Extrasystole
The content of the article:
- Causes of extrasystole
- Forms of the disease
- Symptoms of extrasystole
- Features of extrasystole in children
- Diagnostics
- Treatment
- Possible complications
- Forecast
- Prevention
Extrasystoles are untimely contractions of the myocardium under the influence of an impulse that occurs in the conducting system of the heart.
Several parts of the heart are responsible for generating impulses and ensuring that the heart contracts with a certain frequency, the main generator of such impulses is the sinus node. While it is functioning normally, impulses generated by other foci are suppressed. If one of the other foci is active, an extraordinary, early contraction of the heart occurs, when there is still not enough blood in it to be released into the vessels - estrasystole. After the extrasystole, there is a compensatory pause, which can be complete and incomplete.
Extrasystole is a relatively common type of arrhythmia, heart rate irregularities can periodically occur in healthy people due to psychoemotional and vegetative stress. With age, extrasystole progresses, after fifty years, such disorders from time to time occur in most people. The appearance of 200 episodes of extrasystoles per day is considered acceptable.
Source: ytimg.com
Causes of extrasystole
Extrasystole can occur both with lesions of the heart muscle, and under the influence of extracardiac influences. Risk factors include:
Heart disease:
- mitral valve prolapse;
- pericarditis;
- cardiac ischemia;
- heart failure;
- rheumatic heart disease;
- acute coronary syndrome;
- cardiomyopathy;
- hypertrophy of the myocardium of the ventricles of the heart.
Extracardiac diseases:
- respiratory diseases;
- diseases of the thyroid gland;
- chronic renal failure;
- systemic allergic reactions;
- diseases of the nervous system;
- arterial hypertension;
- oncological diseases;
- violations of electrolyte metabolism in the body;
- spine diseases;
- diseases of the gastrointestinal tract.
Toxic effects of the following substances:
- medicines (glucocorticosteroids, cardiac glycosides, sympatholytics, diuretics, tricyclic antidepressants);
- alcohol;
- nicotine;
- caffeine;
- infectious intoxication.
The causes of extrasystole can also be chronic nervous and physical overload, loss of strength.
Forms of the disease
The definition of the form of extrasystole is influenced by many different factors. Extrasystoles are classified according to the localization of the impulse generator, the type of extrasystolic heart rhythm and the pattern of impulses, frequency, number of foci, time of occurrence in diastole, etiology, age factor and life prognosis.
Pulse generator localization classification:
- atrial extrasystoles - impulses arise in the atrium, are transmitted to the sinus node and to the ventricles;
- ventricular extrasystoles - impulses are generated in any part of the ventricles of the heart, alternating with compensatory pauses, are not transmitted to the atria. They can be right and left ventricular;
- atrioventricular (atrioventricular) extrasystoles - impulses are generated at the border of the ventricles and atria, spread down and up, can lead to a reverse blood flow into the heart. Depending on the localization of the foci in the node, they are divided into upper, middle and lower;
- stem extrasystoles - the focus of impulses is in the trunk of the atrioventricular bundle (bundle of His), such impulses are transmitted to the ventricles;
- sinoarthrial extrasystoles - generated in the sinoartial junction.
Source: proserdce.ru
The general name for extrasystoles, which differ in the regularity of occurrence, the alternation of the main rhythm and extrasystole, is allorhythmy. There are several types of allorhythmy:
- bigeminy - extrasystoles following each normal heart beat;
- trigeminia - extrasystoles that occur after every second normal heart beat;
- quadrigeminia - extrasystoles that occur after every third normal heart contraction.
The frequency of occurrence of extrasystoles is distinguished:
- single;
- multiple;
- group (or salvo) - there are several extrasystoles in a row [paired, couplets (two in a row), triplets, etc.].
By the number of foci:
- monotopic - all extrasystoles occur in one focus in the heart;
- polytopic - extrasystoles occur in two or more foci.
By the time of appearance in diastole:
- early - extrasystoles occur at the beginning of diastole (interval, state of the heart muscle during rest);
- late - occur in the middle or end of diastole.
