Ventricular extrasystole

Ventricular extrasystole is one of the types of arrhythmias that represent premature, out-of-turn, ventricular contractions. Ventricular extrasystole is characterized by a feeling of heart failure in the form of failures, weakness, head spin, anginal pains and lack of air. This type of arrhythmia is established after listening to the heart, electrocardiogram and Holter monitoring. And for the treatment of an extraordinary reduction of the ventricles, they use sedative drugs, beta-blockers and antiarrhythmics.

Ventricular extrasystole accounts for almost 62% of all extrasystolic arrhythmias. This violation of the heart rhythm is a consequence of premature excitation of the heart muscle, which comes from the fibers of Purkinje and the bundle of His.

Based on ECG results, this form of cardiac contraction, representing single extrasystoles, is determined in 5% of healthy young people, and in the case of daily monitoring - in almost half of the examined. In addition, this arrhythmia has recently increased dramatically with age.

Ventricular extrasystole causes

The etiology of this extraordinary ventricular contraction is both the absence of cardiac diseases of organic origin and their presence. The first case is characterized by stressful situations, smoking, drinking alcohol, coffee, tea, which increase the activity of the adrenal and sympathetic system. But in most healthy people, extrasystoles appear for no apparent reason.

However, despite the fact that the characteristic form of arrhythmic reductions occurs against the background of many heart lesions of an organic nature, one of the most important causes of ventricular extrasystole is still considered to be IHD.In monitoring during the day, such an arrhythmia is observed in 90% of patients.

The occurrence of ventricular contractions is affected by the acute coronary syndromes present in patients, especially those with myocardial infarction. Among the common causes of ventricular extrasystole, pericarditis and myocarditis, cardiomyopathies and enlarged heart can be distinguished, which in its development is promoted by hypertrophy of the heart muscle, ventricles and heart failure. In addition, extrasystoles of this type of arrhythmia are often detected in the pathology of the mitral valve.

Also, the factors of iatrogenic nature play an important role in the formation of an extraordinary contraction of the ventricles, namely, an overdose with the intake of cardiac glycosides, beta adrenostimulation, and sometimes membrane stimulating drugs of antiarrhythmic action, especially if there are cardiac pathologies of organic origin.

Ventricular extrasystole symptoms of

This form of an extraordinary cardiac contraction of the ventricles can proceed asymptomatically or with feelings of cardiac fading or stroke in the form of a push resulting from an intensified contraction of post-extrasystolic origin. At the same time, subjective sensations do not have a characteristic expression and are not dependent on heart rate and the causes of extrasystoles. With frequent ventricular extrasystole, patients with severe forms of cardiac pathology sometimes experience weakness;Pain, as with angina;May be dizzy and do not have enough air for breathing.

At the time of examination, there is sometimes a pronounced presystolic pulsation of the veins in the neck that occurs with a regular atrial systole on the right side of the closed tricuspid valve as a result of a characteristic premature contraction of the ventricles. This pulsation is called Corrigan's venous pulsation. In this case, the pulse on the artery is practically not probed, has a sufficiently long pause, which occurs after a full pause of the compensatory property.

But the occurrence of atrial fibrillation is facilitated by frequent forms of extrasystole and group. In addition, in many patients it is difficult to determine the pulse. This is due to its deficit. When listening to the heart, the first tone changes its sound due to a non-simultaneous contraction of the atria and ventricles, as well as fluctuations in the P-Q interval. In addition, these abbreviations are out of turn, characterized by the splitting of the second tone.

The main ECG signs of ventricular extrasystole include the appearance of an extraordinary premature change on the electrocardiogram of the QRS ventricular complex. In addition, this complex is considerably enlarged and deformed;There is inconsistency of the extrasystole in the location of the T-wave and RS-T segment with respect to the main QRS complex;There is no P-tooth in front of the ventricular extrasystole, and also, after a characteristic ventricular extrasystole, an absolute compensatory pause.

Ventricular extrasystole is sometimes characterized by a different clinical course and the same prediction that will depend on the existing cardiac pathologies of an organic nature, the form of manifestation and the pronounced degree of disturbances in the cardiac muscle of the ventricles. However, there is evidence that extraordinary cardiac contractions in the ventricles, even the most frequent and complex, with the absence of structural pathologies in the patients, have no significant effect on the prediction of this condition. But with the existing cardiac lesions of organic genesis, these forms of arrhythmic contractions significantly increase the percentage of sudden death as a result of heart diseases and lethality of a general nature, cause a persistent manifestation of ventricular tachycardia and their fibrillation.

