Symptoms and treatment of extrasystole disease in the heart

Specialists in the field of cardiology are often asked if extrasystole of the heart is dangerous, what it is, why this feature occurs, whether it requires medical intervention. There are no definitive answers to some of these questions. It all depends on the form of the disease, the mechanisms of its appearance and concomitant diseases. It is known that extrasystole is very common and its manifestations are recorded in the vast majority of people over 50–55 years old. Often a person, before accidentally measuring an electrocardiogram, does not even realize that he has such a feature. It is desirable to know basic information about this cardiopathology, since sometimes it requires urgent action.

Short description

Extrasystole (ES) is one of the variants of heart rhythm disturbance, which is associated with additional "unscheduled" contractions of the heart or its chambers. The source of normal rhythm is the sinus node. Extraordinary excitations are due to the presence of ectopic (heterotropic) foci, which can be located on any part of the conducting system.

• in the ventricles (62.6% of the total number of cases);
• in the atria (25%);
• in the atrioventricular (atrioventricular) connection (2%);
• different variants of combinations of the listed localizations (10.2%).

It is extremely rare for untimely excitations to occur in the sinoatrial node (one case out of five hundred).

The appearance of untimely impulses is associated with the trigger activity of the foci, as well as with the mechanism of re-entry of excitation (re-entry). Electrical excitations propagate through the conduction system and cause contractions in the diastolic phase that are out of the normal rhythm.

Extraordinary impulses are observed in 60-70% of people, most of whom have no health problems. No more than 200 untimely strikes per day are considered a variant of the norm. More often, such impulses are due to the peculiarities of neurogenic activity. The organic origin of untimely excitations, which often occur, for example, in coronary heart disease (CHD) or cardiosclerosis, is also possible.

If a person does not have cardiopathology, then even with a high frequency of extraordinary strokes, changes in the movement of blood through the vessels are insignificant.

• an increase in the force of contraction that follows an extraordinary one;
• a complete compensatory pause, leading to an increase in the volume of the ventricles at the final moment of filling - diastole.

In cardiopathologies, compensatory mechanisms do not work. If a person suffers from organic cardiopathology, then with frequent (6–8 per minute or more) additional strokes, the minute volume of blood circulation noticeably decreases, since the volume of extraordinary blood ejection is less than normal. With a decrease in the time interval between beats, the volume of blood ejected from the heart muscle decreases. Lack of blood supply can lead to complications of the course of an existing cardio disease. The most undesirable option is ventricular ES, which develops with myocardial damage.

Classification

Many variants of this cardiopathology are known. In some cases, the ectopic complex functions independently of the sinoatrial node, and parasystole is observed, for which two different rhythms (sinus and extrasystolic) have been identified. "Unscheduled" impulses, following two in a row, are called paired, and if there are more than two impulses in a sequence - group. Recently, group (volley) impulses have been called "unsustainable paroxysmal tachycardia."

If normal and anomalous excitations are not connected, then one speaks of a disordered ES.

The ordered variety is called alloarrhythmia, in which there are:

• bigeminy;
• trigeminy;
• quadrigeminy.

With quadrigeminia, an “unscheduled” contraction alternates with three normal ones, with trigeminia - with two, with bigeminia - with one.

• early, manifesting itself on the electrocardiogram at the same time as the T wave or no later than 0.05 s after the end of the cycle;
• medium, manifested 0.45-0.50 s after the T wave;
• late, which develops before the P wave of the subsequent normal cycle.

Depending on the number of extraordinary excitations per unit of time, rare ES (< 5 pulses per minute), medium (from 6 to 15 pulses), frequent (> 15 per minute) are distinguished.

The idiopathic variant of SE is characterized by the fact that the mechanisms of formation of this feature remain unclear.

Why does this cardiopathology appear

Allocate ES of a functional, organic and toxic nature.

Extrasystole of a functional nature is of neurogenic origin.

It is determined by the following factors:

• stress, psycho-emotional stress;
• autonomic dysfunction;
• excessive consumption of coffee or tea;
• smoking, drinking alcohol or drugs;
• neuroses;
• osteochondrosis of the spine in the cervical region.

