Extrasystole: symptoms, treatment, causes, complications

What is this - extrasystole is called a violation of the rhythm of the heart, in which there are one or several extraordinary cuts of the heart per unit time.

Constantly recorded arrhythmia, as well as more than three consecutive extraordinary abbreviations have other names.

Extrasystoles develop due to the fact that at some point the heartbeat is not triggered by the main pacemaker located in the thickness of the heart muscle, but by its secondary "colleagues" who normally should only carry out the main impulse.

Causes of extrasystole are different. Depending on the type of extrasystole, the pathology prognosis may be different;in general, they increase the risk of sudden death.

Classification of

Extrasystoles are classified according to several criteria.

By the nature of the lesion of the heart, the extrasystole happens:

1) Functional: there is no heart disease. Extraordinary reductions are due to:

• of vegetative-vascular dystonia;
  
• of neuroses;
  
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• depression;
  
• of nerve strains;
  
• consuming alcohol or beverages with caffeine;
  
• smoking.

Such extrasystoles develop not during physical exertion, but usually before bed or on waking, when reading or sitting. They stop when you change the emotional background, after rest.

2) Organic, indicating the development in humans or endocrine diseases, or heart pathologies. Such extrasystole is noted in 75-80% of people over 50;her symptoms are often invisible to the patient himself. An extraordinary reduction at the height of physical activity develops.

By localization of the focus, which forms the impulse for an extraordinary contraction, the extrasystole happens:

1. 1) Atrial: the accumulation of specific cells that are capable of generating an electrical impulse is in the atrium, but not in the sinus node that sets the normal rhythm of our heart, and below it;
   
2. 2) Atrial-ventricular: periodically the role of the main driver of rhythm takes on the second most important node of specific cells - the atrioventricular junction;
   
3. 3) Ventricular: their source is the conductive impulse of the pathway located in the ventricles of the heart.

This is the most life-threatening type of extrasystoles in the presence of organic pathology of the heart. There are 62% of elderly people.

Depending on the type of extrasystole and localization of the pathological focus,

• monomorphic monotopic extrasystoles: their source is one specific node, they have the same ECG view;
  
• polymorphic monotopic: the source is one, but the shape is different;
  
• polytopic: several different sources of extrasystoles;
  
• unstable paroxysmal tachycardia - several( more than 3) extrasystoles that go one after another.

Heart rhythm in which frequent extrasystoles are observed, has the following classification:

• bigemia - alternation of normal contraction and 1 extrasystole;
  
• trigeminy: 2 normal contractions, followed by 1 extrasystole;
  
• quadrigemia: 3 contractions after the command from the sinus node, followed by 1 extrasystole.

According to the frequency of occurrence, extraordinary cuts are:

• rare: they are less than 5 per minute;
  
• average: 6-15 per minute;
  
• frequent: more often 15 per minute.

Causes of occurrence of extrasystole

Provoking the development of extrasystole can such pathologies:

• heart disease;
  
• vegetative-vascular dystonia;
  
• IHD: angina, myocardial infarction;
  
• myocarditis;
  
• myocardial dystrophy;
  
• cardiomyopathy;
  
• cardiosclerosis;
  
• intoxication with developed infectious disease;
  
• hyperthyroidism;
  
• allergic reactions;
  
• tumor processes in the body;

And also:

1. 1) As a response to the increased level of adrenaline / norepinephrine in the body( with stress, some tumors of the endocrine system);
   
2. 2) As a reflex in diseases of internal organs: cholecystitis, hernia of the diaphragm, stomach pathologies;
   
3. 3) For osteochondrosis of the cervical spine;
   
4. 4) Amyloidosis;sarcoidosis;lung diseases;
   
5. 5) With the introduction of certain drugs: "Eufillin", "Ephedrine", "Proserin", "Caffeine", "Digoxin", diuretics, hormones, glucocorticoids;antidepressants;
   
6. 6) Diselectrolyte disturbances are a change in the ratio of sodium, potassium and magnesium ions, which are very important for the conduction system of the heart.
   
7. 7) Smoking;
   
8. 8) Abuse of coffee, drinks containing guarana.

