Atrial extrasystole is a common violation of the heart rhythm, in which, along with regular cardiac contractions, extraordinary pulses occur.
Single rare atrial extrasystoles are not dangerous and do not require special medical treatment, it is enough to observe the right way of life and reject harmful habits.
Frequent and hemodynamic-affecting extrasystoles deserve attention, with a tendency to shift into supraventricular tachycardia.
Description of the disease
Atrial extrasystoles occur because of the formerevremennogo excitation and contraction of cardiomyocytes atrial muscle membranes. Such activity of
is caused by an electrical impulse originating outside the sinus node , but above the atrioventricular junction. 
Three or more extrasystoles are called group, and often recurring extraordinary complexes are called atrial extrasystoles. With this type of heart rhythm disorder , the compensatory pause will be complete , in contrast to the extrasystole from the ventricles.
It is considered normal occurrence of no more than 200 atrial extrasystoles per day .This pathology can rarely occur in healthy people.
In contrast to ventricular and av-nodal extrasystoles, atrial electrocardiographic complexes differ little from normal ones, and there are no expressed hemodynamic disturbances.
Prevalence and development of the disease
According to statistics, single extrasystoles occur in 70% of people , and most often remain unnoticed and pass on their own. Of all types of extrasystole, atrial constitutes about a quarter of cases.
Often them can provoke stressful situations, reception of strong alcoholic drinks or coffee .
Extrasystolia develops with too early depolarization of the myocardium. With atrial extrasystole, the pulse is generated in the atria, a focus of trigger activity arises and the repeated occurrence of excitation into the myocardial cells - cardiomyocytes.
Classification and differences of species, stages
By the number of extrasystolic contractions arising one after another, single atrial extrasystoles, paired and triplets separate, when three extraordinary consecutive contractions appear. Triplets are considered as unstable tachycardia .
Extrasystoles that arise with a certain pattern are called allrhythmia , which are divided into the following types:
- bigemini , in which the pathological impulse follows each normal;
- trigeminia , when the extrasystolic contraction is every third;
- quadrigemination - every fourth.
monotopic is allocated at the place of occurrence - from the same site, and polytopic - from different ones.
The degree of extrasystole is differentiated, based on the relationship with the preceding ventricular complex, distinguish between early and late.
Stages of atrial extrasystoles reflect the number of early cuts that occur in one hour : the first is allowed to appear no more than 30, at the second - more than 30, then polytopic and paired extrasystoles are considered.
Causes and risk factors
The etiology of atrial extrasystole is diverse, it can be associated with the disease of any heart structures or layers of the heart wall, the intake of various drugs or the abuse of harmful habits.
All causes are divided into the following groups:
- non-cardiac causes of : smoking, excessive intake of strong coffee drinks, alcohol, inadequate concentration of potassium ions in the blood, low hemoglobin, increased amount of thyroid hormones caused by thyrotoxicosis, toxic goiter;
- taking medications : psychostimulating agents, drugs, methylxanthines, pyracetam, amitriptyline, citalopram, combined oral contraceptives;
- cardiac causes of : defects, IHD( state after myocardial infarction, various types of angina pectoris), arterial hypertension, cardiomyopathies, infectious endacarditis, inflammatory diseases of the myocardium and pericardium, right heart hypertrophy in the background of pulmonary pathology;
- idiopathic - for unspecified reasons.
The average age of should pay attention to the amount of coffee consumed, to reduce the number of cigarettes smoked per day or to quit smoking, not to expose themselves to stressful situations.
Among elderly patients of in the risk zone, patients who underwent infarctions with prolonged hypertension, which leads to left ventricular hypertrophy.
Symptoms and signs
The clinical picture of the atrial extrasystole consists of complaints related to the immediate sensation of interruptions that occur before the prescribed cardiac contractions and from the symptomatology of cardiac function disorders.
The patient may notice a change in the rhythm of the heart , extraordinary strokes, periods of stoppage.
Sometimes there are chest pains of a different nature and intensity.
Arrhythmia causes insufficient discharge of blood into the circulatory system, because due to the violation of the correct rhythm of contractions, the cells do not have time to fill with the necessary amount of blood.
