Author Ольга Кияница
Extrasystole (ES) is a violation of the pulse generation in the myocardium due to its spontaneous depolarization, often outside the conducting system. Extraordinary impulse can come from different parts of the heart muscle: ventricles, atrium or atrioventricular compounds.
According to statistics, extrasystole is detected in 60-70% of clinically healthy people. But the prognostic value is not favorable in all cases.
Electrocardiography is most often used in the diagnosis of extrasystole. Other research methods are used to evaluate the functionality of other organs and systems. Treatment of ES is prescribed only in the presence of subjective intolerance in the patient or the presence of concomitant severe cardiovascular disease pathology.
The normal heart rhythm is associated with a sinatricial node located in the right atrium, which plays the role of a natural heart pacemaker for the heart. This node generates electrical impulses that pass through the atrium, an atrioventricular node, and then propagate through the bundle of hyza and Purkinje fibers that stimulate the ventricular myocardium.
The system of conduction and myocardium is controlled by the autonomic nervous system and is sensitive to hormones (to catecholamines), which allows to accelerate or slow down the cardiac rhythm in accordance with various activities, stress and excitement.
Extrasystoles are essentially additional beats or abbreviations that interrupt the normal heart rhythm. They arise with electrical stimulation in any part of the heart, except for the sinatricular node. There are many extrasystole variants, but ventricular and atrial electrons are secreted in their place of origin.
In more than 60% of cases, ventricular extrasystoles develop, 25% come from atrial fibrillation, and 10% for combined EC variants. Less commonly, in 2% of cases, ES is determined from an atrioventricular compound.
Both atrial and ventricular extrasystoles can develop at any age.
Additional classifications of extrasystoles:
- By amount of ES: single, pair and group (salvo)
- By frequency of development: rare (up to 3 min), medium (6-15 in min.) And frequent (more than 15 in min.)
- By the number of ectopic foci: monotropic and polythytic
- In shape on the ECG: monomorphic and polymorphic
- By the time of occurrence of extraordinary impulse in diastole: early, middle and late
- Due to appearance: functional, organic and toxic.
There is also a separate classification of the ventricular extrasystole according to Laun and Wolf, respectively, which divides the ES into five classes, from which classes III and V include extrasystoles of high degree, and to class IV - complex.
Often, they are defined in healthy people with normal heart palpitations. Diagnosis is mainly through 24-hour Holter monitoring in more than 60% of adults. The course of ES is often aggravated by the intake of alcohol and caffeine.
In some cases, the outburst of the atrial ectopia may result in paroxysms of atrial fibrillation. [1 - Kaye GC; Percutaneous interventional electrophysiology. BMJ 2003 Aug 2327 (7409): 280-3]
They can occur at any age. They are more common in people with organic heart disease. Ventricular extrasystoles are the most common type of arrhythmia that occurs after myocardial infarction. They can also be manifested in severe left ventricular hypertrophy, hypertrophic cardiomyopathy and congestive heart failure. According to the latest research, ventricular ES can lead to fatal outcome, even in the absence of any heart disease.
There are certain risks for ventricular extrasystoles:
- ESs that arise during physical activity, especially those that are formed during the recovery phase, may indicate an increased risk of mortality. [2 - Frolkis JP, Pothier CE, Blackstone EH, et al; Frequent ventricular ectopy after exercise as a predictor of death. N Engl J Med. 2003 Feb 27348 (9): 781-90]
- Frequent ventricular ectopics (over 1000 per day) can have a negative effect on the function of the ventricles: [3 - Wilber DJ; Ventricular ectopic beats: not so benign. Heart Aug. 25, 2009 (15): 1209-10. Epub 2009 May 7]
- There may be a slight disruption of the LV function, despite the normal left ventricular ejection fraction.
- Frequent ventricular extrasystoles may be associated with slow progression of ventricular function (for several years or decades).
- With significant organic damage to the heart, frequent ventricular extrasystoles indicate an increased risk of sudden cardiac death.
Often the cause of the ectopic rhythm is unknown. Yet there are some factors that can cause or aggravate the course of extrasystoles:
- Some prescription drugs or non-prescription drugs (digoxin, aminophylline, tricyclic antidepressants, cocaine, amphetamines)
- Some narcotic substances (stimulants)
- High levels of adrenalin, usually due to stress
- Physical load
If the ES persists for a long time, it is more likely that there is a serious predictive effect, such as:
- Heart disease (acute myocardial infarction, heart valve disease, cardiomyopathy, ventricular hypertrophy and heart failure)
- Electrolyte disturbances, including hypokalemia, hypomagnesaemia, hypercalcemia.
- Myocardial damage due to heart pathology, infection, or high blood pressure
Sometimes extrasystole is determined by chance during the prophylactic passage of the ECG.
