The cardiac conduction system plays the main role in the rhythmic functioning of the heart. cardiomyocytes , organized into two nodes and a bundle: the sinoatrial node, the atrioventricular node and the atrioventricular bundle (Hiss bundle fibers and Purkinje fibers located in the ventricles). The sinus node is located in the right atrium, it is the first-order pacemaker of the heart, and an impulse is generated in it.

From it, the impulse spreads to the underlying parts of the heart: through the cardiomyocytes of the atria to the atrioventricular node, then to the atrioventricular bundle. In response to the impulse, the heart contracts in a strict order: the right atrium, the left atrium, the retention in the atrioventricular node, then the interventricular septum and the walls of the ventricles. Excitation spreads in one direction - from the atria to the ventricles, and refractoriness (the period of non-excitability of parts of the heart muscle) prevents its reverse propagation.

Excitability - most important feature heart cells. It ensures the movement of a depolarization wave from the sinus node to the ventricular myocardium. Various departments The conduction system also has automaticity and is capable of generating an impulse. The sinus node normally suppresses the automation of other departments, so it is the pacemaker of the heart - it is the center of first-order automation. However, for various reasons, the rhythmic functioning of the heart can be disrupted and various disorders occur. One of which is extrasystole . This is the most common heart rhythm disorder, which is diagnosed in various diseases (not only cardiac) and in healthy people.

Estracystole of the heart, what is it? Extrasystoles are called premature (extraordinary) contractions of the heart or its parts. Premature contraction is caused by a heterotropic impulse that does not originate from the sinus node, but originates in the atria, ventricles, or atrioventricular junction. If the focus of increased activity is localized in the ventricles, then premature depolarization of the ventricles occurs.

Premature ventricular depolarization, what is it? Depolarization means excitation that spreads through the heart muscle and causes the heart to contract in diastole, when the heart should relax and accept blood. This is how they arise ventricular extrasystoles And . If an ectopic focus forms in the atrium, premature depolarization of the atria occurs, which is manifested not only by atrial extrasystole, but also by sinus and paroxysmal tachycardia .

If normally, during a period of long diastole, blood manages to fill the ventricles, then with an increase in the frequency of contractions (with tachycardia) or as a result of an extraordinary contraction (with extrasystoles), the filling of the ventricles decreases and the volume of extrasystolic ejection falls below normal. Frequent extrasystoles (more than 15 per minute) lead to a noticeable decrease in minute blood volume. The earlier the extrasystole appears, the less blood volume manages to fill the ventricles and the less extrasystolic ejection. First of all, this affects coronary blood flow and cerebral circulation. Therefore, the detection of extrasystole is a reason for examination, establishing its cause and the functional state of the myocardium.

Pathogenesis

In the pathogenesis of extrasystole, three mechanisms of its development are important - increased automatism, trigger activity and re-entry of excitation (reentry). Increased automatism means the appearance of a new area of ​​excitation in the heart, which can cause an extraordinary contraction. The reason for increased automaticity is disturbances in electrolyte metabolism or.

With the reentry mechanism, the impulse moves along a closed path - the excitation wave in the myocardium returns to the place of its origin and repeats the movement again. This occurs when areas of tissue that conduct impulses slowly are adjacent to normal tissue. In this case, conditions are created for the excitation to re-enter.

With trigger activity, trace excitation develops at the beginning of the resting phase or at the end of repolarization (restoration of the original potential). This is due to disruption of transmembrane ion channels. The cause of such disorders is various disorders (electrolyte, hypoxic or mechanical).

According to another hypothesis, disruption of autonomic and endocrine regulation causes dysfunction of the sinoatrial node and simultaneously activates other centers of automaticity, and also enhances impulse transmission along the atrioventricular junction and His-Purkinje fibers. Cells located in valves mitral valve, as the level increases catecholamines form automatic impulses, which are carried out on the atrial myocardium. Cells of the atrioventricular junction also cause supraventricular arrhythmias .

Classification

Extrasystole according to localization is divided into:

• Ventricular
• Supraventricular (supraventricular).
• Extrasystole from AV connection.

By time of appearance during diastole:

• Early.
• Average.
• Late.

By form:

• Monomorphic - the shape of all extrasystoles on the ECG is the same.
• Polymorphic - changes in the shape of extrasystolic complexes.

In practical work, ventricular extrasystole is of primary importance.

Ventricular extrasystole

This type extrasystole occurs in patients with ischemic heart disease, arterial hypertension , ventricular hypertrophy , . Often occurs when hypoxemia and increased activity sympathoadrenal system . Ventricular extrasystole is observed in 64% of patients after and is more common among men. Moreover, the prevalence of the disease increases with age. There is a connection between the occurrence of extrasystoles and the time of day - more often in the morning than during sleep.

Ventricular extrasystole: what is it, consequences

What are ventricular extrasystoles? These are extraordinary contractions that occur under the influence of impulses that come from various parts of the conduction system of the ventricles. Most often, their source is Purkinje fibers and the His bundle. In most cases, extrasystoles incorrectly alternate with normal heart contractions. The ICD-10 code for ventricular extrasystole is I49.3 and is encrypted as “Premature ventricular depolarization.” Extrasystole without specifying the location of the outgoing impulse has a code according to ICD-10 I49.4 “Other and unspecified premature depolarization.”

The danger of ventricular extrasystole for humans is its consequences - ventricular tachycardia , which can go into ventricular fibrillation (ventricular fibrillation), and this is common cause sudden cardiac death. Frequent extrasystoles cause insufficiency of coronary, renal and cerebral circulation.

Ventricular extrasystole is classified

By localization:

• Right ventricular.
• Left ventricular.

By number of outbreaks:

• Monotopic (there is one source of impulses).
• Polytopic ventricular extrasystole (presence of several sources of impulses).

By adhesion interval:

• Early.
• Late.
• Extrasystole R on T.

In relation to the main rhythm:

• Trigeminy.
• Bigeminy.
• Quadrohemony.
• Triplet.
• Verse.

By frequency:

• Rare - less than 5 per minute.
• Average - up to 15 per minute.
• Frequent ventricular extrasystole - more than 15 per minute.

By density:

• Single extrasystoles. Single ventricular extrasystole, what is it? This means that extrasystoles occur one at a time against the background of a normal rhythm.
• Paired - two extrasystoles follow each other.
• Group (they are also called salvo) - three or more extrasystoles that follow each other.

Three or more extrasystoles occurring in a row are called “jogs” of tachycardia or unstable tachycardia. Such episodes of tachycardia last less than 30 seconds. To designate 3-5 extrasystoles following each other, the term “group” or “volley” ES is used.

Frequent extrasystoles, paired, group and frequent “jogs” of unstable tachycardia sometimes reach the level of continuous tachycardia, with 50-90% of contractions per day being extrasystolic complexes.

Ventricular extrasystole on ECG

• There is no atrial contraction - there is no P wave on the ECG.
• The ventricular complex is changed.
• After a premature contraction there is a long pause, which after ventricular extrasystoles is the longest compared to other types of extrasystoles.

One of the most well-known classifications of ventricular arrhythmias is the classification extrasystoles according to Laun-Wolff 1971. She considers ventricular extrasystoles in patients with myocardial infarction.

Previously, it was believed that the higher the class of extrasystole, the higher the likelihood of life-threatening arrhythmias (ventricular fibrillation), but when studying this issue, this position was not justified.

Life-threatening ventricular extrasystole is always associated with cardiac pathology, so the main task is to treat the underlying disease.

Lown's classification of ventricular extrasystoles was modified in 1975 and offers a gradation of ventricular arrhythmias in patients without myocardial infarction.

An increase in the risk of sudden death is associated with an increase in the class of extrasystoles in patients with heart damage and a decrease in its pumping function. Therefore, categories of ventricular extrasystoles are distinguished:

• Benign.
• Malignant.
• Potentially malignant.

Extrasystoles in persons without heart damage are considered benign, depending on their gradation. They do not affect life prognosis. For benign ventricular extrasystole, treatment (antiarrhythmic therapy) is used only for severe symptoms.

Potentially malignant - ventricular extrasystoles with a frequency of more than 10 per minute in patients with organic heart disease and decreased contractility of the left ventricle.

Malignant are paroxysms tachycardia , periodic ventricular fibrillation due to heart disease and ventricular ejection function less than 40%. Thus, the combination of high-grade extrasystole and decreased contractility of the left ventricle increases the risk of death.

Supraventricular extrasystole

Supraventricular extrasystole: what it is, its consequences. These are premature contractions of the heart that are caused by impulses from an ectopic focus located in the atria, AV junction, or at the junction of the pulmonary veins into the atria. That is, the foci of impulses may be different, but they are located above the branches of the His bundle, above the ventricles of the heart - hence the name. Let us recall that ventricular extrasystoles originate from a focus located in the branching of the Hiss bundle. Synonym for supraventricular extrasystole - supraventricular extrasystole .

If rhythm disturbances are caused by emotions (of a vegetative nature), infections, electrolyte disorders, various stimulants, including alcohol, caffeine-containing drinks and drugs, drugs, then they are transient in nature. But supraventricular ES can also appear against the background of myocardial lesions of an inflammatory, dystrophic, ischemic or sclerotic nature. In this case, the extrasystoles will be persistent, and their frequency decreases only after treatment of the underlying disease. A healthy person also has supraventricular extrasystoles, the norm per day of which is up to 200. This norm per day is recorded only during daily ECG monitoring.

Single supraventricular extrasystole (occurs one at a time, rarely and without a system) is asymptomatic in the clinic. Frequent ES can be felt as chest discomfort, a lump in the chest, freezing, agitation followed by shortness of breath. Frequent extrasystoles can worsen a person’s quality of life.

Supraventricular extrasystoles are not associated with the risk of death, but multiple extrasystoles, group and very early (type R on T) can be a harbinger of atrial fibrillation ( atrial fibrillation ). This is the most serious consequence of supraventricular extrasystole, developing in patients with atrial dilatation. Treatment depends on the severity of ES and the patient’s complaints. If extrasystoles occur against the background of heart disease and there are echocardiographic signs of left atrium enlargement, then it is indicated drug treatment. This condition is often observed in patients over 50 years of age.

