Extrasystole. Causes, diagnosis and treatment of pathology. Ventricular extrasystole Ventricular extrasystole and the risk of anesthesia

Extrasystole of the heart can be tracked on the ECG graph, where they appear as single or paired jumps

Extrasystole is another type of heart rhythm disturbance. This type of disorder can be observed in most physically healthy people. The norm is up to 200 extrasystoles (extraordinary contractions) per day. They can be traced on the ECG graph, where they appear as single or paired jumps. If there are three or more jumps, this is called unstable tachycardia, which can occur as a result of stress, physical exertion, etc.

Extrasystole for a healthy person is a completely normal phenomenon and does not cause any harm to the body. Another thing is people who have any kind of heart disease.

Causes and types of extrasystole

Extrasystole is of two types:

1. Ventricular - premature excitation of the heart muscle, resulting from impulses emanating from various areas of the conduction system of the ventricles.
2. Supraventricular - also premature excitation of the muscle, but the cause of premature excitation is impulses coming from outside the conduction system.

The most common option is ventricular extrasystole, since various heart diseases that disrupt the functioning of the heart muscle can be associated with it.

All reasons are divided into two main types:

• functional;
• organic.

Functional - arise as a natural reaction of the body to various types of reactions (smoking, physical and emotional stress, frequent use of alcoholic and caffeinated drinks, sleep disturbance, nutrition, etc.)

organic- indicate abnormalities in the work of the heart muscle. The most common reasons are:

• ischemia;
• myocardial infarction;
• myocarditis;
• heart failure.

Extrasystole of the heart: symptoms (signs)

The extrasystole itself has practically no external manifestations and it is rather difficult to distinguish it without special instruments. But with frequent occurrences of extrasystoles in patients, there may be:

• complaints of strong beats and tremors of the heart;
• sinking feeling in the chest.

It is most likely to determine the disease by the resulting consequences:

• increased sweating;
• unreasonable feelings of fear, anxiety;
• feeling of lack of air;
• angina attacks;
• frequent fainting.

It is worth remembering that the above symptoms may be signs of other diseases associated with both the cardiovascular and other systems of the human body. Therefore, do not hesitate, it is better to immediately contact a cardiologist who will prescribe all the necessary tests and help find the true cause of the symptoms.

Consequences of extrasystole

Extrasystole is divided into several classes, depending on the complexity of the manifestation.

1 class - the occurrence of up to 30 extraordinary strokes within an hour. It is not dangerous to human life, since such a number of strokes is considered the norm.

Grade 2- over 30 extraordinary strokes per hour, a more complex manifestation than class 1, but practically does not lead to negative consequences.

Grade 3 - extrasystoles in a certain section of the ECG have a different shape (they are also called polymorphic). With frequent occurrence, additional diagnostics and treatment are required.

4th grade subdivided into 2 subclasses:

• 4A - pair races, following one after another;
• 4B - from 3 to 5 extrasystoles in a row.

5th grade- the occurrence of early extraordinary strikes.

If classes 1-3 practically do not harm the body and with timely treatment, the symptoms completely disappear, then 4 and 5 can lead to ventricular fibrillation and tachycardia, which in turn causes a complete cardiac arrest. This is especially true for people over the age of 50 and those with heart disease.

With a large number of extrasystoles, the performance of the heart also decreases, since the main function of the heart is disrupted.

Methods for diagnosing extrasystole

The disease can be diagnosed in several ways. The most common option is that a patient with appropriate complaints and symptoms comes to the doctor, who, in turn, prescribes the most common daily ECG. After that, depending on the identified class of the disease, treatment is prescribed. The latter happens only if it is really necessary.

The main diagnostic methods include:

• daily ECG monitoring;
• analysis of patient complaints;
• differential diagnosis.

If it is not possible to detect a rhythm disturbance in a calm state with the help of an ECG, special tests are prescribed in which the body is physically loaded (running, walking, physical exercises).

The most common tests:

• treadmill test - the use of a treadmill with an electrocardiograph and devices for measuring blood pressure connected to the patient;
• bicycle ergometry - the use of an exercise bike to create physical activity, equipment for measuring ECG and blood pressure during the actual exercise, as well as at the rest stage.

In the presence of possible concomitant abnormalities in the work of the heart, the following can also be prescribed:

• Ultrasound of the heart;
• magnetic resonance therapy of the heart (MRI);
• stress Echocardiogram.

Extrasystole of the heart - methods of treatment

Based on the analyzes obtained and the presence of the number of daily extrasystoles in the amount of more than 200, treatment is prescribed. The very process of getting rid of the disease is aimed at eliminating the cause of its occurrence. In some cases (if extrasystole is manifested as a result of neurogenic factors), an additional consultation with a neurologist is required, who will prescribe complex therapy aimed at normalizing the functioning of the nervous system. This may be taking various decoctions of herbs, for example, motherwort, or the use of sedative medications.

The treatment of extrasystole of physiological origin, depending on the stage, will be dealt with therapist, cardiologist, general diagnostician or cardiac surgeon.

In the treatment, drugs against arrhythmias are used, strictly in an individual amount. The patient is under constant supervision, and each change (in a positive or negative direction) is strictly controlled and recorded. If the current drugs are ineffective, others are prescribed.

If stage 4 or 5 of development is detected, it may be necessary to install a defibrillator-cardioverter (aka a pacemaker), since there is a rather high probability of cardiac arrest.

Depending on the forecasts for the development of extrasystoles, you can install the device temporarily or permanently. If the heart needs constant stimulation, the device is sewn under the fat layer.

In this case, only local anesthesia is used and the patient is conscious during the operation.

Surgical intervention during implantation is not dangerous and leaves practically no traces. The place of implantation (left or right) will be determined with each patient individually.

A defibrillator-cardioverter will stop fibrillation if necessary, and in case of cardiac arrest it can deliver up to 6 discharges, which will help the organ to work again.

In any case, if a disease is detected, it will be necessary to refuse:

• alcoholic and tobacco products;
• drinks containing caffeine (coffee, tea, cola, etc.);
• excessive physical activity;
• as with most diseases of the cardiovascular system, regulate food intake (especially fatty foods), and, if necessary, with the help of a nutritionist, draw up an appropriate diet course

Medications / drugs in the treatment of extrasystole

Modern classical medicine, unfortunately, is not yet developed enough to completely treat diseases without the use of medicines.

Supraventricular extrasystole:

• ethacizin;
• beta blockers;
• propafenone;
• verapamil,
• amiodarone.

Ventricular extrasystole:

• sotalol,
• amiodarone,
• etatsizin,
• propafenone.

The most commonly used treatment is propafenone.

propafenone is a drug that belongs to the class 1C antiarrhythmic drugs. It normalizes the rhythm of contraction of the heart muscle, and also dilates blood vessels, thereby reducing excessive cardiac workload. During its existence, with proper application, it shows efficiency results of more than 70%.

The drug can be administered orally or intravenously. With intravenous administration, the dose is calculated based on the total weight of the patient. It is administered under ECG monitoring, and if side effects occur, the dose and rate of administration are reduced.

Side effects: dizziness, double vision, feeling of heaviness in the head.

Contraindications: if the patient has renal or hepatic insufficiency, impaired excitation of the conduction pathways of the heart, as well as intraventricular conduction; in case of circulatory insufficiency, as well as pregnant women, it is used only under the close supervision of the attending physician.

Medicines and methods of treatment are offered for information only and in no way for self-treatment. Examination and treatment is carried out by a specialist doctor.

Despite the fact that the initial stages of extrasystole do not pose any threat to a healthy human body, it is still necessary to periodically undergo a preventive examination, since this is the best way not only to cure the disease at an early stage, but also to prevent its occurrence with all the negative consequences.

In any case, when symptoms are detected, you should not rely on the fact that this is temporary, but you should immediately seek advice from the appropriate specialist. Such an action will help save health, nerves, as well as money for treatment.

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Bear asks:

I have an arrhythmia of the following character: a strong push of the heart, extending into the throat, and then a normal rhythm. after this push, there is almost always a strong burp. The frequency of such tremors is different, sometimes they are single, sometimes repeated several times in a row, but they bother me every day. It happens that these tremors are accompanied by a wave of heat, weakness (as if I would lose consciousness). these attacks are accompanied by a feeling of fear, I start to get nervous, and I think that by doing so I provoke the next attack. What can it be and how to deal with "it" ??? Thanks in advance for your reply.

Responsible Sarazhin Konstantin Ivanovich:

Hello. It is necessary to determine the nature of the arrhythmia, for which it is necessary to conduct daily Holter ECG monitoring, and then develop a treatment strategy.

Responsible Vykhovanyuk Ivan Vasilievich:

Hello. Most likely at you an extrasystolic arrhythmia. To find out the possible cause and determine the tactics of treatment, it is necessary to undergo further examination - to conduct a daily ECG monitor, to do an ultrasound of the heart, to take tests, etc.

Vladimir asks:

Hello! My heart problems started three years ago. I am 47 years old. but no improvement. In February, I did VEM, echo, Holter. VEM: sinus regular rhythm HR68-75 normal position of the EOS focal blockade of the right leg, initial LV hypertrophy of the IVS moderate early ventricular repolarization syndrome, CLC phenomenon interval 0.11 s, IHD test - OTR. TFN-high. ECHO ;- thickening of the aortic walls, minimal mitral regurgitation, moderate enlargement of the left atrium of the ventricular cavity, taking into account the area of ​​the body, signs of initial hypertrophy of the IVS are not enlarged, myocardial contractility is satisfactory. on average 4 per hour, paired atrial extrasystole with an interval of 500 total 1. group atrial extrasystole with a heart rate from 118 to 137 average 127 beats per minute in total 2. single ventricular extrasystole with an interval of 320 total .ST-T changes. 2FN performed in the form of lifting power from 54 to 95 (average 74) W The volume of work is from 3450 to 103509 (CP6900) With a heart rate from 138 to 159 (average 148) which is 84-97% of the maximum for this age. The submaximal frequency was achieved in 2 cases. I am interested in how serious the diagnosis is - atrial fibrillation and fibrillation - atrial flutter and what treatment. Thank you in advance.

Responsible Bugaev Mikhail Valentinovich:

Hello. Atrial fibrillation is a serious and unpleasant diagnosis. requires constant treatment, a number of restrictions in life, regular monitoring by doctors. You need to exclude alcohol, limit coffee, strong tea. Examine the thyroid gland. If you have hypertension, be sure to drink pills to normalize blood pressure. And - to the cardiologist (competent).