Video: Extrasystole With Detoxial Vegeto-Vascular Disorders (VSD), Panic Attacks, and Neurosis | Pavel Fedorenko
- The heartbeat is the main symptom of extrasystole:
- Extraordinary contractions usually occur against the background of normal heart rhythm and accompanied by a pause that lasts until normal heart rhythm is restored. Therefore, they can be felt as "missed" strokes or in the form of "feeling that the heart stopped".
- In some cases, the ES is perceived as a knock or a strange sensation, such as a chest or an additional blow. They can cause a sense of discomfort or significant anxiety in some people.
- The condition is usually worse at rest and improves during exercises. Symptoms that increase with the background of exercise are more disturbing and clinically significant.
Other possible manifestations:
- Fainting or half-bad condition (dizziness)
- Atypical chest pain
- Extreme fatigue
- There are reports of cases where a chronic cough or fainting after coughing is a precursor to extrasystole [4 - Brandon N; Premature atrial contraction as an etiology for cough. Chest 2008 Mar133 (3): 828].
Emergency medical care is required in the event of the following symptoms:
- Appeared severe pain in the chest, shortness of breath or ill, lost consciousness.
- A rapid heartbeat with a sudden onset and a rhythm disturbance is detected, indicating a pathological tachycardia.
- Serious disturbances on the ECG.
- Heavy concomitant heart disease, endocrine organs or the presence of metabolic disorders, infections.
- Heartless noises.
- The presence of close relatives of sudden death or heart disease at a young age.
When determining a patient with a disturbed heartbeat, the following tests are prescribed:
- Standard ECG in 12 leads
- Analysis for serum calcium and magnesium
- ECG monitoring:
- If the symptoms are short, but often occur (2-3 times per week), use a 24-hour Holter monitor
- If the symptoms are short and infrequent (less than 1 time per week), use an event monitor or transcephalon recorder
- Echocardiography - To evaluate the function of LV and the structure of the heart.
- Stress stress testing - the extrasystole relationship with physical activity is determined, which can have a predictive value.
- Forced extrasystoles
These are premature P waves, which differ from the usual P wave. They can be hidden in the segment ST or T-wave of the previous sinus pulse. Behind them can either follow the usual QRS complex, or an extended PR interval, or the pulse may not be performed at all.
- Ventricular extrasystoles
The wide abnormal forms of QRS complexes are determined. Extracystoles occurring at each second or third rhythm are called bigemines or trigemines, respectively.
Patients with low risk without other heart disease and symptoms (or only with minor signs), specific treatment, as a rule, is not prescribed.
Patients with heart disease, a risk of heart attack, or severe symptoms usually need further diagnosis, treatment, or medical observation.
Possible treatment options:
- Refusal to use caffeine-containing products with subsequent observation.
- Treatment of the underlying disease (for example, hypertension, electrolyte abnormalities, ischemia or heart failure) and the elimination of factors contributing to the development of extrasystole.
- Medicines - beta-blockers (for example, atenolol, metoprolol)
- Radiofrequency catheter ablation of ectopic focal point.
- Implantation of the heart defibrillator, especially if the patient is at high risk of developing severe ventricular arrhythmia.
There are several simple ways that can help reduce the likelihood of premature contractions. First of all, you need to pay attention to what causes the symptoms of ES and then you should eliminate them. Common provocative factors are alcohol, smoking and caffeine. Failure from these substances can help keep the heart rate under control.
If symptoms are related to stress, you should try methods of self-help, such as meditation and exercise. If stress is experienced for a long time, you need to contact a doctor for information on ways to reduce psychological stress. In severe cases, the use of special medications, such as beta-blockers, may be beneficial.
Rarely occurring extrasystoles do not pose a serious threat to the health and life of the patient, especially in the absence of other cardiovascular diseases.
An unfavorable prognosis is when extrasystoles occur frequently, and even more so against other heart diseases. In such cases, the risk of sudden death and heart failure increases. Nevertheless, recent studies have confirmed that LV dysfunction in patients with frequent EC can be restored after eliminating rhythm disturbances by drug treatment or catheter ablation.
It is important to diagnose a variety of arrhythmias, which leads to untimely reduction of ventricles. The signal for extraordinary depolarization comes from an additional (ectopic) focal point of excitation. To prevent the development of serious complications, it is necessary to conduct timely treatment of ventricular extrasystoles.
One of the most common forms of arrhythmia is the extrasystole of the heart. What it is and how to treat the disease you need to know everyone, especially if there is a predisposition to cardiovascular disease. With the help of modern methods of therapy, it is possible to achieve a positive result even with a complex development of pathology.
During pregnancy, various disorders of the rhythm, including ventricular extrasystoles, can be determined. The disease can represent a danger to fetal development and for the health of the mother. With the help of modern methods of research, the pathology is determined both at the planning stage, however, at the early stages of pregnancy, which allows timely carrying out the necessary therapeutic measures.