For reasons and conditions of occurrence:
- functional (neurogenic);
- organic - occur in people with a history of cardiac diseases who have undergone heart surgery;
- idiopathic - arises for no apparent objective reason, often hereditary processes;
- psychogenic.
According to the age factor, congenital and acquired extrasystoles are distinguished; according to the life forecast - safe, potentially dangerous and life-threatening.
There is also a separate type of extrasystole - parasystole, in which untimely impulses are generated regardless of the main ones, two parallel rhythms are formed (sinus and extrasystolic).
Symptoms of extrasystole
Very often, extrasystole is asymptomatic, has no pronounced subjective sensations, there is no pain syndrome. If patients have subjective complaints, they describe irregularities in the heart rhythm as cardiac arrest, cardiac arrest, then a feeling of a strong shock from the inside and failure. Symptoms of extrasystole are also dizziness, sensations of "tumbling and turning" of the heart, distention of the chest, lack of air, hot flashes, weakness, pallor, increased sweating, anxiety, fear, panic. When determining the pulse, you can detect the loss of individual pulse waves.
Harder tolerance of extrasystole in people suffering from vegetative-vascular dystonia, patients with organic lesions of the heart tolerate it more easily. Patients suffering from ischemic heart disease may develop angina attacks, and patients with signs of cerebral atherosclerosis may develop cerebral circulation disorders (paresis, fainting, aphasia). With an organic lesion, the patient is better placed in a horizontal position, with a functional one - in a vertical position.
Source: ritmserdca.ru
Features of extrasystole in children
Extrasystole in children is often associated with the development and growth of organs, but it can also be caused by congenital heart defects or other diseases. All types of cardiac arrhythmias observed in children are classified as extrasystoles, they can be single and paired. More often, the appearance of extrasystoles is recorded in boys.
In infants, extrasystoles (in the absence of organic heart disease) are usually the result of hypoxia. Such children may exhibit increased excitability, pain in the region of the heart, and sleep disturbances. It is especially important in such cases to make up for the lack of trace elements (magnesium, calcium, potassium) and keep breastfeeding. If breastfeeding cannot be maintained, highly adapted nutritional formulas are used.
In young children, as a rule, a form of extrasystole is diagnosed, in which no more than 5 extrasystoles appear within a minute. But sometimes severe forms of extrasystole are found - arterial hypertension or Fallot's tetrad (the so-called "blue" heart disease).
With the active and rapid growth of the body, the needs of organs for blood increase, the heart muscle begins to experience difficulties with blood circulation, changes occur that can cause extrasystole.
For the treatment of extrasystole in children, nootropic and nootropic drugs, membrane stabilizing agents and metabolic drugs are used, which have an adaptive trophic effect and contribute to an increase in the metabolic activity of cells.
If a stable, infrequent extrasystole or a labile extrasystole of rest is diagnosed, then physical activity is not prohibited for the child.
Diagnostics
When collecting anamnesis, the frequency of occurrence of extrasystoles and the circumstances under which they appear (physical or psycho-emotional stress, in a calm state, during wakefulness or sleep, etc.), the effect of taking medications, the presence of cardiological or extracardiac diseases are taken into account.
When measuring the pulse, extrasystoles are defined as episodes of pulse loss or a violation of the synchrony of its frequency, which indicates insufficient diastolic filling of the ventricles.
Methods of instrumental diagnostics of extrasystole:
- electrocardiography (ECG) - reveals the presence of extrasystoles, their shape and focus, however, it may not record all heart rhythm disturbances that occur over a long period;
- daily ECG monitoring (Holter ECG monitoring) - taking readings for several days; allows you to fix all possible extrasystoles that occur both day and night. In this case, the subject notes all the factors that affect the work of the heart (periods of physical activity, medication, etc.);
- ECHO cardiogram (ultrasound of the heart) - visualizes changes in the functioning of the myocardium and heart valves;
- veloergometry - conducting an ECG directly at the time of physical activity; allows you to clarify the presence of extrasystoles and identify signs of ischemic processes;
- transesophageal electrophysiological examination of the heart - measuring the reaction of the heart muscle to impulses using a sensor inserted through the esophagus;
- magnetic resonance imaging (MRI) of the heart and blood vessels.
