Single extrasystoles. Extrasystole and compensatory pause The occurrence of a compensatory pause of the heart is due to

In Latin, there is a word compensatum, which means "balance". Compensatory pause is a term that characterizes the diastolic pause that comes after. In time, such a pause is lengthened. Its duration is equal to two pauses usual for the heart rhythm.

There comes a compensatory pause after and lasts until the next independent contraction.

Causes of the compensatory pause

After an extrasystole of the ventricle, a refractory period is observed, characterized by the fact that the ventricle does not respond to the next impulse coming from the sinus. This leads to the fact that the ventricle does not contract after the first, but after the second sinus impulse. There are cases when the heartbeat is very rare, the end of the refractory period is observed after the extrasystole and before the next sinus impulse. Such changes in the heart rhythm can lead to the absence of a compensatory pause.

The heart rhythm can be nomotopic and heterotopic. Their simultaneous presence in a person is called, which can often be the cause of compensatory pauses.

Another reason for their appearance can be, which is a serious pathology associated with impaired circulatory function and heart rhythm.

Types of compensatory pauses

Compensatory pauses are of two types:

1. Full.
2. Incomplete.

A complete compensatory pause after ventricular extrasystoles appears as a result of the fact that there is no passage of an extraordinary impulse through the atrioventricular node. The charge of the sinus node is not destroyed.

The next sinus impulse reaches the ventricles at the time when an extraordinary contraction occurs in them. This period is called refractory. The ventricles respond only to the next sinus impulse, which is equal in time to two cardiac cycles.

This means that the time denoting the intervals before and after extrasystoles is equated to two normal intervals R - R.

An incomplete compensatory pause is characterized by the appearance of excitation in the ectopic focus. The impulse reaches the retrograde sinus node, after which the charge formed in it is destroyed. At this point, another normal is formed. This means that the interval that appeared after the extrasystole is equated to one ordinary R - R interval and the time during which the extrasystolic impulse travels from the ectopic focus to the sinus node. That is, this situation suggests that the distance from the sinus node to the ectopic focus affects the pause after extrasystole.

The location of the ectopic focus and the atrioventricular node affects the interval of atrial extrasystole P - Q. Finding the node near the focus significantly shortens P - Q.

How does this phenomenon threaten human health?

The compensatory pause is a cause for concern, and its occurrence always negatively affects the pumping function of the heart. This condition may appear after emotional arousal, a large amount of coffee drunk, nicotine abuse, sleep disturbance.

Of particular danger are compensatory pauses resulting from signals in the area of ​​ischemic and infarct zones. Such cases, judging by the statistics, often lead to development, which, in turn, ends in the death of the patient.

A compensatory pause may be evidence of serious diseases:

• myocarditis,
• chronic heart failure.

Treatment

In order to get rid of compensatory pauses, it is important to cure the underlying disease that provoked them. For this, sedatives and tranquilizers are used, with the help of which extrasystoles are reduced. Perfectly cope with drugs based on quinidine.

In addition, sometimes it is necessary to resort to the help of a psychotherapist.

Prevention

It is important to observe the sleep and rest regimen, exercise regularly and focus on.

It is very important to give up all bad habits that adversely affect human health and try to avoid stressful situations.

Conclusion

Any disease has a positive prognosis if it is diagnosed on time. Each person must learn to listen to his body and pay attention to all its signals. should be a cause for concern if it happened more than once or twice. Timely and adequate treatment guarantees a favorable prognosis.

- this is a variant of heart rhythm disturbance, characterized by extraordinary contractions of the whole heart or its individual parts (extrasystoles). It is manifested by a feeling of a strong cardiac impulse, a feeling of sinking heart, anxiety, lack of air. Diagnosed by the results of ECG, Holter monitoring, stress cardiotests. Treatment includes elimination of the root cause, medical correction of the heart rhythm; in some forms of extrasystole, radiofrequency ablation of arrhythmogenic zones is indicated.

