Extrasystolia
Extrasystole is a special arrhythmia that is characterized by extraordinary extrasystoles( cardiac contractions) with certain impulses occurring in the myocardium as an additional site of excitation. Since the cardiac muscle after its contraction remains unexcitable at some point, the next normally occurring impulse is unable to cause a systolic contraction, so a definite pause of compensatory character develops.
Extrasystolia is characterized by short-term cardiac fading, that is, by the occurrence of disruptions in its functioning. As a rule, atrial arrhythmia and ventricular are distinguished, which are characterized by single and multiple forms of flow, and also manifest by normal or erratic contractions. It is rare enough to note the appearance of group extrasystoles. This arrhythmia can appear in people who have no cardiac pathology. In the main, a single-occurrence extrasystole does not have a characteristic symptomatic pattern.
Extrasystolia in the atria develops as a result of mitral cardiac defects and cardiosclerosis. Often this arrhythmia, especially in the group form, in the presence of these pathologies is a precursor of fibrillation.
Extrasystolia in the ventricles is a consequence of nervous and mental disorders, myocardial damage, and other changes. Frequent arrhythmia, which comes from different parts of the heart, can provoke ventricular fibrillation.
To diagnose this condition, ECG is used. Treatment is prescribed, starting from the cause of extrasystole. Sometimes resort to the use of antiarrhythmic drugs.
Heart extrasystole
A heart rhythm with impairments, which is characterized by additional contractions of individual extrasystoles or the heart as a whole, is called extrasystoles of the heart. This condition is a strong heart attack with a feeling of a dying heart, the appearance of anxiety and lack of air. With extrasystoles of the heart, cardiac output decreases, as a result of which the blood flow in the coronary and cerebral vessels decreases, and this leads to the development of angina pectoris, syncope, paresis and other pathologies. The appearance of extrasystole provokes the onset of fibrillation and cardiac arrest. Also extrasystole of the heart can occur in almost non-sick people. Based on the studies of the electrocardiogram this type of arrhythmia is defined in 75% of patients after fifty years.
The development of extrasystole is caused by the increased activity of ectopic foci, which are localized in the ventricles, atria and atrioventricular node. And the characteristic impulses that arise in them outside the queue, spread through the myocardium and cause cardiac contractions of a premature nature in the phase of diastole. Such complexes can appear in any part of the conducting system.
Extrasystolia is characterized by a reduced release of blood, so frequent contractions can cause a marked decrease in IOC( minute volume of circulation).Therefore, early development of extrasystole leads to a decrease in blood volume during extrasystolic ejection. And this affects the coronary circulation and can cause heart complications.
Heart extrasystole is a variety of arrhythmias that are characterized by the unequal significance of the symptoms and the prediction of these conditions. Among the most dangerous are extrasystoles of the ventricles, developing with heart damage of an organic nature.
As a rule, the location of the localization of the exciting ectopic focus influences the extrasystole; therefore, they are atrioventricular, ventricular and atrial, and also different in their combinations. Very rarely, the characteristic impulses come from the sinus and atrial node, and sometimes there is a simultaneous contraction - extrasystolic and sinus. Such an arrhythmia is called parasystole.
Extrasystoles that consistently appear are considered paired, and more than two arise - volley or group.
The heart rhythm, which is characterized by the alternation of extrasystoles and systoles of a normal nature, is bigemini, and with the alternation of extrasystoles with two normal systoles - trigeminia. With regularly repeating these abbreviations, allorhythmia is formed.
Heart extrasystolia can be early, which is recorded on the electrocardiogram simultaneously with the T-tooth;Middle - 0.50 seconds after the T-wave and later - before the P-tooth of the usual cardiac contraction. In addition, extrasystoles are rare, medium and frequent, and can also appear in one focus of excitation( monotopic) and in several( polytopic).
Basically, the causes of heart extrasystoles are neurogenic( psychogenic) disorders of the heart rhythm caused by chemical and nutritional factors, alcohol, nicotine and drug use.
