in this case, the exclusion of paroxysmal (paroxysmal) is required.
Sometimes a curious pattern can be noted: the most unpleasant are "harmless" functional extrasystoles that are not associated with damage to the heart. And more serious rhythm disturbances a person may not feel at all. This is likely related to the arrhythmia sensitivity threshold in patients and the degree of damage to the heart muscle.
Periods of supraventricular extrasystoles are usually not accompanied by serious violations hemodynamics (blood supply). However, in patients with organic heart damage, chest pains of a different nature may occur, shortness of breath, weakness, dizziness may appear or increase, and exercise tolerance also decreases.
Supraventricular extrasystole with vegetative-vascular dystonia is accompanied by severe fatigue, weakness, increased sweating, periodic headache, dizziness, irritability.
The occurrence of interruptions in the work of the heart during extrasystole can be associated with the action of provoking factors (smoking, alcohol, excessive physical activity, etc.), exacerbation of the disease that caused the extrasystole. However, the symptoms of arrhythmia may appear without connection with any provoking factors.
Pathogenesis of supraventricular extrasystole
There are several mechanisms for the origin of extrasystoles:
- Re-entry of the excitation wave (re-entry). Normally, an electrical impulse passes through the conduction system of the heart only once, after which it fades. Upon re-entry, the impulse can again spread to the myocardium, causing its premature excitation. Further, conduction circulation occurs with repeated tissue re-excitation in the absence of a cardiac relaxation interval.
- Increased excitability of the myocardium arising below sinus node as a result of various factors. At the same time, the activity of cell membranes of individual sections of the atria and the AV junction increases.
It should be noted that the ectopic (wrong) impulse from the atria propagates from top to bottom along the conduction system of the heart. An extraordinary impulse that occurs in the AV junction propagates in two directions: from top to bottom along the conduction system of the ventricles and from bottom to top (in the opposite direction) through the atria.
Identification of the etiopathogenetic mechanism (i.e., the cause and mechanism of development) of the occurrence of supraventricular extrasystoles is very important, since this determines the therapeutic tactics.
With careful questioning of the patient, it is possible not only to identify signs various diseases heart, but also to establish the frequency and regularity of smoking, drinking tea, coffee, alcohol, psychostimulants and drugs, as well as a number of drugs that provoke supraventricular extrasystole. The mechanism of occurrence of extrasystoles in this case is associated with stimulation of the sympathetic nervous system.
In all patients with SVE, it is necessary to check the function of the thyroid gland, since a change in its functional state sometimes causes arrhythmia. For example, an increase in thyroid hormone levels can cause palpitations, supraventricular and ventricular extrasystoles, and atrial fibrillation. If in the future it is necessary to prescribe the antiarrhythmic drug "Amiodarone", it is necessary to check the level TSH hormones, T3 and T4.
When acute development supraventricular extrasystole, it is necessary to exclude hypokalemia, i.e., a decrease in the level of potassium in the blood.
The connection of the first episode and repeated increases in extrasystole, which flows in waves, with infections indicates past myocarditis. The appearance or intensification of extrasystole may be the only or one of the manifestations of IHD. In this case, there is an increase in interruptions in the work of the heart during physical exertion, when there is a discrepancy between the blood supply to the heart and the increased need for blood flow. In other identified organic heart diseases (heart defects, cardiomyopathies, hypertensive heart, mitral valve prolapse), the severity of supraventricular extrasystole is often associated with the amount of atrial expansion.
It is often possible to identify the connection of SVE with the activation of the sympathetic (during exercise) or parasympathetic (during sleep, after eating, with,) nervous system. In the first case, during exercise, the amplitude and heart rate increase, which can provoke supraventricular extrasystole. In the second, the rate of heart contraction slows down, which can also cause rhythm disturbance.
Classification and stages of development of supraventricular extrasystole
Classification of supraventricular extrasystoles by place of origin:
- atrial - premature contractions of the heart from impulses from the atria;
- nodal or atrioventricular - premature impulses from the AV junction.
By frequency of occurrence:
- rare - less than five per minute;
- frequent - more than five per minute.
Density:
- single;
- paired (couplets);
- group (triplets);
- jogging paroxysmal over ventricular tachycardia(more than four extrasystoles in a row).
Single extrasystoles can occur chaotically or be of the type bigeminy (every second contraction is an extrasystole), trigeminy and quadrigeminy (every third and fourth complex is extraordinary). Such extrasystole, when extraordinary complexes appear after one, two, three sinus, is called rhythmic.
Extrasystoles can be monotopic, coming from the same part of the conduction system of the heart, and polytopic - from its different parts.
Complications of supraventricular extrasystole
Supraventricular extrasystole can provoke the developmentsupraventricular tachycardia, which is characterized by sudden onset and cessation of pathologically rapid cardiac activity. During an attack, the heart rate rises to 220-250 beats per minute . If at this moment it is possible to take an ECG, then paroxysm (attack) of supraventricular tachycardia can be recorded.
One of the consequences of this disease can be atrial fibrillation (atrial fibrillation). These are chaotic and frequent excitations and contractions of the atria, as well as twitching of some groups of atrial muscle fibers. During an attack, the heart rate rises significantly, the correct heart rhythm is disturbed. The risk of atrial fibrillation should serve as a criterion for the malignancy of supraventricular extrasystole (high risk of sudden death). A harbinger of atrial fibrillation is frequent group supraventricular extrasystole with runs of paroxysmal (paroxysmal) supraventricular tachycardia.
Diagnosis of supraventricular extrasystole
The diagnosis of supraventricular extrasystole can be made on the basis of patient complaints, according to an objective examination, auscultation (listening) of the heart, according to the results of electrographic examination (ECG), 24-hour Holter ECG monitoring.
After evaluating complaints during an objective examination during auscultation or palpation of the pulse, extrasystoles are defined as premature contractions against the background of normal sinus rhythm. The pause after supraventricular extrasystole is not very long (on this basis, one can suspect its supraventricular origin). With bigeminia and trigeminia, as well as frequent extrasystole, a pulse deficit can be determined. However, the diagnosis of NVE can be confirmed only with the help of instrumental studies.
First of all, the patient undergoes an ECG, which can fix an extraordinary complex. Often on the ECG, supraventricular extrasystoles are detected by chance (in the absence of complaints).
Characteristic signs of supraventricular extrasystole:
An important role is played by the evaluation of the clutch interval (from the P wave preceding the normal complex to the P wave of the extrasystole). Its constancy indicates the monotony of supraventricular extrasystoles (i.e., they come from one focus).
Since the ECG is performed in a short period of time, and extraordinary excitation does not always occur at the time of its removal, this type of study does not reveal the problem in 100% of cases. For accurate diagnosis, daily or longer (for two days, for example) ECG monitoring, which is called Holter(by the name of the author who proposed this technique). To assess the frequency of supraventricular extrasystoles, the study should be carried out in the absence of antiarrhythmic therapy. The number of extrasystoles is not more than 30 per hour.
After recording, the ECG monitoring data is decoded by a specialist and it becomes possible:
- clarify the number of supraventricular extrasystoles, their shape, determine the presence of pairs, groups, as well as runs of paroxysmal supraventricular tachycardia;
- determine at what point they occur, whether the appearance of extrasystoles depends on physical activity or other factors (the patient indicates these data in the diary that he keeps during the monitoring);
- to fix the dependence of the occurrence of supraventricular extrasystole on the state of sleep or wakefulness;
- to monitor the effectiveness of drug therapy;
- identify other possible rhythm and conduction disturbances.