ICD-10

I49.1 I49.2 I49.3

General information

Extrasystole - premature depolarization of the atria, ventricles, or atrioventricular junction, leading to premature contraction of the heart. Single episodic extrasystoles can occur even in practically healthy people. According to the electrocardiographic study, extrasystole is recorded in 70-80% of patients older than 50 years. A decrease in cardiac output during extrasystoles leads to a decrease in coronary and cerebral blood flow and can lead to the development of angina pectoris and transient cerebrovascular accidents (fainting, paresis, etc.). Extrasystole increases the risk of developing atrial fibrillation and sudden cardiac death.

Causes of extrasystole

Functional extrasystole, which develops in practically healthy people for no apparent reason, is considered idiopathic. Functional extrasystoles include:

• rhythm disturbances of neurogenic (psychogenic) origin associated with food (drinking strong tea and coffee), chemical factors, stress, alcohol intake, smoking, drug use, etc .;
• extrasystole in patients with autonomic dystonia, neuroses, osteochondrosis of the cervical spine, etc.;
• arrhythmia in healthy, well-trained athletes;
• extrasystole during menstruation in women.

Extrasystole of an organic nature occurs in case of myocardial damage with:

• IHD, cardiosclerosis, myocardial infarction,
• pericarditis, myocarditis,
• chronic circulatory failure, cor pulmonale,
• sarcoidosis, amyloidosis, hemochromatosis,
• cardiac operations,
• in some athletes, the cause of extrasystole may be myocardial dystrophy caused by physical overstrain (the so-called "athlete's heart").

Toxic extrasystoles develop with:

• feverish conditions,
• proarrhythmic side effect of certain drugs (aminophylline, caffeine, novodrine, ephedrine, tricyclic antidepressants, glucocorticoids, neostigmine, sympatholytics, diuretics, digitalis preparations, etc.).

The development of extrasystole is due to a violation of the ratio of sodium, potassium, magnesium and calcium ions in myocardial cells, which negatively affects the conduction system of the heart. Physical activity can provoke extrasystoles associated with metabolic and cardiac disorders, and suppress extrasystoles caused by autonomic dysregulation.

Pathogenesis

The occurrence of extrasystole is explained by the appearance of ectopic foci of increased activity, localized outside the sinus node (in the atria, atrioventricular node or ventricles). The extraordinary impulses arising in them propagate through the heart muscle, causing premature contractions of the heart in the diastolic phase. Ectopic complexes can form in any part of the conduction system.

The volume of extrasystolic blood ejection is below normal, so frequent (more than 6-8 per minute) extrasystoles can lead to a marked decrease in the minute volume of blood circulation. The earlier the extrasystole develops, the less blood volume accompanies the extrasystolic ejection. This, first of all, is reflected in the coronary blood flow and can significantly complicate the course of the existing cardiac pathology.

Different types of extrasystoles have different clinical significance and prognostic characteristics. The most dangerous are ventricular extrasystoles that develop against the background of organic heart damage.

Classification

According to the etiological factor, extrasystoles of functional, organic and toxic genesis are distinguished. According to the place of formation of ectopic foci of excitation, there are:

• atrioventricular (from the atrioventricular connection - 2%),
• atrial extrasystoles (25%) and various combinations of them (10.2%).
• in extremely rare cases, extraordinary impulses come from the physiological pacemaker - the sinoatrial node (0.2% of cases).

Sometimes there is a functioning of the focus of the ectopic rhythm, regardless of the main (sinus), while two rhythms are noted simultaneously - extrasystolic and sinus. This phenomenon is called parasystole. Extrasystoles, following two in a row, are called paired, more than two - group (or volley). Distinguish:

• bigeminy- rhythm with alternating normal systole and extrasystole,
• trigeminy- alternation of two normal systoles with extrasystole,
• quadrihymenia- following an extrasystole after every third normal contraction.