Extrasystole of the heart of functional genesis is noted in patients with VSD, osteochondrosis and neuroses. And in people who are practically healthy, it appears among athletes, women during the menstrual cycle, after stress, drinking coffee or tea. This form of extrasystole is considered idiopathic, which develops for no apparent reason.
Extrasystolia of organic etiology is formed as a result of IHD, cardiosclerosis, pericarditis, pulmonary heart, hemizromatosis, amyloidosis, cardiomyopathies, cardiac malformations, myocardial damage against the background of sakoidosis. And for a certain group of athletes the cause of this arrhythmia is myocardial dystrophy as a result of physical overstrain.
Extrasystolia of toxic genesis is due to fever temperature rise, side effect on antiarrhythmics and thyrotoxicosis. Also these arrhythmias can be formed as a consequence of violations of the relationships between magnesium, calcium, sodium and potassium ions in the myocardium, which have a negative effect on the system that conducts pulses. Loads of a physical nature can cause extrasystoles as a result of cardiac changes and metabolism.
The symptomatic picture of the extrasystole is characterized by an impulse in the heart region from the inside, as a result of abrupt ventricular contractions after a compensatory pause. In addition, there is a cardiac fading and a violation of his work.
With functional extrasystole, hot flashes occur, discomfort appears in the form of weakness, anxiety, sweating and lack of air.
Frequent early arrhythmias, as well as group ones, reduce cardiac output, reduce blood circulation in the renal, cerebrovascular and coronary vessels by almost 25%.In patients with atherosclerotic lesions of the cerebral vessels, head spinning, aphasia, loss of consciousness and paresis, and with coronary artery disease, angina develops.
Complications of extrasystole may be atrial flutter, paroxysmal tachycardia, atrial fibrillation. And often occurring extrasystoles cause chronic insufficient circulation in the coronary vessels, kidneys and brain. The most dangerous are ventricular extrasystoles, since they can provoke ventricular fibrillation or sudden death.
For the diagnosis of extrasystoles, an electrocardiogram is used, but this type of arrhythmic cardiac contraction can be assumed when examining the patient and the patient's characteristic complaints.
Extrasystole causes
This type of arrhythmia is quite often detected in individuals who are considered to be completely healthy. So, for example, when examining a large number of people, extrasystole was found in almost 49%.And during a multiple examination of a hundred people over the course of a day with the help of tele-electrocardiography, this kind of arrhythmia was detected in almost 30%.Thus, interruptions occurring in the work of the heart, are not a sign of the pathological process of the myocardium.
Basically, extrasystole develops as a consequence of some extracardiac influences. With the help of the conducted experiments it was found out that the extrasystole is caused by the irritation of a certain part of the brain. These departments include: the brain's cortex, the hypothalamus, the thalamus, the medulla oblongata, and the cerebellum. Isolate the extrasystole, which is formed against a background of anxiety, conflict, anger, fear, emotional experiences. In addition, this arrhythmia can be a manifestation of a common neurosis.
The causes of reflex extrasystole are exacerbations of stomach diseases, chronic form of cholecystitis, pancreatitis, diaphragmatic hernia and abdominal surgery, as well as pathological processes in the mediastinum, lungs, various pleural joints and pericardium. Thus, a significant role in the formation of extrasystole is given to the state of the central nervous system and vegetative.
But the most common cause contributing to the development of this arrhythmia is considered to be organic disorders occurring in the myocardium. It is important to know that even the most insignificant pathologies of the cardiac muscle in combination with functional factors can lead to the formation of an ectopic focus of excitation. In addition, various forms of IHD with changes in the myocardium can lead to extrasystole. Practically in 90% of patients with a diagnosis of myocardial infarction there is a violation of the rhythm of the heart and basically it is extrasystole. Sometimes it is formed in the presence of early emerging and unique signs of a failure of the coronary circulation. At some moments, this arrhythmia promotes the development of angina pectoris. To date, it has been proven that the often occurring ventricular extrasystoles on the background of coronary disease, after a heart attack, significantly worsen the prediction of the pathological condition and increase the percentage of sudden death after ventricular fibrillation.
Extrasystolia is also noted in patients with the presence of acquired rheumatic malformations, especially as a result of mitral valve damage. Also among the main reasons for the formation of extrasystoles of an organic nature in young people is rheumatism.