It should be noted that it is fundamentally important to assess the frequency of SVE, since the treatment tactics will depend on this.
Supraventricular extrasystole may be first detected during exercise tests(veloergometry or treadmill test).
Indication for carrying out electrophysiological study(EFI) it may become necessary to more accurately establish the location of the occurrence of extrasystoles (with frequent monotopic supraventricular extrasystole) in the case of subsequent surgical treatment. With EPI through electrical stimulation of the myocardium, the load on the heart increases. Such stimulation is carried out using electrodes that supply electrical currents of physiological power at a high frequency to the heart muscle. As a result, the myocardium begins to contract faster, a provoked increase in heart rate occurs (). With a high heart rate, various types of arrhythmia may appear, including supraventricular extrasystole.
Treatment of supraventricular extrasystole
NVE may be benign. In this case, the risk of sudden death is very low, sometimes the patient does not even feel a rhythm disturbance. Such extrasystole does not always require treatment.
If possible, it is necessary to eliminate the etiological factor:
- normalize sleep;
- limit or completely stop taking provocative drugs and drinks;
- stop smoking:
- normalize thyroid function with;
- adjust the level of potassium in the blood;
- delete gallbladder in case of gallstone disease;
- avoid a horizontal position after eating at;
- normalize arterial pressure;
- raise physical activity according to the capabilities of the organism;
- avoid excessive physical activity (weightlifting, weight lifting).
Indications for antiarrhythmic therapy are:
1. Poor tolerance of supraventricular extrasystoles. In this case, it is necessary to determine in what situations and at what time of the day a violation of the heart rhythm most often occurs, and then time the drug intake to this time.
2. The occurrence of SVE (not necessarily frequent) in patients with heart defects (primarily with mitral stenosis) and other organic heart diseases. At such patients the overload and expansion of auricles progress. Supraventricular extrasystole in this case serves as a harbinger of atrial fibrillation.
3. Supraventricular extrasystole, which arose as a result of an etiological factor prolonged in time in patients without previous organic heart disease and atrial expansion (with thyrotoxicosis, inflammation in the heart muscle, etc.). If antiarrhythmic treatment (along with etiotropic) is not carried out, the risk of fixation of SVE increases. Frequent supraventricular extrasystole in such situations is potentially malignant in relation to the development of atrial fibrillation.
4. Frequent (700-1000 extrasystoles per day or more) NZhE also requires the appointment of antiarrhythmic therapy, even if it is regarded as idiopathic, since there is a risk of complications. The approach in these cases should be differentiated. It is also possible to refuse antiarrhythmic therapy, if there are grounds for that:
- absence of subjective symptoms and complaints;
- border number of extrasystoles;
- intolerance to antiarrhythmic drugs;
- signs of sick sinus syndrome or AB conduction disturbances.
Antiarrhythmic drugs used in NVE:
- Beta blockers (Metoprolol, Bisoprolol) ), calcium antagonists ("Verapamil" ). It is pathogenetically justified to prescribe drugs of this group to patients with hyperthyroidism, a tendency to tachycardia, when SVE occurs against a background of stress and is provoked by sinus tachycardia. Beta-blockers are indicated for coronary artery disease, arterial hypertension, sympathetic-adrenal crises. "Verapamil" is prescribed for concomitant , variant angina pectoris, nitrate intolerance, patients with coronary artery disease., "Propanorm", "Etacizin" ). The use is not indicated in patients with coronary artery disease who have recently had a myocardial infarction due to arrhythmogenic effects on the ventricles.
- Amiodarone ("Cordarone"). Amiodarone is the most effective of the existing antiarrhythmic drugs. M may be prescribed to patients with organic heart damage.
- With insufficient effectiveness of monotherapy (i.e., the use of one antiarrhythmic), combinations of drugs can be used.
With a good effect of the prescribed therapy, antiarrhythmics should not be quickly canceled. Treatment is carried out for several weeks (months). If there is a threat of developing atrial fibrillation or if there are episodes of atrial fibrillation in the anamnesis, NVE therapy is carried out for life. In the case of continuous antiarrhythmic therapy, the minimum effective doses are selected. Patients with an undulating course of NVE should seek to stop the antiarrhythmic at periods of improvement (excluding cases of severe organic myocardial damage). Cancellation of antiarrhythmics is carried out gradually with a decrease in dosages and the number of doses per day. After cancellation, the patient is advised to carry the drug with him (the “pill in the pocket” strategy) in order to quickly take it when the arrhythmia resumes. .
If there is no effect of antiarrhythmic therapy, with frequent NVE (up to 10,000 per day), the question of surgical treatment - radiofrequency ablation of arrhythmogenic foci (destruction of foci with the help of electric current) .
Forecast. Prevention
Supraventricular extrasystole is one of the most common cardiac arrhythmias. Rare, single premature contractions of the heart in healthy people do not lead to threatening consequences for health and life. More dangerous is frequent extrasystole with the presence of episodes of paroxysmal supraventricular tachycardia, which can lead to hemodynamic disorders and the development of atrial fibrillation.
- If you have a hereditary predisposition to heart disease, you should contact a cardiologist as soon as possible.
- Very carefully and only under the supervision of a doctor, use drugs that affect the heart rate and electrolyte composition of the blood (diuretic drugs, glycosides).
- In the presence of endocrine diseases ( diabetes, hyperfunction of the adrenal glands or thyroid gland) it is necessary to undergo an examination for the development of cardiovascular pathologies.
- Give up bad habits: smoking, drinking, etc.
- Observe the regime of the day (requires proper sleep and rest). Eat a balanced diet: include foods rich in potassium and magnesium in the diet; exclude too hot, fried and spicy food.
- If possible, reduce the effect of stress factors, avoid emotional overstrain. You can consider the use of relaxation methods and autogenic training.
Extrasystole is a type of arrhythmia, which is characterized by extraordinary contractions of the entire myocardium or its individual parts. This anomalous phenomenon is accompanied by a sensation of an intense jolt in the chest, sudden anxiety, lack of air, it seems to the patient that the heart has simply stopped. In the absence of treatment for extrasystole, its symptoms can cause angina pectoris, lead to transient circulatory disorders of the brain (fainting, paresis of the limbs, dizziness, etc.).
Classification
Types of extrasystole (criterion - the place of formation of ectopic foci):
- ventricular;
- atrial;
- atrioventricular;
- various combinations of the above extrasystoles.
Sometimes (no more than 0.2% of total number) extraordinary impulses come from the sinoatrial node.
The focus of the ectopic rhythm can function independently of the main (sinus) rhythm - this phenomenon is called parasystole.
Another classification of extrasystoles (the criterion is the time of arrhythmia on the electrocardiogram):
- early;
- average;
- late.
By frequency of occurrence:
- rare (single) (less than 5/minute);
- medium (multiple) (5–15/minute);
- frequent extrasystole (group) (more than 15/minute);
- steam room (two in a row).
Depending on the number of ectopic foci, extraordinary impulses are divided into mono- and polytopic.
By nature (etiology), there are also several varieties of extrasystole:
- organic;
- functional;
- toxic origin.