Regularly repeated bigeminy, trigeminy and quadrihymeny are called allorhythmy. According to the time of occurrence of an extraordinary impulse in diastole, early extrasystole is isolated, which is recorded on the ECG simultaneously with the T wave or no later than 0.05 seconds after the end of the previous cycle; middle - 0.45-0.50 s after the T wave; late extrasystole, which develops before the next P wave of the usual contraction.

According to the frequency of occurrence of extrasystoles, rare (less than 5 per minute), medium (6-15 per minute), and frequent (more often than 15 per minute) extrasystoles are distinguished. By the number of ectopic foci of excitation, extrasystoles are monotopic (with one focus) and polytopic (with several foci of excitation).

Symptoms of extrasystole

Subjective sensations with extrasystole are not always expressed. Tolerability of extrasystoles is more difficult in people suffering from vegetative-vascular dystonia; patients with organic heart disease, on the contrary, can tolerate extrasystole much easier. More often, patients feel extrasystole as a blow, a push of the heart into the chest from the inside, due to vigorous contraction of the ventricles after a compensatory pause.

There are also "somersaults or overturning" of the heart, interruptions and fading in its work. Functional extrasystole is accompanied by hot flashes, discomfort, weakness, anxiety, sweating, lack of air.

Frequent extrasystoles, which are early and group in nature, cause a decrease in cardiac output, and, consequently, a decrease in coronary, cerebral and renal circulation by 8-25%. In patients with signs of cerebral atherosclerosis, dizziness is noted, transient forms of cerebrovascular accident (fainting, aphasia, paresis) may develop; in patients with coronary artery disease - angina attacks.

Complications

Group extrasystoles can transform into more dangerous rhythm disturbances: atrial - into atrial flutter, ventricular - into paroxysmal tachycardia. In patients with atrial congestion or dilatation, extrasystole may progress to atrial fibrillation.

Frequent extrasystoles cause chronic insufficiency of the coronary, cerebral, renal circulation. The most dangerous are ventricular extrasystoles due to the possible development of ventricular fibrillation and sudden death.

Diagnostics

Anamnesis and physical examination

The main objective method for diagnosing extrasystole is an ECG study, however, it is possible to suspect the presence of this type of arrhythmia during a physical examination and analysis of the patient's complaints. When talking with the patient, the circumstances of the occurrence of arrhythmia (emotional or physical stress, in a calm state, during sleep, etc.), the frequency of episodes of extrasystole, the effect of taking medications are specified. Particular attention is paid to the history of past diseases that can lead to organic damage to the heart or their possible undiagnosed manifestations.

During the examination, it is necessary to find out the etiology of extrasystole, since extrasystoles with organic heart damage require a different treatment strategy than functional or toxic ones. On palpation of the pulse on the radial artery, the extrasystole is defined as a prematurely occurring pulse wave followed by a pause or as an episode of pulse loss, which indicates insufficient diastolic filling of the ventricles.

During auscultation of the heart during an extrasystole, premature I and II tones are heard above the apex of the heart, while the I tone is increased due to the small filling of the ventricles, and the II tone is weakened as a result of a small ejection of blood into the pulmonary artery and aorta.

Instrumental diagnostics

The diagnosis of extrasystole is confirmed after an ECG in standard leads and daily ECG monitoring. Often, using these methods, extrasystole is diagnosed in the absence of patient complaints. Electrocardiographic manifestations of extrasystole are:

• premature occurrence of the P wave or QRST complex; indicating a shortening of the preextrasystolic clutch interval: with atrial extrasystoles, the distance between the P wave of the main rhythm and the P wave of the extrasystole; with ventricular and atrioventricular extrasystoles - between the QRS complex of the main rhythm and the QRS complex of the extrasystole;
• significant deformation, expansion and high amplitude of the extrasystolic QRS complex with ventricular extrasystole;
• absence of P wave before ventricular extrasystole;
• following a complete compensatory pause after a ventricular extrasystole.

Holter ECG monitoring is a long-term (over 24-48 hours) ECG recording using a portable device attached to the patient's body. Registration of ECG indicators is accompanied by keeping a diary of the patient's activity, where he notes all his sensations and actions. Holter ECG monitoring is performed for all patients with cardiopathology, regardless of the presence of complaints indicating extrasystole and its detection in a standard ECG.