Atrial extrasystole is considered as a type of supraventricular extrasystole, when the arrhythmogenic focus is located in the right or left atrium. According to Holter monitoring, atrial extrasystoles are observed in 60% of healthy individuals during the day. They are asymptomatic and do not affect the prognosis. If there are prerequisites (myocardial damage of various origins) can cause supraventricular tachycardia and paroxysmal supraventricular tachycardia.

Atrial extrasystole on ECG

• P waves are premature.
• Always differ in shape from the sinus P wave (deformed).
• Their polarity is changed (negative).
• The PQ interval of the extrasystole is normal or slightly prolonged.
• Incomplete compensatory pause after extrasystole.

Causes of extrasystole

Cardiac reasons:

• Cardiac ischemia . Extrasystole serves as an early manifestation of myocardial infarction, is a manifestation of cardiosclerosis, or reflects electrical instability in a post-infarction aneurysm. Supraventricular ES is also a manifestation of ischemic heart disease, but has a lesser effect on the prognosis.
• . Ventricular ES is the most early symptom hypertrophic cardiomyopathy and determines the prognosis. Supraventricular extrasystole not typical for this disease.
• Dysplasia connective tissue of the heart. With it, abnormal chords appear in the ventricle, extending from the wall to the interventricular septum. They are the arrhythmogenic substrate for ventricular extrasystole.
• Cardiopsychoneurosis . Rhythm and automaticity disorders in NCD are common and varied. Some patients exhibit rhythm disturbances in the form of polytopic extrasystole, paroxysmal supraventricular tachycardia and atrial flutter. Ventricular and supraventricular extrasystoles occur with the same frequency. These rhythm disturbances appear at rest or during emotional stress. The nature of the extrasystoles is benign, despite the fact that interruptions in the work of the heart and the fear of stopping it frighten many patients, and they insist on treating the arrhythmia.
• Metabolic cardiomyopathies , including alcoholic cardiomyopathy .
• , including infective endocarditis and myocarditis in autoimmune diseases. The connection with infections is characteristic feature myocarditis. Extrasystoles appear in waves during exacerbations of myocarditis. Patients have antibodies to streptococci , tumor necrosis factor (for immune myocarditis). There is a moderate expansion of the chambers (sometimes only the atria) and a slight decrease in the ejection fraction. The only manifestation of sluggish myocarditis is extrasystoles. To clarify the diagnosis of indolent myocarditis, a myocardial biopsy is performed.
• Dilated cardiomyopathy . This disease is characterized by a combination of ventricular and supraventricular extrasystole, which turns into atrial fibrillation.
• Congenital and acquired (rheumatic). Ventricular ES appears early in aortic defects. PVCs with mitral defects indicate active rheumatic carditis. Mitral defects (especially stenosis) are characterized by the appearance in the early stages of the disease of supraventricular ES, which occurs due to overload of the right ventricle.
• Restrictive cardiomyopathy accompanied by both types of ES in combination with blockades. Amyloidosis occurs with restrictive changes and in the form of damage to the atria only with the occurrence of supraventricular ES and atrial fibrillation.
• Hypertonic disease . The severity of ventricular ES correlates with the severity of left ventricular hypertrophy. A provoking factor for ES may be the use of non-potassium-sparing diuretics. As for the supraventricular form, it is less typical.
• Mitral valve prolapse . VES often occurs with myxomatous valve degeneration, and NVES occurs against the background of severe mitral regurgitation.
• Chronic cor pulmonale . With this disease, supraventricular extrasystoles and right ventricular extrasystoles appear.
• "The Heart of an Athlete" Extrasystole and sports are quite common combinations. Various rhythm and conduction disturbances develop against the background of myocardial hypertrophy with inadequate blood supply. If a rare PVC is diagnosed for the first time and there is no heart pathology, sports of any kind are allowed. For athletes with frequent ventricular extrasystoles, radiofrequency ablation of the arrhythmia focus is recommended. After the operation, an examination is carried out 2 months later, including an ECG, ECHO-CG, Holter monitoring, and a stress test. In the absence of recurrence of extrasystole and other rhythm disturbances, all types of sports are permitted.
• Heart injuries.

Extracardiac reasons:

• Electrolyte imbalance ( hypokalemia , hypomagnesemia or hypercalcemia ). Long-term hypomagnesemia is associated with a high incidence of ventricular extrasystoles and ventricular fibrillation. Mortality increases in patients with hypomagnesemia. Magnesium preparations are used as antiarrhythmic drugs that combine the properties of class I and IV antiarrhythmic drugs. In addition, magnesium prevents the cell from losing potassium.
• Overdose cardiac glycosides (they provoke both types of extrasystoles), tricyclic antidepressants , thiazide and loop diuretics, hormonal contraceptives.
• Taking narcotic drugs.
• Use of anesthetics.
• Taking antiarrhythmic drugs IA, IC, III class.
• . Hormone screening is mandatory in patients with ES. thyroid gland.
• . Against the background of increased hemoglobin, the course of extrasystole improves.
• long-term non-scarring. In a greater percentage of cases, atrial extrasystole occurs, but ventricular extrasystole can also occur. Extrasystole in patients with peptic ulcer occurs more often at night and against the background bradycardia . An effective drug in this situation is .
• Infection.
• Stress.
• . In this condition, extrasystoles are accompanied by fear, panic, and increased anxiety, which are very poorly compensated by self-soothing and require drug correction. With nervousness, extrasystoles of the first two classes according to the Lown classification, therefore it is necessary to treat the neurosis, not the heart.
• Abuse of alcoholic beverages, tea, coffee, heavy smoking.

All of the above factors can be divided into three groups. There is a division of extrasystoles depending on etiological factors:

• Functional. This includes rhythm disturbances of psychogenic origin associated with chemical exposure, stress, alcohol, drugs, coffee and tea. Functional extrasystole occurs when vegetative-vascular dystonia , . There are also cases of extrasystole development in women during menstruation.
• Organic. This group of extrasystoles develops against the background of various myocardial lesions: myocarditis , cardiosclerosis , myocardial infarction , IHD, heart defects , hemochromatosis , amyloidosis , condition after surgical treatment of the heart, “athlete’s heart.”
• Toxic. They are caused by the toxic effects of certain medicines, thyroid hormones with thyrotoxicosis , toxins in infectious diseases.

Extrasystole: a forum for people suffering from it

All of the above reasons are confirmed in the topic “extrasystole, forum”. Most often there are reviews about the appearance of extrasystoles in vegetative-vascular dystonia and neuroses. Psychological reasons for the appearance of extrasystoles are suspiciousness, fears, and anxiety. In such cases, patients turned to a psychotherapist and psychiatrist, and taking sedatives ( Vamelan , ) or long-term use of antidepressants gave a positive result.

Very often extrasystoles were associated with a hernia hiatus diaphragm. Patients noted their association with eating large amounts of food while lying or sitting. Restricting food in volume, especially at night, was effective. There are often reports that taking magnesium preparations (,) helped reduce the number of extrasystoles and they became less noticeable to patients.

Symptoms of extrasystole

Symptoms of ventricular extrasystole are more pronounced than with supraventricular extrasystole. Typical complaints are interruptions in the work of the heart, a feeling of fading or cardiac arrest, increased contraction and rapid heartbeat after a previous freezing. Some patients experience chest pain and severe fatigue. There may be pulsation of the jugular veins, which occurs in atrial systole.

Single ventricular extrasystoles - what is it and how do they manifest? This means that extrasystoles occur one at a time among normal heart contractions. Most often they do not manifest themselves and the patient does not feel them. Many patients feel interruptions in their heart function only in the first days of the appearance of extrasystoles, and then they get used to it and do not pay attention to them.

Symptoms such as “strong stroke” and “cardiac arrest” are associated with an increased stroke volume, which is ejected after the extrasystole by the first normal contraction and a long compensatory pause. Patients describe these symptoms as “heart inversion” and “freezing.”

With frequent group extrasystoles, patients feel palpitations or heart fluttering. The sensation of a wave from the heart to the head and a rush of blood to the neck are associated with blood flow from the right atrium to the veins of the neck while the atria and ventricles contract simultaneously. Pain in the heart region is rarely observed in the form of short, vague pain and is associated with irritation of receptors when the ventricles are overfilled during a compensatory pause.

Some patients develop symptoms that indicate cerebral ischemia: dizziness, nausea, unsteadiness when walking. To some extent, these symptoms may also be caused by neurotic factors, since the general symptoms of arrhythmia are a manifestation of autonomic disorders.

Tests and diagnostics

Clinical and biochemical examinations:

• Clinical blood test.
• If myocarditis is suspected, inflammatory markers (CRP level), cardiac troponins (TnI, TnT), natriuretic peptide (BNP), and cardiac autoantibodies are examined.
• Blood electrolyte levels.
• Study of thyroid hormones.

Instrumental studies

• ECG. ECG examples the main types (ventricular and atrial) were given above. Atrial premature beats are more difficult to diagnose if the patient has a wide QRS complex (similar to a His bundle block), early supraventricular ES (the P wave overlaps the previous T and makes it difficult to identify the P wave), or blocked supraventricular ES (the P wave does not extend into the ventricles). Complex rhythm disturbances present even greater difficulties. For example, polytopic extrasystole . With it, extrasystoles are generated by several sources in the heart, which are localized in different areas. Extrasystoles appear on the ECG, which have different shapes, different durations of compensatory pauses, and an inconsistent pre-extrasystolic interval. If in the future the excitation follows one path, then the extrasystoles will have same shape is a polytopic monomorphic form. Polytopic polymorphic extrasystoles occur in different directions of impulses. This type of arrhythmia indicates serious myocardial damage, severe electrolyte imbalance and hormonal changes.
• Holter monitoring. Evaluates changes in heart rate per day. Repeated Holter monitoring during treatment makes it possible to evaluate its effectiveness. CM is performed in the presence of rare extrasystoles, which are not detected during a standard electrocardiographic study. The most important thing during the study is to determine the number of ES per day. No more than 30 ES per hour is allowed.
• Tests with physical activity. Treadmill test - a study with a load on a treadmill with ECG recording in real time. The subject walks along a moving walkway and the load (movement speed and elevation angle) changes every 3 minutes. Before and during the study, blood pressure and electrocardiogram are monitored. The study is stopped if the patient complains. When performing a stress test, the occurrence of paired VES at a heart rate less than 130 per minute in combination with “ischemic” ST is important. If extrasystoles occur after exercise, this indicates their ischemic etiology.
• Echocardiography. The dimensions of the chambers, structural changes of the heart are studied, the state of the myocardium and hemodynamics are assessed, signs of arrhythmogenic dysfunction and changes in hemodynamics during extrasystoles are identified.
• Magnetic resonance imaging of the heart. Examination and assessment of the function of the right and left ventricles, identification of fibrous, cicatricial changes in the myocardium, areas of edema, lipomatosis.
• Electrophysiological study (EPS). It is carried out before surgery to clarify the location of the source of pathological impulses.

