Ventricular extrasystole. All about ventricular extrasystole: symptoms, treatment, consequences ECG multiple extrasystole

Ventricular extrasystole (VC)- 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.

ECG - signs of ventricular extrasystole

See picture below
1. Premature appearance of an altered QRS complex on the ECG
2. Significant expansion (up to 0.12 seconds or more) and deformation of the extrasystolic QRS complex
3. The location of the RS segment - G 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 ventricular extrasystole
5. The presence of a complete compensatory pause after ventricular extrasystole

With a left ventricular extrasystole, the interval of internal QRS deviation is increased in lead V1, with a right ventricular extrasystole - in lead V6.

There is no compensatory pause. Threatening ventricular extrasystoles are extrasystoles, which are often harbingers of more severe rhythm disturbances (,)

Threatening ventricular extrasystoles include:
1. Frequent
2. Polytopic
3. Pairs or groups
4. Early ventricular extrasystoles

The shape of extrasystolic QRS complexes is characteristic of ventricular extrasystoles, the pause is completely compensatory.

Consider the picture below. On him:
A - atrial extrasystoles (premature P waves are indicated by arrows - extrasystoles of the “P to T” type, the second atrial extrasystole is directed to the ventricles with blockade of the left bundle branch);
B - ventricular extrasystoles;
B - left: group atrial extrasystoles (a premature P wave is recorded before each extrasystole); - right: group ventricular extrasystoles;
G - ventricular parasystole; (C - confluent complex), the minimum interval between two parasystoles (1.4 seconds) is a common “divider” for all other interectopic intervals.

It has been proven that the following pose a danger to human life:
- frequent ventricular extrasystoles (more than 30 per hour), group (more than 3 in a row);
- polytopic ventricular extrasystoles (various shapes, dilated ventricular complexes and ECG);
- early ventricular extrasystole, the so-called “R” on “T”.

The above-mentioned ventricular extrasystoles that occur in persons with coronary artery disease, especially with AMI, ACS, are dangerous. In these cases, it is necessary to administer lidocaine 2% - 80 mg. IV jet, or 10% - 2.0 IM. In other cases of emergency administration

ECG criteria for ventricular extrasystole

Ventricular extrasystoles can originate in any part of the myocardium: at the base of the heart, in the interventricular septum, in any of the walls of the right and left ventricles. Depending on the place of origin and the state of the conduction system of the heart, extrasystolic complexes will have different shapes and polarities in different leads.

Ventricular extrasystoles are usually wide (more than 0.12 sec.) with a sharply changed QRS morphology, different from normal contractions.
Discordant ST+T shift (this means that ST+T shifts in the opposite direction from the ventricular complex: up if the complex is negative, and down if positive).
Usually after an extrasystole there is a complete compensatory pause ().
Extrasystole can sometimes retrogradely excite the atria, passing through the AV node.

Extrasystoles: left ventricular and right ventricular

Despite the fact that ventricular extrasystoles can originate in any part of the ventricular myocardium, in clinical practice, right and left ventricular extrasystoles are traditionally distinguished. To determine their type, evaluate leads V1 and V6:

Left ventricular extrasystoles have a complex morphologically similar to right bundle branch block (positive in V1, negative in V6).
Right ventricular extrasystoles form a complex similar to left bundle branch block (negative in V1, positive to V6).

Classification of extrasystoles depending on frequency:

Rare
Frequent(more than 5 per minute or more than 30 per hour with Holter monitoring).

Types of extrasystoles depending on the number of ectopic foci and morphology

Monotopic (one focus, for example, in the right ventricle)
Polytopic (two or more foci, for example, in the right and left ventricles)
Monomorphic (all extrasystoles are identical - this only happens if they are from the same source)
Polymorphic (the shape of extrasystoles is different, although they can come from the same anatomical area)

Depending on the rhythm and “accuracy” of occurrence

Example 1: Left Ventricular Trigeminy

The rhythm is sinus, irregular, 75 beats per minute.
Left ventricular trigeminy (left ventricular - because the extrasystolic complex is positive in the right leads V1-V2 and negative in V6).

