Ventricular extrasystole
Content:
- Causes of ventricular premature beats
- Signs of ventricular extrasystole
- Ventricular extrasystole gradation according to ryan
- Treatment of ventricular extrasystole
Ventricular extrasystole - what is it?
Ventricular extrasystole is one of the types of cardiac arrhythmias. Pathology manifests itself in extraordinary, premature contractions of the ventricles of the heart. At the same time, the patient himself at such moments experiences dizziness, weakness, pain in the heart, a feeling of lack of air. To detect the disease, a comprehensive cardiological examination is necessary. Treatment is most often medication.
Extrasystolic arrhythmias, which include ventricular premature beats, are the most common cardiac arrhythmias. They are diagnosed at any age and differ depending on the location of the excitation focus. It is ventricular extrasystole that occurs more often than others and is diagnosed in about 62% of cases.
During an ECG, single ventricular extrasystoles are recorded on average in 5% of young healthy people. With age, this figure rises to 50%. Therefore, we can say with confidence that ventricular extrasystole is a heart rhythm disorder, which is typical for patients over 45-50 years old.
There are two types of cardiac arrhythmias: benign and life-threatening (malignant) ventricular extrasystole. The first type of pathology is corrected by antiarrhythmic therapy, and the second is a consequence of heart disease and is considered a cardiac pathology (requires treatment of the underlying disease).
The main danger of such heart rhythm disturbances lies in the fact that they can provoke ventricular fibrillation and lead to sudden cardiac death.
Causes of ventricular premature beats
The causes of ventricular extrasystole are mainly due to organic diseases of the heart muscle, however, in some cases, the etiological factor in the development of pathology remains unclear.
So, the following cardiac causes leading to ventricular premature beats can be distinguished:
- Ischemic heart disease.
- Postinfarction cardiosclerosis. So, people who have had a heart attack suffer from ventricular premature beats in 95% of cases.
- Pericarditis and myocarditis.
- Arterial hypertension.
- Chronic heart failure.
- Pulmonary heart.
- Dilated cardiomyopathy.
- Hypertrophic cardiomyopathy.
For reasons other than heart disease include:
- Disorders of micro-exchange of elements in the body, manifested in hypo-magnesium and potassium, as well as in hypercalcemia.
- Taking medications in high doses. Tricyclic antidepressants, diuretics, Amitriptyline, Fluoxetine, etc. are especially dangerous in this regard.
- The use of narcotic and psychotropic drugs, including Caffeine, cocaine, amphetamine, alcohol.
- Use of anesthetic drugs.
- Irritation of the vagus nerve when having trouble sleeping or due to strenuous mental work.
- Smoking.
- Cervical osteochondrosis.
- Vagotonia and neurocirculatory dystonia.
- Infectious diseases.
- Frequent stress, pronounced emotional upheaval.
It has been established that in people with increased activity of the parasympathetic nervous system, ventricular extrasystole occurs during rest, and during physical exertion, on the contrary, it can disappear. It is possible that heart rhythm disturbances may appear in people without any diseases, that is, against the background of absolute health.
Signs of ventricular extrasystole
Signs of ventricular extrasystole may often be absent altogether, although in some cases patients present with the following complaints:
- The appearance of a feeling of interruptions in the work of the heart. Sometimes the appearance of its fading or a feeling of an intensified "push" is possible.
- Increased fatigue, excessive irritability, episodes of headache, dizziness - all these signs may indicate a ventricular extrasystole if it occurs against the background of vegetative-vascular dystonia.
- The feeling that a person is suffocating due to lack of air often appears when the heart rhythm is disturbed against the background of cardiopathologies. The appearance of heart pains, feelings of weakness are possible. In some cases, fainting occurs.
During the examination, the doctor may notice the characteristic pulsation of the veins in the neck, which in cardiological terminology is called Corrigan venous waves. The pulse is arrhythmic, with long pauses and extraordinary waves. To make sure that there are heart rhythm disturbances, instrumental diagnostics is necessary. First of all, this is an ECG and a Holter ECG.