Polytopic extrasystole

Treatment of extrasystole

How to treat extrasystole? First of all, you need to know that the presence of extrasystole is not an indication for prescribing antiarrhythmic drugs. Asymptomatic and low-symptomatic extrasystoles do not require treatment in the absence of cardiac pathology. This is a functional extrasystole, to which people with vegetative-vascular dystonia are prone. What should you do in this case?

Lifestyle changes are important stages in the treatment of extrasystole. The patient must lead healthy image life:

• Avoid drinking alcohol and smoking, introduce walking in the fresh air.
• Eliminate potential factors that cause arrhythmia - strong tea, coffee. If extrasystole occurs after eating, you need to observe what food it occurs after and exclude it. However, for many, extrasystoles occur after eating a large meal and drinking alcohol.
• Eliminate psycho-emotional tension and stress, which in many patients are factors that provoke the appearance of extrasystoles.
• Introduce foods rich in magnesium and potassium into your diet: raisins, cereals, citrus fruits, lettuce, persimmons, dried apricots, bran, prunes.

In such patients, echocardiography is indicated to identify structural changes and monitor left ventricular function. In all cases of rhythm disturbances, patients should be examined to exclude metabolic, hormonal, electrolyte, disturbances and sympathetic influences.

If detected thyrotoxicosis , myocarditis the underlying disease is treated. Correction of arrhythmias in case of electrolyte disorders involves the administration of potassium and magnesium supplements. With the predominant influence of the sympathetic nervous system Beta blockers are recommended.

Indications for the treatment of extrasystole:

• Subjective intolerance to sensations of rhythm disturbance.
• Frequent group extrasystoles that cause hemodynamic disturbances. Supraventricular ES of more than 1-1.5 thousand per day against the background of organic heart damage and atrial dilatation is considered prognostically unfavorable.
• Malignant ventricular ES with a frequency of 10-100/hour against the background of heart disease, with paroxysms of tachycardia or cardiac arrest.
• Potentially malignant - threat of development of ventricular fibrillation.
• Detection of deterioration in parameters (decreased output, dilatation of the left ventricle) during repeated echocardiography.
• Regardless of tolerance, frequent extrasystole (more than 1.5-2 thousand per day), which is combined with a decrease in myocardial contractility.

Treatment of extrasystole at home involves taking antiarrhythmic drugs. It is better to select a drug in a hospital setting, since this is done by trial and error: the patient is sequentially (3-5 days) prescribed drugs in average daily doses and their effect is assessed based on the patient’s condition and ECG data. The patient takes the selected drug at home and periodically comes for a control ECG test. It sometimes takes several weeks to evaluate the antiarrhythmic effect.

Antiarrhythmic drugs for extrasystole

Different groups of drugs are used:

• Class I - sodium channel blockers: Quinidine Durules , Aymalin , Ritmilen , Pulsnorma , Ethmozin . These drugs are equally effective. IN emergency conditions use intravenous administration Novocainamide . All representatives of class I antiarrhythmic drugs increase the mortality rate of patients with organic heart disease.
• Class II - these are β-blockers, which reduce the sympathetic effect on the heart. They are most effective for arrhythmias that are associated with psycho-emotional stress and physical activity. Drugs, Korgard , Trazicore , Visken , Cordanum .
• Class III - potassium channel blockers. Drugs that increase the duration of the action potential of cardiomyocytes. ( active substance amiodarone) and (additionally has beta-blocker properties).
• IV class - blockers calcium channels: , Falicard .

• If patients of the first group are not bothered by extrasystoles, they are limited general recommendations and explanations about the non-hazardous nature of such violations. If people in this group have more than 1000 extrasystoles per day or significantly less, but with poor tolerance, or if the patients are over 50 years old, then treatment is necessary. Calcium antagonists (,) or β-blockers are prescribed. These groups of drugs are effective for NZHES. Begin treatment with half doses and, if necessary, gradually increase. One of the β-blocker drugs is prescribed: , . If extrasystoles appear at the same time, use a single dose of the drug at this time. Verapamil is recommended for a combination of extrasystoles and bronchial asthma. If there is no effect from these drugs, they switch to half doses of class I drugs (,). If they are ineffective, they switch to or Sotalol .
• Treatment of patients in group 2 is carried out according to the same scheme, but in larger doses. IN complex treatment also enter , . If you need to quickly achieve an effect, amiodarone is prescribed without testing other drugs.
• Patients of the 3rd group begin treatment with amiodarone 400-600 mg per day, Sotalola or Propafenone . Patients in this group need to take medications constantly. Also used ACE inhibitors And .
• For patients with NVES due to bradycardia, it is recommended to prescribe Rhythmodan , Quinidine-durules or Allapinina . Additionally, you can prescribe drugs that increase heart rate: Teopek (theophylline), Nifedipine . If ES occurs against the background of nocturnal bradycardia, the drugs are taken at night.

Patients of the first and second groups after 2-3 weeks of taking the drug can reduce the dosage and completely stop the drug. The drug is also discontinued in case of undulating course of supraventricular ES during periods of remission. If pacemakers reappear, medications are resumed.

Extrasystoles caused by electrolyte imbalance

The antiarrhythmic activity of magnesium preparations is due to the fact that it is a calcium antagonist, and also has a membrane-stabilizing property, which class I antiarrhythmics have (prevents the loss of potassium), in addition, it suppresses sympathetic influences.

The antiarrhythmic effect of magnesium appears after 3 weeks and reduces the number of ventricular extrasystoles by 12%, and the total number by 60-70%. In cardiological practice, it is used, which contains magnesium and orotic acid. It is involved in metabolism and promotes cell growth. The usual regimen for taking the drug: 1st week, 2 tablets 3 times a day, and then 1 tablet 3 times. The drug can be used for a long time, it is well tolerated and does not cause side effects. In patients with this, stool returns to normal.

Other groups of drugs are used as auxiliary:

• Antihypoxants. Promotes better absorption of oxygen by the body and increases resistance to. Among the antihypoxic drugs used in cardiology.
• Antioxidants. They interrupt the reactions of free radical oxidation of lipids, destroy peroxide molecules, and compact membrane structures. Among the drugs, and are widely used.
• Cytoprotectors. Reception reduces the frequency of extrasystoles and episodes of ischemic ST depression. Available on the Russian market, Trimetazid , .

The doctors

Medicines

• Antiarrhythmic drugs: , , Aymalin , Ritmilen , Pulsnorma , Ethmozin .
• Beta blockers: Korgard , Trazicore , Visken , Cordanum .
• Magnesium and potassium preparations: , .
• Antioxidants and cytoprotectors: Trimetazid , .

Procedures and operations

Lack of efficiency conservative treatment is an indication for surgical techniques. How to get rid of extrasystole forever? An option for radical treatment of extrasystole is radiofrequency ablation of the ectopic focus. It is recommended in all cases of ES with a frequency of 10 thousand per day or more.

Radiofrequency ablation for supraventricular tachycardia is a first-line treatment method. For arrhythmogenic dysplasia of the right ventricle, surgical intervention should be early, since with the relief of arrhythmia, fatty degeneration of the myocardium stops. If the operation is not performed on time, in the later stages only heart transplantation is possible. The need to prescribe antiarrhythmic drugs after ablation may remain, but their effectiveness becomes higher than before surgery. In some cases, patients are able to wean off medications after ablation after 4-12 months.

To identify arrhythmogenic foci during surgery, an electrophysiological study is performed. Under local anesthesia, the main vessels are catheterized. Then catheters (for diagnostics) and an ablation electrode (to cauterize the lesion) are inserted into the heart. The procedure is often painless, but sometimes the patient feels discomfort in the heart area. General anesthesia is used for ablation of complex arrhythmias, which include ventricular arrhythmias and atrial fibrillation.

If there is a high risk of threatening rhythm disturbances (ventricular tachycardia or ventricular fibrillation), patients are implanted with a cardioverter-defibrillator. In case of extrasystole in patients with bradycardia, a permanent pacemaker is implanted.

Treatment of extrasystole with folk remedies

Treatment folk remedies can only be used in combination with medication. Plants, vegetables and fruits that have a sedative, anti-sclerotic effect, contain potassium and magnesium, and reduce blood clotting will be useful. It can be serviceberry, raspberries, yarrow flowers, hawthorn fruits, currants, apricots, nuts, dried apricots, raisins, plums, cucumbers, watermelon, grapes, melon, cabbage, potatoes, parsley, vegetable tops, beans, beets, apples, valerian root , lemon balm herb.

Herbal diuretics: cornflower flowers, corn silk, bearberry leaf, lingonberry and birch leaves. Replenishment of potassium losses: birch leaves, parsley and hernia grass, apricot, quince, peach juice.

The following herbs are toxic and should be used with caution. However, this is not necessary, since official preparations are prepared on their basis:

• aconite herb (preparation);
• cinchona bark ( Quinidine sulfate );
• Rauwolfia serpentine roots (preparation Aymalin ).

Extrasystole in children

The appearance of extrasystoles in children is a consequence of:

• myocardial hypoxia;
• hormonal and electrolyte imbalance;
• neurovegetative disorders;
• inflammatory myocardial damage;
• anatomical damage to the myocardium;
• occur without obvious causes (idiopathic, found in most pediatric cases).

The incidence of idiopathic extrasystole depends on age. Single ventricular extrasystoles are detected in 23% of healthy newborns. The frequency of occurrence decreases to 10% in preschool children and schoolchildren, then increases again to the original figures in adolescents.

Left ventricular extrasystole often has a benign course in children and resolves independently with age. The course of right ventricular extrasystole is also favorable, but may be a consequence of arrhythmogenic dysplasia of the right ventricle.

