Ventricular premature beats - Causes, Symptoms and Treatment .MF .
Lifestyle, complications and prognosis
Reduced ventricular along with the atria is done through electrical impulses along the conduction system, which includes the sinoatrial and atrioventricular nodes, the bundle of His and the Purkinje fibers.The fibers transmit signals to muscle cells of the ventricles, directly involved in the release of blood from the heart to the great vessels (aorta and pulmonary artery).In a normally functioning heart atria to ventricles simultaneously reduced, allowing the correct timing contractions with a frequency of 60 - 80 beats per minute.
If the heart muscle of the ventricles occurs a pathological process (inflammation, necrosis, scarring), it can create an electrical inhomogeneity (diversity) ventricular muscle cells.Develop mechanisms for re-entry excitation wavelength, that is, if the path of the pulse there is some portion electrically neutral scar tissue, for example, its momentum can not be circumvented, and t
Ventricular premature beats - this is one of arrhythmia characterized by premature ventricular contractions extraordinary.There are the following types:
1. By frequency:
- rare (less than 5 min),
- average speed (6 - 15 min),
- frequent (more than 15 per minute).
2. According to the density of the location on the cardiogram isolated single and twin (two cuts in a row) beats.
3. Localization - the right - and left ventricular premature beats, which can be distinguished on the ECG, but the special value of this division does not.
4. The nature
excitation center location - monotopnye beats emanating from the same
hearth - politopnye coming from located in different parts of the ventricular myocardium foci
5. The shape of the ventricular complexes
- monomorphic beats having the same shape overrecording a cardiogram
- polymorphic, with different shapes
6. According rhythm
- periodic (alloritmicheskie) beats - an extraordinary contraction of the ventricles occurs at a frequency, for example, "fall" every second set of normal, instead of which there extrasystole - bigemeniya, every third -trigemini, every fourth - kvadrimeniya
- non-recurring (sporadic) beats irregularly occur regardless of the leading cardiac rhythm.
7. Depending on the results of daily monitoring of beats classified according to criteria developed by Lown and Wolf.There are five classes of extrasystoles:
- Class 0 - extrasystoles registered during the day
- 1 class - are rare, to 30 - hour, monomorphic, monotopnye beats
- Grade 2 - frequent, a 30 - hour, single, monomorphic, monotopnye beats
- 3 class - registered single politopnye beats
- 4A class - paired politopnye beats
- 4B class - volley beats (more than three in a row once) and runs of ventricular tachycardia
- grade 5 - early and very early beats, such as«R on T» ECG arising in the early, initial phase of ventricular diastole, when the muscle relaxation occurs.These premature beats may lead to ventricular fibrillation and asystole (cardiac arrest).
This classification is important prognostic terms as 0 - 1 threat classes for life and health are not present, and 2 - 5 classes tend to occur against the background of organic heart lesions and have a tendency to malignant course, that is, may lead tosudden cardiac death.
Causes of ventricular arrhythmia
Ventricular premature beats may occur under the following conditions and diseases:
1. functional reasons. Often the appearance of individual rare extrasystoles recorded on ECG in healthy individuals with no heart disease.To this can cause emotional stress, vegetative - vascular dystonia, drinking coffee, energy drinks in large quantities, smoking of a large number of cigarettes.
2. organic heart damage. included in this group of reasons:
- ischemic heart disease, 60% of ventricular arrhythmia due to this disease
- acute myocardial
myocardium - myocardial infarction
- post-infarction left ventricular aneurysm
- postmiokarditichesky cardio
- congenital and acquired heart defects
- small anomalies of heart development, in particular, mitral prolapse valve
hypertension - chronic heart failure
3. toxic effect on the heart muscle. develops with alcohol intoxication organism, narcotics, drugs - cardiac glycosides, drugs used in the treatment of bronchial asthma (aminophylline, salbutamol, Flomax), antiarrhythmic drugs of class C 1 (propafenone, etmozin).Also, beats may occur in thyrotoxicosis, when there is intoxication thyroid hormones and their cardiotoxic effect.