The most dangerous type of arrhythmia - ventricular - is usually divided into 5 classes (determined only after a 24-hour ECG):
- I - transient extrasystoles are not registered.
- II - up to 30 monotopic extraordinary impulses are recorded in 60 minutes.
- III - 30 or more extrasystoles per hour (time of day is not taken into account).
- IV - both mono- and polytopic impulses are noted (subclass "a" - there are paired ventricular extrasystoles, subclass "b" - runs of ventricular tachycardia).
- V - early ventricular extrasystoles.
Important: rhythm failures related to the first class are considered to be physiologically conditioned. They do not affect the state of health and well-being of the patient, they do not threaten his life, they do not require drug therapy. Why are ventricular extrasystoles II - V classes dangerous: they lead to deterioration of the coronary, cerebral circulation, can cause ventricular fibrillation and even cause death.
There are also such types of ventricular arrhythmia:
- benign (not associated with a risk of cardiac arrest, the muscle is not damaged);
- potentially malignant (it is accompanied by problems with blood circulation, as well as organic lesions of the myocardium);
- malignant (numerous extrasystoles, significant probability of death of the patient).
Why there is a problem
Single cardiac extrasystoles can occur even in practically healthy people. So, according to research results, such rhythm failures are present in 70–80% of men and women who have already crossed the 50-year age limit.
The causes of extrasystole are foci of excessive activity of the heart muscle located outside the sinus node (ventricles, atria). Such impulses pass throughout the myocardium, "provoking" its premature contraction.
Important: portions of the ejection of blood during extrasystoles are less than normal, therefore frequent arrhythmias lead to a decrease in the minute volume of blood circulation.
Functional (psychogenic) failures of the heart rhythm are explained by food, chemical factors, smoking, frequent alcohol intake, drug use, etc. The causes of extrasystole of a functional type are neurosis, cervical osteochondrosis, vegetative dystonia, etc.
Extraordinary heart rhythm failures are a common phenomenon that occurs, among other things, in athletes who exercise regularly and do not have any special health problems.
Important: in a number of professional athletes, extrasystoles are caused by myocardial dystrophy - a consequence of regular physical overstrain (this phenomenon is called "athlete's heart").
The causes of female extrasystole can be a hormonal imbalance in the body that accompanies menstruation. Single functional extrasystoles are caused by emotional overstrain, occur after drinking a large amount of coffee, tea.
Other reasons for the appearance of functional extrasystoles:
- severe stress;
- overwork;
Symptoms of extrasystole of an organic type are a consequence of a variety of myocardial dysfunctions:
- ischemic disease;
- cardiosclerosis;
- heart attack;
- pericarditis;
- myocarditis;
- heart defects;
- sarcoidosis;
- transferred surgical intervention on the myocardium.
The occurrence of toxic types of extrasystoles is explained by febrile conditions, thyrotoxicosis (disruption of the thyroid gland). This abnormal phenomenon can occur after taking certain medications (Novodrin, Eufillin, glucocorticoids, diuretics, sympatholytics, etc.).
Violation of the ratio of minerals and trace elements (in particular, magnesium, calcium, potassium ions) in the heart cells also causes frequent extrasystoles (affects the conduction system of the myocardium).
This type of arrhythmia in pregnant women occurs with anemia, may be the result of overwork or diseases of the thyroid gland, bronchopulmonary or cardiovascular systems.
Some patients experience extrasystole after eating - this phenomenon is associated with the parasympathetic nervous system, it occurs when a person who has just taken food has given the body a horizontal position.
Clinical picture
As such, the subjective sensations that accompany extrasystole are not always present. Worse, such an anomalous phenomenon is tolerated by patients with vegetovascular dystonia, but patients with organic myocardial lesions practically do not feel changes in their own body.
People who have experienced from their own experience what extrasystoles are, complain of tremors or beats of the heart muscle (these symptoms are the result of an increased contraction of the ventricles after a compensatory pause).
Other signs of extraordinary myocardial impulses:
- the so-called flipping or somersaulting of the muscle;
- malfunctions, heart failure;
- functional extrasystoles (symptoms: weakness, lethargy, frequent hot flashes, unreasonable anxiety, hyperhidrosis, shortness of breath, a person may not have enough air, deterioration in general well-being).
Features of children's extrasystole
Previously, doctors believed that children mainly experienced ventricular arrhythmias. But the results of modern research prove that all types of extrasystoles occur with almost identical frequency. The reason for this is quite simple: children's body grows intensively, develops, the heart cannot cope with the additional functional load, therefore, it begins to compensate for the “lag” with extrasystoles.
As a rule, only the period of active growth ends, the arrhythmia disappears without medical intervention.
What is dangerous extrasystole in children: this pathological phenomenon can be the result of various pathologies of the thyroid gland, lungs, myocardium. At the same time, small patients complain of the same manifestations as adults - frequent dizziness, weakness, heart "tremors" in chest.
Important: drug treatment ventricular arrhythmias are indicated only when the daily number of extrasystoles reaches 15,000 (children are prescribed metabolic, antiarrhythmic therapy). Such patients are necessarily put on dispensary records, comprehensively examined at least 1 time per year.
Possible Complications
Frequent group extrasystoles entail a decrease in cardiac output, and hence a decrease in blood circulation by 8–25% (both cerebral and coronary, renal). They can also flow into more dangerous forms of arrhythmia:
- atrial lead to atrial flutter;
- ventricular cause ventricular paroxysmal tachycardia.
Important: in patients with atrial overload, even single extrasystoles can eventually provoke attacks of atrial fibrillation.
It is noteworthy that the systolic rhythm with multiple extraordinary heart impulses can not only accelerate (tachycardia), but also slow down (bradycardia). The heart rate in this situation decreases to 30 times / minute - this is a life-threatening phenomenon, since it is associated with impaired conduction and a significant risk of myocardial blockade.
The most dangerous type of extrasystole - complicated ventricular - can cause death.
Diagnostics
The main method by which this type of arrhythmia can be detected is the ECG. It is possible to suspect extrasystole during the physical examination of the patient, as well as in the analysis of his complaints.
During a conversation with the patient, the doctor should find out when and how often arrhythmia attacks occurred (intense physical activity, stressful situations, sleep periods), what medications he takes. The specialist pays special attention to the anamnesis (list of ailments), because a number of pathologies can lead to organic damage to the heart.
To clarify the diagnosis, the doctor may prescribe an ECG Holter monitoring to the patient - this is a long-term recording of an electrocardiogram using a special device (attached to the patient's body).
To determine that it was the extrasystoles that provoked certain deterioration in general well-being, modern diagnostic methods such as bicycle ergometry and the treadmill test also help. Their main task is to detect arrhythmia under load.
With concomitant extrasystole violations of the heart, the examination includes ultrasound, MRI of the myocardium, stress ECHO-KG.
Principles of treatment of extrasystole of the heart
The causes, shape and localization of extrasystoles are the main criteria influencing the choice of therapy. So, with single arrhythmias not caused by cardiac pathologies, special curative measures not required. When the causes of the problem are malfunctions digestive system, hormonal imbalance and direct damage to the myocardium, the fight is primarily against the underlying disease.
With the neurogenic nature of extrasystole, the patient must be sent for a consultation with a neurologist. The doctor will prescribe natural sedatives (tinctures of hawthorn, motherwort) or select sedatives (Relanium, Rudotel). If arrhythmia is a consequence of taking certain medications, they are canceled (analogues are selected).