Very often extrasystoles develop in myocarditis, rheumatic and non-rheumatic genesis, infections and myocardiopathy. More rarely, the appearance of this arrhythmia occurs as a result of thyrotoxicosis. But the treatment with cardiac glycosides with signs of overdose cause the occurrence of ventricular extrasystole. Such an arrhythmia sometimes appears after the application of certain types of anesthesia, therapy with electrical impulses or stimulation of the heart muscle.
In addition, extrasystolic arrhythmia can cause severe poisoning with insecticides of organophosphorus properties in the form of bigemini, ventricular extrasystole in a single form, trigemini, transiting into polytopic extrasystole and ventricular fibrillation. This cardiac arrhythmia is affected by changes in the electrolyte balance of the myocardium, heart surgery, sounding of its cavities, coronagraphy and other causes.
Extrasystole symptoms of
As a result of untimely cardiac contraction of the heart or individual chambers, extrasystole arises as one of the most recorded types of arrhythmias. Practically in 65% of people it is possible to find extrasystoles, which are neurogenic( functional) nature, provoked by nicotine, alcoholic beverages, tea and coffee. And organic extrasystoles are caused by various myocardial injuries.
As a rule, any patient suffers from extrasystole in the form of a jolt, fading, stopping and changes in the work of the heart, and their emotional sensations can be described in detail and in all colors by strongly emotional patients. In some cases, patients do not understand that they have a special kind of arrhythmia, but when they learn to understand the extrasystole by pulse interruption with the help of a doctor's consultation, patients feel them. And this brings to many patients subjective suffering.
It is rare in patients with certain changes in the heart muscle and in the presence of extrasystole, there are no irregularities in the activity of the heart. As a rule, this is observed in elderly people, patients with a diagnosis of coronary atherosclerosis and atherosclerotic lesions of cerebral vessels as a consequence of a high threshold of CNS irritability. A certain category of patients complains of short-term dizziness, which coincides with a compensatory pause after additional arrhythmia and pain that compresses the heart.
Some clinicians claim that in some patients the extrasystole appears in a state of absolute rest, and in others - against a background of certain strains. Extrasystolia at rest has a functional form and is manifested with an increase in the tone of the parasympathetic part of the CNS, and during extrasystole with a physical strain - against the background of increased tone of the SNS and mainly in cardiac damage to the organic properties. With volley forms, extrasystoles are characterized by extraordinary, loud, consecutive tones. This extrasystole comes from such cardiac parts of the heart as the atria, ventricles and atrial-ventricular connections.
With frequent ventricular extrasystole, the coronary blood flow decreases, and on the background of IHD it provokes angina attacks. In addition, such extrasystoles reduce the blood circulation of the brain by 10%, with fainting, paresis, dizziness and aphasia. When palpating the pulse, you can determine a premature pulse wave, followed by a pause or note the absence of a pulse on the artery in the region of the radius.
When listening to the upper part of the heart, two tones are determined, one of which is strengthened and characterized by a slight ventricular filling, and the second is somewhat weakened as a result of a lowered cardiac output in the LA and aorta. In those moments when the extrasystoles occur early and at the same time do not open the valves of the LA and the aorta, two normal cardiac tones and one extrasystolic are heard. If it is not possible to determine the compensatory pause after an additional contraction, an atrial extrasystole is suggested, and in the case of its expression - ventricular. To confirm the diagnosis, ECG is used.
Frequent extrasystole
This form of arrhythmia is characterized by extrasystoles of premature contraction, which are detected on an electrocardiogram. According to the location of the source of frequent extrasystoles, the ventricular form and supraventricular are isolated.
Frequent extrasystole is characterized by cardiac contractions of more than thirty per hour. They can appear in healthy people. Normally, up to two hundred contractions per day of the supraventricular form and as much as the ventricular form are tolerated. Sometimes there are paired or solitary extrasystoles. But, in general, often occurring three consecutive arrhythmias are called tachycardia. Unsustainable heartbeat is characterized by episodes of tachycardia less than thirty seconds. In some cases, a frequent extrasystole is a group or volley. And also she, especially in a pair and giving a relapse, achieves a degree of continuously-recurring contraction, in which almost 85% a day make complexes of an ectopic nature, and sinuses are single contractions or short-term episodes of a given rhythm.