Graduation of ventricular extrasystole

A healthy heart works automatically, that is, at a certain point in the cardiomyocytes there is an exciting pulse, which is then transmitted to the cardiac muscle of the myocardium. But when various small-focal or large-focal changes occur in it, a repeated injection of the pulse is observed, and therefore the myocardium is subjected to repeated stimulation.

In the heart muscle, the left ventricle is considered to be the most vulnerable part, since dystrophic changes and sclerotic lesions often occur after coronary artery disease or infarction. Therefore, extraordinary extrasystoles are much more likely to develop in the LV, while the right ventricle is less prone to such changes. Hence it can be concluded that ventricular extrasystole is an extraordinary contraction of the heart, due to the ectopic impulse located in the ventricle. Therefore, the initiation of a re-excitation located in the septum between the ventricles or on its wall occurs via a re-entry focus. And this means that the focus of excitation can be formed in any part of the LV and cause a ventricular extrasystole.

For prognostic evaluation of such ventricular extrasystoles, the classification of Lown and Wolf is used, in which five gradation classes of this arrhythmia are distinguished. The first class includes a single ventricular extrasystole with a heart rate of less than thirty per hour. Therefore, this kind of arrhythmia is considered harmless and practically normal, if a person does not have a cardiac pathology.

To the second class belong single extrasystoles, which also form in the ventricles at a frequency exceeding thirty per hour. This arrhythmia is somewhat more significant, but very rarely manifests itself with any consequences.

The third class is characterized by polymorphous forms of an extraordinary cardiac contraction of the ventricles, which differ in different leads of the electrocardiogram. In the case of recurring episodes of a characteristic form of arrhythmia, special treatment is prescribed.

In the fourth grade( A), there are paired heartbeats that follow in succession, that is, in a row. In the fourth class( B) - group arrhythmias, which are characterized by the repetition of three or five extrasystoles in the ventricles.

And for the fifth class, early forms of arrhythmias or "R on T" are characteristic. In addition, from the third to the fifth class, ventricular extrasystoles are considered a high degree of gradation, which can lead to ventricular tachycardia and ventricular fibrillation, and this can lead to cardiac arrest and death.

But the significance of an extraordinary cardiac contraction of low graduation ventricles is determined by the presence of certain symptoms that arise with these extrasystoles. Sometimes with every second stroke this form of arrhythmia develops, and the patient does not feel it at the same time. But when the extrasystole appears only two or three times per hour, the patient can feel very bad, down to loss of consciousness. Therefore, how much the specific form of an extraordinary cardiac contraction of the ventricles is dangerous for life is decided strictly individually for each patient.

Ventricular extrasystole ECG

This type of arrhythmia occurs in the presence of cardiac diseases of an organic nature and without them. According to Holter's daily monitoring, ventricular extrasystole is noted in 60% of the subjects. And in the absence of cardiac pathology does not have a characteristic effect on the prediction of arrhythmia.

After a heart attack myocardial ventricular extrasystole in its distribution is 80%.In this case, frequent and paired extrasystoles are characterized by an increased lethal outcome. However, these forms of this arrhythmia do not relate to significant risk factors, in contrast to the low LV ejection fraction.

In the electrocardiogram, the ventricular extrasystole is an extraordinary wide deformed QRS complex that does not have the preceding teeth. And the interval between linked complexes can be permanent. In addition, when it varies heartbeats with a common divider, they speak of the ventricular form of parasystole. With this arrhythmia, the extrasystoles originate from the focus of excitation, in which no impulses of the sinus node arrive.

Ventricular extrasystole can be manifested by single heart beats, and also repeated sequentially( bigemini), every second QRS complex in the form of trigeminia or the third in the form of quadrigemini.

Two consecutive arrhythmias are called paired, and more than three at a frequency of 100 per minute - ventricular tachycardia or unstable form. In addition, the ventricular extrasystole can have the same or different shape, that is, it is characterized by a monomorphic or polymorphic extrasystole.

Generally, extraordinary pulses are not conducted to the atrium and do not discharge the sinus node, so the resulting impulses are unable to excite the ventricles as a result of their refractoriness. This is what causes the complete compensatory pause on the background of the ventricular extrasystole, that is, the interval between the extrasystolic teeth R, before and after, equal to the RR interval is formed. As a result of an extraordinary impulse to the atrium, in the form of retrograde teeth P, the sinus node may be discharged and the compensatory pause will become incomplete.