Example 2: polytopic extrasystole against the background of acute coronary syndrome

Sinus rhythm, irregular, heart rate 100 beats/min, sinus tachycardia, frequent polytopic ventricular extrasystole (complexes with different directions), episode of paired ventricular extrasystole.
EOS is deviated to the left
Signs of disturbance of coronary blood flow in the anterolateral wall of the left ventricle: oblique ST depression and T wave inversion in I, aVL, V2-V6). At the prehospital stage, such an ECG makes it possible to make a diagnosis of “acute coronary syndrome”, because there are characteristic ECG signs of myocardial ischemia in conjunction with the clinical picture

Example 3: single ventricular extrasystole

Rhythm: atrial (biphasic P waves in II, III, aVF, V1-V 6); rhythm frequency: 58 beats/min; PQ - 0.20 s, QRS - 0.07 s, QT - 0.40 s; normal position of the EOS (angle α +500)
Single ventricular extrasystole (presence of an extraordinary altered ventricular QRS complex, significant expansion and deformation of the extrasystolic complex, complete compensatory pause)
Disruption of repolarization processes in the lower diaphragmatic and lateral parts of the LV wall (horizontal depression of the ST segment by 1 mm in II, III, aVF, V 5-V 6), probably due to ischemia.

Example 4: frequent ventricular extrasystole due to atrial fibrillation

Atrial fibrillation with heart rate 90-150 per minute. (on average - 115 per minute). Normal EOS (maximum QRS amplitude in lead II).
Frequent single ventricular extrasystoles.
The first, sixth, ninth and fourteenth contractions on this ECG are extrasystolic. Please note that extrasystolic complexes differ sharply from normal ones in width and morphology.
The fourth and twelfth complexes can be considered as a transient blockade of LPPG, which is supported by the similarity of this complex with the normal complexes of this patient, as well as the morphology similar to LPPG. Such transient blockade can be observed in patients with long-term coronary artery disease, especially against the background of atrial fibrillation, and is considered as a sign of myocardial ischemia. Read more: Ashman phenomenon.

Example 5: frequent polytopic extrasystole and ventricular tachycardia in a patient with coronary artery disease

Sinus rhythm, irregular, frequent group polytopic polymorphic ventricular extrasystole (represented by wide QRS complexes, after which a compensatory pause is observed), runs of ventricular tachycardia (> 3 ventricular extrasystoles in a row)
Heart rate ≈ 90 beats/min.
EOS is deflected to the left (angle α ≈ -10°)
Signs of myocardial ischemia along the anterior wall of the LV (sloping depression of the ST segment in I, II, V2-V6)
Please note that very few normal contractions are recorded on the ECG: these are the sixth, tenth, eleventh, twelfth complexes, and one each before episodes of extrasystole in the chest leads.

Ventricular extrasystoles are characterized by the premature appearance of a widened and deformed QRS complex.

Unlike an atrial extrasystole, there is always a compensatory pause before a ventricular extrasystole.

Ventricular extrasystole is a common heart rhythm disturbance. It can be observed both in healthy people, not accompanied by any other symptoms, and in people with heart disease.

Ventricular extrasystole- frequent heart rhythm disturbances, which can be observed in healthy people, not accompanied by any other symptoms, but more often in people with various heart diseases, in particular coronary artery disease, heart defects, cardiomyopathies, myocarditis. The cause of ventricular extrasystole is an ectopic focus of excitation in the RV or LV.

Under ventricular extrasystole understand premature contraction of the ventricles caused by the focus of excitation, which is located in the ventricles themselves. Using electrocardiography, it is easier to recognize ventricular extrasystole than supraventricular (atrial extrasystole). Ventricular extrasystoles are characterized by premature widened (more than 0.11 s) and deformed QRS complexes, which in their configuration resemble PG branch block.

So, when extrasystoles in the right ventricle (RV) it is excited earlier than the left ventricle (LV), therefore a wide QRS complex is recorded, reminiscent in configuration of LBP blockade, since the LV excitation occurs with a delay. If the focus of the extrasystole is in the LV, then the configuration of the QRS complex resembles PNPG block.