In addition, it was previously assumed that a high degree of gradation of the extrasystole is the most dangerous. But for today it is clarified that the symptomatic and prognostic values of this arrhythmia mainly depend on the nature of the underlying pathology, the degree of cardiac damage and the state of the heart muscle.
In patients who have no signs of heart muscle damage with normal LV operation, extrasystole with episodes of unstable VT and continuously repeated tachycardia, is not life threatening and does not affect further prediction. Arrhythmia without cardiac damage of an organic nature is considered idiopathic. A extrasystole with postinfarction cardiosclerosis, dilatation or hypertrophy of the LV is characterized by an unfavorable prognosis. Thus, any extrasystole even frequent, in itself is safe. It is also called cosmetic, and thereby underscores its safety.
Therefore, antiarrhythmic drugs prescribed for the treatment of this condition do not increase positive prediction. These medicines do not treat arrhythmia, but for a while they eliminate this extrasystole. In addition, the complications and side effects of taking medications can be much more dangerous than the extrasystole itself. Also, this arrhythmia, which occurs without symptoms or with minor manifestations, does not need specialized treatment. Such patients are on dispensary supervision, which is prescribed echocardiography twice a year in order to reveal possible structural changes in the LV and its functional state.
Thus, indications for the treatment of frequent extrasystoles is the group form, which causes abnormalities in the hemodynamic process;Subjectively expressed intolerance of sensations of interruptions in the activity of the heart;The findings were found after repeated examination by echocardiography of worsening of myocardial functions, as well as a reduced ejection fraction and LV dilatation.
Extrasystolia in children
Heart rhythm disturbances in children in the form of single and paired premature contractions of the entire heart or its individual parts as a consequence of the excitation of the heart muscle, which originated from a hetereretropic source, is called extrasystole. This arrhythmia very often occurs in children, and over the past decade has reached 75% in the structure of heart rhythm disturbances.
In children, extrasystole is found at any age, even in newborns and in the prenatal period. In addition, this arrhythmia is congenital and acquired, and etiological factors are combined, extracardiac and cardiac. In the first case, the causes of extrasystole may be cardiac malformations of a different etiology, cardiomyopathy, endocarditis of infectious genesis, rheumatic carditis, non-rheumatic carditis, etc.
A specific etiological group includes deterministic genetic pathologies in which ventricular extrasystole and VT are considered the main symptomatic manifestations. This is an anomaly in the development of the heart muscle - arrhythmogenic dysplasia of the prostate. In most cases, this disease is a hereditary predisposition and very often leads to a sudden lethal outcome.
In addition, in children the extrasystole develops against the background of existing diseases of the nervous and endocrine system, infections, intoxications, drug overdoses and visceral reflexes to cholecystitis, diaphragmatic hernia, and also after various physical and emotional overloads.
The formation of children in the extrasystoles is affected by changes in the psyche and dysfunction of the vegetative system. Also in the etiology of this arrhythmia, an important role is played by pathologies in the perinatal period. But when it is impossible to find out the cause of extrasystole, the diagnosis of arrhythmia is established in the form of an idiopathic form.
In children, this violation of the heart rhythm proceeds without special signs and in 70% of cases it is detected quite by accident. But if the child complains, they are made up of feelings of heart failure, fading, a brief stop, followed by a strong blow( postextrasystolic potency).In some cases, this is accompanied by the appearance of acute pain. But in the prepubertal and pubertal period, this is characterized by pain in the heart, significantly increased excitability, sensitivity to weather changes and sleep disturbances. And such symptoms as twisting of the head and a state of general weakness arise with extrasystole with severe heart lesions and hemodynamic disorders.
When listening to determine a loud tone or two tones, one of which is amplified, and the other - is weakened. They appear prematurely, accompanied by a compensatory pause. Sometimes, when an extrasystole swells cervical veins, and after it - a single heart beat is amplified. In addition, pulse strokes drop out, and bigemia is characterized by bradisphigma. Confirm the extrasystole in children due to ECG parameters.