Tatyana asks:

Hello. I am 29 years old. For 2 months now I have been worried about the loss of the pulse, especially after physical activity. The cardiogram of extrasystoles did not show, there were no organic changes. From my words, heartbreak and a terrible feeling of fear, I was prescribed betaxolol, trimetazidine, multivitamins and hawthorn. Is it worth taking these drugs, in my opinion they are quite serious or do I need to undergo an additional examination, if necessary, which one. Thank you. Hello. If no rhythm disturbances were found on the ECG, then this does not mean anything. In order to make sure about the nature of cardiac arrhythmias that bother you, you need to conduct a Holter study and then choose a treatment method.

Responsible Dovgan Alexander Mikhailovich:

Hello. If no rhythm disturbances were found on the ECG, then this does not mean anything. In order to make sure about the nature of cardiac arrhythmias that bother you, you need to conduct a Holter study and then choose a treatment method.

Answers:

Hello! it is necessary to do Holter monitoring, preferably in a special clinic, and then, based on the results, take medications. Preparations to you are picked up good, but all the same it is necessary to be examined.

Olga asks:

Good evening, Mikhail Valentinovich!
I accidentally stumbled upon this site and, of course, there was a desire to ask a specialist a question, because. My doctor has retired and unfortunately no longer works.
In the summer of 2007, I developed a cough of unknown etiology, after a while I began to lose consciousness. The local therapist ruled out the possibility of disease of any organs other than the heart and brain. In this connection, I was assigned a complete examination of both the heart and the brain.
Since tomography in Veliky Novgorod is far from being a "realizable" dream for everyone, we had to wait two months.
In order not to lose time, I was assigned an ECG and an ultrasound of the heart, as well as an encephalogram of the GM.

ECG revealed tachycardia, early repolarization syndrome, electrolyte changes.
Ultrasound - the presence of chords and some changes (hereditary). Based on the results of the ultrasound, I was assigned a monitor.

Here is an extract from MN's diary:

"1. The dynamics of heart rate without features. The decrease in heart rate at night is insufficient.

2. During the examination, the following types of rhythms were observed:
1) Sinus rhythm.
Against the background of this rhythm with a heart rate of 54 to 132 (average 72) beats per minute, which continued throughout the entire observation period, the following types of arrhythmias were registered:
a) Group supraventricular extrasystole with a heart rate of 93 bpm. Selected fragments - 1.
b) Single ventricular extrasystole with pre-ectopic interval from 460 to 523 (mean - 483) m/sec. Selected fragments - 16.
Total: 926. (from 0 to 435, average - 98 per hour). Day: 92. (23 per hour). Night: 834. (155 per hour).
c) A group of supraventricular and ventricular extrasystoles (class: 51, 52, 53) with heart rate from 102 to 121 (average - 109) beats / min. Selected fragments - 8.
Total: 8. (from 0 to 5, average 1 per hour). Day: 0. Night: 8. (1 per hour).

3. ST-T changes:
In lead V4, the mean ST 71+-23.1, max. 120 min. -19 uV
In lead Y, avg. ST -2+-28.6, max. 81, min. -136 uV
In lead V6, avg. ST -2+-29.9, max. 77 min. -113 uV.

During the observation time, 2 physical exercises were performed in the form of climbing stairs with a power of 68 to 97 (average - 82) W. The volume of work performed is from 990 to 1188 (average - 1089) kg * m with heart rate from 132 to 156 (average - 144), which corresponds to 72-85% (average - 79) of the maximum for this age. The submaximal heart rate has been reached. Reason for termination of loads: submax. Heart rate - 2 (100%). Tolerance to loading - average.

Conclusion: against the background of sinus rhythm, frequent ventricular extrasystoles were registered, sometimes as bigemenia, in just a day - 12745. Ischemic changes in ST-T wave were not detected.

Has passed or has taken place course of treatment karvitol.

Now, after some time, a cough has reappeared, pain in the region of the heart (feelings - "a blade in the heart"), radiates to the left shoulder, fading, lack of air (especially at night - I wake up feeling unable to breathe), sometimes an incomplete "loss" of consciousness (as if there is a short-term "loss" of mental activity, dizziness appears, there are no headaches).
ECG from 07.02.2012 also showed blockade of the right leg, blood pressure at the time of the ECG - 140/120 without headaches.

Current diseases: pyelonephritis of the left kidney (no recurrence since 2003), VVD, hypotension (80/50 without headaches) since 2000. (postpartum). In general - healthy. My maternal grandmother suffered from heart failure and died at the age of 58 from a massive heart attack (during a severe thunderstorm). The youngest son has problems with the Eustachian valve (five times longer than the norm) since birth - he is under observation.

Prompt please - than it is possible to facilitate the shown signs?
Thank you.

Responsible Bugaev Mikhail Valentinovich:

Hello. You need a consultation at a good cardiology center. You need to measure the pressure in the pulmonary artery. You also need to deal with group ventricular extrasystoles and the cause of loss of consciousness. Alternatively, there is such a diagnostic device - an implantable cardiac event recorder. It is sewn under the skin and records an electrocardiogram for several years. When there is a loss of consciousness, the patient activates the device by pressing a button on the remote control (immediately after the attack) and goes to a specialist who, using a programmer, reads information from the registrar. This makes it possible to accurately determine whether the loss of consciousness is associated with cardiac arrhythmias. This information is critical for correct treatment and prognosis.

Svetlana asks:

HELLO! I ASSOCIATE MY EXTRASYSTOLS WITH THE SPINE BECAUSE I EXCLUDED ALL THE REASONS THAT COULD PROVOKE THEM BY EXAMINATIONS AND REMOVAL OF THE BUBBLE. IF IT IS THE SPINE THEN HOW TO TREAT.? help me no longer have the strength to endure this!

Responsible Medical consultant of the portal "site":

Hello Svetlana! Diseases of the spine rarely lead to extrasystoles. Much more likely causes of extrasystoles are diseases of the myocardium (heart muscle), damage to the conduction system of the heart, as well as stress, alcohol, caffeine, and tobacco abuse. Since you are not a specialist in the diagnosis and treatment of cardiac diseases, we advise you to provide the identification of the cause of the development of extrasystole to a qualified cardiologist. It is with the cardiologist that you should discuss your suspicions about the influence of spinal disease on the appearance of cardiac arrhythmia - the doctor will give you his thoughts on this matter in a personal meeting. Take care of your health!

Irina asks:

Hello, help me figure it out! I am 32 weeks pregnant, the doctor diagnosed me with ventricular extrasystole and gave me a referral to the hospital. How dangerous is such a diagnosis for me and my baby? Do I really need hospitalization?

Responsible Medical consultant of the portal "site":

Dear Irina! To draw conclusions about the nature of extrasystoles, you need to see your cardiogram as a whole and, at a minimum, listen to your heart with a phonendoscope, so I cannot draw any conclusions. But if your doctor gave a referral, and the term is already long (which already increases the load on the heart), it is better to play it safe and observe for some time in the hospital.

Victoria asks:

Good afternoon .. I’m worried about chest pains, I give it to my back, in 2003 I had an operation on the PDA, I was observed at the dispensary and talked about my symptoms, the doctor says it’s nervous, it was like going up to the 3rd floor my heart began to beat strongly and pain in my chest called an ambulance paroxysmal tachycardia, did a holter in April and the ECG showed sinus arrhythmia and several extrasystoles ... I decided to go to where they did the operation, they did an ECHO-norm (only earlier they detected PMK 1 st strange why they didn’t say now) and the ECG sinus tachycardia, the holter is correct sinus rhythm with an average heart rate of 89 per minute, 33 minutes of sinus tachycardia with a heart rate of up to 153 per minute against the background of physical and emotional stress. minimum heart rate during a night's sleep.
ectopic activity is minimal within acceptable limits for relatively regular episodes of sinus arrhythmia.
at rest, episodes of ST segment elevation according to the type of early ventricular repolarization syndrome. Against the background of physical and emotional load of 120-150 hrs, several episodes of obliquely ascending ST segment depression up to -190 μV in lead CM 6 and horizontal ST segment depression up to -213 μV with inversion were noted T wave in lead IS is accompanied by discomfort in the chest. these changes can be regarded as a decrease in blood supply in the area of ​​the anterior-lateral and posterior walls of the myocardium. The most max ST was when I ran 7 minutes on a bike simulator at home. did an ECG with a load of 20 squats sinus rhythm tachycardia 104 . semi-vertical position. moderate violations of the repolarization of the lower lateral wall of the left ventricle htfrwbz myocardium for a load adequate heart rate 124 per minute after 5 minutes heart rate 112 per minute ... just who says that this is due to ischemia. who that neuralgia and osteochondrosis I have cervical second degree .. but I'm tired of everyday pains here and there .. sometimes the pressure rises to a maximum of 140 to 100 but still ...... soon I will have a diagnostic mini-operation fertiloscopy I would like to know if it is possible to do general anesthesia. Thank you in advance

Responsible Lishnevskaya Victoria Yurievna:

Good afternoon. What you describe, if a competent doctor deciphered it, deserves attention. Unfortunately, heart disease is getting younger. But such changes in the ECG can also be with vegetative-vascular dystonia and myocardial metabolic disorders. But it is better to play it safe - to be examined (treadmill test, test with ergometrine to exclude spasm of the coronary vessels).

asks Larisa Nikolaevna:

Hello dear doctor. My age is 66 years old. In 2011, the diagnosis was made: hypertension 2 tbsp. and tachycardia. I take Coronal 5mg 1/4 tab on a regular basis. in the morning and normodipine 5 mg 1/2 tab. in the evening. Pressure and pulse are normal. Some time ago, heart rhythm disturbances began to appear. After visiting a cardiologist, a diagnosis was made (according to my complaints) of paroxysmal atrial fibrillation, hemodynamically significant unstable paroxysms, and medications were prescribed: etacizine 50 mg. 1/2 tab. 3 times a day and omacor 1 tab. in the morning. and undergo an echocardiogram, a holter ecg. I started taking the medicine, and after 2 weeks I passed the recommended examinations. After taking the medicine, side effects appeared: problems with the stomach, and the heart began to twitch strongly (this feeling happens when a wound breaks). The results of EKG Holter monitoring: DURING THE MONITORING PERIOD, SINUS RHYTHM WITH HR MIN.=55 BPM, HR MAX. =117 UD. MIN. CIRCAD INDEX 1.2. REVEALED: SINGLE VENTRICULAR EXTRASYSTOLES (37), SOMETIMES INTERPOLATED. NO CHANGES IN THE ST SEGMENT. PAUSES AND SIGNIFICANT INCREASE IN THE QT INTERVAL IS NOT DETECTED. ECHOCARDIOGRAPHY CONCLUSION: ATHEROSCLEROSIS OF THE AORTIC, AORTIC AND MITRAL VALVES. THE CAVITIES OF THE HEART ARE NOT DILATED. SYSTOLIC FUNCTION SAVE. DIASTOLIC DYSFUNCTION BY TYPE 1. ECCENTRIC LVH. INSUFFICIENCY MK 0-1, TK 0-1, LK 0-1. STRETCHING OF THE PERICARDIAL SHEETS ON THE FRONT BACK WALL UP TO 5 MM., LATERAL UP TO 8 MM. QUESTION: DO I NEED TO TAKE MEDICINES PRESCRIBED BY A CARDIOLOGIST AND HOW SERIOUS IS IT? THANK YOU FOR YOUR REPLY.