Ventricular extrasystole. Scheme.
a Left ventricular extrasystole with a compensatory pause (picture of PNPG block).
b Right ventricular extrasystole with a compensatory pause (picture of LBP block).

Ventricular extrasystole:
a Ventricular extrasystole in the form of bigeminy. fixed paired ventricular extrasystoles.
b Interpolated and non-interpolated ventricular extrasystoles.
The last three ventricular extrasystoles are not interpolated; there is a compensatory pause.
c Heterotopic multiple ventricular extrasystoles.
d Group ventricular extrasystoles with the “R to T” phenomenon (x).

Clinical significance ventricular extrasystole depends on how often extrasystoles appear and whether they are single, paired or group. A group is understood to mean several extrasystoles following each other. Next, you should also take into account the configuration of the extrasystoles. If the extrasystoles have the same configuration, then they come from the same focus and are called monomorphic or monotopic, but if the extrasystoles are different in configuration, then we are talking about polymorphic or polytopic extrasystoles.

At ventricular extrasystole, unlike atrial extrasystole, there is always a compensatory pause. This means that the total duration of 2 contractions (before and after the extrasystole) is equal to twice the RR interval of normal contractions. The RR interval is understood, as mentioned earlier in the chapter on atrial extrasystoles, to be the distance from one R wave to the adjacent R wave.

The compensatory pause is explained as follows: the excitability of the sinus node and atria is not impaired during ventricular extrasystole. Since excitation from the sinus node reaches the ventricles in the absolute refractory period associated with extrasystole, excitation of the ventricles is impossible. Only when the next wave of excitation arrives from the sinus node is normal contraction of the ventricles possible.

At ventricular extrasystole due to the pathological propagation of the excitation wave, a secondary repolarization disorder also appears in the form of depression of the ST segment and a negative T wave.

For treatment of ventricular extrasystole The doctor has various antiarrhythmic drugs at his disposal, for example, beta-adrenergic receptor blockers and propafenone (prescribed only for severe clinical symptoms). Due to the arrhythmogenic effect inherent in all antiarrhythmic drugs (the frequency of cardiac arrhythmias caused by them is on average 10%), the attitude towards them is currently more restrained and they are prescribed with greater caution.

Features of the ECG with ventricular extrasystoles:
Premature appearance of the QRS complex
Widening of the QRS complex, the configuration of which resembles the blockade of the corresponding leg of the PG
Presence of a compensatory pause
Sometimes occurs in healthy people, but more often in people with heart disease
Treatment is indicated only when clinical symptoms appear. Beta-adrenergic receptor blockers, propafenone, amiodarone are prescribed

Ventricular extrasystole.
Premature appearance of a widened and deformed QRS complex; every second ventricular contraction is an extrasystole (VES),
Therefore, this heart rhythm disorder is called ventricular bigeminy.

Multiple ventricular extrasystoles in myocardial infarction (MI) of lower localization.
Frequent quadrigemynia. Normal complexes show signs of myocardial infarction (MI) of lower localization (x).

Educational video ECG for extrasystole and its types

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Extraordinary contractions of the heart are called extrasystole. Depending on the location of the source of excitation, several forms of pathology are distinguished. Ventricular extrasystole is considered clinically unfavorable; what it is will be discussed in detail.

Cardiovascular diseases are among the top five diseases that lead to human disability. Extrasystole is the most popular, as it occurs in 70% of people. It can be detected at any age; there is also no connection between the pathology and gender and constitutional characteristics.

Predisposing factors for the development of extrasystole include arterial hypertension, coronary heart disease, heart defects, lack of potassium and magnesium in the blood, as well as gender and age.

Extrasystoles are usually divided into two large groups: atrial and ventricular. The second type is characterized by an unfavorable clinical course, so it is worth knowing why ventricular extrasystole is dangerous and what treatment options are offered by modern medicine.

Description of ventricular extrasystole

The term “ventricular extrasystole” (VES) refers to a pathological process occurring in the left or right ventricle and causing premature contraction of the corresponding parts of the heart.

There are three mechanisms for the development of the disease: violation of automaticity, trigger activity, circular passage of a wave of excitation (re-entry).