Treatment
In the case of functional extrasystole, drug therapy is not necessary. Single extrasystoles, not caused by cardiac insufficiency, also do not require treatment. The recommendations of a cardiologist in such cases are to exclude intense physical and psycho-emotional stress, to correct the daily regimen and diet, and to quit bad habits.
The indications for the appointment of drug treatment of extrasystoles is an increase in the daily number of extrasystoles to 200, the presence of cardiac pathology and subjective complaints in patients. If the development of the disease is due to diseases of the endocrine, digestive system, the treatment of extrasystole begins with the underlying disease. If the cause of the appearance of extrasystole is osteochondrosis, it is necessary to undergo treatment with a neurologist, vertebrologist. Extrasystole caused by drugs requires their cancellation. With extrasystoles of neurogenic origin, therapy is recommended to relieve stress and anxiety. Sedatives, sedative preparations (motherwort, valerian, peony tinctures, hawthorn, lemon balm), antidepressants are prescribed. In some cases, psychotherapy sessions.
The choice of the drug is determined by the form of extrasystole and the heart rate. The most effective therapy for extrasystole is the intake of ß-blockers, which can reduce the number of episodes of extrasystole and the strength of postpathological contractions. It should be borne in mind that taking drugs of this series may be associated with serious side effects and complications.
With a pronounced process, antiarrhythmic drugs (AAP) are used. The decision on the appropriateness of their intake and the selection of the dosage is carried out strictly individually under the control of Holter ECG monitoring due to their possible harmful effects in organic diseases of the heart system. Treatment begins with low dosages, AARP is taken for a long period (several months) under the constant supervision of a physician. With the disappearance of extrasystoles, the drug is gently canceled, gradually reducing the dose of the drug. With a malignant ventricular form, antiarrhythmic drugs are taken for life.
In severe cases, with the ineffectiveness of conservative therapy of extrasystole, radiofrequency ablation (RFA) of the heart can be applied, consisting in cauterization of the arrhythmogenic area of the myocardium and implantation of a cardioverter-defibrillator. The method has an efficiency of over 80%.
Possible complications
The most dangerous complications of extrasystole are:
- atrial fibrillation;
- ventricular fibrillation;
- atrial fibrillation;
- supraventricular paroxysmal tachycardia, accompanied by a jump in heart rate;
- organic myocardial damage;
- cardiogenic shock;
- aortic stenosis, which reduces cardiac output and decreases coronary, cerebral, and renal blood supply;
- sudden cardiac death.
Forecast
The prognosis depends on the presence of cardiac diseases and organic lesions of the heart and the degree of myocardium. Concomitant diseases worsen prognosis: atrial fibrillation, postinfarction cardiosclerosis, ventricular fibrillation, persistent tachycardia, chronic heart failure, myocarditis.
The malignant course of ventricular extrasystoles can lead to persistent ventricular tachycardia and ventricular fibrillation, supraventricular extrasystoles - to the development of atrial fibrillation and sudden death.
In the absence of structural lesions and severe cardiac pathologies, extrasystole does not significantly affect the prognosis. Functional extrasystoles, as a rule, do not threaten health, however, they can provoke other, more significant arrhythmias, therefore, when they appear, constant medical supervision is necessary.
Prevention
Prevention of arrhythmias provoked by extrasystoles consists of the following measures:
- prevention of diseases of the cardiovascular system or their timely therapy;
- timely treatment of chronic and current diseases;
- exclusion of drug, chemical, food intoxication;
- decrease in psycho-emotional stress, taking sedatives according to indications;
- quitting smoking and drinking alcohol;
- compliance with the correct daily routine;
- regular but moderate physical activity;
- introduction of foods enriched with selenium, magnesium and potassium salts into the diet.
YouTube video related to the article:
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
