Extrasystoles
Extrasystoles is a kind of disturbance of the rhythmic work of the heart, which manifests itself in an extraordinary reduction of one or more chambers of the heart. This phenomenon is caused by excessive and untimely generation of an electrical impulse by specific structures of the myocardium - pacemakers.
Excessive electrical impulse can occur in the ventricles, atria or at the atrioventricular node.
Extrasystoles in the heart can be detected by in-depth examination in many people who do not suffer from cardiovascular diseases. Periodic occurrence of extraordinary cardiac contractions can occur in absolutely healthy people after exposure to certain factors: the use of beverages containing caffeine or alcohol, a strong stress situation, physical stress, coupled with stress or lack of sleep.
In addition, extrasystoles can occur in people of any age and sex. In adolescents, they are associated with the restructuring of the hormonal background, in elderly people the cause may be ischemic heart disease. And in middle age people, connective tissue diseases or oncological diseases can manifest themselves.
Extrasystoles are distinguished by the location of the focus, which generates excess impulses, as well as by quantitative and qualitative characteristics.
Localization of the focus distinguishes sinus, atrial extrasystoles, ventricular, supraventricular and combined.
There are many narrowly defined classifications, the easiest to understand is the gradation of Laun-Wolff. It includes several degrees, divided by quantitative characteristics and ECG symptoms. The first category according to this classification corresponds to single, morphological extrasystoles, the number of which should not exceed three dozen per hour. The next category is allotted to the same extrasystoles from the same focus, but in a larger number. The third type is extrasystoles of different origin. Groups 4 "a" and 4 "b" include repeated and frequent forms of extrasystoles. The latter group is most dangerous to health and can cause severe complications leading to death - atrial flutter or ventricular fibrillation.
Still, doctors are of the opinion that the category of extrasystoles is not so important for predicting the outcome of the underlying disease. Dangers themselves are the consequences of certain diseases, the symptoms of which are different types of extrasystoles.
Ventricular extrasystoles
The appearance of ventricular extrasystoles in most people does not cause any unpleasant sensations. If anyone notices, then does not give the symptoms of special significance. Basically, this feeling is an excessively strong heart beat in the chest, more palpable than a simple heartbeat. Most often, people call this phenomenon "interruptions".This kind of extrasystole arises because of the spread of the pulse on the myocardium only in the ventricles before another normal contraction.
The causes of ventricular extrasystoles are previously undiagnosed cardiac diseases. For example, ischemic disease, cardiomyopathy, hypertension, myocardial infarction.
There are a number of common causes that can lead to extrasystoles - frequent stressful situations accompanied by prolonged emotional stress, depressive conditions, alcohol abuse, smoking, excessive coffee consumption, and the use of stimulant drugs( cocaine, amphetamine, pervintine).
To determine the location of the impulse that leads to extrasystoles, electrocardiography is used. You can take the indicators several times a day with a stationary device, but a more informative method is the daily monitoring of the heart by a special mobile device. The researcher is set up with sensors to read the electrical activity of the heart and during the day he leads an ordinary way of life for him. After a day the doctor removes the device and deciphers the indications. This method can indicate the reason for the occurrence of extrasystoles, as well as to specify their localization and character.
Nadzheludochkovye extrasystoles
Nadzheluduchkovaya extrasystole occurs if the focus of automatism is in the atrio-ventricular node.
Symptoms of supraventricular extrasystoles are similar, differ only in the cardiogram and further examination. Often, people experiencing periodic extrasystoles, feel heart sinking, followed by an intensified stroke( or several strokes).After that, the rhythm is restored. Depending on the severity of the underlying disease, the symptom of which are extrasystoles, the frequency of occurrence of such symptoms varies throughout the day.
The electrocardiogram shows characteristic changes: negative or deformed tooth P, which appears untimely. And after the wave of the extrasystole a pause occurs, that is, the forced dropout of one or more complexes of contraction of the heart. This pause is caused by excessive electrical impulses, after which the heart muscle did not have time to fully recover and proceed to a consistent, rhythmic work.
In some patients, supraventricular extrasystole may be accompanied by a partial or complete blockade of the right leg of the bundle Guiss( a specific node in the cardiac muscle that distributes electrical impulses throughout the myocardium in a certain sequence).
Causes of supraventricular extrasystoles may be cardiac or non-cardiac. Heart diseases, which can cause such extrasystoles, are often chronic and lethargic. For example, ischemic heart disease, atherosclerosis of the coronary arteries of the heart, cardiomyopathy, pericarditis.
In people with concomitant cardiac disease, supraventricular extrasystoles( supraventricular) can become a trigger in a series of life-threatening arrhythmias: atrial flutter, ventricular fibrillation, or spontaneous cardiac arrest.