Violation of automaticity carried out in the direction of increasing heart rate. This is due to the subthreshold potential of the pathological focus located in the ventricles. Under the influence of a normal rhythm, it transitions to a threshold rhythm, resulting in premature contraction. A similar development mechanism is typical for arrhythmias developing against the background of myocardial ischemia, electrolyte dysfunctions, and excess amounts of catecholamines.

Trigger activity - represents the occurrence of an extraordinary impulse under the influence of post-depolarization, which is associated with the previous action potential. There are early (formed during repolarization) and late (formed after repolarization) trigger activity. It is associated with those extrasystoles that appear during bradycardia, myocardial ischemia, electrolyte disorders, and intoxication with certain drugs (for example, digitalis).

Circular passage of the excitation wave (re-entry) is formed during various organic disorders, when the myocardium becomes heterogeneous, which interferes with the normal passage of the impulse. In the area of scar or ischemia, areas with unequal conductive and restorative rates are formed. As a result, both single ventricular extrasystoles and paroxysmal attacks of tachycardia appear.

Symptoms of ventricular extrasystole

In most cases there are no complaints. To a lesser extent, the following symptoms occur:

uneven heartbeat;
weakness and dizziness;
lack of air;
chest pain is located in an atypical location;
the pulsation can be very pronounced and therefore felt by the patient.

The occurrence of the latter symptom complex is associated with an increase in the force of contraction that appears after extrasystole. Therefore, it is not felt as an extraordinary contraction, but rather in the form of a “fading heart.” Some symptoms of ventricular extrasystole are caused by the underlying pathology that caused the development of the rhythm disturbance.

Corrigan's venous waves- pathological pulsation that occurs with premature contraction of the ventricles against the background of a closed tricuspid valve and right atrium systole. It manifests itself as pulsation of the neck veins, which is so pronounced that it can be noticed during an objective examination of the patient.

When measuring blood pressure, arrhythmic cardiac activity is determined. In some cases, a pulse deficit is established. Sometimes extrasystoles occur so often that an erroneous diagnosis may be made.

Causes of ventricular extrasystole

Non-cardiac and cardiac factors in the occurrence of pathology are considered.

Non-cardiac causes associated more with electrolyte disorders, often occurring during a lack of potassium, magnesium and excess calcium concentration in the blood. The latter disorder is largely associated with malignant processes occurring in the skeletal system, hyperparathyroidism, Paget's disease, and treatment with calcium preparations (which is observed in the treatment of peptic ulcers).

Stressful situations, unhealthy diet, disruption of sleep and rest patterns, and intake of harmful substances (toxic, alcohol, drugs) have a negative impact on the cardiac system. Sometimes after surgery, anesthesia or hypoxia, ventricular extrasystole also develops.

Cardiac factors associated with various pathological conditions of the cardiovascular system. First of all, the ventricular myocardium suffers during heart attacks and ischemic heart disease. Heart defects (mitral valve prolapse), cardiomyopathies and myocarditis have a negative effect on the structure of muscle tissue. Against the background of a slow and rapid heart rate, extraordinary contractions of the ventricles often occur.

Types of ventricular extrasystole

During the study of ventricular extrasystole as a pathology, various classifications and characteristics were created. Based on these, diagnoses are made and subsequent treatment is carried out.

Single and polytopic ventricular extrasystoles

Extrasystoles formed by premature ventricular contractions differ in their characteristics:

the frequency of display on the ECG divides extrasystoles into single, multiple, paired and group;
the time of occurrence of extrasystoles can characterize them as early, late and interpolated;
the number of pathological foci varies, therefore polytopic (more than 15 times per minute) and monotopic extrasystoles are distinguished;
orderliness of extrasystoles is considered in the case of their uniform presence on the ECG; disordered extrasystoles also occur.

The course of ventricular extrasystole

In most cases, benign PVCs occur. If they are present, organic changes are not detected in the heart, the patient may not have any complaints or they are insignificant. In this case, the prognosis is favorable, so you should not worry about whether this disease, ventricular extrasystole, is dangerous.

