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Ventricular extrasystole – what is it?
Ventricular extrasystole – This is one of the varieties 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 medical.
Extrasystolic arrhythmias, which include ventricular extrasystole, are the most common cardiac arrhythmias. They are diagnosed at any age and differ depending on the location of the focus of excitation. It is ventricular extrasystole that occurs more often than others and is diagnosed in approximately 62% of cases.
During the ECG, single ventricular extrasystoles are recorded on average in 5% of young healthy people. With age, this figure increases to 50%. Therefore, it can be said with certainty that ventricular extrasystole is a heart rhythm disorder, which is typical for patients older than 45-50 years.
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 a heart disease and is considered as a cardiac pathology (requires treatment of the underlying disease).
The main danger of such cardiac arrhythmias lies in the fact that they can provoke ventricular fibrillation and lead to sudden cardiac death.
Causes of ventricular extrasystole
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, we can distinguish the following cardiac causes leading to ventricular extrasystole:
CHD.
Postinfarction cardiosclerosis. So, people who have had a heart attack suffer from ventricular extrasystole in 95% of cases.
Pericarditis and myocarditis.
Arterial hypertension.
Chronic heart failure.
Lung heart.
Dilated cardiomyopathy.
Hypertrophic cardiomyopathy.
Causes unrelated to heart disease include:
Violations of the microexchange of elements in the body, manifested in hypomagnesemia and potassium, as well as in hypercalcemia.
Taking drugs in high doses. Particularly dangerous in this regard are tricyclic antidepressants, diuretics, Amitriptyline, Fluoxetine, etc.
The use of narcotic and psychotropic drugs, including caffeine, cocaine, amphetamine, alcohol.
The use of anesthetic drugs.
Irritation of the vagus nerve due to sleep problems or due to strenuous mental work.
Smoking.
Cervical osteochondrosis.
Vagotonia and neurocirculatory dystonia.
Infectious diseases.
Frequent stress, expressed 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 may disappear. It is not excluded the appearance of heart rhythm disturbances 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 there may be a fading or a feeling of increased “push”.
Fatigue, excessive irritability, episodes of headache, dizziness – all these signs may indicate 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. Perhaps the appearance of heart pain, feelings of weakness. In some cases, fainting occurs.
During the examination, the doctor may notice a characteristic pulsation of the veins in the neck, which in cardiology terminology is called venous Corrigan waves. The pulse is arrhythmic, with long pauses and extraordinary waves. To verify the presence of cardiac arrhythmias, it is necessary to conduct instrumental diagnostics. First of all, this is an ECG and a Holter ECG.
Gradation of ventricular extrasystole according to ryan
Gradation of ventricular extrasystole according to ryan 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 flickering and ventricular flutter.
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, the severity of extrasystole. In addition, if a person does not have any significant heart disease, and extrasystole objectively does not manifest itself in any way, then treatment is not carried out at all.
If the symptoms of heart rhythm disturbances still periodically disturb a person, then it is recommended that he avoid aggravating factors as much as possible, including: stress, alcohol consumption, smoking, etc. Therapy should be aimed at maintaining a normal electrolyte balance, it is equally important to control the level of blood pressure .
In addition, all patients, without exception, are recommended to adhere to a dietary diet that will be additionally enriched with potassium salts. Equally important is the fight against physical inactivity, which involves 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 Mexiletin. 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 shown 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 drugs with 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.
Recommends taking a specific drug exclusively by the attending physician, who is familiar with the patient’s history.
Radiofrequency ablation (RFA) for extrasystoles
RFA as a treatment for ventricular arrhythmia is not recommended for every patient. There are certain indications for which this type of therapeutic effect is prescribed. It is recommended to patients who are not helped by drug correction, but the extrasystole is monomorphic, happens quite often and worries the patient with severe symptoms. RFA is also recommended for those groups of patients who refuse medical correction for a long time.
RFA involves a minimally invasive surgical intervention under the control of x-ray equipment. This is a low-risk catheter operation that restores the heart rhythm well.
Implantation of cardioverter-defibrillators
The installation of implants is resorted to only if patients have a malignant ventricular extrasystole, which carries a high risk of sudden cardiac death.
The prognosis of ventricular extrasystole depends on what form of cardiac arrhythmia 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 sudden death increases significantly.