What is ventricular extrasystole - treatment and types

Ventricular extrasystole is considered a condition intermediate between norm and pathology. There are many factors that affect the conditions developing in the body in this pathology. The doctor must take them into account during the treatment. This is not only a change in the electrical activity of the heart, but also the consequences for hemodynamics( blood flow through the vessels) and the overall well-being of the patient.

Normal electrical activity of the heart: determination of extrasystole

Ventricular extrasystole is a kind of arrhythmia, expressed in premature, extraordinary ventricular contractions. This is the most common type of heart rhythm disturbances that occurs in representatives of different age categories. The contractions of the heart are coordinated by electrical impulses, which are propagated by the cardiac conduction system. Normally, they are generated in the sinus-atrial node, which determines the frequency of electrical impulses and contractions of the heart muscle.

But the ability to generate impulses is possessed not only by the cells of the sinoatrial node, but also by all the cardiomyocytes, therefore spontaneous foci of excitation generating their own impulse may arise. In this case, there is an extraordinary contraction of the heart, which is called the extrasystole. Such a process can occur and is normal.

Pathological condition is considered in the case when the foci of excitation have a persistent character, and extrasystoles cause a violation of hemodynamics and deterioration of the patient's well-being. Ventricular extrasystole is considered relatively safe, but it can be a harbinger of more serious diseases associated with heart rhythm disturbances.

Ventricular extrasystole: causes and forms of

Rhythm disturbance by type of ventricular extrasystole occurs for various reasons. For example, it can be damage to the myocardium due to a heart attack or as a result of inflammatory changes.

The development of the pathological process can lead to a violation of electrolyte balance( lack of potassium, magnesium or calcium), excessive use of substances that enhance the excitability of the heart( caffeine, alcohol).In some cases, the cause of rhythm disturbance may be the use of antiarrhythmic drugs if the active substance or dosage is incorrectly selected.

The development of ventricular extrasystole is most often observed in the following pathologies:

• ischemic heart disease;
• postinfarction cardiosclerosis;
• pericarditis;
• myocarditis;
• chronic heart failure;
• hypertension;
• hypertrophic cardiomyopathy.

Often, this pathology develops in persons suffering from neurocirculatory dystonia or osteochondrosis of the cervical spine. The cause of development of functional ventricular extrasystole can be chronic stress, long-term smoking, alcohol abuse or beverages with high caffeine content.

Single ventricular extrasystoles may occur during pregnancy, as fluctuations in the hormonal background and increased stress on the body of a woman during this period often provoke irregularities in the functioning of the heart muscle. If there are complaints about instability of the heart rhythm, the pregnant woman should be sent for a full examination.

Classification of the disease

In medicine, there are several classifications of extrasystoles, each of which reflects a certain aspect of the disease. In the place of origin, a monotopic( from the same focus) and polytopic( from different foci) extrasystole are isolated. The polytopic type is considered more dangerous.

By alternating normal contractions and extrasystoles, irregular and regular extrasystoles are isolated. Regular is divided into quadrugemia( three normal contractions + extrasystoles), trigeminy( two normal + extrasystoles) and bigemini( normal contraction + extrasystole).The more often after a normal contraction follows the extrasystole, the more dangerous this type of pathological condition is for a patient's health.

The classification of Laun and Wolf is specific, it is designed to assess the risk of developing fibrillation in patients who have experienced extrasystole following a previous myocardial infarction. In it, five degrees of risk are distinguished, some specialists allocate an additional zero degree when there is no extrasystole.

• The first graduation involves no more than 30 monotopic extrasystoles within an hour, which is considered a low risk.
• The second is characterized by a higher frequency, but the focus is still the same.
• Third - the development of polytopic extrasystoles is observed irrespective of the frequency of occurrence.
• Fourth - there are group extrasystoles( paired or salvo).
• Fifth - on the ECG, a stratification of the extrasystole is observed for a normal contraction. This is the most dangerous type of extrasystole after myocardial infarction.

Addition to the previous classification - clarifications on Ryan .In them, to the fourth degree, only paired extrasystoles belong, and volleys extrapolate to the fifth, and ventricular tachycardia, i.e., rapid heartbeat, is referred to it, when the focus of excitation is in the left ventricle.

Symptoms and complications of

The patient's state of health and hemodynamic features in case of extrasystole depend on many factors. If the extrasystoles occur occasionally and irregularly, they practically do not manifest themselves, and the patient may not be aware of them. In some cases, even monotopic bigeminia can be asymptomatic, but this happens rarely.