With potentially malignant ventricular extrasystole, organic changes in the structure of the heart are determined. Most of them are associated with cardiac pathology - heart attack, ischemic heart disease, cardiomyopathies. In this case, the likelihood of premature cessation of cardiac activity increases.

The malignant course of ventricular extrasystole is extremely dangerous for the patient’s life. Cardiac arrest may develop and, in the absence of medical assistance, death. Malignancy is caused by the presence of serious organic disorders.

Classifications of ventricular extrasystoles

The Lown and Ryan classifications were previously often used in medical practice. They include five classes, from the lightest 0 to the heaviest 5, characterized by organic changes in the tissues of the heart. The first three classes are almost identical in their properties in both classifications:

0 - no ventricular extrasystole;

1 - extrasystoles are monotypic, appear infrequently, no more than 30 per hour;

2 - extrasystoles are monotypic, occur frequently, more than 30 per hour;

3 - polytypic extrasystoles are determined

4a - paired extrasystoles;

4b - ventricular tachycardia with the occurrence of VES of 3 or more;

5 - early ventricular extrasystoles occur.

According to Ryan, classes are described differently:

4a - monomorphic extrasystoles follow in pairs;

4b - polymorphic extrasystoles are arranged in pairs;

5 - ventricular tachycardia with the development of VVCs of 3 or more.

In modern medicine, another division of ventricular extrasystole is common, according to Myerburg from 1984. It is based on monomorphic and polymorphic ventricular extrasystoles that occur in a single variant.

In accordance with the new classification by frequency, PVCs are divided into five classes: 1 - rare extrasystoles, 2 - infrequent extraordinary contractions, 3 - moderately frequent extrasystoles, 4 - frequent premature contractions, 5 - very frequent.

According to the characteristics of the rhythm disturbance, ventricular extrasystoles are divided into types: A - monomorphic in a single number, B - polymorphic in a single number, C - running in pairs, D - unstable in their dynamics, E - stable.

Complications of ventricular extrasystole

Basically, there is a worsening of the underlying disease against which the PVC developed. The following complications and consequences also occur:

the anatomical configuration of the ventricle changes;
transition of extrasystole to fibrillation, which is dangerous with a high risk of death;
the development of heart failure is possible, which most often occurs with polytopic, multiple extrasystoles.
the most dangerous complication is sudden cardiac arrest.

Diagnosis of ventricular extrasystole

It begins with listening to the patient’s complaints, an objective examination, and listening to the activity of the heart. Next, the doctor prescribes an instrumental examination. The main diagnostic method is electrocardiography.

ECG signs of ventricular extrasystole:

the QRS complex appears prematurely;
in its shape and size, the extraordinary QRS complex differs from other normal ones;
there is no P wave in front of the QRS complex formed by the extrasystole;
after an incorrect QRS complex there is always a compensatory pause - an elongated segment of the isoline located between the extraordinary and normal contractions.

Holter ECG monitoring- often prescribed to patients with severe or unstable left ventricular failure. During the study, it is possible to determine rare extrasystoles - up to 10 per minute and frequent - more than 10 per minute.

EPI, or electrophysiological study, shown to two groups of patients. First, there are no structural changes in the heart, but correction of drug treatment is necessary. Second, organic disorders are present; diagnostics are carried out to assess the risk of sudden death.

Signal-averaged ECG- a new method that is promising in terms of identifying patients with a high probability of developing severe forms of PVCs. Also helps in determining unstable ventricular tachycardia.

Treatment of ventricular extrasystole

Before starting therapy, the following situations are assessed:

manifestations of ventricular extrasystole;
factors provoking the development of the disease, which may be associated with structural disorders, the presence of coronary heart disease, and left ventricular dysfunction.
undesirable conditions in the form of proarrhythmic effects that can complicate the course of the disease.