Forecast

The prognostic assessment of extrasystole depends on the presence of an organic lesion of the heart and the degree of ventricular dysfunction. The most serious concerns are caused by extrasystoles that have developed against the background of acute myocardial infarction, cardiomyopathy, and myocarditis. With pronounced morphological changes in the myocardium, extrasystoles can turn into atrial or ventricular fibrillation. In the absence of structural damage to the heart, extrasystole does not significantly affect the prognosis.

The malignant course of supraventricular extrasystoles can lead to the development of atrial fibrillation, ventricular extrasystoles - to persistent ventricular tachycardia, ventricular fibrillation and sudden death. The course of functional extrasystoles is usually benign.

Prevention

In a broad sense, the prevention of extrasystole provides for the prevention of pathological conditions and diseases underlying its development: coronary artery disease, cardiomyopathies, myocarditis, myocardial dystrophy, etc., as well as the prevention of their exacerbations. It is recommended to exclude drug, food, chemical intoxication that provoke extrasystole.

Patients with asymptomatic ventricular extrasystoles and no signs of cardiac pathology are recommended a diet enriched with magnesium and potassium salts, smoking cessation, drinking alcohol and strong coffee, and moderate physical activity.

Extrasystole is one of the types of arrhythmia. On the ECG, it is recorded as untimely depolarization of the heart or its individual chambers. On the cardiogram, they look like a sharp change in the ST and T wave (the line seems to suddenly fail). Extrasystoles are found in 65-70% of the world's population, but the reasons for their occurrence are different.

The disease can occur after nervous tension or physical exertion, or with various heart diseases. For example, ventricular extrasystole can occur as a concomitant factor with various lesions of the heart muscle.

Healthy people can have 200 supraventricular and ventricular extrasystoles per day. There are cases when absolutely healthy patients had several thousand extrasystoles.

By themselves, they are absolutely safe, however, in diseases of the cardiovascular system, extrasystoles are an additional unfavorable factor, therefore, treatment of extrasystoles is mandatory.

Classification

According to the nature of the occurrence, extrasystoles are divided into physiological, functional and organic. Let's consider them in more detail.

Physiological extrasystole occurs in healthy people due to negative emotions, nervous tension, physical activity, or autonomic dysfunction. This is due to the ever-increasing pace of modern life, high demands in educational institutions and at work. In this case, the patient needs rest and rest.

Functional extrasystole is observed in smokers or lovers of caffeinated drinks - strong tea and coffee.

There are also psychogenic extrasystoles, which are characteristic of people with latent depression. They occur with mood swings, upon awakening, on the way to work, or when anticipating conflict situations. As in the case of physiological extrasystoles, the patient needs rest, a change of scenery, positive emotions and, if possible, a vacation.

Organic extrasystoles appear after 50 years of age and are most often accompanied by other heart diseases, various disorders of the endocrine system, or chronic intoxication. In this case, extrasystoles are observed after physical exertion, and at rest they almost completely disappear. Patients do not feel any discomfort. On the ECG, these extrasystoles are atrial, atrioventricular, ventricular, polytopic or group. Especially dangerous is ventricular extrasystole, since it often accompanies serious heart disease.

According to the number of foci, extrasystoles are divided into monotypic and polytopic. Sometimes patients have bigeminia - this is an alternation of extrasystoles and normal contraction of the ventricles. If, after two normal contractions, an extrasystole follows each time, this is trigeminia.

Extrasystoles are also divided according to the place of occurrence:

• atrial;
• ventricular;
• atrioventricular.

Let's consider them in more detail.

Atrial extrasystoles are mainly associated with organic lesions of the heart. With an increase in the number of contractions, the patient may experience complications such as paroxysmal tachycardia or atrial fibrillation.