Indications for drug treatment of extrasystoles:
- deterioration in the general well-being of the patient, some symptoms of arrhythmia affect the quality of life of the patient;
- heart disease;
- the number of extrasystoles / day exceeds 1000.
The doctor selects drugs depending on the type of arrhythmia and heart rate.
Important: atrial extrasystole is fought with beta-blockers (Metoprolol, Bisoprolol), Verapamil, Amiodarone and Etatsizin, and ventricular extrasystoles are fought with Propafenone, Amiodarone, Etatsizin and beta-blockers (Metoprolol, Bisoprolol).
The standard duration of the course of treatment is up to 2 months, but patients with a malignant form of ventricular extrasystole are shown to take lifelong antiarrhythmic drugs.
If drug therapy is ineffective, poorly tolerated, and the daily frequency of extrasystoles is up to 20-30 thousand, then patients are prescribed radiofrequency ablation of the heart. If there is a high risk of developing ventricular fibrillation, it is possible to implant a cardioverter-defibrillator - this is a small device that delivers an electrical shock to the heart at the time of a life-threatening arrhythmia attack.
folk therapy
When the course of extrasystole is not associated with serious hemodynamic disturbances and does not pose a danger to the patient's life, you can cope with the symptoms of arrhythmia on your own. So, while taking diuretics, calcium and magnesium are actively washed out of the patient's body, so it is necessary to introduce food products containing these valuable substances (for example, chocolate or raisins) into the daily diet.
At home, you can prepare a medicinal tincture with antiarrhythmic, sedative, cardiotonic properties (it is taken three times a day, 1 tablespoon / time).
Medicine prescription:
- Combine 5 parts of motherwort herb and lemon balm, add 4 parts of heather, 3 - hawthorn, 2 - hop cones.
- Dry crushed plant mass (2 tablespoons) is poured with two glasses of boiling water, left for 1 hour, after straining, they drink according to the scheme described above.
Important: since most medicinal herbs- potential allergens, before starting a home fight against extrasystole, you should consult a doctor. Besides, folk remedies can affect the action of various medications, weakening or enhancing their effects.
Forecast and prevention
The presence of an organic lesion of the heart muscle and the degree of ventricular dysfunction are the factors that determine the prognostic assessment of extrasystole. Arrhythmias that develop during myocardial infarction and other severe pathological processes lead to the most serious consequences.
Functional extrasystoles proceed benignly, they do not pose a serious health hazard.
Prevention of the development of arrhythmia - prevention of abnormal conditions that can cause it (heart disease), and their exacerbations.
- adherence to a practically salt-free, potassium and magnesium enriched diet with a minimum amount of saturated fats;
- it is necessary to completely abandon the drinking of strong alcoholic beverages, do not drink tea, coffee, stop smoking;
- regular exercise of moderate intensity;
- weight normalization.
So, extrasystole is a dysfunction of the heart muscle, which can be the result of abnormal processes in the body. An increased number of systoles is often disguised as a number of pathologies of the endocrine, cardiovascular, bronchopulmonary systems; they can only be detected on an ECG. Establishing the true causes and correct treatment of extrasystole will help to avoid the consequences of this form of arrhythmia (heart problems, circulatory disorders), and in complicated forms of the phenomenon, even save the patient's life.
This pathology has many different causes. The heart has a protective mechanism that responds to changes in heart rate. Sometimes the cause of the violation of organ contractions is unknown and then the extrasystole is called idiopathic.
If rhythm disturbances are caused by physiological factors, extrasystoles in the heart are not a pathology. They disappear immediately after the elimination of irritants. These reasons include:
- nervous and emotional outbursts,
- increase in blood pressure,
- alcohol abuse,
- smoking,
- heavy physical activity,
- pregnancy or menopause.
Other causes of extrasystoles include:
- organic lesions of the heart,
- osteochondrosis,
- lack of potassium in the body,
- Vegetovascular dystonia.
The pathogenesis of extrasystole disease is different, it can be caused by many factors. Even periodic female cycles against the background of certain pathologies of the body. But there is a division into two large groups: functional causes and organic.
A common type of arrhythmia is a premature contraction of the heart muscle.
Untimely depolarization of the heart on the ECG
Types of extrasystoles
There are four types of this disease - sinus, atrioventricular, atrial, ventricular. The first two are extremely rare.
The types of cardiac extrasystole are different, as well as the parameters for dividing into groups. Classification according to the place of formation of ectopic foci:
- Ventricular extrasystolic arrhythmia - occurs most often.
- Supraventricular, including ventricular extrasystole.
- Atrial, including stem extrasystoles.
- Sinus or nodal extrasystole.
- Atrioventricular.
- There are also various combinations of the mentioned varieties - in 10% of cases.
- Least of all, but sometimes extraordinary impulses come from the sinoatrial node - 0.2% of cases.
A rhythm disturbance can occur both in the elderly and at a young age, regardless of the sinus - the main one. In this case, extrasystolic and sinus rhythm can be observed. This condition is called parasystole.
If there are two consecutive impulses, then these are paired extrasystoles, if more than two, group extrasystoles are also called volley.
Another classification:
- Bigeminia - this is the name of the rhythm in which single extrasystoles alternate with normal systole.
- Trigeminia - 2 consecutive normal systoles 1 extrasystole.
- Quadrihymenia - 3 normal systoles turn into 1 extrasystole.
If such repetitions become constant, then a diagnosis of allorhythmia is made.
In medical practice, there are several types of extraordinary contractions of the heart muscle. Depending on this, extrasystole manifests itself in different ways and develops in the future.
Extrasystole when carrying a child
The reason for the appearance of extrasystole during childbearing is a powerful hormonal restructuring. During this period, a woman can experience all types of the pathological condition in question. Often, treatment of extrasystole of the heart in this case is not required. Discomfort conditions that are felt will pass after delivery.
It used to be that the more common form of extrasystole in children was ventricular. But now all types of extrasystoles occur with almost the same frequency.
This is due to the fact that the child's body grows rapidly, and the heart, unable to cope with such a load, "turns on" compensatory functions due to all the same extraordinary contractions. Usually, as soon as the growth of the child slows down, the disease disappears by itself.
Symptoms
Often, patients with extrasystole do not feel its symptoms. The signs of this pathology are more pronounced in people suffering from vegetovascular dystonia.
With some organic lesions of the heart, extrasystoles can be tolerated even more easily than in the absence of concomitant diseases.
With extrasystole, patients note peculiar tremors, “turning over” of the heart, in other words, sharp interruptions and fading. At functional disorders there may be general discomfort, weakness, hot flashes, sweating, shortness of breath.
In people with atherosclerosis, coronary circulation disorders, dizziness, paresis, fainting are possible.
Extrasystoles are not always clinically pronounced. It depends on the functional and morphological features of the organism.
Most people do not feel this arrhythmia, but only accidentally detected on electrocardiography:
- Feeling of interruptions behind the sternum (in the heart);
- Weakness;
- Dizziness;
- Malaise;
- Labored breathing;
- restless state;
- Fear of dying;
- Panic attack.
Extrasystole can be accompanied by both a reduction and an increase in heart rate. With a disease of vegetovascular dystonia, the self-regulation of the heartbeat is disturbed and the nervous system is excessively excited.