Extrasystole in children in 80% develops against the background of neurovegetative disorders. They may not feel them or complain of “fading” of the heart and unpleasant sensations. By nature, extrasystoles are most often single and inconsistent. They are recorded mostly in a lying position, and decrease in a standing position or after exercise. Frequent and group extrasystoles and their combination with other changes on the ECG have more serious causes and a not very favorable prognosis. But in this case, the autonomic nervous system is also of great importance. Children with extrasystole do not require emergency treatment.

The decision to start treatment is made in children with frequent ventricular extrasystole. It depends on the concomitant pathology of the heart, the age of the child and hemodynamic disorders that cause extrasystoles. But in any case, the underlying disease is treated.

• Idiopathic PVCs, given their benign course, most often do not require treatment.
• In children with rare extrasystoles and good tolerance, only a comprehensive examination is performed.
• Children with frequent asymptomatic ventricular extrasystoles with normal myocardial contractile function are also not treated with medication. In some cases with frequent or polymorphic extrasystole, beta blockers or calcium channel blockers are prescribed, but their constant use is not recommended.
• With frequent ventricular ectopy, the presence of complaints and the development of arrhythmogenic myocardial dysfunction, the issue of prescribing beta blockers or ablation .
• In case of frequent or polymorphic ventricular extrasystoles and the ineffectiveness of beta blockers/calcium channel blockers, class I or III antiarrhythmic drugs are used.

Extrasystole during pregnancy

During pregnancy, one of the most common cardiac arrhythmias is extrasystole. In half of pregnant women it occurs without changes in the heart, endocrine system or gastrointestinal tract. During pregnancy, a change in the function of the thyroid gland occurs, so this reason is first ruled out. Among other causes of extrasystole in pregnant women, the following should be noted:

• changes in hemodynamics that occurred during this physiological period in women;
• electrolyte imbalance ( hypomagnesemia And hypokalemia );
• hormonal changes (increased levels);
• cardiopsychoneurosis;
• previously rescheduled myocarditis ;
• cardiomyopathy ;
• heart defects;
• emotional arousal;
• abuse of coffee and strong tea;
• drinking alcohol and smoking;
• abuse of spicy foods;
• binge eating.

Most often in women during this period, supraventricular extrasystoles (67%), followed by ventricular (up to 59%). Supraventricular ES is a common finding during routine routine examination and is recorded in healthy women. They are characterized by provoking factors such as stress, infection, overwork, smoking, abuse of caffeine-containing products and products that cause gas formation.

Ventricular extrasystoles either appear for the first time, or their frequency increases in pathological pregnancies and in normal pregnancies.

If the arrhythmia is not a threat to the woman’s life, then the prescription of antiarrhythmic drugs is avoided. Asymptomatic extrasystoles do not need correction with medications, and treatment begins with the elimination of provoking factors (emotional and physical stress, smoking, drinking coffee and alcohol).

If there is still a need to prescribe medications, then the treatment approaches are the same as for non-pregnant women. In this case, the possible effect of the drug on the fetus, the course of pregnancy and childbirth is strictly taken into account.

The drugs of choice during pregnancy are calcium channel blockers ( Verapamil ) and beta blockers ( Bisoprolol , Egilok , Propranolol ). The later medications are prescribed, the lower the risk of their effect on the condition of the fetus and the course of pregnancy. Thus, there are reports of a slowdown in fetal development when taking Atenolol And Propranolol in the first trimester, and their administration in the second trimester is considered safe. Most often pregnant women with frequent ventricular extrasystole are prescribed Bisoprolol . This drug did not have a teratogenic effect in animal studies.

Diet

The nutrition of patients depends on the underlying disease against which extrasystole developed.

• For all diseases of cardio-vascular system the basic one is with a limitation of animal fats and salt. You can use Diet for cardiac arrhythmias or Diet for heart failure .
• For thyrotoxicosis, it is indicated for patients.
• If the cause of extrasystoles was anemia -.

In all cases, it is recommended to eat in small portions, since a large amount of food consumed can become a provoking factor. The last meal should be the lightest and 3 hours before bedtime. Secondly, caffeine-containing foods that increase gas formation (legumes, large amounts of bread and pastries, grapes, raisins, carbonated drinks, kvass), alcohol, and spicy foods are excluded from the diet. Each patient, observing his condition, can determine those foods that cause ES in him.

Nutrition should be rational and balanced in essential nutrients. Taking into account cardiovascular pathology, vegetables and fruits should prevail in the diet. It is also useful to include foods rich in magnesium (sesame, poppy seeds, cashews, almonds, hazelnuts, buckwheat and oatmeal, brown rice, beets) and potassium (apricots, peaches, dried apricots, a moderate amount of raisins) to prevent bloating - nuts , spinach, sun-dried tomatoes, prunes, honey, bee bread, potatoes, watermelons, bananas, melon, beef, fish.

Prevention

The main method of prevention is timely treatment cardiovascular diseases. For patients with cardiac pathology, regular monitoring is important (with mandatory conducting an ECG, Holter monitoring stress test). In this case, it is necessary to determine the influence of the autonomic nervous system on the cardiovascular system, assess the psycho-emotional state, working conditions and bad habits.

Consequences and complications

In addition to unpleasant subjective sensations, after extrasystoles there is an unstable restoration of the function of the sinus node, and the extrasystoles themselves can cause hemodynamic disturbances. These disorders depend on the degree of premature extrasystoles, their location and frequency, and most importantly, on the condition of the heart. A short R-R interval does not provide high-quality blood filling in diastole.

With very early ventricular ES, the blood volume and the force of ventricular contraction are so small that the blood ejection is very small (systoles become ineffective). Frequent extrasystoles significantly reduce cardiac output, coronary and cerebral blood flow, and the pulse often drops (pulse deficiency). In patients with ischemic heart disease, during double ES occurs angina pectoris . Patients with atherosclerosis cerebral vessels may complain of severe weakness and dizziness. With rare extrasystoles, very noticeable changes in the volume of blood ejection do not occur.

The main consequences of ventricular extrasystole can be identified:

• Severe left ventricular hypertrophy.
• Significant decrease in left ventricular ejection fraction.
• Risk of progression to flutter or ventricular fibrillation.
• The main complication of malignant ventricular ES is sudden death.

Consequences of supraventricular extrasystole:

• Enlargement of the cavities of the heart (arrhythmogenic cardiomyopathy develops).
• Development of supraventricular tachycardia. It is characterized by rapid cardiac activity (during an attack, the heart rate reaches 220-250 beats per minute), which suddenly begins and stops.
• Development of atrial fibrillation (synonymous with atrial fibrillation). This is a chaotic and frequent contraction of the atria. During an attack, heart rate increases significantly. The occurrence of atrial fibrillation is a criterion for the malignancy of supraventricular extrasystole.

Forecast

Extrasystoles are safe in most cases, and their prognostic value is completely determined by the degree of heart damage and the condition of the myocardium. In the absence of myocardial damage and normal LV function (if the ejection fraction is 50% or more), extrasystole does not pose a threat to the patient’s life and does not affect the prognosis, since the likelihood of developing fatal arrhythmias is extremely low.

Such arrhythmias are classified as idiopathic. With organic damage to the myocardium, extrasystole is considered an unfavorable sign. Ventricular extrasystoles, if diagnosed with coronary artery disease, are associated with a risk of death. High gradations of extrasystoles are the most dangerous. Patients with potentially malignant ES require treatment to reduce mortality. Polytopic PVC has a worse prognosis than single monotopic PVC. Rare ES do not increase the risk of death.

List of sources

• Diagnosis and treatment of atrial fibrillation. Recommendations of RKO, VNOA, ASSH, 2012 // Russian Journal of Cardiology. 2013. No. 4. P. 5–100.
• Lyusov V.A., Kolpakov E.V. Cardiac arrhythmias. Therapeutic and surgical aspects. – M.: GEOTAR-Media, 2009. – 400 p.
• Shpak L.V. Heart rhythm and conduction disorders, their diagnosis and treatment: A guide for doctors. – Tver, 2009. – 387 p.
• Standard ECG parameters in children and adolescents / Ed. Shkolnikova M. A., Miklashevich I. M., Kalinina L. A. M., 2010. 232 p.
• Shevchenko N.M. Cardiology // MIA. – Moscow 2004 – 540 p. 7. Chazov E.I., Bogolyubov V.M. Heart rhythm disturbances // M.: Medicine, 1972.

Publication date: 2016-06-30

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Symptoms of ventricular extrasystole

Night. You lie in bed in a relaxed state, ready to fall into a deep night's sleep. Suddenly a lump comes to your throat, you swallow convulsively and feel as if something is turning over behind your sternum.

Does it feel familiar? I think that some of you have experienced something similar not only before going to bed, but also while awake. Typically, these symptoms manifest as ventricular extrasystole. And many people ask me the question: is extrasystoles in the heart dangerous?

Atrial extrasystole does not cause such discomfort and is often not felt at all by a person, only with pronounced palpitations.

Often people, noticing rhythm disturbances, begin to panic, clutch their hearts and scream that they are dying. Therefore, I decided to devote a separate article to the causes and symptoms of extrasystole.

What you will learn from this publication:

• interruptions in the heart, what is it; types of cardiac arrhythmia: ventricular extrasystole, atrial extrasystole, etc.
• arrhythmia symptoms
• causes of extrasystoles
• extrasystole with osteochondrosis
• extrasystoles how to get rid of
• treatment of arrhythmia

Ventricular extrasystoles - what is it?

An extrasystole is an extraordinary, but at the same time full, contraction of the heart. The heart has its own autonomous innervation system, which consists of several rhythm-generating nodes and conducting nerve fibers.

The sinoatrial node works normally, and it ensures stable functioning of the heart. But in various situations, the sinus node does not have time to send an impulse, and then other underlying nodes are included in the mechanism for creating contraction.

The process is very complex, and I do not want to immerse you in the jungle of physiology and anatomy. I just have to note that even individual nerve fibers of the heart can create an impulse and cause contraction of muscle fibrils.

In addition to atrial and ventricular cardiac arrhythmias, there are other heart rhythm disorders: atrial fibrillation, bradycardia, sinus tachycardia or other variants, heart block and paroxysmal tachycardia, which we will not talk about today.

Atrial and ventricular extrasystoles can occur against the background of rapid, normal and slow heartbeat. Symptoms of arrhythmia usually depend on this.