Depending on the course, form and severity of PVCs, treatment is carried out in the following areas:

Single, monomorphic, so-called “simple” extrasystoles, which do not cause hemodynamic disturbances, do not require specific treatment. It is enough to adjust your daily routine and diet, and treat the underlying ailment that could cause PVCs.
Unstable VES, the appearance of paired, polytopic, frequent extrasystoles lead to hemodynamic disturbances, therefore, to reduce the risk of ventricular fibrillation and cardiac arrest, antiarrhythmic drugs are prescribed. Basically, they start with beta-blockers, and if necessary, statins and aspirin are prescribed. In parallel, drugs are used to treat the underlying disease that caused the extrasystole.
Malignant PVC often requires the prescription of highly effective drugs - amiodarone, sotapol and the like, which have a good arrhythmogenic effect. If necessary, they are combined with maintenance doses of beta-blockers and ACE inhibitors.

Surgical treatment is indicated in case of ineffectiveness of drug therapy. Depending on the situation, destruction of the pathological focus of excitation, implantation of a cardioverter-defibrillator or an anti-tachycardia device may be prescribed.

Secondary prevention of ventricular extrasystole

To prevent the development of PVCs, you should first of all follow the doctor’s recommendations, which mainly consist of taking medications in a timely manner and observing a sleep and rest schedule. It is also important to eat well and eliminate bad habits. If physical inactivity is observed, you need to increase physical activity according to the body’s capabilities.

Video: Treatment of ventricular extrasystole

Ventricular extrasystole (abbreviation – VES) in cardiology is considered one of the most common pathologies of the heart.

It is characterized by a rhythm disturbance - the occurrence of chaotic extraordinary contractions of the ventricles. The localization of the disorder often becomes the reason for disappointing forecasts for doctors.

Normally, the impulse generator that controls the contraction of the heart is the sinus node. While it is functioning normally, backup sources of impulse are suppressed.

An extrasystole indicates that such a (secondary) source of impulse has intensified its activity.

It is in the intraventricular system (Purkinje fibers, trunk of the His bundle, its branches or legs) that extraordinary impulses arise, causing the ventricles to contract without prior contraction of the atria. This can be seen on the electrocardiogram: there is no full-fledged P wave, indicating the functioning of the atria.

Experts have given a name to this phenomenon – the reentry mechanism. This means that the impulse conducting the excitation passes along a closed path and repeats its action. This mechanism, according to scientists, often causes various forms of arrhythmias.

During an extraordinary contraction, the ventricles do not pump blood, and the transient function does not occur. This is a fruitless waste of the strength of the heart, which at that moment should have been “resting”, but as a result – “working for wear and tear”.

There are relative norms for the number of extrasystoles occurring during the day:

600-950 - are considered a non-life-threatening condition if there are no other abnormalities in the heart and disturbing symptoms (tachycardia, causeless shortness of breath).
1000-1200 are polymorphic extrasystoles. They are accompanied by a noticeable failure of the heart, which is not only displayed on the ECG, but also felt by the patient himself.
1200 or more extraordinary contractions of the ventricles per day are a direct threat to human life and health.

In healthy people, up to one hundred rare extraordinary extrasystoles can occur during the day, which do not in any way affect the overall functioning of the heart or the person’s well-being. In a child, PVCs and other heart rhythm disturbances (abbreviated as HRS) are often observed during puberty.

Causes of extrasystole

The general list of causes of ventricular extrasystole can be divided into 2 groups:

functional disorders - contractions of the ventricles that arose under the influence of short-term physiological factors;
organic disorders - intercalary extrasystoles, provoked by pathological changes (diseases of the heart and blood vessels).

Neurogenic factors

They are also called idiopathic (non-cardiac) causes of extrasystoles.

These include:

smoking;
alcohol consumption;
passion for strong coffee (increased tone of the sympathetic nerve);
frequent stay in a state of stress, depressive tendencies;
insomnia, overeating or mental work (irritation of the vagus nerve occurs;

Neurogenic factors provoke increased activity of the sympathetic-adrenal system. As a result, extraordinary contractions of the ventricles of the heart occur.

Heart diseases

A number of pathologies of the cardiovascular system can be a direct trigger for ventricular extrasystoles:

Coronary heart disease (CHD).
Myocardial infarction, .
Arterial hypertension.
Atrial tachycardia.
Inflammatory pathologies (endocarditis, myocarditis).
Heart defects in the stage of decompensation.
Cardiomyopathies.
Supraventricular extrasystole.
Heart failure (chronic and acute).
Mitral valve prolapse.
The presence and activation of excess electrical impulse-conducting beams (James or Kent beam).