Symptoms of extrasystole with VVD:
- Heart rhythm failures after excitement or without signs of stress on the psycho-emotional sphere;
- Panic attacks accompanied by unregulated fear;
- Alarm states without visible reasons, it begins to seem that something bad is about to happen;
- Irritability, while you can notice that you are wrong, but it is difficult to stop an attack of anger;
- Weakness, fatigue;
- Insomnia, sleep disturbance;
- Increased or slow heartbeat with one or more missed beats;
- shortness of breath, feeling short of breath;
- When excited, or for no reason throws into a hot sweat or chills;
- Dizziness, fainting due to insufficient saturation of the brain with oxygen in case of heart rhythm failures;
The symptoms of extrasystole are not always obvious, sometimes it can only be recognized on a cardiogram, but there are no clinical manifestations. Explicit symptoms appear in people with organic heart disease. Extrasystole has different symptoms, treatment is prescribed based on them and hardware diagnostics. Specific signs of cardiac extrasystole:
- Sensation of a strong shock in the heart, its upheaval.
- Failing heart, failure of work.
- Discomfort, sometimes mild pain in the heart.
- Swelling of the veins in the neck immediately after an extrasystole.
- Weakness, pallor, shortness of breath.
- Increased sweating, hot flashes.
- It becomes difficult to breathe.
- Anxiety, fear of death.
- Irritability, mood swings.
Night. Lying in bed relaxed, ready to fall into a deep night's sleep. Suddenly, a lump rises to the throat, you swallow convulsively and feel as if something is turning over behind the sternum.
A familiar feeling? I think that some of you have experienced something similar not only before sleep, but also in the waking state. Usually such symptoms are manifested by ventricular extrasystole. And many people ask me the question: is extrasystole in the heart dangerous?
Atrial extrasystole does not cause such discomfort and is often not felt by a person at all, only with a pronounced heartbeat.
Diagnostics
The main diagnostic method for complaints of heart rhythm failures is electrocardiography. For a more accurate picture of the disease, the doctor prescribes general analysis blood and urine. Additional examinations are possible to exclude pathologies of other organs.
Conservative treatment appointed taking into account the patient's condition and diagnostic results. Usually it consists in taking antiarrhythmic drugs. Patients with concomitant organic pathologies of the heart are prescribed sotalol, amiodarone, and adrenoblockers.
A patient who wonders why extrasystoles are dangerous should reconsider his lifestyle, give up bad habits, and eliminate nervous stress. A balanced diet, the right mode of work and rest is the key to a quick recovery.
The prognosis of extrasystole is quite favorable, but this does not mean that the disease can be left to chance. In addition to a cardiologist, the patient may need regular consultations of other specialists - a neuropathologist, an endocrinologist and a general practitioner.
The diagnosis is established on the basis of:
The easiest way to diagnose extrasystole is with an ECG. An electrocardiogram allows you to easily and accurately calculate any type of malfunction of the heart muscle. Indeed, on the ECG tape, normal and irregular, rapid contractions clearly appear.
But, unfortunately, it is not always possible to detect extrasystoles using an electrocardiogram. The fact is that this procedure does not last long, as a result of which violations of the work of the heart muscle may not be recorded.
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Treatment
The question of the treatment of extrasystoles is very complex.
When choosing antiarrhythmic treatment and its need, one should be based on the table proposed by Bigger:
- Arrhythmias that have a benign course - extrasystoles and ventricular arrhythmias that do not cause hemodynamic disturbances, as well as the absence of structural disorders of the heart. The prognosis is often favorable in such patients, and they are not required in antiarrhythmic treatment.
- Arrhythmias that have a malignant course - extrasystoles and ventricular arrhythmias causing hemodynamic disturbances, as well as structural changes in the heart tissue, require etiological antiarrhythmic therapy.
- In young people with rare extrasitols, there is no need for specific antiarrhythmic treatment; when choosing a treatment, it is enough to give preference to a sedative drug and follow all preventive measures.
In case of an overdose of cardiac glycosides, it is necessary to cancel the glycoside, apply potassium, defenin preparations and detoxify with unitol.
For the treatment of extrasystoles, it is necessary to control the ions of potassium, iron, magnesium in the blood, since with hypokalemia the effectiveness of antiarrhythmic drugs is significantly reduced.
Among drugs, beta-blockers (propranolol, metoprolol, obzidan, oxprenolol, pindolol) have the best effect.
After conducting the necessary research and revealing that extrasystoles in VVD are functional, and not organic, you need to correct your psycho-emotional state and try to get rid of fears. This is not easy to do, but necessary.
In violation of the heart rhythm as a result of overwork, you need to allow yourself a good rest. First you need to sleep well.
The ideal option is a trip to nature or Spa treatment. The duration of night sleep should be at least 8 hours, while you need to go to bed no later than 22.
00. Physiotherapy calms the nervous system and improves blood circulation.
Breathing exercises allow you to restore correct work hearts.
What to do with extrasystoles, and what is better to avoid, the doctor will tell. Treatment methods:
- Medical therapy emerging disease.
- Sometimes only work with a psychologist.
- ethnoscience. It is possible to cure extrasystole if there are no organic pathologies of the heart.
- radio frequency technique. After RFA of the heart, the rhythm stabilizes even when the number of extrasystoles is 20-30 thousand per day. It is possible to significantly reduce this figure.
The choice of treatment methods for any type of extrasystole is up to the doctor, since they have different effectiveness.
In cases where ventricular extrasystole occurs without symptoms and obvious signs, special treatment is not prescribed. Doctors recommend such patients to follow proper nutrition and exclude provoking factors (smoking, alcohol, coffee). When choosing drugs for the treatment of ventricular extrasystole, it is important to use an integrated approach.
If we talk about drug treatment, then the first series of drugs includes sedatives, which include small doses of tranquilizers: Diazepam and Beta-blockers - Propranolol or Metoprolol.
In cases where sedatives are ineffective, the doctor prescribes antiarrhythmic drugs: Propafenone, Lidocaine, Novocainamide.
Sometimes such a disease requires only psychological treatment. It happens that you just need to get a person out of an anxious or depressive state in order for this disease to go away. To do this, you can contact psychiatrists and psychologists.
You can also be treated with medication. What kind of medicine to take with extrasystole of the heart from unpleasant symptoms? In this case, use the following drugs:
- Allapinin, ethacizin, which are used for arrhythmias
- Metoprolol, Sotalol, which are adrenaline blockers
- Verapamil is a calcium antagonist drug.
Before starting treatment, you must always consult with your doctor. In no case should you self-medicate, since arrhythmia is a serious disease that can lead to various complications.
The doctor will conduct the necessary examination, measure blood pressure, prescribe additional methods examination and, if necessary, prescribe appropriate medications. Remember: only a specialist should prescribe treatment for extrasystole of the heart.
If extrasystole is not life-threatening and is not accompanied by hemodynamic disorders, you can try to defeat the disease yourself. For example, when taking diuretics, potassium and magnesium are excreted from the patient's body.
Due to the fact that single extrasystoles are recorded in most healthy people, it cannot be said that this pathology can be completely cured.
Prevention
For prevention, you should follow certain rules that will help not only avoid the recurrence of the disease, but also strengthen the body in general:
- Try to adhere to a healthy lifestyle: do not eat fatty foods, exercise within reasonable limits, give up bad habits.