Frequent heartbeats in themselves are not a very pleasant phenomenon, and in the presence of arrhythmia they can cause severe discomfort. Sometimes this condition can be confused with. But it all depends on the condition of the heart.

What are the causes of extrasystoles?

Simply put, the heart has a certain protective mechanism that is triggered when, for some reason, the duration of the cardiac cycle changes. Well, like two partners who work on the same shift. One decided to relax and go smoke and asked the second to replace him for a while. So it is with the heart.

Interruptions in the functioning of the heart, the causes of which are unknown, are called idiopathic.

Known causes of extrasystoles are a lack of potassium due to taking diuretics, working in hot conditions and various diseases, as well as organic heart damage such as myocardial infarction, atherosclerosis, mediastinal tumors, myocarditis, rheumatism, etc.

Can heart failure occur with osteochondrosis?

Both atrial and ventricular extrasystole can be caused reflexively in osteochondrosis, but this is not a very common occurrence.

Moreover, the feeling of interruption in the work of the heart is often accompanied by pain syndrome and mimics or conceals coronary heart disease.

This is not difficult to understand, because part of the nerve fibers of the heart originate from the cervical and thoracic spinal cord.

Other symptoms of cardiac arrhythmia: pallor, sweating, acrocyanosis, coldness skin and sweating are characteristic of serious organic ones.

The combination of rhythm disturbances and the above symptoms requires immediate medical attention. But here we are considering only safe extrasystole.

Is extrasystoles in the heart dangerous?

Let's now figure out how dangerous extrasystoles are. Modern research has proven that heart rhythm disturbances occur in everyone. The difference is in their quantity.

Rare extrasystoles are usually not felt, frequent ones cause anxiety and discomfort in people. Well, how? It's the heart!

But you need to understand that for a healthy heart, arrhythmia is absolutely safe and treatment of such a pathology is not required if there are no other above-mentioned symptoms.

Neurogenic extrasystoles may go away on their own over time.

How to get rid of extrasystoles?

Many people ask doctors how to get rid of cardiac extrasystoles? How to treat extrasystole? So, the antiarrhythmic drugs themselves are even more dangerous than interruptions in the functioning of a healthy heart.

Scientists examined pilots, sailors, military personnel, and athletes; all of them were found to have arrhythmia.

Previously, there was a special gradation of arrhythmia by frequency. It was believed that up to a certain number per day there was no need to treat them. If the number of extrasystoles exceeded a certain limit, therapy was recommended.

Currently, the approach to the treatment of extrasystolic cardiac arrhythmias has changed dramatically. Regardless of frequency, it is not recommended to treat heart failure in a healthy heart because it increases the risk of future death.

Of course, with the sudden appearance of atrial or ventricular cardiac extrasystole, you need to undergo an examination to rule out serious disorders in the heart muscle. But without identifying the cause, you should not self-medicate.

Treatment of arrhythmia with folk remedies is also undesirable until an accurate diagnosis has been established. After all, all medications are based on the action of medicinal plants found in nature, and the harm from them can be no less than from tablets.

Treatment of extrasystole at home should first of all consist of changing lifestyle, diet and sleep patterns. Various relaxation techniques, meditation, breathing exercises and fitness are much more useful than any pills.

Well, if you are completely unable to live without medications, you can drink Corvalol, Validol and soft sleeping pills. You also need to quit smoking, drink alcohol, tea, coffee and avoid stress.

Current health issues: Tips and secrets from an expert doctor

How to become healthy and enjoy life again?

Extrasystole (extrasystoles)– a disruption of the normal rhythm of the heart, characterized by extraordinary contraction of the myocardium and/or its chambers (atria, ventricles). At this moment, a person at the beginning may feel as if the heart has stopped and there is a lack of air, then a strong blow, and at the end - the restoration of the normal rhythm of heart contractions. This clinical picture very well displayed on the electrocardiogram (ECG), a photo of which we will attach a little further.

Extrasystole is one of the types, and can be of a short-term (neurogenic) nature, which is caused by drinking coffee or alcohol, smoking, or a long-term course, signaling the presence of something (coronary artery disease, atherosclerosis,).

The main symptoms are discomfort and pain in the heart area, feelings of anxiety and lack of air, increased sweating.

Development

To understand the principle of the pathogenesis of extrasystoles, you first need to know the mechanism of myocardial contractions. Let's make this short.

Thus, contraction of the heart muscle (myocardium) causes an electrical impulse that is formed in the conduction system of the heart. This neurogenic impulse originates in the sinoatrial (sinoatrial) node and then passes through the internodal pathways of the atria, causing their depolarization. The signal then passes through the atrioventricular node and finally, through the atrioventricular bundle, it is sent to the ventricular muscles.

The slightest impact on the constituent elements of this system leads to disruption of the uniform passage of the impulse, the delay of which (compensatory pause) externally manifests itself in the form of arrhythmia, or, in our case, extrasystoles.

Statistics

According to medical statistics, extrasystoles occur in approximately 65-70% of healthy people in the world. If about 200 ventricular and supraventricular extrasystoles are observed per day, then this is a normal indicator that does not cause discomfort in a person. However, with heart pathologies and other diseases, the number of extrasystoles per day can reach 6-10 thousand, and here it is practically impossible to do without consulting a doctor.

Secondary factors, such as bad habits, poor lifestyle, unhealthy food and stressful situations do their job, causing serious harm not only to the heart, but to the entire body as a whole.

ICD code

ICD-10: I49.3
ICD-9: 427.69

Symptoms of extrasystole

Symptoms depend on the cause of the heart failure, the person’s age and health status.

Single extrasystoles caused by stress, drinking tea or coffee may not manifest themselves and the person will not feel anything. Sometimes sharp shocks of the myocardium may be felt, which the person quickly forgets about.

Extrasystoles that develop against the background of various diseases are accompanied by the following clinical picture:

• A feeling of a sinking heart, as if it had stopped, lack of air and discomfort in the chest, then a sharp shock of the heart muscle, after which the rhythm of the myocardium is restored;
• Anxiety, worry, fear;
• , increased sweating;
• Pain in the heart area;
• Weakening of the pulse.

Group extrasystoles, when disturbances occur repeatedly, one after another, or single, but often, due to less blood flow, normal blood supply decreases, and accordingly the nutrition of the brain, coronary vessels of the myocardium, kidneys and other important organs decreases by approximately 8-25%. This leads to the following symptoms:

• , fainting;
• Disturbances in the functioning of the hearing and speech apparatus (aphasia);
• Pressing pain in the heart ();
• Paresis.

Complications

Among the most common complications of extrasystole are:

• Increased heart rate on a constant basis (paroxysmal);
• Atrial fibrillation;
• Complications of cardiovascular diseases.

External causes of extrasystole:

• Stress is the main culprit in almost all types of arrhythmia;
• , coffee, strong tea;
• Smoking, drugs;
• Uncontrolled use of medications, in particular caffeine, aminophylline, ephedrine, novodrin, neostigmine, glucocorticosteroids (GC), diuretics, tricyclic antidepressants and others;
• Poisoning of the body or various chemicals;
• Large physical exercise on the body.

Internal causes of extrasystole:

• Diseases of the cardiovascular system - cardiosclerosis, cardiomyopathy, ;
• Neurological diseases –, ;
• Diseases of the musculoskeletal system –, ;
• Violation of ion exchange of potassium, magnesium, sodium and calcium in the myocardium;
• Changes in hormonal levels - ovulation (overproduction of hormones by the thyroid gland, large doses which poison the body);
• Other diseases and conditions are inflammatory processes, amyloidosis, sarcoidosis, hemochromatosis.

Classification of extrasystole

The classification of extrasystole is as follows:

By localization

• Ventricular – 62.5% of cases;
• Atrial – 25% of cases.
• Atrioventricular and nodal (atrioventricular) – 2%.
• Sinoatrial (sinus extrasystole) – 0.5%.
• Combined – 10%

By etiology (cause of occurrence):

Functional extrasystoles– development occurs primarily as a result of dysfunctions of the nervous system, in particular with neuroses and autonomic dysfunction. Characterized by presence at rest, and cessation after emotional experiences or physical exertion. The ECG displays monotopic changes in the ventricles.

Organic extrasystoles- development occurs as a result of pathologies of the heart, blood vessels, endocrine system or poisoning of the body. Diagnosed most often in elderly people. The ECG shows extrasystoles in all parts/nodes of the heart, one at a time or in a group, everywhere at the same time. An important factor in the appearance is physical fatigue and stress.

By source of excitation:

Monotopic - a stable interval between peaks on the cardiogram and one focus of excitation;

Polytopic - different intervals between extrasystoles and several foci of appearance.

Unstable paroxysmal tachycardia - group extrasystoles, coming one after another.

Classification of ventricular extrasystoles “Lown & Wolf”

I class– characterized by single repeating extrasystoles in an amount of up to 30 per hour. It is not dangerous and does not require correction.

II class– characterized by single repeating extrasystoles in an amount of 30 or more per hour. Despite minor deviations in rhythm, there are no serious health consequences.

III class– characterized by chaotic cardiac complexes with varying intervals, shape and number of episodes. Man demands medical care in the correction of heart function.

IVa class– characterized by paired extrasystoles following one after another, as well as high variability, leading to pathological changes in the cardiovascular system.

IVb class– 3-5 bursts of extrasystoles, following each other, high gradation and irreversible consequences in the functioning of the body, especially the heart and blood vessels. Represents a danger to human life.

V class– characterized by early extrasystoles (R, T) and high gradation, leading to cardiac arrest.

Diagnostics

Diagnosis of extrasystole includes:

• Initial examination, anamnesis;
• , incl. daily monitoring (ECG-Holter) and ECG under physical activity (bicycle ergometry);
• To clarify the diagnosis, a heart may also be required.

How to treat extrasystole? The treatment regimen for extrasystole looks approximately as follows:

1. Exclusion of a pathogenic factor.
2. Diet.
3. Drug treatment.
4. Surgical treatment.

The prescription of medications and the treatment regimen directly depend on the type of pathology, its etiology, the presence of concomitants and the patient’s health status.

1. Exclusion of a pathogenic factor

We have already written about what medications and factors affect the heart in such a way that its normal rhythm of work changes (see “Causes of extrasytolia”).
First of all, it is necessary to exclude these factors. If the rhythm is restored in the first or two days, then there is no need to go to the doctor. This is precisely the period when most drugs that can cause extrasystoles are removed from the body.