Pathological conditions also include ventricular extrasystoles caused by an overdose of cardiac glycosides.

Other diseases

Among other pathologies of a non-cardiological nature, experts note:

Thyroid gland dysfunction. This is excessive or low production of essential hormones.
Vegetovascular dystonia (VSD), neurocirculatory dystonia, vagotonia.
Pulmonary diseases (PVS are provoked by many drugs used in treatment - Eufillin, Berodual, Salbutamol and others).
Cervical osteochondrosis of the spine.
Diseases for which diuretics, antidepressants, and ß-agonists are used.

Classification

The classification of ventricular extrasystoles covers all the characteristics of the phenomenon that has arisen.

This is necessary for specialists in order to adequately assess the threat to health, prescribe effective treatment (if necessary) and make a prognosis.

Consequently, according to the source of occurrence of PVCs there are:

Monotopic - with one ectopic focus of the impulse (in one ventricle).
Polytopic - with several secondary foci of impulse (left ventricular and right ventricular at the same time).

According to the duration of the compensatory pause:

A complete compensatory pause means that the sum of the pre- and post-ectopic interval is equivalent in duration to the two main cardiac cycles.
Incomplete compensatory pause - if the sum of the intervals is less than the duration of the two main cardiac cycles.

According to Lown-Wolf-Ryan (B. Lown, M. Wolf, M. Ryan), ventricular extrasystoles are divided into 5 degrees to take into account the risk of developing fibrillation:

1st degree – monomorphic extrasystoles (less than 30 per hour allowed).
2nd degree – monomorphic, more than 30 per hour.
3rd degree – polymorphic (group, paired) extraordinary contractions.
4th degree - divided into subcategories “a” - twin, “b” - salvo.
Grade 5 – volley polymorphic PVCs (3-5 in half a minute), fixing paroxysmal supraventricular tachycardia. In such a situation, a person needs emergency help.

There is also a 0 (zero) degree. It means the complete absence of extrasystoles (single).

Gradation by time of occurrence:

Early - occurring during the passage of an impulse through the atria.
Interpolated - simultaneous contraction of the right and left ventricles with the atria occurs.
Late - extrasystoles during the “rest” of the upper chambers of the heart.

Circadian types of extrasystoles:

mixed;
daytime;
nocturnal

According to their rhythm, they are divided into allorhythms (periodic) and sporadic (single, irregular) extraordinary contractions.

Allorhythmia is divided into:

– for every second normal contraction there is 1 extrasystole.
Trigemy - every third.
Quadrigeminiy - every fourth contraction is interrupted by an extraordinary contraction.

Symptoms

If the patient does not have underlying cardiac pathologies, then, paradoxically, ventricular extrasystole is more difficult for them to tolerate than with the presence of diseases.

This is due to some compensatory capabilities of the body.

In a young, relatively healthy person, VES will manifest itself:

A feeling of “cardiac arrest” followed by a series of palpable beats. Trying to describe their condition, patients say that their heart is sinking.
Several strong heartbeats against the background of a calm state.

Women during pregnancy also often experience a sensation of extraordinary shocks in the heart area. This is due to hormonal changes, but if the symptoms are alarming, you need to consult a doctor and measure all indicators.

Even in the presence of all the above symptoms and signs, it is possible to assert the presence of ventricular extrasystole only on the basis of diagnostic results.

Important: if any symptoms appear, you must consult a general practitioner or cardiologist.

ECG and other diagnostic methods

The following methods are used to diagnose the disease:

ECG. Allows you to record everything that happens to the human heart during systole (contraction) and diastole (relaxation). When deciphering the cardiogram, the appearance of an expanded and deformed ventricular QRS complex, a complete compensatory pause, the absence of a P wave before an extraordinary contraction, and a change in the refractory period are observed.
. This is a diagnostic method during which a special device with sensors is attached to a person, with which he must live his normal day. It is this daily observation that gives specialists the opportunity to track the periods and frequency of occurrence of extraordinary contractions of the ventricles. Holter monitoring is the main method for diagnosing PVCs.
. The method is used to confirm or refute the relationship between pathology and physical activity.