Insufficient blood flow into the small circle and large circles of blood circulation can trigger occurrence of dizziness due to insufficient intake of oxygen to the brain of , general malaise and shortness of breath.
The discrepancy between cardiac performance and the mismatch of myocardial blood supply by coronary arteries causes cardiac ischemia and anginal pain as angina .Compensating is possible an increase in the frequency of contractions, acceleration of the pulse.
Diagnostic measures
Symptoms of atrial extrasystole are revealed when listening to cardiac tones .Auscultative data reveals premature contractions of the heart against the background of a normal regular rhythm.
The electrocardiogram pattern confirms the presence of a premature tooth P , which differs slightly from normal, and the unchanged ventricular complex following it.
With rare extrasystoles, Holter ECG monitoring should be used, which will allow to track myocardial activity during the day. Laboratory tests of blood and hormones make it possible to ascertain possible out-of-cardiac causes of the disease.
Differential diagnostics on the ECG
For differential diagnosis, the ECG method is used. The atrial extrasystole is distinguished by the presence of the P wave, which is changed with respect to the sinus.
Unlike pulses from the atrioventricular junction, the P wave precedes the ventricular complex .If the contraction occurred in the upper atrial region, P will be positive in the II lead, from the lower atrial to negative.
First aid
First of all, if a disease occurs, should stop the effect of the provoking factor, seat the patient, calm .It is possible to use psychotherapy.
Antiarrhythmics are used with frequent atrial extrasystoles and at risk of transition to tachycardia. As first aid, bisoprolol, propafenone can be used.
In acute pathology and in patients with heart disease, is shown to hospitalize in a specialized hospital.
Tactics for treatment of
Non-pharmacological treatment consists in eliminating risk factors, non-cardiac diseases that caused atrial extrasystole. Abolition of provoking drugs, normalization of the thyroid gland, correction of anemia, potassium level.
Indications for prescribing antiarrhythmics:
- poor tolerance of atrial extrasystole;
- presence of heart defects, organic lesions, suffered myocardial infarction;
- risk of developing atrial fibrillation, atrial flutter;
- more than 700 extrasystoles per day.
beta blockers are used for treatment: bisoprolol 2.5 mg once a day, calcium antagonists: verapamil 40 mg 3 times a day. To maintain sinus rhythm, a propanorm of 150 mg is used.300 mg of cardone is used for rapid cupping under stationary conditions.
Surgical treatment of consists in performing radiofrequency ablation of foci of extrasystoles. Most often, it is performed with monotopic extrasystole in young patients without severe concomitant chronic pathology.
Rehabilitation
Usually does not require , since the disease does not cause a marked decrease in cardiac function. Stay in cardiovascular sanatoriums is indicated for patients with organic cardiac pathology.
With the normalization of the heart rate, should gradually abolish the antiarrhythmic drugs to prevent complications and adverse reactions.
Prognosis, complications and consequences
The prognosis depends on the type, frequency of the extrasystole and the severity of the disease, which was the reason for the extrasystole. In general, with little symptomatology and with no effect on the work of organs and systems, the prognosis is favorable .
Frequent, paired and group extrasystoles may be complicated by by the occurrence of supraventricular tachycardia, atrial fibrillation and flutter. Such rhythm disturbances can significantly affect hemodynamics and have serious consequences.
In polytopic disordered atrial contractions of the atrial , turbulence of the blood flow and formation of thrombi in the cavities of the heart chambers, the occurrence of thromboembolic syndrome are possible.
Relapse prevention and prevention
is required to reject the bad habits of , from taking drugs, reducing the amount of coffee consumed, strong tea and alcoholic beverages. It is important to be able to withstand emotional stress.
Patients with coronary events that have been transferred should be monitored daily for blood pressure and pulse( it is recommended to always have a blood pressure monitor and heart rate meter at hand), to undergo the necessary examinations in a timely manner. To prevent relapses, low doses of antiarrhythmics are necessary for the doctor's prescription.
In general, with timely diagnosis of arrhythmias, modification of risk factors and prevention of atrial extrasystole transition into complicated forms of , the disease proceeds favorably, with rare clinical manifestations of .