Don’t forget about rest for the body - reduce physical activity, remove a stress factor, which could be, for example, watching a news report.

There is a good effect on the heart when swimming, moderate walking, slow riding or cycling.

2. Diet for extrasystole

Magnesium (Mg)– an important macronutrient in living organisms, which has a beneficial effect and promotes the normal functioning of the heart and other muscle tissues. A special point worth paying attention to simultaneous administration magnesium, responsible for the functioning of the nervous system.

The following foods have a high magnesium capacity - pumpkin seeds, various nuts, cereals (buckwheat, rolled oats, oats, wheat), watermelon, mackerel, spinach, lettuce, persimmons, raisins, dried apricots, bananas, apples, legumes and others. It is necessary to exclude heavy fatty foods, fried foods, and smoked foods from the diet.

A large amount of Omega-3 is present in sea fish, flaxseed oil,.

A large amount of potassium is present in candied fruits, apricots, dried apricots, wheat bran, beans, peas, tomato paste, prunes, raisins, and flaxseed.

“Extrasystoles in the heart” - if you hear such a diagnosis from a doctor, then first of all what comes to mind is some kind of incurable, even fatal disease. But is it? In fact, extrasystoles are nothing more than a heart rhythm disturbance. This problem occurs in more than 60% of people and is a type of arrhythmia. To fight attacks, you need to figure out what kind of disease it is and whether extrasystoles are dangerous.

Characteristic features of the disease

Extrasystole is an untimely complete contraction of the heart. The main reasons for the appearance of extrasystole are: alcohol and tobacco consumption, frequent stress, excessive amounts of strong coffee and tea. In this case, the attack may be one-time or rare. Often, people suffering from extrasystole have almost the same complaints, which bring quite unpleasant sensations:

• painful internal blows in the chest area;
• lack of air;
• sudden feeling of anxiety;
• feeling of a frozen heart.

Heartache

Group extrasystoles entail a cough spasm, severe dizziness and pain in the chest area. When a healthy heart works, electrical impulses appear in the so-called sinus node. In this case, the rhythm is not disturbed. For the appearance of extrasystole in the heart, nervus vagus somehow overlaps the rhythm-forming node. As a result, impulse transmission is slowed down.

Places of increased activity appear outside the sinus node (in the atria, ventricles). To release the accumulated energy, the resulting impulses, with the help of the heart muscle, independently cause an extraordinary contraction of the heart. After which there is a pause, which causes the feeling of a frozen heart. This is an attack of extrasystole in the heart.

Normally, a healthy person experiences about 200 single extrasystoles per day. This phenomenon is normal for those who play sports. Extrasystole is often diagnosed in infants, children in adolescence and people over 60 years of age. There are even reflex extrasystoles, for example, with bloating and gastrointestinal diseases.

Sometimes all of the above symptoms during extrasystole may be completely absent or disguised as other diseases.

Reasons for the development of extrasystoles

There can be many reasons for heart rhythm disturbances. It is important to understand the cause and nature of the disease. Extrasystoles are divided into several groups.

Functional extrasystole

This type of extrasystole generally does not require drug treatment. The main method of preventing heart rhythm disturbances is to eliminate the factor that causes extrasystoles. In this case, the development of extrasystole is provoked by the following reasons:

• psychogenic – the presence of stress, psycho-emotional fatigue;
• physical – carrying heavy objects, overwork, running;
• hormonal – menstruation, pregnancy, abortion, menopause.

You should avoid overeating, especially at night. The cause of extrasystole in this case is dysfunction of the vagus nerve.

Organic extrasystole

Frequent extrasystole occurs against the background of various diseases of the cardiovascular system, which is why it is called organic. In this case, an electrical heterogeneity occurs in the heart muscle, which affects the myocardium. Why is this happening:

• previous cardiac surgeries;
• ischemic disease hearts;
• heart disease;
• myocardial infarction;
• pulmonary heart;
• pericarditis;
• sarcoidosis;
• amyloidosis;
• hemochromatosis;
• development of myocardial dystrophy.

Not only heart disease can lead to extrasystole. Often the provocateurs can be malignant and benign tumors, allergies of various types, hepatitis, HIV and even banal osteochondrosis of the thoracic region.

Toxic extrasystole

This is the most rare cause of extrasystoles. It develops in cases where there was drug poisoning, which resulted in an overdose or side effects:

• tricyclic antidepressants;
• glucocorticoids;
• aminophylline;
• caffeine.

Extrasystole in the heart can also appear during a feverish state.

Diagnosis and detection of extrasystole

The key to successful treatment of extrasystole is a correct diagnosis. First of all, the cardiologist examines and interviews the patient. The main complaints with extrasystole are a long stop between heartbeats, heart tremors in the chest.

During the conversation, the doctor must find out the nature and causes of the arrhythmia, which will help establish the group of extrasystole. An important indicator is the frequency of rhythm disturbances and the patient’s history of previous diseases.

When palpating the pulse on the wrist, extrasystoles can be easily determined by premature pulse waves followed by a long pause. This indicates low diastolic filling of the ventricles.

Confirmation of extrasystole takes place after a series of diagnostic studies. Basically they resort to the following procedures:

• electrocardiogram (ECG) – this study carried out within 5-10 minutes. Indicators of extrasystole are the early appearance of the P wave or the QRST complex, obvious changes and increased amplitude of the extrasystolic QRS complex and insufficient compensatory pause;
• Ultrasound examination (ultrasound) - takes about 10-15 minutes and helps to identify more serious heart diseases, such as a heart attack (if there is scarring on the organ). With this outcome of the study, the treatment of extrasystole fades into the background and is a concomitant disease, not the main one;
• An ECG Holter study is the longest time-consuming method for diagnosing extrasystole, taking place within one or two days. This type of diagnosis is prescribed to all patients with heart pathologies, despite the presence of complaints that indicate extrasystoles in the heart.

If the doctor still has doubts about the origin of the extrasystole, he can additionally prescribe MRI (heart, coronary vessels), bicycle ergometry. It should be noted that the treatment of organic extrasystoles will be radically different from the treatment of functional or toxic ones. It would not be amiss to conduct a hormonal study of the body, especially for women, in order to determine and eliminate a malfunction of the endocrine system.

Classification of extrasystoles by type

The occurrence of extrasystole in the heart can occur anywhere in the conduction system. In accordance with where the pathological impulse originated, the following types of disease are distinguished:

• supraventricular (it includes the atrial, lower atrial and midatrial) - 3% of patients. It is considered the rarest form of extrasystole. The main reason for the appearance of this type is organic damage to the heart. The volley of heartbeats should attract the attention of the doctor, since the next step will be atrial fibrillation;
• ventricular – 62% of patients. It is the most common form of extrasystole. The danger of the species lies in terms of prediction, so maximum attention and accuracy in diagnosis is required. It often develops into ventricular tachycardia, which results in unexpected, sharp bursts of frequent ventricular contractions;
• nodular – 26% of patients. A fairly common type of extrasystoles, often caused by functional factors. The extrasystoles that appear are sporadic, accompanied by bradycardia (slow pulse), and in patients of the older age group - tachycardia;
• polytopic – 9% of patients. A peculiar type of extrasystole that requires long-term medical supervision. The difficulty lies in the fact that the location of the excitation has not yet attached to a certain area, or the damage to the heart is too extensive that the impulse occurs anywhere.

If the patient has an atrial extrasystole, then the center of origin of the impulse is in the atrium, and then enters the sinus node and then down to the ventricles. This form of the disease mainly appears with organic damage to the heart. Often, extrasystole occurs when the patient is sleeping or simply in a supine position.

Atrioventricular extrasystoles can be divided into three types:

• the atria and ventricles are excited simultaneously;
• defective excitation of the ventricle, after which the atrium is excited;
• a disease with excitation of the atrium, and then ongoing excitation of the ventricle.

Depending on the frequency of occurrence of extrasystoles, they are classified: rare (less than 5 per minute), medium (about 6-14 per minute) and frequent (more than 15 per minute). Based on the number of foci, they are divided into: polytopic extrasystoles (there are several centers of excitation at once) and monotopic extrasystoles (only one focus of excitation).

Illness and pregnancy

Almost 50% of all pregnant women have extrasystole in one form or another. The main reason for this is and will be hormonal changes in a woman’s body. Expectant mothers are very concerned that this problem may cause a contraindication to pregnancy. In fact, there is nothing to be afraid of. Extrasystoles in the heart are normal. It is important that the pregnant woman does not have heart disease.

And to prevent extrasystoles of the heart, it will be enough to provide a calm environment during pregnancy, not to overwork (physically and emotionally), and spend more time in the fresh air.

Today, medicine has moved forward and doctors have the opportunity to measure the heart rate of a developing fetus. In most cases, babies have extrasystoles in the heart. An acceptable deviation from the norm is the appearance of extrasystoles at least every 10 heart beats.

If a woman has “simple” extrasystoles, then natural childbirth is not contraindicated for her. But if a woman in labor is diagnosed with an organic heart pathology, then she should be observed by a cardiologist throughout pregnancy, and it is advisable to give birth by cesarean section.

What you need to know about treatment

In many cases, specialized drug treatment for cardiac extrasystoles is not required. In most cases, it is necessary to eliminate the cause that caused the heart rhythm disturbance. But to improve your well-being and prevent unexpected extrasystoles, it is advisable to eat right, give up bad habits, and take sedatives in stressful situations (preferably homeopathic remedies or herbs).

Traditional methods of treating extrasystole are only preventive in nature, and in no case can replace a doctor’s prescription. To maintain treatment, you can use the following recipes:

• add 2 teaspoons of hawthorn tincture to green tea;
• make a decoction of lemon balm, heather, hops, hawthorn, motherwort (all in equal parts). For a glass of boiling water, add a tablespoon of dry herbal mixture. Take 1/3 cup three times a day;
• A teaspoon of cornflower tincture is brewed in 200 g of boiling water; you only need to drink 50 g on the day of the attack.

If you are worried about attacks of frequent extrasystoles, in this case it is important to do the following:

• take a lying position;
• stop any types of loads;
• ensure uninterrupted supply of fresh air;
• drink a sedative;
• perform breathing exercises with your eyes closed – inhale very deeply – hold your breath for a few seconds – exhale completely.