The possibility of such dangerous conditions should always be taken into account and if supraventricular extrasystoles were recorded on the ECG, a more in-depth examination in a cardiac hospital should be carried out.
In the hospital, specific cardiac examinations are carried out at rest and under dynamic load. This makes it possible to determine what factor in this patient leads to the occurrence of extrasystoles and other rhythm disturbances.
Single extrasystoles
Single extrasystoles are a consequence of some extraordinary impulses of a normal or pathological focus of excitement. Usually, single extrasystoles do not have any patterns of alternation with normal Q-R-S complexes.
This kind of extrasystole is common in absolutely healthy people. According to foreign scientists, more than 58% of men over 50 years old have single extrasystoles at rest. Given the absence of diseases of the cardiovascular system, this phenomenon does not carry any danger to life and health. And if a person has not undergone planned examinations for a long time, but there are single extrasystoles on the ECG, then he should conduct a thorough pre-examination for hidden pathology.
To avoid the appearance of single extrasystoles, doctors recommend limiting the use of strong tea and coffee, as well as being more careful with bad habits.
In addition, single extrasystoles can have different parameters on the electrocardiogram, are observed equally often both at rest and during physical exertion.
If the focus of excessive excitation is not carried out to the rhythm driver in effect at the time, then the CA node is not recharged, which means that a compensatory pause follows the extrasystole. This pause is a manifestation of the protective function of the myocardium, because this protection is primarily aimed at preventing obvious overloads for the heart.
In the opposite case, when after a single ventricular extrasystole does not follow a full or partial compensatory pause, extrasystoles are considered intercalary.
Very often, the disease of the cardiovascular system that causes extrasystoles remains without proper treatment. This leads to a chronic process and the development of mechanisms of decompensation( a condition in which the body can no longer compensate for the consequences of the disease due to its own resource).Decompensation of heart disease develops very slowly. Symptoms, in general, remain unchanged, but their severity increases at times. For example, single extrasystoles can turn into multiple extrasystoles. They, in turn, have more tangible manifestations.
In addition, multiple extrasystoles tend to produce clear sequences and patterns when they appear.
Episodes of extrasystoles may alternate with normal rhythm. Based on the period of alternations, they have corresponding names. So the extrasystole that occurs after three normal cycles is called quadrigemia, the one that follows after two normal contractions of the heart chambers - trigeminy. If the extrasystoles alternate with the normal rhythm of the heart beat, then this is bigemini.
In some cases, ventricular extrasystoles follow one after another and if there are more than three episodes in a row, then this indicates an unstable ventricular tachycardia. This condition can cause ventricular fibrillation.
Extrasystoles causes
Extrasystoles are in fact a manifestation of diseases of various organs and systems. Most often - heart disease, endocrine glands, various disorders of the nervous system, stress and mental disorders.
To heart diseases, which are manifested by extrasystoles can be attributed to ischemic disease, cardiosclerosis, rheumatic myocardial damage, myocarditis, cardiomyopathy, cardiac hypertrophy, simple obesity of the heart, amyloidosis, as well as atherosclerosis.
Endocrine disorders that trigger the onset of extrasystoles: hypothyroidism and hyperthyroidism( thyroid disease), hypothalamic and pituitary gland disorders( hormone-producing or squeezing tumors), adrenal diseases( pheochromocytoma, Itenko-Cushing's disease), diabetes mellitus.
Violations of the nervous regulation of the heart can also cause extrasystoles. These disorders include wandering nerve damage, infringement of spinal cord roots, disorders of nerve trophism in the pericardium or mediastinum.
Frequent extrasystoles can cause recurring stressful situations. Being in constant nervous tension, a person can not stay healthy for a long time. Sooner or later the body will stop coping with large volumes of negative emotions. Often, the cardiovascular system takes a hit.
Heart diseases are found even in people who lead a healthy lifestyle, but are in a state of constant stress. The first manifestations can be uncaused pain behind the sternum, as well as extrasystoles. In the future, if you do not change the situation or your attitude towards it, it can go into hypertension, angina pectoris or even myocardial infarction.
The state of depression also has a detrimental effect on the functioning of the heart. Basically, due to a violation of the exchange of serotonin and norepinephrine. These hormones regulate many processes in the body, including cardiac activity.
From biochemical factors, it should be noted changes in the ionic composition of the blood. If you follow a strict diet, improper diet, diseases of the gastrointestinal tract or pathologies of hormonal regulation systems, homeostasis, perhaps a change in the amount of trace elements that will affect the work of muscle tissue.