Unlike others, this extrasystolic arrhythmia begins when the patient is in a horizontal position. The ECG will show early, out-of-order appearances of the P wave, immediately followed by a normal QRS complex, incomplete compensatory pauses, and no changes in the ventricular complex.

Ventricular extrasystoles are much more common than others. On the ECG, excitations will not be transmitted to the atria, which means that they will not affect their contraction rhythm. In addition, compensatory pauses will be observed, the duration of which will depend on the moment the extrasystoles begin.

Extrasystoles of the ventricular type are the most dangerous, because they can turn into tachycardia. If the patient has myocardial infarction, then such extrasystoles can occur at all points of the heart muscle and even lead to ventricular fibrillation. Symptoms of extrasystole are manifested in the form of "fading" or "shock" in the chest.

On the ECG, ventricular extrasystoles are accompanied by compensatory pauses, the ventricular complex will occur prematurely without a P wave, and the T wave will be directed in the opposite direction from the QRS complex of the extrasystole.

Atrioventricular extrasystoles are extremely rare. They may begin with excitation of the ventricles or with simultaneous excitation of the atria and ventricles.

Causes

The causes of extrasystoles depend on their nature and are divided into:

• heart disease: defects, heart attacks;
• alcohol abuse;
• constant stress, nervous tension, depression;
• physical activity on the body;
• medications (often the disease occurs as a result of taking drugs that are prescribed for bronchial asthma).

Symptoms of the disease

Extrasystolic arrhythmia can pass without pronounced symptoms. Patients who suffer from vegetative-vascular dystonia tolerate it worse than, say, patients with organic heart disease.

Ventricular extrasystole is felt as a push or blow to the chest. This is due to a sharp contraction of the ventricles after a compensatory pause. Patients may feel interruptions in the work of the heart, its "somersaults". Some compare the symptoms of ventricular premature beats to riding a roller coaster.

Functional extrasystolic arrhythmia is often accompanied by bouts of weakness, sweating, hot flashes, and a feeling of discomfort.

Dizziness can be observed in patients with signs of atherosclerosis, and in violation of cerebral circulation, fainting, aphasia and paresis can occur. In ischemic heart disease, extrasystole may be accompanied by angina attacks.

Treatment

Treatment of extrasystole should be accompanied by an accurate diagnosis, which will determine the place and shape of extrasystoles. If extrasystolic arrhythmia is not provoked by any pathological abnormalities or is not of a psycho-emotional nature, treatment is not required.

If the disease is caused by disorders in the endocrine, digestive, cardiovascular system, the treatment of extrasystole should begin with measures aimed at eliminating them.

The help of a neurologist will be needed if the disease occurs against the background of neurogenic factors. The patient is prescribed sedatives, various sedative herbal preparations and complete rest.

Functional ventricular extrasystole does not pose a threat to the patient's life, however, if it develops along with organic heart disease, the likelihood of a sudden death increases by 3 times.

Ventricular premature beats should be treated with radiofrequency ablation. The patient is prescribed a diet enriched with potassium, smoking, drinking alcoholic beverages and coffee are prohibited. Drug treatment is prescribed only if the patient does not experience positive dynamics: sedatives and ß-blockers. It is necessary to take medicines with small doses and under the strict supervision of a doctor.

If you are concerned about the symptoms of extrasystole, immediately consult a cardiologist and undergo a thorough examination. Remember that functional extrasystoles are not dangerous, however, ventricular extrasystoles can signal more serious heart problems that require immediate attention.

Extrasystole is a common form of heart rhythm pathology, caused by the appearance of single or multiple extraordinary contractions of the whole heart or its individual chambers.

According to the results of ECG Holter monitoring, extrasystoles are recorded in approximately 90% of the examined patients older than 50–55 years, both in those suffering from heart disease and in relatively healthy people. In the latter, “extra” heart contractions are not dangerous for health, and in people with severe cardiac pathologies, they can lead to serious consequences in the form of deterioration, relapse of the disease, and the development of complications.