Ventricular extrasystole gradation according to ryan
The ryan gradation of ventricular premature beats is one of the options for classifying cardiac arrhythmias. This is a fairly complete description of extrasystole, so it is used by cardiologists at the present time, although it was last modified in 1975.
So, the following stages of ventricular extrasystoles are distinguished:
- O - there is no extrasystole.
- 1 - the number of extrasystoles does not exceed 30 episodes in 60 minutes (rare ventricular arrhythmia).
- 2 - the number of extrasystoles exceeds 30 episodes in 60 minutes.
- 3 - the presence of multifocal extrasystoles.
- 4a - the presence of paired monotropic extrasystoles.
- 4b - polymorphic ventricular extrasystoles with fibrillation and flutter of the ventricles.
- 5 - ventricular tachycardia with three or more ventricular extrasystoles.
Treatment of ventricular extrasystole
Treatment of ventricular extrasystole is a rather difficult task. The tactics of therapy should be determined by many factors, and first of all, by the severity of extrasystole. In addition, if a person does not have any significant heart disease, and the extrasystole does not objectively manifest itself in any way, then the treatment is not carried out at all.
If the symptoms of cardiac arrhythmias nevertheless periodically bother a person, then he is advised to avoid aggravating factors as much as possible, including: stress, alcohol consumption, smoking, etc. Therapy should be aimed at maintaining the electrolyte balance in a normal norm, it is equally important to control the blood pressure level …
In addition, all patients, without exception, are advised to adhere to a dietary diet, which will be additionally enriched with potassium salts. Of no small importance is the fight against hypodynamia, which implies an adequate increase in physical activity.
Antiarrhythmic therapy
Ventricular extrasystole responds well to a large number of drugs, including:
- Fast sodium channel blockers. This includes several classes of drugs. Class 1A includes Disopyramide, Quinidine, Procainamide. Class 1B includes Meksiletin. Class 1C includes Flecainide, Propafenone. Each class of drugs has its own advantages and disadvantages and should be selected by a doctor based on the characteristics of the clinical picture. In addition, clinical studies have revealed that the use of these drugs in patients with myocardial infarction leads to an increase in mortality.
- Beta-blocker drugs. They are prescribed to patients who have organic diseases of the heart muscle.
- Medicines such as Amiodarone and Sotalol are prescribed only in extreme cases when there are life-threatening arrhythmias. Although sometimes doctors replace beta-blockers with amiodarone (if the patient has an individual intolerance).
- The appointment of calcium channel blockers is not excluded, however, recent data indicate that they do not play any significant role in the treatment of ventricular premature beats.
It is recommended that a particular drug be taken exclusively by the attending physician who is familiar with the patient's history.
Radiofrequency ablation (RFA) for extrasystole
RFA as a method of treating ventricular arrhythmias is not recommended for every patient. There are certain indications for which this type of therapeutic effect is prescribed. It is recommended for patients who are not helped by drug correction, but the extrasystole is monomorphic, it happens quite often and worries the patient with severe symptoms. RFA is also recommended for those groups of patients who refuse drug correction for a long time.
RFA involves minimally invasive surgery under the control of X-ray equipment. This is a low-risk catheter operation that restores the heart rate well.
Implantation of cardioverter defibrillators
The installation of implants is resorted to only if the patients have a malignant ventricular extrasystole, which carries high risks of sudden cardiac death.
The prognosis of ventricular extrasystole depends on what form of cardiac arrhythmias is diagnosed in the patient, whether there is an organic pathology of the heart and hemodynamic disturbances. If we are talking about functional extrasystole, then it does not pose any threat to human life. However, in the presence of lesions of the heart muscle, the risk of developing sudden death increases significantly.
The author of the article: Molchanov Sergey Nikolaevich | Cardiologist
Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".
