Extrasystole

Extrasystole

Extrasystole – premature depolarization and contraction of the heart or its individual chambers, the most frequently recorded type of arrhythmias. Extrasystoles can be found in 60-70% of people. Basically, they are functional (neurogenic) in nature, their appearance is provoked by stress, smoking, alcohol, strong tea and especially coffee. Extrasystoles of organic origin appear when the myocardium is damaged (CHD, cardiosclerosis, dystrophy, inflammation). An extraordinary impulse can come from the atria, the atrioventricular junction, and the ventricles. The occurrence of extrasystoles is explained by the appearance of an ectopic focus of trigger activity, as well as the existence of a reentry mechanism. The temporal relationship of the extraordinary and normal complexes characterizes the interval of adhesion.

• • Classification
  • Monotonous (monomorphic, single-focal) extrasystoles – one source of occurrence, constant (fixed) clutch interval in the same ECG lead (even with different durations of the QRS complex)
  • Polytopic extrasystoles – from several ectopic foci, various linkage intervals in the same ECG lead (differences are more than 0.02-0.04 s)
  • Unsustainable paroxysmal tachycardia – three or more extrasystoles following one after another (previously referred to as group, or volley, extrasystoles). As well as polytopic extrasystoles, they indicate a pronounced electrical instability of the myocardium.
  • Compensatory pause – the duration of the period of electrical diastole after extrasystole. Divided into complete and incomplete
  • Full – the total duration of a shortened diastolic pause before and an extended diastolic pause after an extrasystole is equal to the duration of 2 normal cardiac cycles. Occurs when there is no impulse propagation in a retrograde direction to the sinoatrial node (it does not discharge)
  • Incomplete – the total duration of a shortened diastolic pause before and an extended diastolic pause after an extrasystole is less than the duration of 2 normal cardiac cycles. Usually, an incomplete compensatory pause is equal to the duration of a normal cardiac cycle. Occurs if the condition of discharge of the sinoatrial node is observed. Elongation of the postectopic interval does not occur with interpolated (inserted) extrasystoles, as well as late replacement extrasystoles. Gradation of ventricular extrasystoles
  • I – up to 30 extrasystoles for any hour of monitoring
  • II – more than 30 extrasystoles for any hour of monitoring
  • III – polymorphic extrasystoles
  • IVa – monomorphic paired extrasystoles
  • IVb – polymorphic paired extrasystoles
  • V – three or more extrasystoles in a row with an ectopic rhythm more than 100 per minute. Frequency (for 100% the total number of extrasystoles is taken)
  • Sinus extrasystoles – 0.2%
  • Atrial extrasystoles – 25%
  • Extrasystoles from the atrioventricular junction – 2%
  • Ventricular extrasystoles – 62.6%
  • Various combinations of extrasystoles – 10.2%. Etiology
  • Acute and chronic heart failure
  • ischemic heart disease
  • Acute respiratory failure
  • Chronic obstructive pulmonary disease
  • Osteochondrosis of the cervical and thoracic spine
  • Viscerocardial reflexes (diseases of the lungs, pleura, abdominal organs)
  • Intoxication with cardiac glycosides, aminofillin, adrenomimetic products
  • Reception of TAD, B-adrenergic agonists
  • Physical and mental stress
  • Focal infections
  • caffeine nicotine
  • Electrolyte imbalance (especially hypokalemia).

Clinical picture

• • Manifestations are traditionally absent, especially with the organic origin of extrasystoles.
  • Complaints about tremors and strong heart beats due to vigorous ventricular systole after a compensatory pause, a feeling of sinking in the chest, a feeling of a stopped heart.
  • Symptoms of neurosis and dysfunction of the autonomic nervous system (more typical for extrasystoles of functional origin): anxiety, pallor, sweating, fear, feeling short of breath.
  • Frequent (especially early and group) extrasystoles lead to a decrease in cardiac output, a decrease in cerebral, coronary and renal blood flow by 8-25%. With stenosing atherosclerosis of the cerebral and coronary vessels, transient cerebrovascular accidents (paresis, aphasia, fainting), angina attacks may occur.

Treatment: Management Tactics

• • Elimination of provoking factors, treatment of the underlying disease.
  • Single extrasystoles without clinical manifestations are not corrected.
  • Treatment of neurogenic extrasystoles
  • Compliance with the regime of work and rest
  • Dietary advice
  • Regular exercise
  • Psychotherapy
  • Tranquilizers or sedatives (for example, diazepam, valerian tincture).
  • Indications for treatment with specific antiarrhythmic products
  • Expressed subjective sensations (interruptions, a feeling of sinking heart, etc.), sleep disturbances
  • Extrasystolic allorhythmia
  • Early ventricular extrasystoles superimposed on the T wave of the previous cardiac cycle
  • Frequent single extrasystoles (more than 5 per minute)
  • Group and polytopic extrasystoles
  • Extrasystoles in the acute period of MI, as well as in patients with postinfarction cardiosclerosis.

See also Cardiac arrhythmias, Extrasystole, Ventricular extrasystole, Atrial extrasystole, Extrasystole from the atrioventricular node

ICD

• 149.3 Premature ventricular depolarization
• 149.1 Premature atrial depolarization