Responsible Bugaev Mikhail Valentinovich:

Hello. If you have hypertension and attacks of atrial fibrillation, then drug treatment is with you for life. Doses of antihypertensive drugs are selected strictly individually. Antiarrhythmic drugs are taken constantly, doses are usually also individual, but there are fewer options. Etatsizin, if necessary (side effects), can be replaced by propafenone, this is a drug of the same group and effectiveness. Doses of ethacizin are usually not 25, but 50 mg 3-4 r / day. And you need to consider the possibility of constant intake of anticoagulants - anticoagulants (warfarin, Xarelto or Pradaxa) - to prevent the most formidable complication of atrial fibrillation - thromboembolic stroke.

Vova asks:

Frequent ventricular extrasystoles

Responsible Medical consultant of the portal "site":

Hello! The norm is the presence of no more than 5 extrasystoles per minute. Moreover, the frequency of extrasystoles is determined not by subjective sensations, but by the results of Holter monitoring (ECG is taken during the day in the mode of normal life, and then deciphered). The more frequent appearance of extrasystoles is unequivocally considered a sign of arrhythmia - a violation of the heart rhythm. The causes of arrhythmia can be very diverse: neurocirculatory dystonia (NCD), rheumatism, myocarditis, heart defects, cardiomyopathy, coronary heart disease, etc. It is always important to determine the type of extrasystole, its cause, and it is imperative to treat the underlying disease that caused the rhythm disturbance. Be healthy!

Svetlana asks:

Hello, I have a question of the following content: after what period of time should I take antiarrhythmic drugs? According to the results of the holter, 35176 single and 8 paired ventricular extrasystoles were detected, the average heart rate was 89, after taking etacizine (1/2 * 2 times) for 3 weeks, the number of extrasystoles fell to 4750, after 2.5 months it again increased to 22975 single, 350 pairs. EchoCG results: PMK (3mm), add. notochord in the left ventricle. Thyroid is normal. For the last six months, my heart has begun to whine and tingle, sometimes I feel blows and sips my left shoulder, and I’m already tired of going to the doctors. Therefore, can I periodically take medication myself, for how long and after what period of time? P.S. 30 years old, height 170, weight 67.

Responsible Bugaev Mikhail Valentinovich:

Hello. Antiarrhythmic drugs act only for the period of time while they are in the body, after they are removed, the action ends. So in your case, periodic reception is quite meaningless. Another question is how dangerous these extrasystoles are and they need to be treated - this should be decided by the cardiologist, taking into account all the data of your examination.

Mykola Yarmotsyk asks:

Hello. I am 24 years old. I have been professionally involved in sports (Triathlon) for 12 years. (Triathlon is an endurance sport. Swimming, cycling and running). In April 2009, during a medical examination, extrasystoles were found on the ECG. which showed 1024 extrasystoles per day. He took magnesium, training decreased in volume by 30%, the intensity was removed. By the end of May 2009, he resumed training in full, began to gain sports form, performed well in competitions. The season ended in November, after a medical examination and an ECG prescribed mildronate, vitamins, magnesium. And after holtermonitoring, it already showed 9120 extrasystoles per day. I started a new preparatory season in December 2009, I feel extrasystoles. can help. And are there really no other drugs for extrasystole, except for magnesium, panangin and mildronate. Thank you.

Responsible Bugaev Mikhail Valentinovich:

Hello. In fact, extrasystole is not a disease, it is just an extraordinary contraction of the heart. The listed drugs do not treat in general, and extrasystole in particular. And sports, especially professional ones, have not made anyone healthy yet. Reduce the load - there will be fewer extrasystoles. Start to be treated with antiarrhythmics - it can get even worse.

Sasha asks:

Hello, I am 22 years old, height 190, weight 102 kg. Recently did daily monitoring of the heart. Can I play sports or not? (If so, which ones)
Here is the conclusion:
Sinus rhythm, sinus arrhythmia, circadian index 1.44 (increased), tachycardia prevailed during the day.
Minimum heart rate 47 beats. in minutes - at 07.01. (dream)
Maximum heart rate in min. – at 18.22 (climbing stairs)
3 supraventicular extrasystoles were noted.
52 polymorphic ventricular extrasystoles were observed, incl. paired, confluent complexes, late, trigeminy.
Incomplete blockade of the right leg of n. Gisa was revealed.
There were 6 episodes of downward-sloping ST segment depression on channel 1, cont.
1 -3.30 min., against the background of syn.tachycardia, during physical. load, 1.6 mm., which may be due to the peculiarities of conduction and the influence of hyposympathicotonia.

Responsible Krapivner Marina Mikhailovna:

Lyudmila, your extrasystole is more likely to be associated with a pathology of the heart. Therefore, you need to rule out non-cardiac causes. For this, FGDS is done. I agree, this is not the most pleasant procedure, but, in extreme cases, it can be done under general anesthesia. Radiography of the stomach, even with functional tests, cannot always replace gastroscopy. Besides to you it is necessary to make US of OBP. If there are menstrual irregularities, you need to see a gynecologist. A consultation with a vertebrologist and/or a neuropathologist also makes sense. Antiarrhythmic drugs in your situation are taken with poor subjective tolerance of extrasystoles or with a large number of extrasystoles (more than 1%).

Try taking your pulse when you're excited and when you're calm.
The first is to take Panangin 1t 2 times a day for 10 days. If you have VVD, Motherwort tincture helps a lot.
In the next letter, describe what worries you, how your pulse is kept, whether close relatives have cardiovascular diseases, at what age you are (menopause affects s.s.s.), etc.
In general, you have nothing serious.

Olga asks:

I am 34 years old. I suffer a lot with arrhythmia. I did Holter monitoring, here are the results: a single extrasystole was registered: a total of 1032, 407 during the day, and 625 at night. I completely lost my peace from this, I’m very afraid that this can lead to something terrible. Please help tell me how to recover from this, otherwise it’s very unpleasant sensations. And please tell me, does this mean I have a sick heart? I did an EKG many times - they say that everything is fine, although I am tormented by constant pain in my heart, it hurts between my breasts of such an acute nature, the pain is growing in nature and lasts a day or even two, so I don’t understand this heart pain or maybe the spine? I don’t want to believe that I have a heart condition, because 5 years ago my husband died of a heart attack, now I have a constant fear of death, tell me ventricular extrasystoles can be fatal?

Responsible Bugaev Mikhail Valentinovich:

Hello. Your pain, most likely, is not connected with the heart, examine the spine. Extrasystole also does not pose any threat to your life, and most likely does not need treatment. But it makes sense to look for its cause - it can be chronic diseases of other organs - the gallbladder, lungs, etc. Get an ultrasound of the heart.

Extrasystole is the most common cardiac arrhythmia variety arrhythmias ), which is characterized by premature extraordinary ( earlier than expected) contractions of the heart muscle ( extrasystoles ). The occurrence of extrasystoles is associated with the appearance of new foci of excitation in the heart muscle, which are located in an atypical place ( anywhere other than the sinoatrial node). In these foci, extraordinary impulses arise that propagate through the heart muscle and cause premature contractions. hearts in the relaxation phase diastolic phase).

There are the following types of extrasystole:

• Atrial extrasystole- this is premature excitation and contraction of the heart muscle of the atria. As a rule, such patients do not have any other cardiovascular pathologies against the background of which this arrhythmia could appear. Quite often, atrial extrasystole occurs in people who abuse coffee, tobacco, are subjected to psycho-emotional stress and overwork. Of all the varieties of extrasystoles, the frequency of occurrence of atrial extrasystole is 25% of cases.
• Atrioventricular ( atrioventricular) extrasystole- this is a type of heart rhythm disturbance, in which the pathological impulse originates in the atrioventricular node ( between atria and ventricles). This type of extrasystole occurs in only 2 - 3% of cases.
• Ventricular extrasystole is premature arousal reduction) the heart, which occurs under the influence of impulses emanating from various parts of the conduction system of the ventricles ( branching of the bundle of His and Purkinje fibers). This condition can occur at any age and in the absence or presence of damage to the cardiovascular system. The frequency of registration of ventricular extrasystole is about 60 - 62%.

Sometimes atrial and atrioventricular extrasystoles are combined under the name supraventricular extrasystoles because of their similar clinical significance.

Single extrasystoles can also be detected in healthy people ( including athletes). And over the age of 50, extrasystole occurs in 70% of people. Their occurrence is provoked by emotional overload ( stress), smoking, drinking alcohol or energy drinks. In the absence of any violations of the cardiovascular system, extrasystole has a favorable course and does not lead to the development of complications.

Anatomy and physiology of the heart

The heart is a muscular organ in the form of a cone ( the apex of the cone points down and to the left), which is located in the center of the chest and ensures the movement of blood through the blood vessels.

The main functions of the heart are:

• automatism- the ability of the heart to produce impulses that cause excitation without the influence of external stimuli;
• conductivity- the ability of the heart to conduct impulses from the place of their origin ( normal from the sinoatrial node) to the muscles of the atria and ventricles;
• excitability- the ability of the heart to be excited under the influence of generated impulses;
• contractility- the ability of the heart to contract under the influence of impulses and ensure the function of the pump;
• refractoriness- the impossibility of excited heart cells to be activated again when additional impulses occur.

The walls of the heart are:

• endocardium- a thin layer of cells lining the cavities of the atria and ventricles from the inside;
• myocardium- a thick muscle layer consisting of cardiomyocytes ( special cells found only in the heart muscle), which are able to contract and relax under the influence of impulses;
• pericardium ( pericardium) - a thin outer layer that separates the heart from other organs located in the chest.

The heart is made up of four chambers ( cameras), which are separated from each other by partitions and valves. All chambers of the heart contract systole) and relax ( diastole) in a certain sequence, thereby ensuring a constant circulation of blood in the body.

The chambers of the heart are:

• atrium ( right and left) - occupy the upper part of the heart and pump blood into the ventricles;
• ventricles ( right and left) - occupy the lower part of the heart and receive blood from the atria, pumping it then into the arteries.