Causes of extrasystole

In a healthy person, the presence of up to 200 extrasystoles per day is considered the norm, but, as a rule, there are even more of them. The etiological factors of functional arrhythmias of a neurogenic (psychogenic) nature are:

• alcohol and alcoholic drinks;
• drugs;
• smoking;
• stress;
• neuroses and neurosis-like states;
• drinking large amounts of coffee and strong tea.

Neurogenic extrasystole of the heart is observed in healthy, trained people involved in sports, in women during menstruation. Extrasystoles of a functional nature occur against the background of spinal osteochondrosis, vegetative dystonia, etc.

The causes of chaotic contractions of the heart of an organic nature are any damage to the myocardium:

• heart defects;
• cardiosclerosis;
• heart failure;
• inflammation of the membranes of the heart - endocarditis, pericarditis, myocarditis;
• dystrophy of the heart muscle;
• cor pulmonale;
• ischemic heart disease;
• heart damage in hemochromatosis, sarcoidosis and other diseases;
• damage to organ structures during cardiac surgery.

Thyrotoxicosis, fever, intoxication during poisoning and acute infections, and allergies contribute to the development of toxic arrhythmias. They can also occur as a side effect of certain drugs (digitis, diuretics, aminophylline, ephedrine, sympatholytics, antidepressants, and others).

The cause of extrasystole may be an imbalance of calcium, magnesium, potassium, sodium ions in cardiomyocytes.

Functional extraordinary contractions of the heart that appear in healthy people for no apparent reason are called idiopathic extrasystoles.

The mechanism of development of extrasystole

Extrasystoles are provoked by heterotopic excitation of the myocardium, that is, the source of impulses is not a physiological pacemaker, which is the sinoatrial node, but additional sources - ectopic (heterovascular) areas of increased activity, for example, in the ventricles, atrioventricular node, atria.

Extraordinary impulses emanating from them and propagating through the myocardium cause unplanned heart contractions (extrasystoles) in the diastolic phase.

The volume of blood ejected during an extrasystole is less than during a normal contraction of the heart, therefore, in the presence of diffuse or large-focal lesions of the heart muscle, frequent unscheduled contractions lead to a decrease in the IOC - the minute volume of blood circulation.

The sooner a contraction occurs from the previous one, the less blood ejection it causes. This, affecting the coronary circulation, complicates the course of existing heart disease.

In the absence of cardiac pathology, even frequent extrasystoles do not affect hemodynamics or affect, but only slightly. This is due to compensatory mechanisms: an increase in the force of contraction following an unscheduled one, as well as a complete compensatory pause, due to which the end-diastolic volume of the ventricles increases. Such mechanisms do not work in heart diseases, which leads to a decrease in cardiac output and the development of heart failure.

The significance of clinical manifestations and prognosis depend on the type of arrhythmia. Ventricular extrasystole, which develops as a result of organic damage to the heart tissue, is considered the most dangerous.

Classification

Gradation of rhythm pathology depending on the localization of the focus of excitation:

• . The most commonly diagnosed type of arrhythmia. Impulses that propagate only to the ventricles, in this case, can originate on any segment of the legs of the bundle of His or at the place of their branching. The rhythm of atrial contractions is not disturbed.
• Atrioventricular, or atrioventricular extrasystole. Occurs less frequently. Extraordinary impulses originate from the lower, middle or upper part of the Aschoff-Tavar node (atrioventricular node), located on the border of the atria with the ventricles. Then they spread up to the sinus node and atria, and also down to the ventricles, provoking extrasystoles.
• Atrial or supraventricular extrasystoles. The ectopic focus of excitation is localized in the atria, from where the impulses propagate first to the atria, then to the ventricles. An increase in episodes of such extrasystole can cause paroxysmal or atrial fibrillation.

Atrial extrasystole

There are also options for their combinations. Parasystole is a violation of the heart rhythm with two simultaneous sources of rhythm - sinus and extrasystolic.

Rarely, sinus extrasystole is diagnosed, in which pathological impulses are produced in the physiological pacemaker - the sinoatrial node.