Additional diagnostic methods are used:

General and biochemical blood test (to detect cholesterol levels, which could trigger the development of atherosclerosis).
Blood test for thyroid hormones.
Polycardiography.
Rhythmocardiography.
Transesophageal ECG.
Sphygmography.

Usually, to determine the correct diagnosis, the patient only needs to undergo an ECG and a Holter study, but in some cases a detailed blood test and stress tests may be required.

Therapy for ventricular extrasystole

Depending on the cause of the pathology, the specialist individually selects a method of treating the patient.

There is one general rule: therapy must be comprehensive. This is the only way to relieve symptoms.

First of all, patients should exclude idiopathic factors that provoke ventricular extrasystoles and possible complications:

Quit smoking (completely).
Reduce the amount of coffee and strong tea to 1 cup per day.
Abstain from drinking.
Do simple exercises (exercises) every day.

As for athletes, if they feel tremors in the heart after physical activity and this is visible on electrocardiography, it should be moderated or eliminated for a while. If the symptoms of PVCs do not manifest themselves in characteristic episodes, or they are single, then you can play sports.

Diet is what doctors prescribe for almost any disease. Indeed, properly organized nutrition at home will help the cardiovascular system cope with pathology faster.

You should refuse:

fat;
fried;
products with synthetic food additives (yogurt, chips);
salty (salt increases blood pressure, which can increase the frequency of extrasystole attacks).

It will be useful to include in your diet:

bananas;
dried fruits;
natural dairy products;
raw vegetables, nuts.

Drug treatment

If pathological contractions of the ventricles of the heart occur more than 30 times per hour, and lifestyle and nutrition adjustments have not helped, and the patient complains of a palpable, sharp heartbeat, doctors prescribe medication.

Its goal is to eliminate symptoms and prevent the development of severe types of arrhythmias:

Stage 1 - sedative herbal medicines, ß-blockers (Obzidan, Anaprilin, Nebilet), blood thinners (Aspirin, Cardiomagnyl), Panangin, Asparkam.
Stage 2 – administration of antiarrhythmic drugs (if there is no effect of treatment at stage 1). According to cardiologists, class 2 antiarrhythmics are considered the safest. These are Allapinin, Amiodarone, Propranolol, Metoprolol, Verapamil. "Etatsizin" (1st class), "Lidocaine", "Mexarithm".
Stage 3 - taking class 3 antiarrhythmic drugs (Amiodarone, Cordarone) - the drugs of choice to prevent ventricular fibrillation.
Stage 4 – use of a combination of drugs (ß-blockers, antiarrhythmics).

Important: These medications have a pronounced cardiac effect, so only a doctor can take into account all the risks and prescribe it to the patient. The choice of medication and dosage should be entrusted to a cardiologist; self-medication with antiarrhythmics is unacceptable.

Surgical methods

The opinions of cardiologists regarding surgical intervention for this pathology agree on one thing - it is indicated for the patient only if it was not possible to get rid of extrasystole with the help of medications.

The most commonly used method is called radiofrequency ablation (RFA). During the procedure, with the help of radio waves, sources of pathological impulses are destroyed.

A contraindication to surgery in adults may be that the patient is not able to tolerate general anesthesia.

Possible consequences

The development and outcome of the pathology depends on at what stage it was diagnosed, how it manifested itself, and what methods were used to treat it.

Physiological extrasystoles do not threaten life and health, but organic ones, if untimely and improperly treated, are dangerous and sooner or later will cause disability or premature death of a person.

Forecast

Even if the patient has been diagnosed with ventricular extrasystole due to heart disease, treatment should be started as early as possible, not deviate from the pill regimen prescribed by the doctor, and lead a healthy lifestyle. Only in this case will the prognosis be favorable and the person will be able to cure the pathology and live a long, fulfilling life.

Even if the heart is not bothered by interruptions in its work, it is very important to understand that many pathologies occur hidden and are detected too late (especially in men). Therefore, it is extremely important to undergo a routine medical examination and an ECG every year.