The conduction system of the heart is a collection of atypical cardiomyocytes that form nodes ( sinoatrial and atrioventricular), bundles ( Bachmann, Wenckebach and Torel bundles, His bundle) and fibers ( Purkinje fibers). The conduction system of the heart generates ( Launches) a wave of excitation, providing rapid conduction of impulses to the contractile myocardium ( heart muscle that can contract), as well as contraction of the atria and ventricles in a certain sequence.

Normally, the conduction system of the heart begins at the sinoatrial node ( Keyes-Fleck node, sinus node), which is the main pacemaker ( pacemaker), triggering a wave of excitation. This node is located in the upper part of the right atrium. The bundles of Bachmann, Wenckebach and Torel depart from the sinoatrial node, through which a wave of excitation is transmitted. The Bachmann bundle is located transversely, which ensures the conduction of excitation to the myocardium of the right and left atria. The Wenckebach and Torel bundles stretch to the atrioventricular node, which is located in the lower part of the right atrium and is adjacent to the interatrial ( between the atria) and atrioventricular ( between atrium and ventricle) partitions. The bundle of His departs from the atrioventricular node, which is located in the interatrial septum and branches into the right and left legs. Along the legs of the bundle of His, excitation spreads to the myocardium of the ventricles. In turn, the legs are divided into anterior and posterior branches and end with Purkinje fibers, which penetrate the entire muscle of the heart and conduct impulses directly to the contractile myocardium. If any disturbances occur in the conduction system of the heart, it begins to work intermittently, resulting in heart rhythm failures.

Causes of extrasystole

Extrasystole is one of the most common cardiac arrhythmias, and therefore there are a huge number of reasons for the development of this condition. Extrasystole can appear both in young and perfectly healthy people, and in older people who have diseases of the cardiovascular system. This rhythm disorder increases the risk of developing other pathological conditions of the heart, which can lead to dangerous and irreversible changes. The most formidable complication is sudden death. It is very important to suspect extrasystole in a timely manner, identify its cause and conduct a course of treatment.

Myocardial diseases

Other reasons

Sinoatrial node dysfunction is a condition in which the sinoatrial node generates heart impulses too slowly ( belatedly triggers a wave of excitation to the myocardium) that do not meet physiological needs. As a result, rhythm disturbances and changes in heart rate occur.

Idiopathic causes

In the case when the cause of the development of extrasystole is not identified, then the diagnosis of idiopathic extrasystole is made ( extrasystole of unknown cause). Such a diagnosis is made very rarely, since in most cases, after a survey and various examinations, it is possible to identify the cause of the development of extrasystole.

Symptoms of extrasystole

Clinical manifestations ( symptoms) with extrasystole can be detected both independently and during an accidental examination. In the absence of confirmed problems from the cardiovascular system, patients, as a rule, attribute discomfort in the heart area to stress or overwork. Patients with pre-existing heart disease ( ischemic heart disease, cardiomyopathy and others) should be more attentive to the appearance of new symptoms, since the development of extrasystole in this case can be dangerous and lead to severe complications, up to a sudden death.

Symptoms of extrasystole

Symptom	Development mechanism	How is it manifested?
Disorders in the work of the heart	This condition is provoked by the occurrence of extraordinary impulses located outside the sinoatrial node. That is, disturbances in the work of the heart are caused by excessive excitation of the entire myocardium or part of it.	Most patients experience sudden jolts ( blows) in the region of the heart. Some describe these disturbances as a feeling of being frozen ( stops) heart or turning sensation ( tumbling) hearts in the chest. Such symptoms appear, as a rule, after physical exertion or a stressful situation. It is also possible to develop them against the background of taking strong coffee, alcohol, energy drinks and smoking.
Violation of the heart rate(rhythm)hearts	A change in the heart rhythm occurs due to a violation of the basic functions of the heart ( automatism, excitability, conduction). In the presence of diseases of the cardiovascular system, the formation of impulses can be disturbed and the speed of their conduction can change. Also, a violation of the heart rate is observed with an imbalance in the work of the autonomic nervous system ( responsible for the regulation of many physiological processes).	Patients feel interruptions in the work of the heart in the form of a rapid or increased heartbeat, which is not normally felt. Some determine these changes by pulse ( on the wrist). There may be long pauses, and then extraordinary contractions. Patients notice this condition most often in the supine position.
Heartache	The appearance of pain in the heart with extrasystole may indicate the presence of any heart disease. Heart pain is associated with the effect of certain substances on the nerve endings. Also, pain can develop with stretching of the chambers of the heart, lack of oxygen.	Patients may experience pain in the heart or pain in the chest area. Such pain is aching, stabbing in nature. Pain sensations are not always limited to the region of the heart, but can be given to the left half of the body ( arm, shoulder).
Dyspnea	The development of shortness of breath can be caused by heart failure. In this case, the heart pumps an insufficient volume of blood, as a result of which the exchange of gases in the lungs deteriorates. The consequence of this is a decrease in the concentration of oxygen in the arterial blood, which reflexively causes an increase in the frequency and depth of breathing.	Shortness of breath is accompanied by an increase in the frequency and depth of respiratory movements. Manifested in the form of a subjective feeling of lack of air. There is a feeling of breathlessness. Shortness of breath can be triggered by an attack of angina pectoris or be a consequence of physical exertion.
sweating	Increased sweating develops reflexively as a result of the entry of stress hormones into the blood ( epinephrine, norepinephrine). Their release leads to constriction of blood vessels and provides blood flow to the muscles. As a result, the body requires large energy costs and more sweat is released.	With the development of extrasystole, patients complain of a sharp sensation of heat and excessive sweating. The most profuse sweating can be seen in the face, armpits and palms.
Dizziness	Dizziness occurs due to the fact that the heart begins to pump blood poorly. As a result of this, an insufficient amount of blood enters the brain, and it reacts with clouding of consciousness.	Dizziness can be felt by the patient as an imbalance, a feeling of unsteadiness ( the ground is slipping away from under your feet). It may seem that your own body and all objects revolve around. This condition usually lasts a few seconds, and if left untreated, a few minutes.
Fainting (loss of consciousness)	The main mechanism for the development of syncope is a decrease in blood circulation in the brain due to a decrease in cardiac output. As a result, hypoxia occurs when sufficient oxygen is not supplied to the brain.	Fainting comes on rather abruptly. This condition may be preceded by dizziness and tinnitus. Fainting is accompanied by the appearance of heaviness in the limbs, darkening in the eyes. Patients remember how they slowly slide down, or fall, as if falling asleep at the same time. The fainting lasts, as a rule, several minutes.
Pulsation of the neck veins	The pulsation of the cervical veins is associated with the stagnation of venous blood. This stasis of blood is accompanied by dilation of the veins, swelling and visible pulsation in the neck at the moment when the blood from the right ventricle returns to the right atrium.	With extrasystole, the veins in the neck swell and become clearly visible due to pulsations ( jerky movements of the walls of blood vessels).
Fatigue	The development of this symptom is caused by a decrease in the pumping function of the heart. This means that the heart is unable to pump enough blood and the result is hypoperfusion ( insufficient blood supply) of all organs, including skeletal muscles ( are part of the musculoskeletal system).	Fatigue with extrasystole is characterized by a feeling of weakness, lethargy, impotence. The patient feels a decline in strength, which affects his performance. As a rule, this state does not last long.
Anxiety	Anxiety is a subjective sensation of the patient, which occurs reflexively ( unconsciously) and is associated with disruption of the autonomic nervous system.	Due to the fact that extrasystole is manifested by the occurrence of a sharp shock in the region of the heart, patients are immediately overcome by a feeling of anxiety and panic. Some patients have a fear of dying suddenly.

Diagnosis of extrasystole and the causes of this condition

Extrasystole is a disease of the cardiovascular system. Diagnosis and treatment of such diseases is carried out by a cardiologist. Many people attribute the appearance of discomfort in the heart area to stress, physical activity, drinking a lot of coffee and other reasons. If you experience any symptoms, unusual sensations in the heart area, you should not postpone a visit to the doctor. It is possible to identify the presence of extrasystole on your own, if you are attentive to your health. But, as a rule, patients do not seek help from specialists, and this rhythm disturbance is detected during a random examination.

One of the main points in the formulation of any diagnosis is communication with the patient. The first thing the doctor should do is to collect an anamnesis, that is, to conduct a conversation ( poll). A correctly collected anamnesis helps to suggest a diagnosis without additional examinations in 80% of cases. In this case, much depends not only on the doctor, but also on the patient, who must responsibly approach the doctor's questions and answer them truthfully, without hiding anything. During the interview, the doctor should find out the complaints ( disease symptoms) of the patient. Then it is necessary to clarify the circumstances in which the symptoms of extrasystole occur ( during physical or emotional stress, at rest, during sleep, after drinking coffee, and so on). After identifying the circumstances, it is important to find out how long such attacks last and how often they develop. The next item in the collection of anamnesis may be the question of the treatment taken, and what is the effect of it. Particular attention should be paid to past diseases that may be the cause of the development of extrasystole. In order to confirm this diagnosis, it is necessary to conduct a number of additional examinations. The number of examinations may vary and is prescribed strictly by the attending physician or cardiologist.