Regarding the causes:

• Functional.
• Toxic.
• Organic.

Regarding the number of pathological pacemakers:

• Monotopic (one focus) extrasystole with monomorphic or polymorphic extrasystoles.
• Polytopic (several ectopic foci).

Concerning the sequence of normal and additional abbreviations:

• Bigemia - the rhythm of the heart with the appearance of an "extra" contraction of the heart after each physiologically correct.
• Trigeminia - the appearance of an extrasystole every two systoles.
• Quadrihymenia - following one extraordinary heartbeat every third systole.
• Allorhythmia - regular alternation of one of the above options with a normal rhythm.

Regarding the time of occurrence of an additional impulse:

• Early. The electrical impulse is recorded on the ECG tape no later than 0.5 s. after the end of the previous cycle or simultaneously with h. T.
• Average. The impulse is registered no later than after 0.5 s. after registration of the T wave.
• Late. It is fixed on the ECG immediately before the P wave.

Gradation of extrasystoles depending on the number of consecutive contractions:

• Paired - extraordinary reductions follow in a row in pairs.
• Group, or salvo - the occurrence of several consecutive contractions. In the modern classification, this option is called unstable paroxysmal tachycardia.

Depending on the frequency of occurrence:

• Rare (do not exceed 5 contractions per minute).
• Medium (from 5 to 16 per minute).
• Frequent (more than 15 contractions per minute).

Clinical picture

Subjective sensations for different types of extrasystole and for different people are different. Those who suffer from organic heart disease do not feel “excessive” contractions at all. Functional extrasystole, the symptoms of which are more difficult for patients with vegetovascular dystonia, is manifested by strong tremors of the heart or its beats in the chest from the inside, interruptions with fading and subsequent increase in rhythm.

Functional extrasystoles are accompanied by symptoms of neurosis or failure of the normal functioning of the autonomic nervous system: anxiety, fear of death, sweating, pallor, a feeling of hot flashes or lack of air.

Patients feel that the heart "turns over or somersaults, freezes", and then can "gallop". A short-term sinking of the heart resembles the feeling of a rapid fall from a height or a rapid descent on a high-speed elevator. Sometimes shortness of breath and acute pain in the projection of the apex of the heart, lasting 1-2 seconds, joins the above manifestations.

Atrial extrasystole, like most functional ones, often occurs at rest, when a person is lying or sitting. Organic extrasystoles appear after physical activity and rarely at rest.

In patients with vascular and heart disease, unplanned frequent burst or early contractions reduce renal, cerebral and coronary blood flow by 8–25%. This is due to a decrease in cardiac output.

In patients with atherosclerotic changes in the vessels of the brain, extrasystole is accompanied by dizziness, tinnitus and transient disorders of cerebral circulation in the form of temporary loss of speech (aphasia), fainting, and various paresis. Often in people with coronary heart disease, extrasystoles provoke an angina attack. If the patient has problems with the rhythm of the heart, then the extrasystole only aggravates the condition, causing more serious forms of arrhythmia.

Extraordinary contractions of the heart muscle are diagnosed in children of any age, even during their prenatal development. In them, such a violation of the rhythm can be congenital or acquired.

The causes of the appearance of pathology are cardiac, extracardiac, combined factors, as well as determined genetic changes. The clinical manifestations of extrasystole in children are similar to the complaints made by adults. But as a rule, in babies, such arrhythmia is asymptomatic and is found in 70% of cases only during a general examination.

Complications

Supraventricular extrasystole often leads to atrial fibrillation, various forms of atrial fibrillation, changes in their configuration, and heart failure. Ventricular form - to paroxysmal tachyarrhythmia, fibrillation (flicker) of the ventricles.

Diagnosis of extrasystole

It is possible to suspect the presence of extrasystoles after collecting patient complaints and a physical examination. Here it is necessary to find out constantly or periodically a person feels interruptions in the work of the heart, the time of their appearance (during sleep, in the morning, etc.), the circumstances that provoke extrasystoles (experiences, physical activity, or, conversely, a state of rest).