Symptoms of ventricular arrhythmia
Sometimes beats not felt by the patient.But in most cases, the main manifestation of the disease are feeling disruptions of the heart.Patients would describe as "somersault", "turning" the heart, followed by a sensation of fading heart, caused a compensatory pause after the beats, then perhaps a sense of shock in heart rhythm, called ventricular myocardial contraction power after a pause.In cases of frequent premature beats or episodes of ventricular tachycardia may be experienced palpitations.Sometimes these symptoms are accompanied by weakness, dizziness, sweating, anxiety.In cases of frequent premature beats may lose consciousness.
Complaints poorly tolerated by the patient, or suddenly arisen for the first time, require urgent treatment to the doctor, so you need to call an ambulance, especially if the pulse is often a hundred beats per minute.
If you have symptoms of an organic lesion of the heart actually beats complemented manifestations of the underlying disease - pain in the heart when coronary heart disease, shortness of breath and edema in heart failure, etc.
In the case of ventricular fibrillation occurs clinical death...
following methods are used for the diagnosis of ventricular arrhythmia:
1. Poll and clinical examination of the patient.
- evaluation of complaints and anamnesis (medical history) suggests the diagnosis, especially if there is an indication of the organic heart disease in patients.The frequency of occurrence of disruptions in the heart, subjective feelings, communication with the load.
- auscultation (listening) of the chest.When listening to the heart may be determined by the weakened heart sounds, abnormal noise (at heart defects, hypertrophic cardiomyopathy).
- when probing pulse recorded spasmodic pulse amplitude varying - to arrythmia heartbeat sets the low amplitude of the pulse wave, after the beats - a large amplitude due to increased blood supply to the ventricle during a compensatory pause.
- tonometry (measurement of blood pressure).Blood pressure can be reduced in healthy subjects with signs of vegetative - vascular dystonia in patients with dilated cardiomyopathy, in the later stages of heart failure or aortic valve defects, and may be increased or remain normal.
2. Laboratory examination methods. Appointed common blood and urine tests, biochemical blood tests, hormone studies, immunological and rheumatological tests, if necessary, check the level of cholesterol in the blood, to exclude endocrine abnormalities, autoimmune diseases, or rheumatism, leading to the development of acquired heart defects.
3. Instrumental methods of examination.
- ECG does not always register the beats, when it comes to healthy people without organic heart disease.Most beats are recorded accidentally during routine examination with no reports of disruptions heartbeat.
ECG - signs of premature beats: advanced, the QRS complex ventricular deformed, appearing prematurely;in front of him missing tooth P, reflecting the atrial contraction;Complex longer with 0.12, after it there is complete compensatory pause caused by electrical nonexcitability after ventricular premature beats.
beats in the ECG trigemenii type.
In cases where there is underlying disease, the ECG revealed signs of myocardial ischemia, left ventricular aneurysm, left ventricular hypertrophy, or other chambers of the heart and other disorders.
- echocardiography (ultrasound of the heart) reveals the underlying pathology, if any -.. Heart disease, cardiomyopathy, myocardial hypertrophy, the zone of reduced or no reduction in myocardial ischemia, ventricular aneurysm, etc. In the study estimated indicators of cardiac activity (ejection fraction,the pressure in the chambers of the heart) and ventricular and atrial dimensions.
- Holter ECG monitoring should be conducted for all persons with cardiac disease, especially in patients who have had a myocardial infarction for the registration of arrhythmia are not perceived subjectively attacks heartbeats and disruptions in the heart, not supported by a single ECG, as well as to identify other violations of rhythm and conduction.It is important to study in the medical plan and prognostic for patients with frequent ventricular premature beats, as the class of arrhythmias depends on the treatment and prognosis.It allows you to evaluate the nature of the arrhythmia before treatment and to monitor the effectiveness of therapy in the future.
- exercise test (treadmill test) must be carried out very carefully and only in cases where the occurrence of attacks of palpitation has a clear connection with the load, as in most cases, this connection points to koronarogenny character beats (caused by impaired patency of coronary artery ischemiainfarction).If in the process of recording an electrocardiogram after a walk on a treadmill arrythmia is confirmed with signs of myocardial ischemia, it is quite possible that after the initiation of treatment of ischemia preconditions for the emergence of frequent premature beats are eliminated.