- get enough sleep
- Eat all kinds of vitamins
- Spend a lot of time outdoors
- Reduce emotional stress
- Avoid caffeine and energy drinks
After all, heart health should be a priority for every person!
Forecast
Infrequent extraordinary contractions of the myocardium are recorded on the ECG in more than 80% of people. Most of them are perfectly healthy and do not require any medical care. It is only necessary to control the ECG in dynamics. The threat is posed by rhythm disturbances against the background of organic changes in the heart.
Prognostically more dangerous is ventricular extrasystole, which, unlike other types, is associated with an increase in mortality from blood flow disorders in the heart and brain. Moreover, this type of arrhythmia is more likely a reflection of the stage of damage to the heart tissue than the very cause of lethal ventricular fibrillation.
Therefore, in the case of an asymptomatic course of the disease, extrasystoles do not require treatment. Patients are shown the correction of the underlying cardiac pathology.
In case no pathological change structures of the myocardium, but ventricular extrasystolic arrhythmia of any form is recorded, the risk of sudden death increases by 2-3 times.
For patients with acute myocardial infarction and (or) insufficient function of the heart muscle, this risk increases up to 3 times. This is due to the fact that extrasystoles, especially frequent and group ones, worsen the course of any cardiac pathology, quickly leading to the development of left ventricular failure.
Despite this, ventricular extrasystoles themselves, even in severe form, are not an independent prognostic criterion for life and working capacity. In most cases, any additional heartbeats are not dangerous.
Identification of this type of violation of the rhythm of myocardial contractions is an occasion for a full examination. Its goal is to exclude diseases of the myocardium and internal organs.
“Extrasystoles in the heart” - if you hear such a diagnosis from a doctor, then first of all, some kind of incurable, even fatal disease comes to mind. But is it? In fact, extrasystoles are nothing more than a violation of the heart rhythm. This problem occurs in more than 60% of people and is a type of arrhythmia. To fight seizures, you need to figure out what kind of disease it is and whether extrasystoles are dangerous.
Characteristic features of the disease
An extrasystole is an untimely full contraction of the heart. The main reasons for the appearance of extrasystole are: the use of alcohol and tobacco, frequent stress, an immoderate amount of strong coffee and tea. In this case, the attack may be one-time or rarely occurring. Often, people suffering from extrasystole have almost the same complaints, which carry quite unpleasant sensations:
- painful internal blows in the chest area;
- lack of air;
- sudden feeling of anxiety;
- feeling of a frozen heart.
Heartache
Group extrasystoles entail cough spasm, severe dizziness and pain in the chest. When a healthy heart works, electrical impulses appear in the so-called sinus node. In this case, the rhythm is not broken. For the appearance of an extrasystole in the heart, the vagus nerve somehow blocks the rhythm-forming node. As a result, the momentum transmission is slowed down.
There are places of increased activity outside the sinus node (in the atria, ventricles). To release the accumulated energy, the resulting impulses, with the help of the heart muscle, independently cause an extraordinary contraction of the heart. Then there is a pause, which causes a feeling of a frozen heart. This is an attack of extrasystoles in the heart.
Normally, a healthy person has about 200 single extrasystoles per day. This phenomenon is normal for those who play sports. Often, extrasystole is diagnosed in infants, children in adolescence and people over 60 years of age. There are even reflex extrasystoles, for example, with bloating and gastrointestinal diseases.
Sometimes all of the above symptoms with extrasystole may be completely absent or disguised as other diseases.
Reasons for the development of extrasystoles
There can be many reasons for the occurrence of heart rhythm disturbances. It is important to understand the cause and nature of the disease. Extrasystoles are divided into several groups.
Functional extrasystole
This type of extrasystole basically does not need medical treatment. The main method of preventing heart rhythm failures is to eliminate the factor that causes extrasystoles. In this case, the development of extrasystole is provoked by the following reasons:
- psychogenic - the presence of stress, psycho-emotional overwork;
- physical - carrying weights, overwork, running;
- hormonal - menstruation, pregnancy, abortion, menopause.
Avoid overeating, especially at night. The cause of extrasystole in this case is dysfunction of the vagus nerve.
Organic extrasystole
Frequent extrasystole occurs against the background of various diseases of the cardiovascular system, so it is called organic. In this case, an electrical heterogeneity occurs in the heart muscle, which affects the myocardium. Why is this happening:
- transferred cardiological operations;
- cardiac ischemia;
- heart disease;
- myocardial infarction;
- cor pulmonale;
- pericarditis;
- sarcoidosis;
- amyloidosis;
- hemochromatosis;
- development of myocardial dystrophy.
Not only heart disease can lead to extrasystoles. Often provocateurs can be malignant and benign tumors, allergies different types, hepatitis, HIV and even banal osteochondrosis of the thoracic region.
Toxic extrasystole
This is the most rare cause of extrasystoles. It develops in cases where there was poisoning medicines caused by an overdose or side effects:
- tricyclic antidepressants;
- glucocorticoids;
- eufillin;
- caffeine.
Another extrasystole in the heart may appear in a feverish state.
Diagnosis and detection of extrasystole
The key to successful treatment of extrasystoles is a correct diagnosis. First of all, the cardiologist examines and interviews the patient. The main complaints with extrasystole are a long stop between heartbeats, heart tremors in the chest.
During the conversation, the doctor should find out the nature and causes of the arrhythmia, which will help establish the extrasystole group. An important indicator is the frequency of occurrence of rhythm failures and anamnesis of previously transferred diseases of the patient.
When performing palpation of the pulse on the wrist, extrasystoles are easily identified by premature pulse waves with a further prolonged pause. This indicates low diastolic filling of the ventricles.
Confirmation of extrasystole takes place after a series of diagnostic studies. Basically, they resort to the following procedures:
- electrocardiogram (ECG) - this study is carried out within 5-10 minutes. Indicators of extrasystole are the early appearance of the P wave or the QRST complex, obvious changes and increased amplitude of the extrasystolic QRS complex and insufficient compensatory pause;
- ultrasound examination (ultrasound) - takes about 10-15 minutes and helps to identify more serious illness heart, for example, a heart attack (if there are scars on the organ). With this outcome of the study, the treatment of extrasystole fades into the background and is a concomitant disease, and not the main one;
- An ECG Holter study is the longest method for diagnosing extrasystole, it takes one or two days. This type of diagnosis is prescribed to all patients with heart pathologies, despite the presence of complaints that indicate extrasystoles in the heart.
If the doctor has doubts about the origin of extrasystole, he may additionally prescribe an MRI (heart, coronary vessels), bicycle ergometry. It should be noted that the treatment of organic extrasystole will be fundamentally different from the treatment of functional or toxic. It would not be superfluous to conduct a hormonal study of the body, especially for women, in order to determine and exclude a malfunction in the endocrine system.