Prescription of treatment for extrasystole and selection of dosage of drugs occurs exclusively together with the attending physician. It is important to remember that extrasystoles have a different nature, so you may additionally need to consult a neurologist, endocrinologist and gastroenterologist.

The best treatment is prevention

Doctors noticed that in the fight against relapses of extrasystole, it is necessary to eat enough foods rich in potassium and magnesium. They are found in bananas, potatoes, dried apricots, pumpkin, and beans. It is also important to avoid frequent consumption of alcohol, coffee and strong tea.

• preventive gymnastics;
• use of sedatives and anti-inflammatory drugs;
• take food in small portions, do not overeat at night;
• avoid physical and emotional exhaustion;
• replenish vitamins and microelements.

If extrasystole appears or an increase in discomfort in the heart area, you should immediately consult a specialized doctor. Self-medication can cause serious complications and delay the recovery process.

Important to remember

Now, knowing the problem, and having analyzed it into its component elements, the question does not arise: extrasystoles in the heart - is this a dangerous disease? But like any change in the body, this problem requires proper attention, prevention and, if necessary, timely treatment.

Symptoms and treatment

What is supraventricular extrasystole? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Irina Vyacheslavovna Kolesnichenko, a cardiologist with 23 years of experience.

Publication date August 30, 2019Updated October 04, 2019

Definition of disease. Causes of the disease

Normally, the heart works in an orderly manner. The rhythm of the heart is set by the sinus node, which generates electrical impulses. Under their influence, the atria contract first, then the ventricles. Sometimes the heart rhythm is disturbed and premature excitation and contraction of the heart or its parts occurs, which is called extrasystole.

Supraventricular (supraventricular) extrasystole (SVE)) - these are extraordinary premature contractions of the heart from impulses emanating from the upper or lower parts of the atria or from the atrioventricular junction (AV junction), which is located between the atria and ventricles of the heart .

The causes of extrasystole can be cardiac and extracardiac. Cardiac associated with diseases of the cardiovascular system (organic extrasystole). Noncardiac causes associated with diseases of other organs and systems, as well as with the action of certain factors (functional extrasystole). In some cases, supraventricular extrasystole is not associated with problems of the heart or other organs and the action of provoking factors. In this case, idiopathic extrasystole is diagnosed.

Organic extrasystole occurs with heart diseases: coronary heart disease (CHD), and with thickening of the wall of the left ventricle, cardiomyopathies, heart defects, and mitral valve prolapse (bending) and other diseases of the cardiovascular system.

Causes functional extrasystole:

• electrolyte imbalance: decrease or increase in blood concentrations of potassium, calcium and sodium, decrease in magnesium;
• various types of intoxication, including infectious diseases;
• diseases accompanied by oxygen starvation of tissues: anemia, bronchopulmonary diseases;
• restructuring and diseases of the endocrine system: decrease or increase in hormonal activity of the adrenal glands and thyroid gland, diabetes mellitus, development/imbalance/decay of ovarian function (onset of menstruation, menopause), pregnancy;
• imbalance of the autonomic nervous system: , autonomic influences in diseases of the gastrointestinal tract.
• smoking, stress, consumption of large amounts of caffeine-containing or alcoholic beverages, leading to an increase in the activity of the sympathetic-adrenal system and the accumulation of catecholamines (adrenaline, norepinephrine, etc.), which sharply increase the excitability of the myocardium. In this case, there is a clear connection with the provoking factor, but there are no organic changes in the heart muscle.

It is very important to identify the etiological factor that caused supraventricular extrasystole: the recommended treatment will depend on this.

Group of reasons	Causal factors
Cardiovascular diseases	⠀ ⠀Chronic coronary heart disease (CHD) and myocardial infarction ⠀ ⠀Cardiomyopathies ⠀ ⠀Arterial hypertension leading to left ventricular hypertrophy ⠀ ⠀Myocarditis (inflammation of the heart muscle) ⠀ ⠀Heart failure ⠀ ⠀Congenital and acquired heart defects ⠀ ⠀Mitral valve prolapse
Effect of medications	⠀ ⠀Overdose or uncontrolled use of medications (Digoxin, antiarrhythmics, diuretics, beta-agonists, antidepressants, Eufillina, Berodual, Salbutamol)
Electrolyte imbalance	⠀ ⠀Decreased or increased blood concentrations of potassium, calcium and sodium, decreased magnesium
Intoxication	⠀ ⠀Alcohol, chemicals, industrial hazards, smoking ⠀ ⠀Infectious diseases
Imbalance of the autonomic nervous system	⠀ ⠀Vegetative-vascular dystonia, vegetative influences in diseases of the gastrointestinal tract
Diseases accompanied by oxygen starvation of tissues	⠀ ⠀Anemia, pathology of the bronchopulmonary system
Diseases and conditions of endocrine system restructuring	⠀ ⠀Decreased or increased hormonal activity of the adrenal glands and thyroid gland ⠀ ⠀Diabetes mellitus ⠀ ⠀Development/imbalance/decay of ovarian function (beginning of menstruation, menopause) ⠀ ⠀Pregnancy
Lifestyle Features	⠀ ⠀Nervousness, worries, negative emotions ⠀ ⠀Frequent stressful situations ⠀ ⠀Excessive physical activity, low physical activity
No reason identified	⠀ ⠀There is no connection between arrhythmia and diseases or other factors

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of supraventricular extrasystole

It is not difficult to suspect supraventricular extrasystole in a patient if it is felt. Most often, patients complain about feeling of interruptions in the heart: premature contractions, pauses, freezing. If the arrhythmia occurs at night, the patient may wake up and feel anxious. Less often, patients are bothered by attacks of frequent irregular heartbeats; in this case, the exclusion of paroxysmal (paroxysmal) is required.

Sometimes a curious pattern may be observed: the most unpleasant are “harmless” functional extrasystoles that are not associated with damage to the heart. And a person may not feel more serious rhythm disturbances at all. This is likely due to the sensitivity threshold to arrhythmia in patients and the degree of damage to the heart muscle.

Periods of supraventricular extrasystole are usually not accompanied by serious hemodynamic (blood supply) disturbances. However, patients with organic heart damage may experience pain in the chest of a different nature, shortness of breath, weakness, dizziness may appear or worsen, and exercise tolerance also decreases.

Supraventricular extrasystole with vegetative-vascular dystonia is accompanied by severe fatigue, weakness, increased sweating, periodic headaches, dizziness, and irritability.

The occurrence of interruptions in the work of the heart during extrasystole may be associated with the action of provoking factors (smoking, alcohol, excessive physical activity, etc.), exacerbation of the disease that caused the extrasystole. However, symptoms of arrhythmia may appear without connection with any provoking factors.

Pathogenesis of supraventricular extrasystole

There are several mechanisms for the origin of extrasystoles:

• Excitation wave re-entry. Normally, an electrical impulse passes through the conduction system of the heart only once, after which it fades. Upon re-entry, the impulse can again spread to the myocardium, causing its premature excitation. Next, conduction circulation occurs with repeated repeated excitation of the tissue in the absence of an interval of cardiac relaxation.
• Increased myocardial excitability, arising below the sinus node as a result of the action of various factors. At the same time, the activity of the cell membranes of individual areas of the atria and the AV junction increases.

It should be noted that the ectopic (irregular) impulse from the atria spreads from top to bottom along the conduction system of the heart. An extraordinary impulse arising at the AV junction propagates in two directions: from top to bottom along the conduction system of the ventricles and from bottom to top (in the opposite direction) through the atria.

Identification of the etiopathogenetic mechanism (i.e., the cause and mechanism of development) of the occurrence of supraventricular extrasystoles is very important, as this determines therapeutic tactics.

Careful questioning of the patient can not only reveal signs various diseases heart, but also to establish the frequency and regularity of smoking, drinking tea, coffee, alcohol, psychostimulants and narcotic drugs, as well as a number of medications that provoke supraventricular extrasystole. The mechanism for the occurrence of extrasystoles in this case is associated with stimulation of the sympathetic nervous system.

In all patients with NVT, it is necessary to check the function of the thyroid gland, since changes in its functional state sometimes cause arrhythmia. For example, an increase in thyroid hormone levels can cause palpitations, supraventricular and ventricular extrasystoles, and atrial fibrillation. If you subsequently need to prescribe the antiarrhythmic drug Amiodarone, you must check the levels of the hormones TSH, T3 and T4.

In the case of acute development of supraventricular extrasystole, it is necessary to exclude hypokalemia, i.e., a decrease in the level of potassium in the blood.

The connection between the first episode and repeated intensification of extrasystole, which flows in waves, with infections indicates previous myocarditis. The appearance or intensification of extrasystole may be the only or one of the manifestations of IHD. In this case, an increase in interruptions in the functioning of the heart during physical activity is typical, when a discrepancy between the blood supply to the heart and the increased need for blood flow occurs. In other identified organic heart diseases (heart defects, cardiomyopathies, hypertensive heart, mitral valve prolapse), the severity of supraventricular extrasystole is often associated with the magnitude of atrial dilatation.

It is often possible to identify a connection between NVE and the activation of the sympathetic (during exercise) or parasympathetic (during sleep, after eating, during, ) nervous system. In the first case, during exercise, the amplitude and frequency of heart contractions increases, which can provoke supraventricular extrasystole. In the second, the heart rate slows down, which can also cause rhythm disturbances.

Classification and stages of development of supraventricular extrasystole

Classification of supraventricular extrasystoles by place of origin:

• atrial - premature contractions of the heart from impulses from the atria;
• nodal or atrioventricular - premature impulses from the AV connection.

By frequency of occurrence:

• rare - less than five per minute;
• frequent - more than five per minute.

By density:

• single;
• paired (couplets);
• group (triplets);
• runs of paroxysmal supraventricular tachycardia (more than four extrasystoles in a row).

Single extrasystoles can occur chaotically or be of the type of bigeminy (every second contraction is an extrasystole), trigeminy and quadrigeminy (every third and fourth complex is extraordinary). Such an extrasystole, when extraordinary complexes appear after one, two, three sinus ones, is called rhythmic.

Extrasystoles can be monotopic, emanating from the same part of the conduction system of the heart, and polytopic - from different parts of it.