Precautions need to conduct research as well as the load can cause ventricular tachycardia or ventricular fibrillation.Therefore, in the office of the study must be set to perform cardio - pulmonary resuscitation.
- coronary angiography - eliminates the pathology of coronary artery, causing myocardial ischemia and ventricular arrhythmia koronarogennuyu nature.
Treatment of ventricular arrhythmia treatment arrhythmia
directed to treatment of the underlying disease, which is the cause and symptom relief arrhythmia.In order to determine the necessity of certain products developed arrhythmia classification, depending on the purity of the flow.
Benign ventricular arrythmia , usually observed in the absence of organic heart disease and is characterized by the presence of rare or medium frequency of premature beats, asymptomatic or mild subjective symptoms.The risk of sudden cardiac death is very low.Therapy in such cases can not be appointed.In case of poor tolerability of the symptoms are appointed by antiarrhythmic drugs.
potentially malignant course occurs when the beats in the background of the main cardiac diseases, characterized by frequent or average frequency of beats, the absence or presence of symptoms, good or bad their portability.The risk of sudden cardiac death significantly, as recorded unstable ventricular tachycardia.Therapy in such cases is shown for the purpose of relief of symptoms and reduce mortality.
malignant ventricular arrythmia from potentially malignant characterized in that in addition to core symptoms, a history there are indications of syncope (fainting), and / or cardiac arrest (weathered through resuscitation).The risk of cardiac death is very high, therapy is aimed at reducing the risk.
Frequent ventricular premature beats, which appeared for the first time or already occurring before, but at the moment develop suddenly, is an indication for hospitalization and intravenous drugs.
Selection of drugs for the treatment should be carefully carried out by the attending physician in the clinic or hospital, with a mandatory analysis of possible contraindications and the selection of an individual dose.Initiation of therapy should be gradually increasing doses, abrupt withdrawal of drugs is unacceptable.The duration of treatment is determined individually, in cases of potentially malignant course of careful removal of the drug should be fixed Holter ECG monitoring to confirm the effectiveness of therapy.When malignant course of therapy continues for a long time, perhaps for life.
antiarrhythmic drugs have side effects as pro-arrhythmic effect, that is, are capable to induce arrhythmias.Therefore, their use alone is not suitable, is justified by their co-administration with beta - blockers that reduce the risk of sudden cardiac death.From antiarrhythmics preferred appointment propanorm, etatsizina, VFS, Amiodarone, Cordarone, sotalol in combination with low doses of beta - blockers (propranolol, bisoprolol, etc.).
Persons with acute myocardial infarction and myocarditis in acute phase, shown amiodarone Cordarone or because other antiarrhythmics in acute disease of the heart muscle can cause other cardiac arrhythmias.In addition to these drugs, nitrates (nitroglycerin kardiket, nitrosorbid) assigned when organic heart disease, ACE inhibitors (enalapril, lisinopril, perindopril), calcium channel blockers (verapamil, diltiazem), antiplatelet agents (aspirin), drugs that improve the nutrition of the heart muscle (Pananginum, magnerot, vitamins and antioxidants - aktovegin, mexidol).
therapy is performed under the control of an electrocardiogram every two - three days during their stay in hospital, and every 4 - 6 weeks in the clinic in the future.
Lifestyle with ventricular arrythmia
When ventricular arrhythmia, especially caused by other heart conditions, need more rest, often remain in the fresh air, to observe the regime of work and rest, eat properly, to eliminate the use of coffee, alcohol, reduce or eliminate smoking.
patients with benign type of ventricular arrhythmia is no need to limit physical activity.In malignant type should be limited to significant stress and psycho-emotional situations that can lead to an attack.
Complications Complications of benign type of ventricular arrhythmia, as a rule, do not develop.Threatening complication in malignant type are sustained ventricular tachycardia that can go in the atrial or ventricular fibrillation, and then lead to asystole, ie, cardiac arrest and sudden cardiac death.
benign course and the absence of basic cardiac disease prognosis.
therapists Sazykina OJ