An extraordinary cardiac contraction from a pulse from the conduction system of the ventricles is called ventricular extrasystole( JE).
This is a common rhythm disorder, rare extrasystoles "slip" in many healthy people.
Often they remain unnoticed and are detected only when daily heart monitoring is performed.
What is this, what are the risks of single( single) and frequent extrasystoles
With ventricular( ventricular) extrasystoles anda pulse can appear in the right and left legs of the bundle of the His, Purkinje fibers or directly in the ventricular myocardium.
Single contractions of the ventricular muscle shell do not have a significant effect on blood circulation, and paired and group refers to ventricular extrasystole, which requires treatment.
In contrast to atrial extrasystole, ventricular excitation only covers the ventricles , therefore on the electrocardiogram they look like expanded and deformed complexes.
Often, their appearance is associated with the presence of any organic heart damage, myocardial infarction and reduced contractile function of the heart muscle.
Prevalence and development of
According to the national guidelines on cardiology, ventricular extrasystoles occur in 40-75% of the examined patients. When the ECG is recorded at once, the chance to meet the EEC is approximately 5%.
The increased risk of disease is noted in the elderly, in people with cardiovascular disasters, in the presence of various myocardial diseases.
In such a contingent of patients, the daily amount of ventricular extrasystoles reaches 5000.
The mechanism of development of extrasystoles is associated with premature depolarization of cardiomyocytes. The presence of a refractory portion of the myocardium leads to a re-entry of excitation into the cells and an extraordinary reduction.
Ventricular extrasystoles are characterized by incomplete compensatory pause and occurrence mainly in the morning and daytime .
Classification and differences of species, stages
The gradation and danger to health and life in ventricular extrasystole are determined by the classification of Lawn. The following classes of ZHE are distinguished:
- 0 - complete absence of ventricular extrasystoles;
- 1 - single abbreviations caused by a pulse from the same source;
- 2 - the pulse is also monomorphic, but their number is more than 30 per hour;
- 3 - extrasystoles from different foci;
- 4 - is divided into two types: A - paired extrasystoles, B - group, which is also called short runs of ventricular tachycardia;
- 5 - ZHE, in which the ventricular complex "climbs" on the tooth T of the preceding cycle. Such extrasystole is the most dangerous and can lead to arrhythmia, which significantly affects hemodynamics, causes shock phenomena and death.
By the time of emergence, three types are distinguished:
- early - contractions of the ventricles occur during the passage of the pulse in the atria;
- interpolated ventricular extrasystoles - concomitantly with a reduction in the upper chambers of the heart;
- late-appearance during diastole.
Ordered ventricular extrasystoles are called allrhythmia .When a heart rhythm disturbance( HRC) by the type of ventricular extrasystole occurs after each normal complex, one speaks of the bigemini , when after two normal ones - about the trigeminy and so on.
Causes and risk factors for
The causes that lead to ZHE can be grouped into several groups:
- Cardiac causes of .
These include heart attacks, angina, cicatricial changes in the heart muscle, heart failure, cardiomyopathy, inflammatory diseases of the muscular membrane, various heart disease.
- Change in the concentration of electrolytes , especially potassium and magnesium.
- Taking certain medicines .ZHE can cause cardiac glycosides, antiarrhythmics, diuretics.
- Harmful habits of , uncontrolled smoking, abuse of alcoholic beverages.
- Diseases endocrine organs , which lead to a change in the production of hormones: thyrotoxicosis, diabetes, pheochromocytoma.
For the elderly, cardiovascular diseases, high blood pressure, IHD, chronic diseases of other organs and systems are most often provoking factors.
Symptoms of
The clinical picture of CE is characterized by symptoms of immediate early contraction and circulatory disorders. The patient can feel heart irregularities, irregularity, some describe the "coup" of the heart in the chest .
Similar symptoms of are often combined with fright, anxiety, fear of death .
A change in hemodynamics causes weakness, dizziness, dyspnea at rest may occur. Sometimes there are pains in the heart like a stenocardia.
On examination, you can see pulsation of the veins of the neck, pulse arrhythmia .In severe cases, ventral extrasystole provokes fainting, loss of consciousness.
Many AS patients undergo without a pronounced clinic .
Diagnosis and signs on ECG
Diagnosis is established based on survey and inspection. The patient complains of interruptions, somersaults of the heart, irregular rhythm. On examination, you can see a pulse deficit, pallor, according to auscultation - arrhythmia.
An important diagnostic method is the ECG, which shows the presence of a premature gastric complex without a preceding atrial tooth. The QRS complex is wide, irregular in shape. Additionally, echocardiography, intracardiac EFI is used.
For diagnosis, refer to the electrocardiographic data. Nadzheludochkovye extrasystole is characterized by undeformed QRS, a tooth P in front of all extraordinary ventricular complexes.
The differential diagnosis of different types of extrasystoles is described in the video:
To provide first aid, needs to be laid on the patient, ensuring fresh air. In some cases, if the diagnosis is made, it will be necessary to take antiarrhythmic drugs, for example, amiodarone, propafenone.
It is also necessary for the to deliver the patient to a specialized cardiac hospital for diagnosis and treatment.
Tactics of therapy
In case of benign ventricular extrasystole, which is well tolerated by the patient, drug treatment is not performed. Recommend rejection of bad habits , modification of risk factors, it is possible to take Corvalol.
When frequent ZHE, expressed clinic, malignant course, antiarrhythmic drugs are prescribed:
- Propafenone is an antiarrhythmic drug of the first class, used for the good quality of the course. Contraindicated in LV aneurysm, severe heart failure.
- Bisoprolol - adrenoblocker, prevents the onset of ventricular fibrillation, it shines the heart rhythm. Contraindicated in patients with bronchial asthma.
- Cordarone is the drug of choice for malignant and prognostically unfavorable HE.Reduces the rate of cardiac death.
Surgical treatment of is performed with frequent ventricular extrasystole, which are not amenable to drug treatment. An electrophysiological study is conducted to establish the exact location of the focus and its radiofrequency ablation.
Rehabilitation
Rehabilitation is indicated for patients with advanced myocardial infarction and high-grade CE, which lead to complications in the form of ventricular tachycardia or flutter of the ventricles after surgical treatment of arrhythmia.
Prognosis, complications and consequences of
The prediction of rhythm disturbances largely depends on the severity of the disease, the risk of cardiovascular disease, to which it can lead.
With rare single( monomorphic) ventricular extrasystoles, the prognosis of a good , frequent and polymorphic prognostically unfavorable, requires careful monitoring of the patients' condition and treatment.
Ventricular extrasystoles of high grade( 4, 5) may be complicated by serious arrhythmias of .Ventricular flutter can lead to loss of consciousness, a significant violation of hemodynamics, a decrease in blood supply to the brain.
Transition to ventricular fibrillation without timely defibrillation leads to death.
Relapse prevention and preventive measures
To prevent relapse, needs to select a quality medical treatment and take daily.
It is important to modify risk factors, to quit smoking and drugs, to limit the intake of alcoholic beverages, to carefully apply the drugs, not exceeding the permitted dosages.
To reduce the risk of cardiovascular complications, it is important for to lead a healthy lifestyle of , to monitor the lipid spectrum and the level of cholesterol in the blood. Of great importance is the control of blood pressure, diabetes, thyroid diseases and adequate treatment.
It is very important for to call a doctor on time, choose the right treatment tactics and be committed to therapy.