Diagnosis of extrasystole

Diagnostic method	How is it carried out?	What signs of the disease does this diagnostic method reveal?
Pulse detection	There are several ways to determine the pulse. The first way is to measure the pulse using a special pulse oximeter device. It is a kind of clothespin that is worn on the finger. The small screen of the pulse oximeter displays the pulse rate and oxygen saturation level for 10 seconds. You can also determine the pulse by self-counting. To do this, you need to attach two fingers ( index and middle) to the wrist and feel for the pulsating artery. Then count the number of pulsations ( blows) within one minute.	heart rate detection ( quickening or slowing down); blood oxygen saturation level.
Auscultation of the heart	auscultation ( listening) of the heart is carried out using a phonendoscope. This method is based on capturing sounds coming from the heart. For auscultation, the patient is asked to undress from the waist up. In some cases, the examination can be performed sitting or lying down. The doctor is positioned to the right of the patient. Then he applies the phonendoscope to certain points ( projection of the heart) on the anterior chest and picks up sounds coming from them. When listening to the heart, the doctor deciphers the sounds heard and issues a conclusion.	changes in rhythm and heart rate; identifying the difference between pulse rate and heart rate; auscultation allows you to suspect some diseases of the cardiovascular system that can cause extrasystole.
Percussion of the heart	During percussion, the patient should undress above the waist. The examination is carried out in the position of the patient standing or sitting, and in severe patients - lying down. After that, the doctor applies the palm of the left hand to certain points of the chest and taps the middle finger of the right hand on the middle finger of the left hand. At different points and with certain diseases, the sound may change ( dull, blunt, etc.). A doctor with experience draws conclusions based on the sounds he hears.	sizing ( borders) hearts ( increase or decrease); determination of the location of the heart.
Electro-cardiography (ECG)	Electrocardiogram ( ECG) is a simple and informative diagnostic method that can be used to determine the functional activity of the heart and identify some pathologies. The ECG is performed in a warm room with the patient lying on his back or sitting. Before the examination, the patient undresses above the waist and exposes the wrists and ankle joints. The skin in the region of the heart is degreased with alcohol, and then a special gel is applied that enhances the conduction of current. After that, electrodes are applied to certain points, which capture electrical impulses that occur in the heart. These electrodes are connected to a special apparatus ( cardiograph). After their installation, the patient is asked to lie still, breathe calmly and not worry. After a few seconds, registration of cardiac impulses begins. The result is obtained as a graphic image on a paper tape.	confirmation of the presence of extrasystoles ( extraordinary cuts); identification of the site of occurrence of the focus of excitation ( pathological impulse) by characteristic changes on the ECG graph.
24 hour Holter ECG monitoring (HMECG)	This diagnostic method is a continuous recording of an electrocardiogram for 24 hours ( registration is possible up to 7 days). For HMECG, adhesive electrodes are attached to the anterior chest wall of the patient ( disposable) that are associated with a portable device ( registrar). Before attaching the electrodes, the skin is degreased, and if necessary, the hair is shaved. After installing the recorder, ECG recording begins. The device itself is worn on a belt or on a belt over the shoulder. During the recording of the ECG, the patient leads a normal life. He is given a diary where it is necessary to record the time and actions performed ( sleep, exercise, food intake, medication, etc.). After 24 hours, the doctor connects the recorder to a computer, on the monitor of which all information is displayed ( ECG). After that, the doctor evaluates the changes on the ECG with the recorded data in the diary and issues a conclusion.	registration of the number of heartbeats within 24 hours; identifying the dependence of the occurrence of extrasystoles on any action ().
Echocardiography of the heart (echocardiography)	Echocardiography is a method of ultrasonic diagnostics ( ultrasound) hearts. This research method helps to assess the structural and anatomical features of the heart ( cavities, valves), his work ( contractility), blood flow. There are several methods for performing echocardiography ( transthoracic and transesophageal). During transthoracic echocardiography, the patient should undress ( above the waist) and lie on the couch on your left side. A special gel is applied to the chest area, and sensors are attached. After that, the doctor, using an ultrasonic nozzle, receives all the information about the state of the heart on the monitor and analyzes it, periodically changing the position of the nozzle. Transesophageal echocardiography involves the refusal of food for 8 to 12 hours before the study. This procedure requires general or local anesthesia ( anesthesia). Transesophageal echocardiography is performed with the patient in the left lateral position. A so-called mouthpiece is fixed between the teeth, which allows you to keep the patient's mouth open. The endoscope is then inserted tube with an image sensor) and advance it to the esophagus. Thus, the doctor examines the heart from all sides and issues a conclusion about its structure and work.	identification of concomitant diseases of the heart muscle; determination of the function of the chambers of the heart.
Treadmill test	Treadmill test is an ECG during physical activity on a special treadmill ( treadmill). In addition to the ECG during the test, the patient's blood pressure is also recorded. This technique allows the doctor to determine the border ( threshold), upon reaching which painful sensations appear ( shortness of breath, chest pain, fatigue). The doctor also assesses the acceptable level of physical activity. To prepare for this study, a few days before it is necessary to stop taking heart drugs and limit food intake ( 1.5 - 2 hours do not eat). When conducting a treadmill test, special electrodes are attached to the anterior chest wall of the patient, which are connected to a device that records ECG in real time. A blood pressure cuff is put on the upper arm. To perform this test, the patient will have to walk on a treadmill, the speed of which will gradually increase. At the same time, the doctor monitors changes in the ECG and the patient's condition, and the nurse records the numbers of blood pressure. The test stops when a certain heart rate is reached or when certain signs appear on the ECG, which are determined by the doctor.
Bicycle ergometry	This research method is carried out using a special simulator ( bicycle ergometer), which resembles a bicycle. The essence of bicycle ergometry is to record an ECG during exercise on a bicycle ergometer ( patient pedaling). In some cases, your doctor may recommend that you stop certain medications before doing this test ( nitroglycerin, bisoprolol). To conduct bicycle ergometry, the patient sits on an exercise bike. The doctor puts on the patient a cuff that measures blood pressure and attaches the electrodes necessary for recording the ECG to the chest. After that, the research begins. The patient begins to pedal, and on the monitor, the doctor monitors ECG changes in real time. Gradually increase the speed on the exercise bike. The criteria for stopping the load are set by the doctor ( decrease in blood pressure, the appearance of intense pain, blanching, ECG changes and others).	helps to identify rhythm disturbances that occur only during exercise.

When is medical treatment needed?

The first stage of treatment of extrasystole involves maintaining a healthy lifestyle and eliminating all factors that can potentially cause rhythm disturbance ( smoking, alcoholic beverages, strong tea and coffee, psycho-emotional stress and others). Then the doctor tries to find out the reason that served as the development of this condition. If, after the examinations, it becomes clear that the development of extrasystole is associated with any disease ( inflammatory heart disease, endocrine diseases and others), then it is necessary to treat the underlying disease.

Extrasystole that is asymptomatic or with few symptoms ( not causing discomfort to the patient) and, if after the examinations no diseases of the cardiovascular system were detected, then there is no need for special treatment. This kind of extrasystole is safe, and taking antiarrhythmic drugs can provoke a deterioration in well-being or be accompanied by various side effects up to the development of dangerous complications.

In the event of extrasystoles against the background of psycho-emotional overload, which are accompanied by a feeling of anxiety, sedatives may be prescribed ( sedatives) facilities . In the absence of the effect of the use of these measures, they resort to the appointment of antiarrhythmic drugs.

The main principles of treatment of extrasystole are:

• determination of indications for the appointment of drug treatment, taking into account the etiology ( reasons), results of surveys;
• The choice of antiarrhythmic drug depends on the location ( localization) ectopic ( additional) focus of excitation;
• with a decrease in the number of extrasystoles ( up to 700 in 24 hours- under the influence of antiarrhythmic treatment, the dose of the drug is reduced to the minimum, at which its antiarrhythmic effect is preserved;
• at the rack ( long) normalization of the rhythm, the antiarrhythmic drug is canceled, gradually reducing the dose;
• with persistent incessant extrasystole, treatment is carried out for a long time in order to prevent sudden death;
• in the event of a decrease in the effectiveness of the antiarrhythmic drug, it is replaced by another;
• in the absence of the effect of taking one drug, a combination of several antiarrhythmic drugs is prescribed;
• to increase the effectiveness of antiarrhythmic treatment, it is necessary to follow a diet enriched with potassium.

Indications for prescribing treatment depending on the results of ECG monitoring(HMECG)are:

• the number of extrasystoles is less than 100 in 24 hours - antiarrhythmic treatment is not required;
• the amount of extrasystole is more than 100, but less than 700 in 24 hours - antiarrhythmic treatment is prescribed if there are discomfort associated with extrasystole;
• the number of extrasystoles is more than 700, but less than 8600 in 24 hours - antiarrhythmic therapy is prescribed with an individual selection of antiarrhythmic drugs;
• the number of extrasystoles is more than 8600 in 24 hours against the background of existing diseases of the heart muscle - intensive antiarrhythmic therapy is necessary.

Before starting treatment, it is necessary to consult a doctor, since an independent choice of drugs and dosages can lead to a deterioration in the condition and irreversible consequences.

Medical treatment

Medication	Mechanism of therapeutic action	Indications
Quinidine	inhibits the automatism of pacemaker cells; reduces the speed of impulses; has a local anesthetic effect; dilates peripheral vessels;	ventricular extrasystole; atrial extrasystole.
Novocainamide	reduces myocardial excitability; reduces automatism and conductivity in the atria, atrioventricular node, His bundle and Purkinje fibers; reduces myocardial contractility.	ventricular extrasystole.
Meksiletin	inhibits automatism in Purkinje fibers; improves intraventricular conduction; has a local anesthetic effect.	ventricular extrasystole.
Ethacizine	slows down the conduction of excitation through the conduction system of the myocardium; has a long antiarrhythmic effect.	atrial extrasystole; ventricular extrasystole.
Lidocaine	reduces automatism; suppresses ectopic foci of excitation; does not affect the conductivity and contractility of the myocardium.	ventricular extrasystole.
propafenone	lengthens the time of excitation through the sinoatrial node and atria; slows down the conduction of excitation along the Purkinje fibers; inhibits the formation of excitation and its spread from the atria to the ventricles; has a local anesthetic effect; dilates the heart vessels; has an antiarrhythmic effect.	atrial extrasystole; atrioventricular extrasystole; ventricular extrasystole.
propranolol	inhibits the automatism of the sinoatrial node; suppresses the occurrence of ectopic foci in the atria, atrioventricular node, ventricles; reduces the speed of excitation in the atrioventricular node;	atrial extrasystole; atrioventricular extrasystole; ventricular extrasystole.
metoprolol	slows sinus rhythm; slows down the rate of propagation of excitation through the atrioventricular node ( inhibits conduction and excitability); inhibits the automatism of the heart; slows down the heart rate.	ventricular extrasystole.
Sotalol	slows down the excitability of the myocardium of the ventricles and atrioventricular conduction; reduces myocardial contractility; reduces the heart rate.	ventricular extrasystole.
Amiodarone	decreased automatism of the sinus node; slows down excitability and conduction in the sinus and atrioventricular nodes; reduces the excitability of cardiomyocytes; reduces myocardial oxygen demand.	atrial extrasystole; ventricular extrasystole.
Verapamil	reduces myocardial contractility; suppresses ( oppresses) automatism of the sinus node; reduces atrioventricular conduction; reduces myocardial oxygen demand by reducing myocardial contractility and reducing heart rate; causes expansion of the coronary vessels of the heart and improves blood flow in them.	atrial extrasystole;
Diltiazem	reduces myocardial contractility; slows down atrioventricular conduction; reduces heart rate; reduces myocardial oxygen demand; dilates the arteries of the heart coronary arteries); improves blood flow in the coronary arteries.	atrial extrasystole; atrioventricular extrasystole.
Diazepam	reduces the feeling of fear, anxiety; eliminates autonomic disorders of the cardiovascular system; has an antiarrhythmic effect; enhances the antiarrhythmic effect of other drugs.	atrial extrasystole; atrioventricular extrasystole; ventricular extrasystole.
Digoxin	slows down the heart rate; reduces the speed of impulses through the atrioventricular node; reduces myocardial oxygen demand.	is prescribed with caution in supraventricular extrasystoles.
Novo-passit	has a calming effect.	It is used for extrasystole in order to relieve patients from feelings of anxiety, fear, which can aggravate the course of arrhythmia.