Extrasystoles in children are classified based on location, premature degree of manifestation, frequency and sequence, as well as compensatory pause, lability of extrasystoles in the application of functional samples.
With atrial extrasystole prematurely arises and deforms tooth P;Its presence before the QRS;The polarity of this tooth;Incomplete pause of the compensatory property.
With ventricular extrasystole, there is no tooth P and is detected after the complex;The QRS deformation and its expansion are expressed;There is a full compensatory pause.
In terms of density in children, extrasystoles are individually localized, paired and group. During the audition, rarely occur at intervals of up to nine per minute, medium - up to fifteen per minute and frequent - more than fifteen. Based on Holter monitoring, frequent extrasystoles are more than 600 per hour. In addition, diagnose extrasystole by circadian type during the day and night.
All extrasystoles of vegetative etiology are divided into dependent, co-dependent and sympathetic dependent. The first group in 48% is noted in older children in the form of frequent, allorhythmic, group forms. The second group is typical for younger children, school children with a mixed type of vegetative-vascular dystonia. The third group is registered in the pubertal period, in which extrasystoles become more frequent in the ortho position and predominate during wakefulness, but decrease during sleep. Their peculiarity consists in the appearance or preservation of tachycardia. Supraventricular extrasystoles
This is called supraventricular arrhythmia more and represents premature pulses arising in ectopic foci that are in the atria or partitions, called antriventrikulyarnoy. Thus, additional and inferior cardiac contractions are formed.
The causes of supraventricular extrasystole include cardiac pathologies, endocrine, toxins, long-term use of cardiac drugs, vegetative disorders, oxygen starvation and electrolyte imbalance.
Supraventricular extrasystole is classified by localization of the focus: atrial( upper heart), atrioventricular( interventricular and interatrial septa);At the heart rate in one minute: single, multiple, group and pair;By the number of ectopic foci: monotopic and polytopic;Depending on the time of occurrence: early, when the atria contract;Average, when there is a time between abbreviations P and M;Late, when the ventricles contract or the heart is completely relaxed. In addition, supraventricular extrasystole may be manifested by alternating normal contraction, or it may not have a certain pattern.
As a rule, this arrhythmia proceeds without any special complaints. Sometimes there may be a shortage of air and shortness of breath, as well as heart disruptions, which are characterized by a sense of his coup or extraordinary blows. Slowly enough, there is a twisting of the head, weakness, irritability.
Diagnosis is based on patient complaints, general examination with auscultation and pulse measurement, as well as anamnesis of the patient. In addition, blood tests, urine tests with simultaneous determination of hormonal status are prescribed.
Among the instrumental methods of diagnosis are: electrocardiogram, eco-cardiography, Holter monitoring, tests with load and ECG records.
Extrasystole treatment
In order to proceed with the treatment of this arrhythmia, the shape and localization of the extrasystole should be considered. Such forms of arrhythmias, as a single, do not require definite treatment. Only in those cases when the violation of the heart rhythm is caused by cardiac pathology, diseases of the endocrine and digestive systems, then the therapeutic treatment of the main disease begins.
With neurogenic extrasystole, consult a neurologist, and then, if necessary, prescribe sedatives( Relanium, Rudotel) and soothing herbs in the form of fees.
For prescribing of medicamentous therapy, there are indications of extrasystoles occurring more than two hundred per day with the presence of subjective complaints and cardiac pathology. Diltiazem, Sotalol, Méxilen, Cordarone, Quinidine, Lidocaine, Novokainamid are very suitable for this. The choice of medication depends on the type of arrhythmia and heart rate, and the dose is determined by Holter monitoring.
In the establishment of rarely occurring or extinct extrasystoles, which are fixed for two months, gradually reduce the dose of the drug or completely cancel. And sometimes, with a severe form of arrhythmia, prescribe antiarrhythmic drugs for life.
Radiofrequency ablation of the heart is used with ventricular extrasystole up to 25,000 per day, with ineffective treatment with antiarrhythmic drugs, their intolerance or with an unfavorable prognosis.