Some patients feel the onset of extrasystoles - it is manifested by a strong blow to the chest, and then - a sense of heart sinking. Sometimes this can be facilitated by dizziness, sudden weakness, aching pain in the heart. Patients complain of increased fatigue, headache, bouts of irritability. In mild forms, these disorders go off on their own and quite quickly, rarely occur more than once a day and may not appear every day.

Ventricular extrasystole of 2 gradations or higher may be manifested by a "rolling" feeling of weakness, blushing of the skin, a feeling of "turning over" the heart, headache, chest pain, impaired respiratory functions, which can lead to a fainting condition. With a physical or emotional load, the patient's condition deteriorates sharply.

Extrasystolia itself very rarely affects hemodynamics. But it is an indicator that there are violations of conduction of cardiac fibers, which means there is a risk of arrhythmia. If the extrasystole arises after severe organic damage to the heart, then it almost always is a harbinger of the development of arrhythmia up to fibrillation. But between the appearance of extrasystoles and life-threatening disorders can take several years.

Diagnostic methods

Frequent ventricular extrasystole is detected on the ECG - this is the first instrumental method that allows to see violations of electrical activity. In disputable cases, such a study as Holter-ECG - round-the-clock observation of the state of excitability of the heart can be assigned to confirm the diagnosis.

Various methods of examining the heart are used to identify the causes of the abnormalities - echocardiography and CT( computer tomography), which allow to see organic disorders of the heart muscle.

In addition, a series of surveys are carried out to identify pathologies of other organs( for example, the nervous system) that can affect the extrasystole. The most accurate estimate of the degree of disturbance of blood flow allows EchoCG with dopplerography. To identify the relationship between physical stress and heart rhythm disturbance, a bicycle ergometry or treadmill test is performed.

Treatment options for

Treatment of ventricular extrasystole consists in the appointment of medications and a diet rich in essential microelements for the heart. In mild forms, including ventricular ekstrasistolii 1 grade according to Laun, changes in lifestyle and regular observation by the doctor is enough to maintain a normal state of health. More severe cases require the appointment of antiarrhythmic drugs.

Various medications use different antiarrhythmics, as well as other types of drugs - antihypertensive drugs, drugs that reduce the load on the heart, diuretics and others. The exact selection of active ingredients and their dosages should be performed only by a cardiologist. Antiarrhythmic drugs are selected for the patient under the control of Holter monitoring and ECG.Incorrect use of drugs for the cardiovascular system can lead to even worse deterioration of the condition, rhythm failure, complications dangerous to life.

Additional recommendations of

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Patients with a similar diagnosis should avoid stress, increased psychoemotional and physical activity whenever possible. If this is not possible, you need to resort to sedative medications to maintain your well-being. Physical activity must be strictly dosed - it should be feasible, not too intense. An increase in motor activity, long walks in the fresh air will benefit.

A special role is assigned to the diet. It is necessary to exclude from the diet or sharply limit the sharp, spicy dishes and all other products containing excitatory substances. Including excluding caffeinated drinks. To prevent swelling, you need to limit salt intake, reduce the amount of liquid drunk per day. A useful addition will be an increase in the content of vegetables, fruits, cereals and dairy products in the diet.

When ventricular extrasystole is necessary in the first place to start fighting with bad habits. It is necessary to completely give up smoking, to minimize the use of alcoholic beverages. Strong coffee and tea should be replaced with mineral water without gas, juices, compotes, fruit drinks, weak green and herbal teas. It is useful to drink a decoction of wild rose, hawthorn and other herbs and medicinal plants, which have long been used in folk medicine to support the work of the heart muscle.

Conclusions

The electrical activity of the heart, which ensures its automatism, obeys rather complex laws, and if violations occur in it, they can have the most negative effect on hemodynamics and the general state of the body. The causes of such disorders can be various phenomena associated with organic cardiac pathology or functional disorders.

Knowing what ventricular extrasystole is, and what the consequences may be, it can be partially prevented, preventing the transition of this condition into a life-threatening disease. In order to take the necessary measures in time, you should contact the cardiologist at the first alarming symptoms and undergo a number of necessary examinations.

The prognosis for ventricular extrasystole largely depends on its shape, the concomitant organic pathologies of the heart and the degree of hemodynamic disorders. As a rule, functional extrasystoles do not pose a threat to the life of the patient, whereas ventricular extrasystole, which develops against the background of organic lesions of the heart muscle, significantly increases the chance of sudden death caused by ventricular fibrillation.