Functional ES sometimes occurs, for example, in professional athletes who are prepared for physical exertion and do not complain about their health. During menstruation, ES is possible in a healthy woman. Functional SE is usually an idiopathic variant of the pathology.

• myocardial infarction;
• ischemic heart disease;
• hypertension;
• pericarditis;
• myocarditis;
• sarcoidosis, amyloidosis, hemochromatosis;
• cardiomyopathies;
• congenital and acquired heart defects;
• chronic heart failure;
• cardiosclerosis;
• pulmonary heart.

Sometimes the development of ES is associated with cardiac surgery. Sometimes ES is associated with myocardial dystrophy, which is caused by regular physical overload during professional sports.

Extrasystoles of a toxic nature are usually associated with hyperthyroidism (thyrotoxicosis), fever, side effects of a number of drugs (for example, caffeine or ephedrine).

ES is often caused by such non-cardiac factors: intoxication in infectious diseases, allergic reactions, poisoning, neoplastic processes. ES is caused by deviations from the electrolytic balance in the myocardium.

Physical activity is a provoking factor for ES, which develops due to cardiological and metabolic pathologies, but contributes to the suppression of the form associated with problems in the regulation of autonomic functions.

Persistent ventricular allorhythmia is typical of an overdose of cardiac glycosides.

About 50% of women during pregnancy report signs of ES. It should be noted that the period of gestation is a serious stress for the body of the expectant mother. In addition, during this period, hormonal changes occur, and most body systems experience increased stress. For most women, ES is temporary, since it is most often associated with natural physiological processes occurring in the female body during this period. It is important to give up bad habits, walk more in the fresh air, constantly monitor your condition.

In a child, ES can be the result of a range of cardiac problems, but it can also be caused by emotional and physical stress while studying. A special case is the presence of congenital organic cardiopathologies.

Symptoms and Diagnosis

Extrasystole often does not have pronounced external manifestations. People suffering from autonomic dysfunction usually endure ES quite hard. People with organic myocardial damage tolerate this feature much easier.

A characteristic manifestation of ES is a feeling of "fading" in the chest, followed by a push from the inside. There may be interruptions in the work of the heart, its “turning, somersaulting”.

External manifestations can also be:

• weakness, dizziness;
• shortness of breath, lack of oxygen;
• circulatory failure;
• increased sweating, a feeling of "heat";
• sleep problems;
• chest pain;
• pallor, fainting;
• general discomfort, anxiety, fear of death.

The doctor assumes the presence of this feature according to the results of the examination and conversation with the patient. As a result of a conversation with the patient, it is specified under what conditions unscheduled strokes occur, the frequency of their occurrence, the result of taking medications. The history of previous diseases that can lead to organic lesions of the myocardium is analyzed with particular attention, and the possibility of the presence of undiagnosed pathologies is considered. The etiology of ES must be established, since the course of therapeutic measures depends on the nature of the pathology. The pulse is examined, the chest is auscultated and tapped.

Measurement of the electrocardiogram is the main method for diagnosing ES. After measuring the cardiogram according to the standard method, it is often possible to make a diagnosis even in the absence of external symptoms and complaints of the subject.

Usually, Holter ECG monitoring (monitoring) is also carried out, which consists in continuous measurement of the cardiogram for 1-2 days. In this case, a special device of small size is used, which is fixed on the body of the subject. The results of the measurements are compared with the records of the patient, in which he recorded everything that he felt and did. This type of examination is performed for any cardiopathology.

If ES could not be detected by measuring the cardiogram, then exercise tests (treadmill test and bicycle ergometry) are used. These techniques allow to detect pathology during physical activity. Cardiopathologies are studied using ultrasound techniques, stress echocardiography, MRI.

Prevention of possible complications and treatment of extrasystole

Decreased blood output in ES leads to insufficient blood flow, which can exacerbate angina pectoris and temporarily change the blood supply to the brain. The likelihood of atrial fibrillation and death increases.

