Ventricular extrasystoles

Author Ольга Кияница

2018-01-17

Extraordinary contractions of the heart are called extrasystoles. Depending on the localization of the focal point of excitation, several forms of pathology are distinguished. Clinically unfavorable is the ventricular extrasystole that this will be considered in detail.

Cardiovascular diseases are among the top five diseases that lead to a person's disability. Extrasystole is the most popular, as it is found in 70% of people. It can be defined at any age, there is also no connection between pathology and gender and constitutional features.

The predisposing factors of the development of extrasystoles include arterial hypertension, ischemic heart disease, heart disease, lack of potassium and magnesium in the blood, as well as sex and age.

Extrasystoles are divided into two large groups: atrial and ventricular. The second species is characterized by unfavorable clinical course, therefore it is worth knowing what is dangerous to the ventricular extrasystole and which variants of treatment are offered by modern medicine.

Description of ventricular extrasystoles

The term "ventricular extrasystole" (ZHEZ) refers to the pathological process that occurs in the left or right ventricles and causes the premature contraction of the corresponding departments of the heart.

Zheludoch-ekstr_1

There are three mechanisms for the development of the disease: disruption of automatism, trigger activity, circular passage of the excitation wave (ri-entry).

Violation of automatism is carried out in the direction of increasing heart rate. This is due to the subthreshold potential of the pathological focal point located in the ventricles. Under the action of a normal rhythm, its transition to a threshold occurs, resulting in premature contraction. Such a mechanism of development is characteristic of arrhythmias that develop from myocardial ischemia, electrolyte dysfunctions, and excess catecholamines.

Trigger activity - is the emergence of an extraordinary pulse under the action of post-de-polarization, which is associated with the previous action potential. They distinguish between early (formed during repolarization) and late (formed after repolarization) trigger activity. It is associated with those extrasystoles that appear in bradycardia, myocardial ischemia, electrolyte disorders, intoxication with certain drugs (for example, digitalis).

The circular passage of the excitation wave (ri-entry ) is formed at various organic disorders, when the myocardium becomes inhomogeneous, which prevents the normal passage of the impulse. In the area of scar or ischemia, areas with different conductive and restoring rates are formed. As a result, there appear both single ventricular extrasystoles and paroxysmal attacks of tachycardia.

Symptoms of ventricular extrasystoles

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

  • uneven heartbeat;
  • weakness and dizziness;
  • lack of air;
  • pain in the chest is located in an atypical location;
  • the ripple can be very pronounced, so it is felt by the patient.

Zheludoch-ekstr_2

The appearance of the last symptom complex is associated with an increase in the contraction force appearing after extrasystole. Therefore, it is not perceived as an extraordinary contraction, but rather as a "fading heart." Some symptoms of ventricular extrasystoles are due to the main pathology that caused the development of rhythm disturbance.

Corrigan's Venous Waves is a pathological pulsation that occurs when premature ventricular contractions occur against the background of a closed trivillary valve and systole of the right atrium. It manifests itself as a pulsation of the cervical veins, which is so pronounced that it can be noticed in the objective examination of the patient.

When measuring arterial pressure, arrhythmic cardiac activity is determined. In some cases, a pulse deficit is established. Sometimes extrasystoles occur so often that an erroneous diagnosis can be made in the form of atrial fibrillation.

Causes of ventricular extrasystoles

Consider the non-cardiac and cardial factors of the onset of the pathology.

Non-cardiac causes are more related to electrolyte disorders, often found during lack of potassium, magnesium, and excess calcium in the blood. The latter disorder is mostly associated with malignant processes occurring in the bone system, hyperparathyroidism, Paget's disease, calcium treatment (which is observed in the treatment of peptic ulcer disease).

Negative influence on the cardiac system is caused by stressful situations, malnutrition, disturbance of sleep and rest, taking of harmful substances (toxic, alcohol, narcotic). Sometimes, after surgery, anesthesia or hypoxia, the ventricular extrasystole also develops.

Zheludoch-ekstr_3

Cardiac factors are associated with various pathological states of the cardiovascular system. First and foremost, the myocardium of the ventricles affects myocardial infarction and IHD. Negative effects on the structure of muscle tissue are heart defects (mitral valve prolapse), cardiomyopathy and myocarditis. Against the background of slowed and accelerated heart rhythms, extraordinary contractions of the ventricles often occur.

Species / photos of ventricular extrasystoles

During the study of ventricular extrasystole as a pathology, various classifications and characteristics were created. On their basis, diagnoses are made and further treatment is performed.

Unitary and polythopic ventricular extrasystoles

Extrasystoles formed by premature ventricular contractions differ in their characteristics:

  • the display frequency on the ECG divides the extrasystoles into unit, multiple, pair, and group;
  • the time of occurrence of the extrasystole can characterize them as early, late and interpolated;
  • the number of pathological foci is different, therefore, polyotropic (more than 15 times per minute) and monotonous extrasystoles are allocated;
  • The order of extrasystole is considered in the event of their uniform location on the ECG, and there is also an unordered extrasystole.