Complications of supraventricular extrasystole

Supraventricular extrasystole can provoke the developmentsupraventricular tachycardia, which is characterized by sudden onset and cessation of pathologically rapid cardiac activity. During an attack, the heart rate rises to 220-250 beats per minute . If at this moment it is possible to take an ECG, then a paroxysm (attack) of supraventricular tachycardia can be recorded.

One of the consequences of this disease may be atrial fibrillation (atrial fibrillation). These are chaotic and frequent excitations and contractions of the atria, as well as twitching of certain groups of atrial muscle fibers. During an attack, the heart rate increases significantly and the correct heart rhythm is disrupted. The risk of atrial fibrillation should serve as a criterion for the malignancy of supraventricular extrasystole (high risk of sudden death). A harbinger of atrial fibrillation is frequent group supraventricular extrasystole with episodes of paroxysmal (paroxysmal) supraventricular tachycardia.

Diagnosis of supraventricular extrasystole

The diagnosis of supraventricular extrasystole can be made based on the patient’s complaints, according to an objective examination, data from auscultation (listening) of the heart, according to the results of electrographic study (ECG)), 24-hour Holter ECG monitoring.

After assessing complaints during an objective examination during auscultation or palpation of the pulse, extrasystoles are defined as premature contractions against the background of normal sinus rhythm. The pause after a supraventricular extrasystole is not very long (based on this feature, one can suspect its supraventricular origin). With bigeminy and trigeminy, as well as frequent extrasystole, a pulse deficit can be determined. However, the diagnosis of NVE can only be confirmed with the help of instrumental studies.

First of all, the patient undergoes an ECG, which can record an extraordinary complex. Often, supraventricular extrasystoles are detected accidentally on an ECG (in the absence of complaints).

Characteristic signs of supraventricular extrasystole:



An important role is played by the assessment of the coupling interval (from the P wave preceding the normal complex to the P wave of the extrasystole). Its constancy indicates the monotopy of the supraventricular extrasystoles (i.e., they come from one focus).

Since an ECG is carried out in a short period of time, and extraordinary excitation does not always occur at the moment it is taken, this type of study does not identify the problem in 100% of cases. For accurate diagnosis, daily or longer (for two days, for example) ECG monitoring, which is called Holterian(after the name of the author who proposed this technique). To assess the frequency of supraventricular extrasystoles, the study should be performed in the absence of antiarrhythmic therapy. The number of extrasystoles per hour is no more than 30 per hour.

After recording, the ECG monitoring data is deciphered by a specialist and it becomes possible:

• clarify the number of supraventricular extrasystoles, their shape, determine the presence of pairs, groups, as well as runs of paroxysmal supraventricular tachycardia;
• determine at what point they occur, whether the appearance of extrasystoles depends on physical activity or other factors (the patient indicates these data in the diary kept during monitoring);
• record the dependence of the occurrence of supraventricular extrasystole on the state of sleep or wakefulness;
• monitor the effectiveness of drug therapy;
• identify other possible rhythm and conduction disturbances.

It should be noted that it is fundamentally important to assess the frequency of NVE, since treatment tactics will depend on this.

Supraventricular extrasystole can be first identified during exercise tests(bicycle ergometry or treadmill test).

Indications for use electrophysiological study(EPI) there may be a need to more accurately determine the location of extrasystoles (with frequent monotopic supraventricular extrasystoles) in the event of subsequent surgical treatment. With EPI, the load on the heart increases through electrical stimulation of the myocardium. Such stimulation is carried out using electrodes that supply high-frequency physiological currents to the heart muscle. As a result, the myocardium begins to contract faster, causing a provoked increase in heart rate (). If your heart rate is high, you may experience different kinds arrhythmias including supraventricular extrasystole.

Treatment of supraventricular extrasystole

NVE may be benign. In this case, the risk of sudden death is very low, sometimes the patient does not even feel the rhythm disturbance. Such extrasystole does not always require treatment.

If possible, the etiological factor must be eliminated:

• normalize sleep;
• limit or completely stop taking provoking medications and drinks;
• quit smoking:
• normalize thyroid function with;
• adjust the level of potassium in the blood;
• delete gallbladder in case of cholelithiasis;
• avoid a horizontal position after eating when;
• normalize blood pressure;
• increase physical activity according to the body’s capabilities;
• Avoid excessive physical activity (weightlifting, heavy lifting).

Products containing potassium

Products containing magnesium

⠀ ⠀ dried apricots; ⠀ ⠀cocoa powder; ⠀ ⠀wheat bran; ⠀ ⠀raisins; ⠀ ⠀sunflower seeds; ⠀ ⠀nuts (pine, almonds, peanuts, walnuts); ⠀ ⠀legumes (peas, lentils, beans); ⠀ ⠀jacket potatoes; ⠀ ⠀avocado; ⠀ ⠀ceps; ⠀ ⠀bananas; ⠀ ⠀citrus fruits; ⠀ ⠀Brussels sprouts and kohlrabi; ⠀ ⠀milk and fermented milk products; ⠀ ⠀cereals (oatmeal, buckwheat, pearl barley, rice); ⠀ ⠀fruits (peaches, pears, watermelon, apples, prunes, apricots, melon); ⠀ ⠀chicory; ⠀ ⠀vegetables (carrots, spinach, green onions, eggplant, cucumbers); ⠀ ⠀chicken eggs; ⠀ ⠀fish and meat; ⠀ ⠀apple juice.

⠀ ⠀oil (sesame, linseed, peanut); ⠀ ⠀cheese (Dutch, Poshekhonsky, goat, with mold); ⠀ ⠀cottage cheese (low-fat and low-fat, curd cheese); ⠀ ⠀bitter chocolate; ⠀ ⠀almost all types of meat; ⠀ ⠀fish (halibut, sturgeon, perch, haddock, cod, saury); ⠀ ⠀duck eggs; ⠀ ⠀cereals (rolled oats, chickpeas, peas, buckwheat, brown rice, lentils); ⠀ ⠀fruits and berries (cherries, kiwi, pineapple, feijoa, raspberries, pears, peach, persimmons); ⠀ ⠀many varieties of tea (for example, “Ivan-tea”) and juices; ⠀ ⠀ginger; ⠀ ⠀mustard; ⠀ ⠀vanilla.

Indications for antiarrhythmic therapy are:

1. Poor tolerance of supraventricular extrasystole. In this case, it is necessary to determine in what situations and at what time of day heart rhythm disturbances most often occur, and then time the drug intake to this time.

2. The occurrence of VVC (not necessarily frequent) in patients with heart defects (primarily mitral stenosis) and other organic heart diseases. In such patients, atrial overload and dilatation progress. Supraventricular extrasystole in this case serves as a harbinger of the occurrence of atrial fibrillation.

3. Supraventricular extrasystole, which arose as a result of a long-term etiological factor in patients without previous organic heart disease and atrial enlargement (with thyrotoxicosis, inflammatory process in the heart muscle, etc.). If antiarrhythmic treatment (along with etiotropic treatment) is not carried out, the risk of persistent EVE increases. Frequent supraventricular extrasystole in such situations is potentially malignant in relation to the development of atrial fibrillation.

4. Frequent (700-1000 extrasystoles per day or more) EVA also requires antiarrhythmic therapy, even if it is regarded as idiopathic, since there is a risk of complications. The approach in these cases should be differentiated. It is also possible to refuse antiarrhythmic therapy if there are reasons for this:

• absence of subjective symptoms and complaints;
• borderline number of extrasystoles;
• intolerance to antiarrhythmic drugs;
• signs of sick sinus syndrome or impaired AB conduction.

Antiarrhythmic drugs used for EVA:

• Beta blockers (Metoprolol, Bisoprolol ), calcium antagonists ("Verapamil" ). It is pathogenetically justified to prescribe drugs from this group to patients with hyperthyroidism, a tendency to tachycardia, when EVE occurs against the background of stress and is provoked by sinus tachycardia. Beta blockers are indicated for ischemic heart disease, arterial hypertension, sympatho-adrenal crises. "Verapamil" is prescribed for concomitant , variant angina, nitrate intolerance, patients with coronary artery disease., "Propanorm" , "Etatsizin" ). Use is not indicated in patients with coronary artery disease who have recently suffered a myocardial infarction due to its arrhythmogenic effect on the ventricles.
• Amiodarone ("Cordarone"). Amiodarone is the most effective antiarrhythmic drug available. M May be prescribed to patients with organic heart damage.
• If monotherapy is insufficiently effective (i.e., using one antiarrhythmic), combinations of drugs can be used.

If the prescribed therapy has a good effect, antiarrhythmics should not be discontinued quickly. Treatment lasts several weeks (months). If there is a threat of developing atrial fibrillation or if there are episodes of it in the anamnesis, NVE therapy is carried out for life. In the case of continuous antiarrhythmic therapy, the minimum effective doses are selected. Patients with an undulating course of EVE should strive to discontinue the antiarrhythmic drug in periods of improvement (excluding cases of severe organic myocardial damage). The withdrawal of antiarrhythmics is carried out gradually with a decrease in dosage and number of doses per day. After discontinuation, the patient is recommended to have the drug with him (the “pill in the pocket” strategy) in order to quickly take it when the arrhythmia resumes .

If there is no effect from antiarrhythmic therapy, with frequent EVE (up to 10,000 per day), the issue of surgical treatment - radiofrequency ablation of arrhythmogenic foci (destruction of foci using electric current) .



Forecast. Prevention

Supraventricular extrasystole is a common cardiac arrhythmia. Rare, single premature heart contractions in healthy people do not lead to life-threatening consequences for health and life. More dangerous are frequent extrasystole with the presence of episodes of paroxysmal supraventricular tachycardia, which can lead to hemodynamic disorders and the development of atrial fibrillation.

1. If you have a hereditary predisposition to heart disease, you should contact a cardiologist as early as possible.
2. Use very carefully and only under medical supervision medicines, affecting heart rate and electrolyte composition of the blood (diuretics, glycosides).
3. In the presence of endocrine diseases ( diabetes mellitus, hyperfunction of the adrenal glands or thyroid gland) it is necessary to undergo examination for the development of cardiovascular pathologies.
4. Give up bad habits: smoking, drinking alcohol, etc.
5. Follow a daily routine (full sleep and rest are necessary). Eat a balanced diet: include foods enriched with potassium and magnesium in your diet; exclude too hot, fried and spicy foods.
6. If possible, reduce the effect of stress factors and avoid emotional stress. You may consider using relaxation techniques and autogenic training.