Group ES can result in threatening changes in heart rhythm: atrial form can lead to atrial flutter, changes in their structure, cardiac failure, and ventricular - to paroxysmal tachycardia, fibrillation (flicker) of the ventricles.

A frequent form causes insufficient blood supply to the most important organs (heart, kidneys, brain). Ventricular pathology is the most malignant because of the possibility of sudden death of the patient.

• on the causes and conditions for the appearance of ES;
• on provoking factors;
• on the mechanisms of the development of the disease;
• on patient tolerance of external symptoms.

The tactics of medical intervention should take into account the characteristics of the disease, as well as the location of areas of increased electrical activity. With rare extraordinary strokes that are not of organic origin, there is no need for special treatment. If the feature is caused by problems in the functioning of the digestive or endocrine systems, myocardial damage, then the primary task of doctors is to cure the primary disease.

In the case of neurogenic etiology, consultation with a specialist in the field of neurology is required. The doctor may prescribe sedatives (for example, rudotel or diazepam), peony tinctures, medicinal collections based on motherwort, lemon balm. If the feature is caused by a side effect of certain drugs, then the doctor may stop taking them or suggest harmless analogues. Medical intervention is carried out with a significant frequency of untimely strokes (more than 200 per day), the patient's complaints about his condition and the presence of cardiac lesions.

The purpose of the drug is carried out taking into account the form of the ES. The choice of an antiarrhythmic drug and the determination of the required dosage is carried out on an individual basis when used to control daily monitoring. First-order drugs (with an efficiency of more than 70%) include Propafenone (Propanorm) and Amiodarone (Cordarone). Medicines of the second order (with an efficiency of 50-70%) include a group of beta-blockers.

With a decrease in the frequency of manifestations or the complete disappearance of symptoms during a two-month follow-up, the dose of medications can be gradually reduced (up to complete abolition). Other patients fail to quickly get rid of ES, then the drugs are taken for a longer period (usually up to several months). With a malignant course of ventricular ES, a person is forced to struggle with ES for life, taking antiarrhythmic drugs.

Endovascular surgery is practiced when the effectiveness of therapeutic measures is low, as well as with an unfavorable prognostic assessment. Typically, radiofrequency ablation is used to treat ventricular ES with a high frequency of "unscheduled" beats (more than 800 per hour). According to reviews, this minimally invasive procedure is easily tolerated, and there is no need to stay in the hospital for a long time. Removal of foci during open surgery is carried out only if it is necessary for other indications.

• take appropriate measures to treat comorbidities;
• promptly inform the doctor about the side effects of drugs;
• Strictly follow all the appointments and recommendations of the attending doctor.

Preventive measures in ES are aimed at preventing the development and prevention of exacerbations of provoking conditions and diseases: coronary artery disease, cardiomyopathies, myocardial dystrophy, and others. It is necessary to exclude drug, chemical, food intoxications that can contribute to the development of ES.

Patients without cardiac lesions with ES that occurs without symptoms are recommended to eat food enriched with layers of potassium and magnesium. It is necessary to fully relax, observe the regime of work and rest, exclude smoking and alcohol, strong coffee. Overloads of any nature are harmful, but moderate physical activity (regular physical education and some sports - with a neurogenic form) will only benefit.

Patients are advised to eat often, but in small portions. It is necessary to exclude overeating (especially in the evening), as it can provoke an exacerbation. The diet should not contain carbonated drinks, as well as foods that promote constipation and flatulence.

Mandatory control of the level of potassium ions in the blood, since a low level of ions reduces the effectiveness of antiarrhythmic drugs. To maintain the desired level of potassium, it is useful to use dried fruits (dried apricots, raisins, prunes), fresh vegetables and fruits (bananas, apples), and sometimes special preparations.

Extrasystole is usually benign, but sometimes worsens the course of the underlying disease, reduces the quality of life, although performance remains at the same level. Possible complications are more serious problems with the functioning of the heart muscle.

The consequences of ES are determined, first of all, by the presence of cardiac lesions, as well as the ability of the ventricles to perform their functions. If there are no structural lesions, then ES has little effect on the prognostic score. The functional variety is usually benign.