When is surgical treatment necessary?

Although drug therapy for extrasystoles is often effective, any antiarrhythmic drug can exhibit an arrhythmogenic effect ( exacerbate manifestations of extrasystole) and cause many side effects. In case of ineffectiveness of antiarrhythmic therapy and in the presence of a high risk of developing severe complications ( fibrillation, sudden cardiac death) may require surgical treatment. Surgical treatment is a radical and effective method of treatment.

Radiofrequency catheter ablation of the ectopic focus

Currently, radiofrequency catheter ablation of the ectopic focus is used quite often. This treatment technique allows isolating the source of arrhythmia and creates conditions under which the propagation of pathological impulses in the atria will be impossible. In other words, it is a procedure that uses radio frequency energy to destroy a small area of ​​heart tissue that is causing the rhythm disorder.

Indications for catheter ablation are:

• failure of medical treatment antiarrhythmic therapy);
• registration of more than 8000 extrasystoles every 24 hours for one year;
• high risk of ventricular fibrillation, atrial fibrillation, sudden cardiac arrest.

Relative contraindications for catheter ablation are:

• unstable angina;
• uncontrolled heart failure;
• uncontrolled arterial hypertension ( high blood pressure);
• disorders of the blood coagulation system;
• stenosis ( constriction) coronary arteries more than 75%;
• chronic renal failure;
• acute infectious diseases.

Catheter ablation is performed in a planned manner. A few days before the procedure, it is necessary to stop taking antiarrhythmic and other drugs. Each drug has its own elimination period from the body, so you need to consult your doctor to clarify any unclear points. No food is allowed 12 hours before the operation. An intestinal cleansing enema may also be performed.

Catheter ablation is a minimally invasive procedure. That is, it does not require any incisions and open access to the heart. The patient is sedated put into a state of semi-drowsiness), after which he enters the operating room. Vascular area ( femoral, subclavian veins, veins of the forearm), which are planned to be punctured ( puncture) are carefully processed and covered with sterile linen. After that, local anesthesia of the puncture site is performed and the operation begins directly. For catheter ablation, a thin, flexible guide catheter is used, which is inserted through a blood vessel and advanced to the source of the abnormal rhythm in the heart. After that, a radio frequency pulse is fed through the conductor, which leads to the destruction of the necessary section of the heart tissue.

The advantages of catheter ablation are:

• minimal trauma;
• no need for general anesthesia anesthesia);
• short duration of the operation;
• short postoperative period one day).

Implantation of a cardioverter-defibrillator ( ICD)

A cardioverter defibrillator is used to treat life-threatening arrhythmias ( ventricular fibrillation, ventricular tachycardia), which can develop as a result of extrasystole. This device is an antiarrhythmic device that automatically recognizes rhythm disturbance and eliminates it according to a given algorithm. For each patient, the therapy algorithm is set individually. When a dangerous arrhythmia is detected, the implantable cardioverter defibrillator delivers an electrical shock to restore normal ( sinus) rhythm.

Implantation of a cardioverter-defibrillator begins with a preparatory stage, which involves creating access to the vessel through which the electrode will be inserted. The area under the left collarbone is anesthetized. Then, an incision is made parallel to the clavicle to the pectoralis major muscle and punctured ( pierced) subclavian vein. One or more electrodes are inserted through a special conductor. Under x-ray control, electrodes are placed in certain structures of the heart. After that, the implantation of a cardioverter-defibrillator is carried out directly.

Implantation of a cardioverter-defibrillator may be indicated:

• patients at high risk of sudden cardiac arrest;
• patients who have undergone clinical death;
• patients with heart disease ischemic heart disease, chronic heart failure), in which stable extrasystole is recorded;
• patients after unsuccessful catheter ablation.

Contraindications for implantation of a cardioverter-defibrillator may include:

• severe condition of the patient associated with the presence of cardiac ( heart failure) or non-cardiac pathology;
• the presence of acute cardiac pathology ( acute myocarditis, acute myocardial infarction);
• severe hemodynamic disturbances ( acute vascular insufficiency);
• an extremely serious condition of the patient due to non-cardiac pathology with a prognosis for life of less than 6 months ( oncology).

Do they take extrasystoles into the army?

Mild forms of extrasystole, not accompanied by a pronounced violation of the pumping function of the heart, are not a contraindication for military service. At the same time, severe extrasystoles, in which complications from the cardiovascular system develop, may be a reason for declaring a person unfit for military service.

Extrasystole is a disease in which the rhythm of heart contractions is disturbed. Under normal conditions, the heart rate is regulated by nerve impulses that occur in a strictly defined area of ​​the heart muscle ( in the so-called sinoatrial node). When a nerve impulse travels through the heart muscle, it contracts, expelling blood into the arteries. After that, the relaxation of the heart muscle occurs, during which the chambers of the heart are filled with another portion of blood, and then a new impulse starts a new heart contraction.

Extrasystole is characterized by the occurrence of an extraordinary nerve impulse that can appear in any part of the heart. Since the impulse occurs too early, the chambers of the heart do not have time to fill with blood. In addition, improper propagation of a nerve impulse can disrupt the contraction of the heart muscle, as a result of which it will not be able to expel blood into the arteries. If extrasystoles are repeated frequently, this can lead to a violation of the pumping function of the heart, as a result of which the blood supply to the brain and other internal organs may be disturbed. The patient may experience increased heart rate, dizziness, or even lose consciousness. Such patients are prohibited from serving in the army, since any physical or emotional stress can provoke or increase extrasystole and lead to the development of complications.

At the same time, it is worth noting that single extrasystoles can be observed in many healthy people. However, immediately after the occurrence of an extrasystole, the normal heart rhythm is restored, as a result of which the blood supply to the brain and internal organs is not disturbed and the patient does not experience any symptoms of the disease. Military service is not contraindicated for such people, however, they should be regularly examined by a cardiologist and perform an electrocardiogram, which will allow timely detection of the progression of the disease and prevent the development of complications.

Is it possible to drink coffee with extrasystoles?

Extrasystole is characterized by the occurrence of a pathological focus of excitation in various areas of the heart muscle, where normally it should not occur. A wave of excitation, propagating through the heart muscle, disrupts the rhythm of heart contractions, as well as the process of muscle contraction itself, as a result of which the pumping function of the heart may be impaired.

One of the reasons for the development of extrasystole may be intoxication with caffeine, which is part of coffee. The fact is that caffeine stimulates the excitability of the heart, thereby increasing the risk of a pathological focus of excitation in various parts of the myocardium ( heart muscle). At the same time, caffeine stimulates certain centers in the brain, which also increases the heart rate ( heart rate). If the heart rate is too high, the blood supply and nutrition of the heart muscle itself can be disturbed, which will lead to metabolic disorders at the cellular level. The presence of these conditions increases the risk of pathological foci of excitation, and will also contribute to the development of extrasystoles. If at the same time the patient had single extrasystoles ( which he may not have noticed at all.), drinking coffee can lead to a series of extrasystoles. Multiple extrasystoles may be accompanied by a decrease in the pumping function of the heart, a decrease in blood pressure, a violation of blood circulation in the body, and so on. At the same time, patients may feel a sharp increased heartbeat in the chest, pain in the heart ( due to insufficient blood supply to the myocardium), headaches or dizziness ( due to insufficient blood supply to the brain).

Is general anesthesia dangerous for extrasystoles?

If the patient has extrasystole, general anesthesia may be associated with certain risks that may occur during or after surgery. That is why, in preparation for surgery and anesthesia, it is recommended that all patients perform an ECG ( electrocardiogram), which will identify the presence of extrasystole and take the necessary measures to prevent the development of complications.

Extrasystole is a pathological condition characterized by a violation of the heart rate. The immediate cause of extrasystoles ( extraordinary heart contraction) is a pathological focus of excitation that occurs in various parts of the heart muscle and causes it to contract abnormally, as a result of which the pumping function of the heart may be impaired. During general anesthesia, the patient is affected by a number of factors that can contribute to the development or strengthening of extrasystoles.

The development of extrasystole during general anesthesia can be facilitated by:

• The impact of certain medications. During general anesthesia, inhalation anesthetics may be used ( anesthetic drugs). Some of them ( e.g. halothane) increase the excitability of the myocardium, resulting in an increased risk of extrasystoles. The longer anesthesia lasts, the more pronounced effect these drugs have on the myocardium and the higher the likelihood of multiple extrasystoles and the development of complications during surgery ( drop in blood pressure, severe arrhythmia). Also, some other medications used during operations can increase myocardial excitability and the risk of developing extrasystoles ( aminophylline, cordiamine, caffeine, atropine and so on).
• medical manipulation. During induction into general anesthesia, the patient's blood pressure may increase, and the oxygen concentration in the blood may temporarily decrease. Against this background, the delivery of blood and energy to the heart muscle may be disrupted, which will be accompanied by a metabolic disorder in it. Accumulation of metabolic by-products, hypoxia ( lack of oxygen) and changes in electrolyte balance increase the excitability of the heart muscle, resulting in extrasystoles.
• Psycho-emotional stress. If the patient is very worried about the upcoming operation, then this may affect the state of his cardiovascular system ( his blood pressure may rise, his heart rate may increase, and so on). If at the same time the patient has single extrasystoles or other factors contributing to the development of this disease ( for example, past heart attacks, heart failure, inflammatory lesions of the heart muscle, and so on), then the risk of developing extrasystole during anesthesia increases.

Why is extrasystole dangerous during pregnancy and childbirth?

The development and progression of extrasystole during pregnancy can lead to a disruption in the delivery of oxygen and nutrients to the fetus, which can cause intrauterine damage. At the same time, extrasystole during childbirth can be accompanied by a deterioration in the condition of the woman herself, and also negatively affect the birth process, which will lead to damage to the fetus.

Extrasystole is a disease characterized by a periodic violation of the heart rate. In this case, extraordinary contractions of the heart muscle occur ( that is, extrasystoles), during which the heart does not contract normally and cannot pump blood. If extrasystoles are single ( that is, they occur once within a few minutes or hours, and the rest of the time, heart contractions proceed normally), then this will not affect the condition of the pregnant woman or the fetus in any way and will not affect the process of childbirth. At the same time, frequent extrasystoles, repeated several times in a short period of time, can lead to a pronounced decrease in the pumping function of the heart and a drop in blood pressure. If blood pressure drops below a certain level, blood supply to the placenta may be disturbed ( organ that transports oxygen from the mother's body to the fetus). In this case, the fetus may develop hypoxia ( lack of oxygen in the body), which can cause damage to his central nervous system ( brain), violations of intrauterine development or even intrauterine death.