Classification of extrasystoles by type
The occurrence of an extrasystole in the heart can occur anywhere in the conduction system. In accordance with where the pathological impulse arose, the following types of disease are distinguished:
- supraventricular (it includes atrial, lower atrial and mid-atrial) - 3% of patients. It is considered the rarest form of extrasystole. main reason the appearance of this species is an organic lesion of the heart. Volleys of heart beats should draw the attention of the doctor, as the next step will be atrial fibrillation;
- ventricular - 62% of patients. It is the most common form of extrasystole. The danger of the species lies in terms of forecasting, therefore, maximum attention and accuracy in diagnosis is necessary. Often develops into ventricular tachycardia, the result of which is unexpected, sharp outbreaks of frequent ventricular contractions;
- nodular - 26% of patients. A fairly common type of extrasystoles, often caused by functional factors. Extrasystoles that appear are of a single nature, accompanied by bradycardia (slow pulse), and in patients of the older age group - tachycardia;
- polytopic - 9% of patients. A peculiar type of extrasystole, which requires long-term observation by a doctor. The difficulty lies in the fact that the place of excitation dislocation has not yet attached to a certain area, or the damage to the heart is too extensive that the impulse occurs anywhere.
If the patient has an atrial extrasystole, then the center of the origin of the impulse is in the atrium, and then it enters the sinus node and then down to the ventricles. This form of the disease mainly appears with organic damage to the heart. Often, the extrasystole manifests itself when the patient is sleeping or simply lying down.
Atrioventricular extrasystoles can be divided into three types:
- atria and ventricles are excited simultaneously;
- defective excitation of the ventricle, after which the atrium is also excited;
- disease with atrial excitation, and then going excitation of the ventricle.
Depending on the frequency of occurrence of extrasystoles, they are classified: rare (less than 5 per minute), medium (about 6-14 per minute) and frequent (more than 15 per minute). According to the number of foci, they are divided into: polytopic extrasystoles (there are several centers of excitation at once) and monotopic extrasystoles (only one focus of excitation).
Disease and pregnancy
Almost 50% of all pregnant women in one form or another have extrasystole. The main reason for this is and will be hormonal changes in the body of a woman. Expectant mothers are very worried that this problem can cause a contraindication to pregnancy. Actually, there is nothing to be afraid of. Extrasystoles in the heart are normal. It is important that the pregnant woman does not have heart disease.
And for the prevention of extrasystoles of the heart, it will be enough during pregnancy to provide a calm environment, not to overwork (physically and emotionally), to be more in the fresh air.
Today, medicine has stepped forward and doctors have the ability to measure the heart rate of a developing fetus. In most cases, extrasystoles in the heart are found in babies. An acceptable deviation from the norm is the appearance of extrasystoles, at least every 10 heartbeats.
If a woman has “simple” extrasystoles, then natural childbirth is not contraindicated for her. But if a woman in labor has an organic pathology of the heart, then she should be observed by a cardiologist throughout the pregnancy, and it is desirable to give birth by caesarean section.
What you need to know about treatment
Specialized drug treatment in many cases of extrasystoles of the heart is not required. In most cases, it is necessary to eliminate the cause that caused the violation of the rhythm of the heartbeat. But in order to improve well-being and prevent unexpected extrasystoles, it is advisable to eat right, give up bad habits, and take sedatives in stressful situations (preferably homeopathic remedies or herbs).
Folk methods for the treatment of extrasystole are only preventive in nature, and in no case can they replace the appointment of a doctor. To maintain treatment, you can apply the following recipes:
- v green tea add 2 teaspoons of hawthorn tincture;
- make a decoction of lemon balm, common heather, hops, hawthorn, motherwort (all in equal parts). In a glass of boiling water, a tablespoon of a dry mixture of herbs. Take 1/3 cup three times a day;
- a teaspoon of cornflower tincture is brewed in 200 g of boiling water, you need to drink only on the day of an attack, 50 g each.
If attacks of frequent extrasystoles are disturbing, in this case it is important to do the following:
- take a prone position;
- stop any kind of load;
- ensure an uninterrupted supply of fresh air;
- drink a sedative;
- do breathing exercises with your eyes closed deep breath- hold your breath for a few seconds - exhale completely.
The appointment of treatment for extrasystole and the selection of the dosage of drugs occurs exclusively in conjunction with the attending physician. It is important to remember that extrasystoles are of a different nature, so it may be necessary to additionally consult a neurologist, endocrinologist and gastroenterologist.
The best treatment is prevention
Doctors have noticed that in the fight against relapses of extrasystoles, it is necessary to eat enough foods rich in potassium and magnesium. They are found in bananas, potatoes, dried apricots, pumpkins, and beans. It is also important to avoid frequent use of alcohol, coffee and strong tea.
- preventive gymnastics;
- the use of sedative and anti-inflammatory drugs;
- take food in small portions, do not eat up at night;
- avoid physical and emotional exhaustion;
- replenish vitamins and minerals.
With the appearance of extrasystole or an increase in discomfort in the region of the heart, you should immediately contact a specialized doctor. Self-medication can cause serious complications and delay the healing process.
Important to remember
Now, knowing the problem, and having analyzed it by its constituent elements, the question does not arise: extrasystoles in the heart - is this a dangerous disease? But like any change in the body, this problem requires proper attention, prevention and, if necessary, timely treatment.
- this is a variant of heart rhythm disturbance, characterized by extraordinary contractions of the whole heart or its individual parts (extrasystoles). It is manifested by a feeling of a strong cardiac impulse, a feeling of sinking heart, anxiety, lack of air. Diagnosed by the results of ECG, Holter monitoring, stress cardiotests. Treatment includes elimination of the root cause, medical correction of the heart rhythm; in some forms of extrasystole, radiofrequency ablation of arrhythmogenic zones is indicated.
ICD-10
I49.1 I49.2 I49.3
General information
Extrasystole - premature depolarization of the atria, ventricles, or atrioventricular junction, leading to premature contraction of the heart. Single episodic extrasystoles can occur even in practically healthy people. According to the electrocardiographic study, extrasystole is recorded in 70-80% of patients older than 50 years. A decrease in cardiac output during extrasystoles leads to a decrease in coronary and cerebral blood flow and can lead to the development of angina pectoris and transient cerebrovascular accidents (fainting, paresis, etc.). Extrasystole increases the risk of developing atrial fibrillation and sudden cardiac death.
Causes of extrasystole
Functional extrasystole, which develops in practically healthy people for no apparent reason, is considered idiopathic. Functional extrasystoles include:
- rhythm disturbances of neurogenic (psychogenic) origin associated with food (drinking strong tea and coffee), chemical factors, stress, alcohol intake, smoking, drug use, etc .;
- extrasystole in patients with autonomic dystonia, neuroses, osteochondrosis of the cervical spine, etc.;
- arrhythmia in healthy, well-trained athletes;
- extrasystole during menstruation in women.
Extrasystole of an organic nature occurs in case of myocardial damage with:
- IHD, cardiosclerosis, myocardial infarction,
- pericarditis, myocarditis,
- chronic circulatory failure, cor pulmonale,
- sarcoidosis, amyloidosis, hemochromatosis,
- cardiac operations,
- in some athletes, the cause of extrasystole may be myocardial dystrophy caused by physical overstrain (the so-called "athlete's heart").
Toxic extrasystoles develop with:
- feverish conditions,
- proarrhythmic side effect some drugs (eufillin, caffeine, novodrine, ephedrine, tricyclic antidepressants, glucocorticoids, neostigmine, sympatholytics, diuretics, digitalis preparations, etc.).