In the work of any muscle of the human body simultaneously participates many mechanisms of regulation, energy exchange, transportation of various substances. In any kind of musculature, there are ion channels that carry out active or passive transport of microelements inside or out of the cell. Thanks to the well-coordinated work of all structures at the cellular and molecular levels, the normal operation of a particular organ can be ensured.
Myocardium is not an exception. If there is excessive amount of calcium or sodium in the blood that goes directly to the heart muscle, and potassium or magnesium compounds are less than normal, serious malfunctions are possible in myocardial work.
In addition to cardiac manifestations in the form of extrasystoles, constipation, convulsions, cough, and dyspnea are possible.
Sometimes the cause of extrasystole may be an increase in the volume of circulating blood on the background of the pathology of the excretory system. Increased stress on the heart muscle can affect the smooth operation of the heart.
Extrasystoles symptoms
Extrasystoles that occur in a healthy person are often overlooked. But it happens that the appearance of sensations of interruptions during the work of the heart occurs against a background of rapid heart rate or high blood pressure. Usually after such complex manifestations people turn to the doctor.
Extrasystolic( paroxysmal) tachycardia is characterized by a sharp increase in the heart rate with constantly alternating extrasystoles. Usually the number of strokes reaches 290-310 per minute and is accompanied by a feeling of fear, pallor, low blood pressure. Such an attack can last from a few minutes to a day.
In children and adolescents, extrasystoles can be the first manifestation of such a functional disorder as vegetative-vascular dysfunction. In addition to disruptions, this disease is often accompanied by a violation in the regulation of the tone of the vascular wall - low or high blood pressure, as well as the symptoms that are characteristic for the defeat of the autonomic nervous system: nausea, dizziness, sweating, hot flashes, loss of appetite, fainting.
Such a combination of symptoms makes parents intensely worry about the health of their child and they begin to examine it in all parameters. And even if complaints about interruptions have receded into the background, electrocardiography is likely to reveal extrasystole.
Pregnant women are also very acutely affected by the appearance of extrasystoles. After all, in this category of people the appearance of any symptom of the pathology of the cardiovascular system causes a feeling of fear, panic and can aggravate the situation.
In a healthy pregnant woman, extrasystoles may appear due to increased stress on the heart. Especially often, disruptions occur after physical exertion or stressful situations. Therefore it is very important for a pregnant woman to observe the regime of the day, not to resort to physical exertion without emergency and to protect her nervous system.
There are also opposite cases, when in the last weeks of pregnancy the expectant mother does not notice any interruptions in the chest, referring to the movements of the fetus. In such cases, the first symptoms of the pathology of the cardiovascular system may be missed.
In elderly people it is difficult to differentiate the extrasystole pathological from the physiological only on complaints. Since this category of people can make complaints for the slightest changes in their state of health( sometimes in order to attract attention to their person).
The most reliable for their examination is the method Holter research( daily monitoring of ECG-indicators of the heart).
In older people, extrasystoles are often accompanied by attacks of hypertension, angina pectoris or tachycardia.
Extrasystoles treatment
Single extrasystoles that can occur during the day in people who do not have health problems usually do not require any medication. It is enough to lead a healthy lifestyle, limiting the use of strong tea, coffee and fatty foods.
If extrasystoles are multiple, high frequency of occurrence, rhythmically inserted into the normal cardiac cycle or when serious accompanying pathology is identified, therapeutic therapies should be used.
Treatment of extrasystoles should be aimed not only at eliminating symptoms, but also at achieving the longest period of recovery from the underlying disease.
Symptomatic therapy includes Novokainamid. This drug is used for various arrhythmias according to the prescribed regimens taking into account the intake of other drugs. According to the chemical structure, this substance is similar to quinidine. It has an antiarrhythmic effect due to weak inhibition of excitability and contractility of the myocardium. In addition, reduces the impact of the vagus nerve, which allows you to take fewer drugs. To a small extent has a vasodilating effect.
The effect of the application occurs when the concentration of the drug in the blood reaches six micrograms per milliliter of blood. To treat the symptoms of ventricular extrasystole is used in a dosage of a quarter of a gram to three grams per day. The dosage depends on the changes in the electrocardiogram. The drug has some side effects: allergies, bitter taste in the mouth( due to a heavy load on the liver), insomnia, seizures.
Aymalin is another drug that has antiarrhythmic effect, eliminates extrasystoles, lowers arterial pressure. This is a herbal medicine, made from the substance contained in rauwolfia.
Acts depressingly on the excitability and conductance of the myocardium, and also increases the refractory( without reaction) period of the heart chambers. Aimalin has found wide application in paroxysmal tachycardia, extrasystoles, Wolff-Parkinson-White syndrome, as well as intolerance of cardiac glycosides or synthetic drugs.