Zheludoch-ekstr_4

Current ventricular extrasystoles

In the majority of cases there are benignly occurring ZHEPS. With their presence in the heart, there are no organic changes, complaints may not be presented by the patient, or they are insignificant. In such a case, the forecast is favorable, therefore, one should not worry whether this disease is dangerous, or ventricular extrasystole.

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

The malignant course of extrasystole of the ventricles is extremely dangerous to the patient's life. There may be a cardiac arrest and, in the absence of medical care, a lethal outcome. Malignancy is due to the presence of serious organic violations.

Classification of ventricular extrasystoles

Classes by Laun and Ryan have often been used in medical practice. They include five classes, from the very light 0 to the most severe 5, characterized by organic changes in the tissues of the heart. The first three classes according to their properties in both classifications are practically the same:

0 - ventricular extrasystole absent;

1 - extrasystoles monotype, appear infrequently, not more than 30 per hour;

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

3 - political extrasystoles are determined

Further, Laun's classification characterizes the classes as follows:

4a - extrasystoles pair;

4b - ventricular tachycardia with the emergence of HPP of 3 or more;

5 - early ventricular extrasystoles arise.,

By Ryan classes are described differently:

4a - the monomorphic extrasystoles follow the pairs;

4b - polymorphic extrasystoles are arranged in pairs;

5 - ventricular tachycardia with the development of HPP from 3 and more.

Zheludoch-ekstr_6

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

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

According to the characteristic of rhythm disturbance, the ventricular extrasystoles are divided into types: A are monomorphic in unit number, B is polymorphic in the unit number, C is pairwise, D is unstable in its dynamics, E is stable.

Complications of ventricular extrasystoles

In the main there is an aggravation of the main disease, against which the ZhEs developed. There are also the following complications and consequences:

  • changes in the anatomical configuration of the ventricle;
  • transition of extrasystole to fibrillation, which is dangerous for a high risk of death;
  • possibly the development of heart failure, which is most commonly encountered in polyotropic, multiple extrasystoles.
  • The most terrible complication is sudden cardiac arrest.

Diagnosis of ventricular extrasystoles

It starts with listening to the complaints of the patient, an objective examination, listening to the activities of the heart. Next, the doctor is assigned an instrumental study. The main diagnostic method is electrocardiography.

ECG signs of ventricular extrasystole:

  • prematurely appears QRS complex;
  • in its form and magnitude the extraordinary complex QRS differs from other, normal;
  • In front of the QRS complex, formed by the extrasystole, there is no tooth P;
  • after an incorrect QRS complex, an compensatory pause is always observed - an elongated insulin segment located between extraordinary and normal abbreviations.

Zheludoch-ekstr_7

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

EFI, or electrophysiological study , is shown in two groups of patients. First, there are no structural changes in the heart, but correction of medical treatment is necessary. The second - organic disorders are present, to assess the risk of sudden death, conduct diagnosis.

Zheludoch-ekstr_8

Signal-averaged ECG is a new method that is promising in terms of identifying patients with a high probability of occurrence of severe forms of HPI. It also helps in determining the unstable tachycardia of the ventricles.

Treatment of ventricular extrasystoles

Before starting therapy, the following situations are assessed:

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

Zheludoch-ekstr_9

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

  1. Single, monomorphic, so-called "simple" extrasystoles that do not cause hemodynamic disorders do not require specific treatment. It is enough to debug the diet and nutrition, to treat the main ailment that could cause the HPE.
  2. Unstable HPP, the appearance of paired, polythytic, frequent extrasystole leads to a violation of hemodynamics, therefore, antiarrhythmic drugs are prescribed to reduce the risk of ventricular fibrillation, cardiac arrhythmias. Basically, they start with beta-blockers, if necessary, statins and aspirin are prescribed. In parallel, drugs are used to treat the underlying disease causing extrasystole.
  3. Malignantly running HPP often requires the administration of highly effective drugs - amiodarone, sotapole 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 the case of ineffectiveness of drug therapy. Depending on the situation, destruction of the pathological focus of excitation, implantation of a cardiverer-defibrillator or an anti-carcinoma device may be prescribed.

Secondary prophylaxis of ventricular extrasystoles

In order to prevent the development of HPP, it is first and foremost to follow the recommendations of the doctor, which mainly consist of the timely taking of drugs and the observance of sleep and rest. It is also important to eat well and eliminate bad habits. If hypodynamia is observed, it is necessary to increase the physical activity according to the possibilities of the organism.

Video Ventricular Extrasystole. Symptoms, causes and methods of treatment


4.67 avg. rating (92% score) - 9 votes - votes

Similar articles

Vaginal extrasystole during pregnancy

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.

More
Extrasystolic arrhythmia

The rhythm of cardiac activity, in which occasionally there are untimely contractions of the entire heart, or its separate cells. It is detected in 70% of people. Without clinical manifestations, no specific treatment is required. In other cases, it is preceded by the appearance of paroxysms, which cause an attack of a malfunction of the heart. Then it manifests itself as symptoms of the underlying disease.

More
Arrhythmia in pathologies of the gastrointestinal tract

Rhythm disturbances are often associated with various diseases of the gastrointestinal tract, which in such cases act as a primary disease. Research in this direction has been going on for many years and today there is a clear link between GI disorders like GERD and cardiovascular system.

More