In the event of an attack of extrasystole during childbirth ( which can be facilitated by an increased burden on the woman's body, the use of certain medications, the use of general anesthesia during a caesarean section, undiagnosed heart diseases, and so on) development of weakness of labor activity is possible ( due to a drop in blood pressure and impaired blood supply to internal organs). Also, in this case, the blood supply to the fetus itself can be disturbed, which can cause various congenital pathologies.

Why does extrasystole occur during physical exertion (walking, running)?

Extrasystole, which occurs only during physical exertion of varying intensity and disappears at rest, may indicate that the patient has additional ( related) heart disease.

Under normal conditions, the heart rate is regulated by nerve impulses that occur in the region of the so-called sinoatrial node. The nerve impulse generated in this area propagates along the heart muscle in a strictly defined direction, as a result of which the heart contracts and expels blood into the vessels. An extrasystole is an abnormal heart contraction that is stimulated by a nerve impulse that occurs outside the sinoatrial node ( in another part of the heart). The cardiac contraction stimulated by such an impulse occurs incorrectly, as a result of which the pumping function of the heart muscle may decrease.

There can be many reasons for extrasystole. One of them is a metabolic disorder in the myocardium ( heart muscle), which develops with damage to the blood vessels of the heart ( what can be observed with atherosclerosis, after a heart attack, after inflammatory heart disease, and so on). At rest, such people may have a normal heart rate, as the heart will receive enough oxygen. At the same time, during exercise, the heart's need for oxygen increases, but damaged blood vessels cannot satisfy it. Due to the violation of oxygen delivery to the cells of the heart muscle, as well as the accumulation of metabolic by-products, there is an increase in the excitability of various parts of the myocardium. As a result, they may experience spontaneous foci of nervous excitation, accompanied by extrasystoles.

When a person stops exercising, myocardial oxygen demand decreases, and blood microcirculation and metabolism in it normalize, as a result of which extrasystoles stop.

Is it possible to get rid of extrasystole forever?

The possibility and effectiveness of treatment of extrasystole directly depends on the cause of its occurrence. In some cases ( with adequate treatment) extrasystole can be eliminated forever, while in other patients this pathology persists throughout life.

Extrasystole is a pathological extraordinary heart contraction that occurs due to a functional or organic lesion of the heart muscle or its nervous apparatus. All causes of extrasystole development can be conditionally divided into removable and irremovable. You can get rid of extrasystole in cases where it is possible to eliminate the cause of its occurrence once and for all. If the cause of the development of the disease is unremovable, then the extrasystole itself will persist.

Eliminable causes of extrasystoles include:

• Coronary artery disease - violation of the blood supply to the heart muscle due to damage to the vessels supplying it.
• Myocarditis - inflammatory damage to the heart muscle.
• Tumors - malignant or benign neoplasms that can compress or destroy heart muscle tissue.
• Taking certain medications cardiac glycosides, adrenaline, drugs for general anesthesia, caffeine and so on.
• Poisoning - alcohol, chemicals and other substances that interfere with heart function.
• Metabolic disorders - decrease in the concentration of potassium or magnesium in the blood.
• Anemia - decrease in the concentration of red blood cells ( erythrocytes) resulting in impaired oxygen delivery to the heart muscle.

Fatal causes of extrasystole are:

• Cardiomyopathy - structural changes in the heart muscle, accompanied by a violation of its contractile function.
• Heart defects - violations of the structure of the heart muscle or heart valves.
• Diabetes - violation of glucose metabolism, eventually leading to irreversible damage to blood vessels and internal organs.
• Hyperthyroidism - a disease of the thyroid gland, in which the concentration of its hormones in the blood increases ( what contributes to the development of extrasystole).
• Idiopathic extrasystole - this pathology is spoken of in cases where, after a complete examination of the patient, it is not possible to establish the cause of the disease.

Is it possible to play sports with extrasystole?

You can go in for sports only for those patients in whom extrasystole is not accompanied by severe violations of the pumping function of the heart, fluctuations in blood pressure and circulatory disorders in various organs. If extrasystole occurs with the development of complications, it is recommended that the sick person exclude or limit physical activity as much as possible, as this can threaten his health or even life.

The essence of extrasystole lies in the fact that a pathological focus of excitation occurs in the heart muscle, which provokes an extraordinary cardiac contraction. In some cases, these extraordinary heartbeats ( extrasystoles) are similar to normal abbreviations and have a single character ( that is, in an hour of research with the help of special equipment, it is possible to register no more than 30 extrasystoles). In this case, the pumping function of the heart does not suffer, systemic arterial pressure is maintained at a constant level, and the blood supply to the brain and other internal organs is not disturbed. Such patients can go in for sports if during training they do not experience an increase in extrasystoles and associated symptoms ( increased heart rate, dizziness, weakness, darkening of the eyes, loss of consciousness, and so on).

If extrasystoles occur too often ( more than 30 times per hour), and also, if frequent series of two extrasystoles in a row are recorded during the examination of the patient, then he is not recommended to go in for sports too often. This is due to the fact that with such extrasystoles, the pumping function of the heart suffers significantly, as a result of which the blood supply to the brain can be disturbed. In this case, the patient may lose consciousness right during training. Moreover, during physical activity, the need for oxygen in the heart muscle increases significantly, which, with developed extrasystole, can lead to the development of complications. The most formidable of these may be ventricular fibrillation, which without emergency ( within minutes) qualified assistance can lead to the death of a person.

From this article you will learn: what is ventricular extrasystole, its symptoms, types, methods of diagnosis and treatment.

Article publication date: 12/19/2016

Date of article update: 05/25/2019

With ventricular extrasystole (this is one of the types), untimely contractions of the ventricles of the heart occur - in another way, such contractions are called extrasystoles. This phenomenon does not always indicate any diseases, extrasystole sometimes occurs in completely healthy people.

If extrasystole is not accompanied by any pathologies, does not cause inconvenience to the patient and is visible only on - no special treatment is required. In the event that ventricular extrasystole was provoked by a violation of the heart, you will need an additional examination by a cardiologist or arrhythmologist, who will prescribe medications or surgery.

This pathology can be completely cured (if treatment is necessary) if the defect that caused it is surgically corrected - or you can achieve a lasting improvement in well-being with the help of medications.

Causes of ventricular extrasystole

The reasons for this phenomenon can be divided into two groups:

1. organic - these are pathologies of the cardiovascular system;
2. functional - stress, smoking, excessive coffee consumption, etc.

1. Organic causes

The occurrence of ventricular extrasystole is possible with such diseases:

• Ischemia (impaired blood supply) of the heart;
• cardiosclerosis;
• dystrophic changes in the heart muscle;
• myocarditis, endocarditis, pericarditis;
• myocardial infarction and postinfarction complications;
• congenital heart defects (open ductus arteriosus, coarctation of the aorta, ventricular septal defects, and others);
• the presence of extra conductive bundles in the heart (Kent's bundle in WPW syndrome, James's bundle in CLC syndrome);
• arterial hypertension.

Also, untimely contractions of the ventricles appear with an overdose of cardiac glycosides, so always consult your doctor before using them.

Diseases that cause ventricular extrasystole are dangerous and require timely treatment. If untimely contractions of the ventricles were found on your ECG, be sure to undergo an additional examination to check if you have the heart pathologies listed above.

2. Functional reasons

These are stress, smoking, drinking alcohol, illegal substances, a large number of energy drinks, coffee or strong tea.

Functional ventricular extrasystole usually does not require treatment - it is enough to eliminate its cause and once again undergo a heart examination in a couple of months.

3. Idiopathic form of extrasystole

In this condition, a completely healthy person has ventricular extrasystoles, the cause of which has not been elucidated. In this case, the patient usually does not have any symptoms, so treatment is not carried out.

Classification and severity

To begin with, we suggest that you familiarize yourself with what types of ventricular extrasystoles exist:

Three scientists (Laun, Wolf and Ryan) proposed the following classification of ventricular extrasystoles (from mildest to most severe):

• 1 type. Up to 30 single extrasystoles of the ventricles per hour (up to 720 pieces per day with a Holter study). Most often, such extrasystole is functional or idiopathic in nature and does not indicate any diseases.
• 2 type. More than 30 single untimely contractions per hour. It may indicate, and may be functional. By itself, such an extrasystole is not very dangerous.
• 3 type. Polymorphic ventricular extrasystoles. May indicate the presence of additional conducting bundles in the heart.
• 4A type. Paired extrasystoles. More often they are not functional, but organic in nature.
• 4B type. Group extrasystoles (unstable). This form occurs due to cardiovascular disease. Dangerous development of complications.
• 5 type. Early group ventricular extrasystoles (visible on the cardiogram in the first 4/5 of the T wave). This is the most dangerous form of ventricular extrasystole, as it often causes life-threatening forms of arrhythmias.

Classification of ventricular extrasystoles

Symptoms of ventricular extrasystole

Rare single extrasystoles of a functional or idiopathic nature are usually visible only on the ECG or during the daily. They do not show any symptoms, and the patient is not even aware of their presence.

Sometimes patients with functional ventricular extrasystole complain of:

• feeling as if the heart stops (this is due to the fact that an extrasystole can be followed by an extended diastole (pause) of the ventricles);
• feeling of tremors in the chest.

Immediately after exposure to the cardiovascular system of an adverse factor (stress, smoking, alcohol, etc.), the following signs may appear:

• dizziness,
• pallor,
• sweating,
• feeling as if there is not enough air.

Organic ventricular extrasystole, which requires treatment, is manifested by symptoms of the underlying disease that caused them. There are also signs listed in the previous lists. They are often accompanied by bouts of squeezing pain in the chest.

Attacks of unstable paroxysmal tachycardia are manifested by the following symptoms:

• severe dizziness,
• fainting state,
• fainting
• "fading" of the heart,
• strong heartbeat.

If the treatment of the disease that caused this type of ventricular extrasystole is not started on time, life-threatening complications may appear.

Diagnostics

Most often, ventricular extrasystole is detected during a preventive medical examination during an ECG. But sometimes, if the symptoms are pronounced, the patients themselves come to the cardiologist with complaints about the heart. For an accurate diagnosis, as well as determining the primary disease that caused ventricular extrasystole, it will be necessary to undergo several procedures.

Initial inspection

If the patient himself came with complaints, the doctor will interview him to find out how severe the symptoms are. If the signs are paroxysmal in nature, the cardiologist must know how often they occur.