At some moments, the impulse to the atria is blocked in the AV node, and this prolongs the PQ interval or promotes the precipitation of the next QRS complex. This extension of the post-extrasystolic interval PQ is due to the manifestation of a latent form of retrograde conduction into the atrioventricular node.

In those cases when a compensatory pause is not formed after ventricular premature beats, an interpolated or intercalated form of arrhythmia appears.

Ventricular extrasystole treatment

The main goals of treatment of ventricular extrasystole are to reduce the unpleasant sensations caused by cardiac contractions and prevent paroxysms of resistant form of VT or ventricular fibrillation.

In the event that it is necessary to reduce only discomfort, patients are subject to empirical treatment, which is oriented to the patients' well-being. As a rule, opinions about the appointment of treatment of ventricular extrasystole, which occurs without symptoms, are somewhat contradictory. The use of antiarrhythmic drugs for the treatment of complex forms of arrhythmias without a characteristic symptomatic pattern is possible only in case of potential danger of this condition and the likely benefits of these medicines. In addition, almost forty percent of patients as a result of side effects of antiarrhythmic drugs, have to abandon these funds. One of the dangers of taking antiarrhythmics is their arrhythmogenic property observed in 10% of patients.

Basically, ventricular extrasystole in the absence of cardiac pathology of organic origin does not increase the risk of sudden death. Although with reduced LV contractility, the probability of forming a stable ventricular extrasystole is slightly increased, and the prediction of this arrhythmia with regard to sudden death is insignificant.

Patients who underwent myocardial infarction and received treatment in the form of Enkainide or Flecainide noted the successful elimination of ventricular extrasystoles, but was accompanied by an increased lethality almost fourfold, in contrast to placebo. Therefore, given these data, empirical treatment with antiarrhythmic drugs is not recommended.

But the indications for hospitalization are for the first time detected ventricular extrasystoles and unfavorable, according to forecasts, the form of arrhythmia.

For the appointment of specialized treatment, the class of graduation of an extraordinary cardiac contraction of the ventricles, the available cardiac pathologies, the nature of cardiac muscle dysfunction, and the severity of this disorder, which are potentially fatal to ventricular extrasystole and lethal outcome, are necessarily taken into account.

Patients without symptomatic signs of cardiac abnormality, even at high grades of B. Lown do not prescribe a specific treatment. Therefore, one should be able to explain to the patient that arrhythmia can be benign, in which a diet enriched with potassium is recommended, with the exception of nicotine, alcohol, coffee and strong varieties of tea, and in cases of hypodynamia, it is necessary to increase physical activity. It is with such activities and begin to treat the asymptomatic form of ventricular extrasystole. And only when they are ineffective, they begin to prescribe medications.

For the treatment of such patients, first-line drugs include sedatives( for example, diazepam or phytopreparations) and beta-adrenoblockers. For a significant number of patients, they have a positive effect due to reduced heart rate under the influence of sedatives and a reduced force of postextrasystolic contraction.

Usually, the appointment of beta-blockers starts with Propranol( Anaprilin, Obsidan) in small doses, and if necessary, they are increased, while controlling the heart rate. In some patients with ventricular extrasystole, the number of extrasystoles increases as the frequency of the rhythm decreases. But with bradycardia in the outcome, as a result of the increased tone of the parasympathetic department of the VNS, especially in young people, bellies and Itropium preparations are used to stop the ventricular extrasystole.

And in very rare cases, with ineffective treatment with sedatives, as well as to correct the tone of the VNS and patients with disturbed health resort to the appointment of Dysopyramide, Novocainamide, Quinidine, Mexiletin, Propavenone and Flecainide. In addition, these membrane-stabilizing agents, unlike beta-blockers, have a significant side effect, so they should be avoided in their assignments, if possible. Also, sedative drugs and adrenoblockers are well used to treat this form of arrhythmia with characteristic symptoms on the background of prolapse mitral valve. And the use of antiarrhythmic drugs of the first class in this case is also acceptable only with a greatly disturbed state of health.

With frequent ventricular extrasystole of monotopic form, which is resistant to drug treatment, or in case of inability to take antiarrhythmic drugs in combination with poor prognosis or intolerance of medicines, intracardiac EFI and heart RFA are prescribed.