When collecting an anamnesis, it is important that the patient has diseases of the heart and blood vessels or past diseases that give complications to the heart. All this information allows you to pre-determine the form of extrasystoles, frequency, time of occurrence of unscheduled "beats", as well as the sequence of extrasystoles relative to normal heartbeats.

Laboratory research:

1. Clinical and biochemical blood tests.
2. Analysis with the calculation of the level of thyroid hormones.

According to the results of laboratory diagnostics, it is possible to identify an extracardiac (not associated with cardiac pathology) cause of extrasystole.

Instrumental research:

• Electrocardiography (ECG)- a non-invasive method of studying the heart, which consists in graphic reproduction of the recorded bioelectric potentials of the organ using several skin electrodes. By studying the electrocardiographic curve, one can understand the nature of extrasystoles, frequency, etc. Due to the fact that extrasystoles can occur only during exercise, an ECG performed at rest will not fix them in all cases.
• Holter monitoring, or daily ECG monitoring- a study of the heart, which allows, thanks to a portable device, to record an ECG throughout the day. The advantage of this technique is that the electrocardiographic curve is recorded and stored in the device's memory under the conditions of the patient's daily physical activity. During the daily examination, the patient makes a list of recorded time periods of physical activity (climbing stairs, walking), as well as the time of taking medications and the appearance of pain or other sensations in the heart area. To detect extrasystoles, full-scale Holter monitoring is more often used, carried out continuously for 1-3 days, but mostly no more than 24 hours. Another type - fragmentary - is assigned for the registration of irregular and rare extrasystoles. The study is carried out either continuously or intermittently for a longer time than full-scale monitoring.
• Bicycle ergometry- a diagnostic method, which consists in recording ECG and blood pressure indicators against the background of constantly increasing physical activity (the subject rotates the pedals of the simulator-veloergometer at different speeds) and after its completion.
• Treadmill test- a functional study with a load, consisting of recording blood pressure and ECG while walking on a treadmill - treadmill.

The last two studies help to identify extrasystoles that occur only with active physical exertion, which may not be recorded with a conventional ECG and Holter monitoring.

To diagnose concomitant pathology of the heart, standard echocardiography (Echo KG) and transesophageal, as well as MRI or stress Echo KG are performed.

Treatment of extrasystole

The tactics of treatment is chosen based on the cause of occurrence, the form of pathological contractions of the heart and the localization of the ectopic focus of excitation.

Single asymptomatic extrasystoles of a physiological nature do not require treatment. Extrasystole, which appeared against the background of a disease of the endocrine, nervous, digestive system, is eliminated by the timely treatment of this underlying disease. If the cause was medication, then their cancellation is required.

Treatment of extrasystole of a neurogenic nature is carried out by prescribing sedatives, tranquilizers and avoiding stressful situations.

The appointment of specific antiarrhythmic drugs is indicated for severe subjective sensations, group polyotopic extrasystoles, extrasystolic allorhythmia, grade III–V ventricular extrasystole, organic myocardial damage, and other indications.

The choice of the drug and its dosage are selected in each case individually. A good effect is given by novocainamide, cordarone, amiodarone, lidocaine and other drugs. Usually, the drug is first prescribed in a daily dose, which is then adjusted, switching to maintenance. Some drugs from the group of antiarrhythmics are prescribed according to the scheme. In case of ineffectiveness, the drug is changed to another.

The duration of treatment for chronic extrasystole ranges from several months to several years, antiarrhythmics in the malignant ventricular form are taken for life.

The ventricular form with an unscheduled heart rate of up to 20-30 thousand per day in the absence of a positive effect or the development of complications from antiarrhythmic therapy is treated with a surgical method of radiofrequency ablation. Another method of surgical treatment is open heart surgery with excision of the heterotopic focus of excitation of cardiac impulses. It is carried out during another intervention of the heart, for example, valve prosthetics.