Also, the doctor will immediately measure blood pressure and pulse rate. At the same time, he can already notice that the heart is contracting irregularly.

After the initial examination, the doctor immediately prescribes an ECG. Focusing on its results, the cardiologist prescribes all other diagnostic procedures.

Electrocardiography

According to the cardiogram, doctors immediately determine the presence of ventricular extrasystoles.

Not on the cardiogram, ventricular extrasystole manifests itself as follows:

1. the presence of extraordinary ventricular QRS complexes;
2. extrasystolic QRS complexes are deformed and expanded;
3. there is no P wave before the ventricular extrasystole;
4. after an extrasystole there is a pause.

Holter examination

If pathological changes are visible on the ECG, the doctor prescribes daily ECG monitoring. It helps to find out how often the patient has extraordinary contractions of the ventricles, whether there are paired or group extrasystoles.

After a Holter examination, the doctor can already determine whether the patient needs treatment, whether extrasystole is life-threatening.

Ultrasound of the heart

It is carried out to find out which disease provoked ventricular extrasystole. It can be used to detect dystrophic changes in the myocardium, ischemia, congenital and acquired heart defects.

coronary angiography

This procedure allows you to assess the condition of the coronary vessels that supply oxygen and nutrients to the myocardium. Angiography is prescribed if the ultrasound showed signs of coronary heart disease (CHD). After examining the coronary vessels, you can find out exactly what provoked coronary artery disease.

Blood test

It is carried out to find out the level of cholesterol in the blood and to exclude or confirm atherosclerosis, which could provoke ischemia.

EFI - electrophysiological study

It is carried out if there are signs of WPW- or CLC-syndrome on the cardiogram. Allows you to accurately determine the presence of an additional conductive bundle in the heart.

Therapy of ventricular extrasystoles

Treatment of untimely contractions of the ventricles is to get rid of the cause that provoked them, as well as stopping attacks of severe ventricular arrhythmia, if any.

Treatment of the functional form of extrasystole

If ventricular extrasystole is functional, then you can get rid of it in the following ways:

• quit bad habits;
• take drugs to relieve nervous tension (valerian, sedatives or tranquilizers, depending on the severity of anxiety);
• adjust the diet (refuse coffee, strong tea, energy drinks);
• observe the regime of sleep and rest, engage in physiotherapy exercises.

Organic Form Treatment

Treatment of the organic form of type 4 disease involves taking that helps get rid of attacks of ventricular arrhythmia. The doctor prescribes Sotalol, Amiodarone or other similar medicines.

Antiarrhythmic drugs

Also, with pathologies of types 4 and 5, the doctor may decide that it is necessary to implant a cardioverter-defibrillator. This is a special device that corrects the heart rate and stops ventricular fibrillation if it occurs.

Treatment of the underlying disease that caused ventricular extrasystole is also required. Often, various surgical procedures are used for this.

Surgical treatment of the causes of ventricular extrasystole

Consequences of ventricular extrasystole

Type 1 ventricular extrasystole, according to the classification given above in the article, does not pose a threat to life and usually does not cause any complications. With type 2 ventricular extrasystole, complications may develop, but the risk is relatively low.

If the patient has polymorphic extrasystole, paired extrasystoles, unstable paroxysmal tachycardia or early group extrasystoles, the risk of life-threatening consequences is high:

Consequence	Description
Stable ventricular tachycardia	It is characterized by prolonged (more than half a minute) attacks of group ventricular extrasystoles. It, in turn, provokes the consequences shown later in this table.
ventricular flutter	Contraction of the ventricles with a frequency of 220 to 300 beats per minute.
Fibrillation (flicker) of the ventricles	Chaotic contractions of the ventricles, the frequency of which reaches 450 beats per minute. The flickering ventricles are unable to pump blood, so the patient usually loses consciousness due to lack of oxygen in the brain. This condition, if left untreated, can lead to death.
Asystole ()	May occur against the background of an attack of ventricular arrhythmia or suddenly. Often, asystole inevitably leads to death, since doctors are not always able to perform resuscitation within a few minutes after cardiac arrest.

To avoid life-threatening consequences, do not delay starting treatment if you have a ventricular premature beat.

Prognosis for pathology

With extrasystole of the ventricles of types 1 and 2, the prognosis is favorable. The disease practically does not affect the quality of life of the patient and does not cause serious consequences.

With ventricular extrasystoles of type 3 and above, the prognosis is relatively favorable. With timely detection of the disease and the beginning of therapy, you can completely get rid of the symptoms and prevent complications.

Any surgical intervention is an additional trauma for the body, therefore, when determining the indications for its implementation, it is necessary to correctly correlate the risk of complications, the benefits of the operation and the severity of the consequences if it is refused. Anesthesia for concomitant heart diseases in itself is associated with a certain risk of complications; special indices are used to assess the likelihood of their development, which take into account the influence of risk factors:

• early or late postinfarction period;
• ischemic heart disease, angina pectoris;
• rhythm disturbances: extrasystole, atrial fibrillation, bigeminia;
• high or low blood pressure;

Patients with hypertension are at risk due to possible complications during surgery

• operated and non-operated heart disease;
• age, the presence of concomitant diseases of other systems and organs.

Each item, depending on the severity and severity of the manifestation of violations, is assigned a certain number of points, and according to their sum, a conclusion is made about the magnitude of the risk of complications during and after the operation. If the risk is low, it is possible to carry out a full surgical intervention, and the type of anesthesia is chosen in accordance with the scope of the proposed intervention. Problems during local anesthesia or anesthesia in patients of this category occur no more often than in healthy patients.

A special risk index is used to determine the indications, choose the method of surgery and pain relief in patients with heart pathology, which is calculated based on the history of a cardiac disease after determining the current state.

With an average level of risk of cardiovascular complications, the least traumatic surgical technique is chosen, with the help of which the desired effect can be achieved. In patients with coronary artery disease and rhythm disturbances, especially atrial fibrillation, local regional anesthesia in combination with sedation is preferred if possible; with heart defects, this issue is resolved individually, depending on the type of pathology. With a high risk of complications, operations are performed exclusively for health reasons, in this case, as a rule, general anesthesia is used.

Endotracheal anesthesia

Operations on the respiratory organs, heart and blood vessels are performed exclusively under general endotracheal anesthesia, as this is the only method of pain relief that can provide adequate analgesia and maintenance of vital functions during such interventions. Open abdominal operations on the abdominal cavity are also performed under general anesthesia, since it is impossible to provide a good level of pain relief and muscle relaxation for a long period with the help of a spinal or epidural block without the risk of additional complications.

When performing laparoscopic operations, interventions on the pelvic organs, perineum, rectum, lower extremities, the choice of anesthesia is carried out taking into account the volume of the operation and the type of concomitant heart pathology. In the process of preparing for a planned operation, the patient should be examined by an anesthesiologist in advance. In this case, he will be able to prescribe all the necessary studies and consultations of related specialists after his examination, and this makes it possible to choose the right technique and tactics of local anesthesia.

Preparing for surgery under general anesthesia

To prepare for surgery, patients with cardiovascular pathology are prescribed an extended examination. In addition to the ECG, echocardiography, ultrasound of the heart, and exercise tests are prescribed. For patients with extrasystole, cardiac arrhythmia, especially its atrial form, as well as with clinical manifestations of sinus bradycardia, 24-hour Holter monitoring is necessary. In addition, blood pressure is regularly measured and the whole range of laboratory tests provided for by the standard scheme is carried out.

The decision to stop taking medications for maintenance therapy is made by the cardiologist together with the attending physician and the anesthesiologist, usually done as follows:

• Nitropreparations, adrenoblockers and vasodilators, calcium channel blockers are taken until the very day of the operation. Cardiac glycosides are canceled a few days before it, to maintain the contractility of the heart, the anesthesiologist will inject special short-acting drugs intravenously;
• Indirect anticoagulants, which are usually taken by patients after valve replacement, stenting or coronary artery bypass grafting 4-5 days before surgery, are replaced with direct ones (heparin, fraxiparin are administered) to make it easier to manage hemostasis during surgery.

Direct acting anticoagulant

• Patients operated on for congenital and acquired defects of the valvular heart system and having endoprostheses can be operated on only after a prophylactic course of antibiotic therapy, this is necessary to prevent the development of infective endocarditis.

In the presence of cardiac arrhythmia, additional therapeutic measures are taken:

• When detecting cardiac arrhythmia, it is important to determine its cause and take measures to eliminate it. It can be caused by ischemia of a portion of the myocardium, improper selection of drugs, or their side effects. Ventricular extrasystole may be associated with a sharp smoking cessation in patients with a long smoking history.
• Atrial fibrillation is a relative contraindication to elective surgery. Surgical intervention is possible only in the normosystolic form, that is, when the contraction of the ventricles, despite inadequate atrial work, occurs in the "normal" mode. If the rhythm in atrial fibrillation cannot be restored with the use of antiarrhythmic drugs, the placement of a temporary pacemaker should be considered.

Important to know: preparation for surgery for patients with diseases of the cardiovascular system includes examination by a cardiologist and correction of previously recommended prescriptions. Especially carefully examine patients with atrial fibrillation.

Man consulting a cardiologist

Physiological sinus bradycardia in trained individuals does not adversely affect the course of anesthesia, in the presence of clinical symptoms, this condition requires correction or the installation of a pacemaker. In addition, additional drugs can be prescribed to correct the rhythm in atrial fibrillation and extrasystole, as well as to improve coronary circulation.

Features of general anesthesia in cardiovascular pathology

Regardless of the method of anesthesia in the presence of coronary artery disease, angina pectoris, cardiac arrhythmia, including atrial fibrillation and extrasystole, it is necessary to conduct continuous cardiorespiratory monitoring throughout the operation. A cardiogram is recorded, pulse, blood pressure and blood oxygen saturation are measured. This helps to recognize bradycardia, an increase or decrease in blood pressure, as well as myocardial hypoxia in time and prescribe drugs that will help restore heart function.

When performing general anesthesia, drugs with a minimal effect on hemodynamics should be chosen. To minimize the negative impact, combined anesthesia is used. For the prevention of bradycardia, anticholinergics (atropine) are introduced into the sedation.

Anticholinergic drug for premedication

How anesthesia can affect the work of the heart and how to get rid of the consequences?

Modern drugs for anesthesia and local anesthesia are completely eliminated from the body within a day after anesthesia and cease to have any effect on the heart. Only intranarcotic complications can affect the work of this organ: acute disturbances in the rhythm and blood supply of the myocardium, disturbances in the rhythm of breathing and electrolyte balance during surgery. Such complications are diagnosed even while the patient is in the hospital, so the doctor has the opportunity to prescribe adequate treatment.