The development of extrasystole is due to a violation of the ratio of sodium, potassium, magnesium and calcium ions in myocardial cells, which negatively affects the conduction system of the heart. Physical activity can provoke extrasystoles associated with metabolic and cardiac disorders, and suppress extrasystoles caused by autonomic dysregulation.
Pathogenesis
The occurrence of extrasystole is explained by the appearance of ectopic foci of increased activity, localized outside the sinus node (in the atria, atrioventricular node or ventricles). The extraordinary impulses arising in them propagate through the heart muscle, causing premature contractions of the heart in the diastolic phase. Ectopic complexes can form in any part of the conduction system.
The volume of extrasystolic blood ejection is below normal, so frequent (more than 6-8 per minute) extrasystoles can lead to a marked decrease in the minute volume of blood circulation. The earlier the extrasystole develops, the less blood volume accompanies the extrasystolic ejection. This, first of all, is reflected in the coronary blood flow and can significantly complicate the course of the existing cardiac pathology.
Different types of extrasystoles have different clinical significance and prognostic characteristics. The most dangerous are ventricular extrasystoles that develop against the background of organic heart damage.
Classification
According to the etiological factor, extrasystoles of functional, organic and toxic genesis are distinguished. According to the place of formation of ectopic foci of excitation, there are:
- atrioventricular (from the atrioventricular connection - 2%),
- atrial extrasystoles (25%) and various combinations of them (10.2%).
- in extremely rare cases, extraordinary impulses come from the physiological pacemaker - the sinoatrial node (0.2% of cases).
Sometimes there is a functioning of the focus of the ectopic rhythm, regardless of the main (sinus), while two rhythms are noted simultaneously - extrasystolic and sinus. This phenomenon is called parasystole. Extrasystoles, following two in a row, are called paired, more than two - group (or volley). Distinguish:
- bigeminy- rhythm with alternating normal systole and extrasystole,
- trigeminy- alternation of two normal systoles with extrasystole,
- quadrihymenia- following an extrasystole after every third normal contraction.
Regularly repeated bigeminy, trigeminy and quadrihymeny are called allorhythmy. According to the time of occurrence of an extraordinary impulse in diastole, early extrasystole is isolated, which is recorded on the ECG simultaneously with the T wave or no later than 0.05 seconds after the end of the previous cycle; middle - 0.45-0.50 s after the T wave; late extrasystole, which develops before the next P wave of the usual contraction.
According to the frequency of occurrence of extrasystoles, rare (less than 5 per minute), medium (6-15 per minute), and frequent (more often than 15 per minute) extrasystoles are distinguished. By the number of ectopic foci of excitation, extrasystoles are monotopic (with one focus) and polytopic (with several foci of excitation).
Symptoms of extrasystole
Subjective sensations with extrasystole are not always expressed. Tolerability of extrasystoles is more difficult in people suffering from vegetative-vascular dystonia; patients with organic heart disease, on the contrary, can tolerate extrasystole much easier. More often, patients feel extrasystole as a blow, a push of the heart into the chest from the inside, due to vigorous contraction of the ventricles after a compensatory pause.
There are also "somersaults or overturning" of the heart, interruptions and fading in its work. Functional extrasystole is accompanied by hot flashes, discomfort, weakness, anxiety, sweating, lack of air.
Frequent extrasystoles, which are early and group in nature, cause a decrease in cardiac output, and, consequently, a decrease in coronary, cerebral and renal circulation by 8-25%. In patients with signs of cerebral atherosclerosis, dizziness is noted, transient forms of cerebrovascular accident (fainting, aphasia, paresis) may develop; in patients with coronary artery disease - angina attacks.
Complications
Group extrasystoles can transform into more dangerous rhythm disturbances: atrial - into atrial flutter, ventricular - into paroxysmal tachycardia. In patients with atrial congestion or dilatation, extrasystole may progress to atrial fibrillation.
Frequent extrasystoles cause chronic insufficiency coronary, cerebral, renal circulation. The most dangerous are ventricular extrasystoles due to possible development ventricular fibrillation and sudden death.
Diagnostics
Anamnesis and physical examination
The main objective method for diagnosing extrasystole is an ECG study, however, it is possible to suspect the presence of this type of arrhythmia during a physical examination and analysis of the patient's complaints. When talking with the patient, the circumstances of the occurrence of arrhythmia (emotional or physical stress, in a calm state, during sleep, etc.), the frequency of episodes of extrasystole, the effect of taking medications are specified. Particular attention is paid to the history of past diseases that can lead to organic damage to the heart or their possible undiagnosed manifestations.
During the examination, it is necessary to find out the etiology of extrasystole, since extrasystoles with organic heart damage require a different treatment strategy than functional or toxic ones. On palpation of the pulse on the radial artery, the extrasystole is defined as a prematurely occurring pulse wave followed by a pause or as an episode of pulse loss, which indicates insufficient diastolic filling of the ventricles.
During auscultation of the heart during an extrasystole over the apex of the heart, premature I and II tones are heard, while the I tone is enhanced due to low filling of the ventricles, and II - as a result of a small ejection of blood into pulmonary artery and the aorta is weakened.
Instrumental diagnostics
The diagnosis of extrasystole is confirmed after an ECG in standard leads and daily ECG monitoring. Often, using these methods, extrasystole is diagnosed in the absence of patient complaints. Electrocardiographic manifestations of extrasystole are:
- premature occurrence of the P wave or QRST complex; indicating a shortening of the pre-extrasystolic clutch interval: with atrial extrasystoles, the distance between the P wave of the main rhythm and the P wave of the extrasystole; with ventricular and atrioventricular extrasystoles - between the QRS complex of the main rhythm and the QRS complex of the extrasystole;
- significant deformation, expansion and high amplitude of the extrasystolic QRS complex with ventricular extrasystole;
- absence of P wave before ventricular extrasystole;
- following a complete compensatory pause after a ventricular extrasystole.
Holter ECG monitoring is a long-term (over 24-48 hours) ECG recording using a portable device attached to the patient's body. Registration of ECG indicators is accompanied by keeping a diary of the patient's activity, where he notes all his feelings and actions. Holter ECG monitoring is performed for all patients with cardiopathology, regardless of the presence of complaints indicating extrasystole and its detection in a standard ECG.
Forecast
The prognostic assessment of extrasystole depends on the presence of organic heart disease and the degree of ventricular dysfunction. The most serious concerns are caused by extrasystoles that developed against the background of acute infarction myocardium, cardiomyopathy, myocarditis. With pronounced morphological changes in the myocardium, extrasystoles can turn into atrial or ventricular fibrillation. In the absence of structural damage to the heart, extrasystole does not significantly affect the prognosis.
The malignant course of supraventricular extrasystoles can lead to the development of atrial fibrillation, ventricular extrasystoles - to persistent ventricular tachycardia, ventricular fibrillation and sudden death. The course of functional extrasystoles is usually benign.
Prevention
In a broad sense, the prevention of extrasystole provides for the prevention of pathological conditions and diseases underlying its development: coronary artery disease, cardiomyopathies, myocarditis, myocardial dystrophy, etc., as well as the prevention of their exacerbations. It is recommended to exclude drug, food, chemical intoxication that provoke extrasystole.
Patients with asymptomatic ventricular extrasystoles and no signs of cardiac pathology are recommended a diet enriched with magnesium and potassium salts, smoking cessation, drinking alcohol and strong coffee, and moderate physical activity.