Upon admission to the gastrointestinal tract starts to act in an hour, and with intravenous administration( in emergency cases or if oral intake is contraindicated) - after 20 minutes.
Dosage at the urgent conditions of 50 milligram of the drug in 10 milliliters of the solvent, injected for five to ten minutes( depending on the severity of the condition).The maximum daily dose is no more than 0.2 grams. Side effects include fever, lowering blood pressure, impaired conduction of the heart.
To treat the symptoms of arrhythmia, as well as extrasystole, Etmosin is used. In addition, this drug has a moderate spasmolytic effect. The drug effect is achieved due to inhibition of premature excitation of the heart muscle, which is due to the blockade of channels through which sodium ions circulate through the cell membranes.
In addition, causes a moderate increase in blood pressure, which can be used for the appointment of strictly individual treatment regimens( for example, if a patient has tachyarrhythmia with extrasystoles against a background of reduced blood pressure).At reception before meal the high concentration of a preparation in a blood begins to appear in an hour.
The drug is not indicated for people with chronic heart failure, atrioventricular blockade( second degree and above), as well as having an individual intolerance. There is no experience of using this drug in pregnant women and children. Doctors do not recommend the use of ethmosin in people with a pacemaker or who have had myocardial infarction. Do not use the drug if a change in the ionic balance of microelements in the blood has been proven( especially when potassium and magnesium are deficient).In the presence of bronchial asthma in the history of the drug should be replaced by a more sparing.
Among the most common side effects are sleep and memory disorders, tinnitus, vision impairment, coughing, vomiting, abdominal pain, chest pain, swelling of the hands and feet, allergies. During treatment should be categorically refuse to use sleeping pills, alcohol, antidepressants.
Of a number of beta-blockers, the classic drug is Anaprilin. By blocking the corresponding receptors in the heart, it reduces the frequency of contractions, as well as the number and strength of excessive electrical impulses. Thus, arrhythmia, extrasystole is eliminated. Arterial pressure also decreases, but the tone of smooth muscles in the bronchi increases. Therefore, this drug can not be used by asthmatics and people with allergic rhinitis or bronchospasm.
Anaprilin is used up to four times a day, depending on the severity of the condition and the prescriptions of the treating doctor. The maximum dose usually does not exceed 600 milligrams per day. Injectable form of Anaprilin is not used as often as tableted. And it is used to arrest individual paroxysms.
Of side effects are possible: itching of the skin, vomiting, cough, Raynaud's syndrome( angiotrophoneurosis).
Of the class of calcium channel blockers used Diltiazem. At the heart of its action is the inhibition of the entry of calcium ions through the membrane of the cells of the myocardium. It is used in the treatment of extrasystoles and arrhythmias of various genesis. The main clinical effects include improving the blood supply to the myocardium, reducing the load on the heart, reducing the strength and heart rate, lowering blood pressure. When taking the tablets, the maximum concentration is reached in the blood in an hour at a time of up to eight hours.
In addition to the treatment of extrasystoles, Diltiazem is used for therapeutic and diagnostic manipulations on the pericardial vessels, as well as for arterial hypertension. Not shown to pregnant women, during breastfeeding, with hypotension, as well as patients with chronic heart failure.
Used internally for 30-40 milligrams to four times a day. With concomitant violations of the liver or kidneys, as well as in elderly people, the dose should be reduced, and the number of receptions reduced to one or two.
With long-term use of the drug( more than six months), tolerance and a sharp decrease in efficacy may occur. Therefore, the drug should alternate with similar in effect.
Intravenously it is applied at rendering of the emergency help on one milligram per minute drip( but no more than three hundred milligrams a day).To restore the rhythm is often used Diltiazem in combination with Anaprilin 100 and 150 milligrams, respectively. With pulmonary edema or pulmonary embolism( pulmonary embolism), up to 700 milligrams per day can be used.
The main side effects depend on the individual characteristics and the concomitant pathology of the body's excretory and processing systems. Often, this reduction in blood pressure, fainting, rash, headache, hyperglycemia, constipation, heartburn, bradycardia.
One of the best antiarrhythmic drugs is deservedly considered Amiodarone. It effectively suppresses extrasystoles, lowers arterial pressure, has an antianginal effect( reduces the need for myocardium in oxygen), eliminates tachycardia. When urgent conditions are used in a dose of up to five milligrams per kilogram of body weight. In other cases, the average dose should not exceed 1.2 grams.
Also applicable: Lidocaine, Dysopyramide, Timolol, Ibutilide.
It is important that the treatment of extrasystoles be directed to the underlying disease, and the symptomatology can either be quenched, or wait for a reduction along with a cure for the underlying disease. After all, if you block the symptoms, you can miss the most appropriate time for adequate therapy.