Symptoms of extrasystole

The most dangerous are rhythm disturbances that are not felt by a person and are detected only with the help of a cardiogram.

If the symptoms of extrasystole are felt, it is described by patients as follows:

• a strong heart beat from the inside;
  
• "turning over" the heart or its "tumbling";
  
• outages, heart fading;
  
• heart rate measurement is often not indicative, since only pulse strokes that develop with normal cardiac contractions reach the limb arteries.

This is accompanied by:

1) With functional extrasystoles - a sensation of hot flushes, anxiety, lack of air, sweating;

2) In organic forms of this arrhythmia, when the rhythm disturbance leads to a decrease in blood supply to the brain, blood vessels of the heart, kidneys, it is felt as:

• dizziness,
  
• headache,
  
• dyspnea,
  
• syncope,
  
• angina attacks( pain in the heart region, behind the breastbone),
  
• decrease in the amount of urine released per day.

Diagnosis of the extrasystole

The diagnosis of the extrasystole begins with a standard ECG study. Then the cardiologist examines the patient, listens to his heart with a phonendoscope, doing this in the patient's sitting position, and then after his rising. Blood pressure is also measured.

Then the cardiologist interrogates the person, finding out what disorders of the heart he feels, after which it arises or intensifies. To find out the causes of extrasystole, we investigate:

• heart ultrasound;
  
• content in the blood of potassium, sodium and magnesium;
  
• level in the blood of sex hormones;
  
• level of thyroid hormones;
  
• content in the blood of bilirubin, as well as enzymes ALAT and ASAT( for the analysis of "liver tests");
  
• the state of the mucous membrane of the stomach, esophagus, duodenum( according to FEGDS).

Not always an extrasystole, painfully tolerated by a patient, is detected using a standard ECG.In this case, the following:

1. 1) Holter ECG monitoring: a patient walks for 1-2 days with a small device that reads a cardiogram continuously, during normal activities and sleep. It should be noted on the graph, at what time and what the patient was doing;
   
2. 2) Bicycle ergometry: ECG monitoring during an increasing load on the treadmill;
   
3. 3) Transesophageal electrocardiography: ECG is recorded during cardiac stimulation with an electrode inserted through the esophagus;
   
4. 4) Stress Echo-CG - ultrasound of the heart, which is carried out not only in the normal regime, but also after the administration of special preparations to man.

These studies are carried out only in hospitals with an intensive care unit, and the diagnostic room itself is equipped with the necessary equipment and preparations.

Treatment of extrasystole

With the functional nature of the extrasystole, no specific treatment is required. It is recommended only to abandon bad habits - smoking, drinking drinks with caffeine and guarana. Sometimes the decisive factor is the change of work or situation, because of which the constant stressful situation will disappear.

With diseases of the digestive, endocrine, nervous systems, treatment is directed to the therapy of the underlying disease. If the extrasystole is caused by medications, they must be canceled.

If the number of extrasystoles exceeds 200 per day, or they are accompanied by subjective complaints, or if they occur against the background of heart pathology, the administration of specific antiarrhythmic drugs is required: Novokainamid, Kordaron, Sotalola, Diltiazema and others.

The choice of the drug is based on the localization of the extrasystole on the ECG.If after 2 months on ECG there is a decrease or complete disappearance of the extrasystoles, then in case it was not ventricular, the dose of antiarrhythmic drugs is gradually reduced until they are completely canceled.

If the patient has a poor tolerance of ventricular ectrasystole, or the number of extraordinary cuts is more than 20,000 per day, or antiarrhythmic drugs are ineffective, minimally invasive surgical treatment is performed - radiofrequency ablation.


In cases where extrasystole develops against the background of the pathology of the heart, it is necessary to perform its therapeutic or surgical treatment.

Complications of the

disease Several consecutive extrasystoles can be transformed into other life-threatening rhythm abnormalities:

• atrial flutter;
  
• paroxysmal tachycardia;Atrial fibrillation;
  
• fibrillation of the ventricles.

If extrasystoles occur frequently, it can lead to the development of circulatory insufficiency of the heart, brain, kidneys with the development of their insufficiency.

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