Extrasystole: Symptoms and Treatment
Extrasystole is one of the most common varieties of arrhythmias (ie, irregularities in the heart rhythm), characterized by the appearance of an extraordinary shortening of the heart muscle or by several extraordinary abbreviations. Extrasystoles, the symptoms of which arise not only in patients but also in healthy people, can be triggered by fatigue, psychological stress, and also by some other external stimuli.
Extrasystoles, which can be caused even by the use of caffeine, alcohol or tobacco, in addition to the factors noted by us in the form of overstrain and overfatigue, is a relatively safe state for a person, his life and health. Meanwhile, if it is a question of its appearance in individuals for whom cardiovascular diseases are present in one form or another, then in this case extrasystole plays the role of an increased risk factor.
The appearance of extrasystole is explained by the appearance of ectopic foci, characterized by increased activity and localized outside the sinus node (i.e., in the ventricles, atria or at the atrioventricular node). The extraordinary pulses formed in these foci begin to spread along the cardiac muscle, thus provoking premature cardiac contractions to the diastole phase.
The volume of ejection of blood with extrasystole is below normal, for this reason, frequent extrasystoles (extraordinary contractions of individual parts of the heart), which occur more often 6-8 times per minute, can lead to noticeable changes in the minute volume of blood circulation. It should be noted that the earlier the extrasystole begins to develop, the less the amount of blood accompanying the extrasystolic ejection, respectively. These features, first of all, are reflected in the coronary blood flow, and can also substantially complicate the cardiac pathology that is already topical for the patient.
Depending on the particular type of extrasystole, their individual clinical significance is determined, as well as their corresponding prognostic characteristics. The most dangerous extrasystoles are gastric. Their development is accompanied by the presence of organic damage to the heart, against which they actually arise.
Types of extrasystole
Depending on the area in which the formation of ectopic foci of excitation occurs, ventricular extrasystole, extrasystole, atrioventricular and atrial extrasystoles are determined. Besides this, some variants of their combination are also singled out. Exceptionally rare cases indicate that extraordinary impulses appear from the sinus-atrial node, that is, from the physiological pacemaker.
In some cases, there are two simultaneous rhythms, that is, sinus and extrasystolic rhythms, which is defined as parasystole.
The following pair of extrasystoles are called paired, if there are more than two, the extrasystoles are called group (or salvo).
A rhythm is also distinguished, in which normal systoles alternate with extrasystoles (i.e. bigemini), a rhythm in which two normal systoles alternate with extrasystole (trigemini) and a rhythm in which the extrasystole follows each third normal contraction. Regular repetition of bigeminy, trigeminy and quadrigeminy determines these conditions as allorhythmia.
Depending on the frequency of formation of extrasystoles, rare extrasystoles are detected (up to 5 per 1 minute), extrasystoles average (from 6 to 15 per 1 minute), and frequent extrasystoles (more than 15 times per minute). Depending on the number of emerging ectopic foci, extrasystole with one focus (monotopic) and extrasystole with several foci (polytopic) are determined.
Depending on the etiological factors, such types of extrasystoles as functional extrasystoles, toxic extrasystoles and organic extrasystoles are determined.
They represent disturbances in the rhythm of psychogenic (neurogenic) origin. They are connected with chemical factors of influence, with the use of alcohol and drugs, with smoking, etc. Functional extrasystole is also recorded in patients diagnosed with autonomic dystonia, osteochondrosis, neuroses and other conditions.
As an example of the considered variety of extrasystole, an arrhythmia that occurs in trained and completely healthy sportsmen can be noted. It can also be noted the frequency of development of functional extrasystole in women during the onset of menstruation. Functional extrasystoles are provoked, among other things, by stresses and by the use of such strong drinks as coffee and tea.
In the case of developing a functional extrasystole without any predisposing factors to it in healthy people, it is defined as an idiopathic functional extrasystole.
The relevance of this variety of extrasystole is determined by the lesion occurring in the myocardium, which occurs particularly in conditions such as myocardial infarction, ischemic heart disease, myocarditis, cardiosclerosis, pericarditis, heart defects, myocardial damage due to sarcoidosis, hemochromatosis, amyloidosis, and Also produced surgical interventions. In athletes the formation of extrasystole may in some cases arise due to myocardial dystrophy, which is formed due to physical overstrain.
In this case, the development of extrasystole of this type occurs as a result of feverish conditions, with thyrotoxicosis and side effects caused by certain medications (caffeine, ephedrine, glucocorticoids, diuretics, sympatholytics, etc.).
Often the development of extrasystole is caused by a violation in the ratio of sodium, calcium, magnesium and potassium ions in the myocardium cells, due to which there is a negative effect on the conduction system of the heart muscle.
During physical exertion, extrasystole may be triggered due to metabolic and cardiac disorders, in addition, physical exertion can also exert a suppressive effect on extrasystoles formed against a background of vegetative dysregulation.
With extrasystoles, sensations of a subjective nature do not always have the expressiveness of their own manifestations. The most severe is the tolerance of extrasystoles in those individuals for whom the actual nature is diagnosed with vegeto-vascular dystonia. At the same time, people who have cardiac lesions on an organic scale may, on the contrary, be much more likely to tolerate a state of extrasystole.
In most of its manifestations, extrasystoles are expressed in a kind of impact or a jerk that arises in the chest from its inner side. Such manifestations are caused by vigorous contractions of the ventricles that appear after the compensatory pause.
In addition, there are also manifestations of this condition, such as «turning over, tumbling» of the heart in combination with interruptions in its work and with fading. For functional extrasystole, the typical manifestations are hot flashes, anxiety, weakness, general discomfort, lack of air and excessive sweating.
Frequent extrasystoles with their characteristic group and early character lead to a decrease in cardiac output, respectively, this provokes a reduction in the order of up to 25% of the parameters of the cerebral, renal and coronary circulation. Patients who have signs of atherosclerosis, experience dizziness, in addition to developing and can develop the transient forms of violations related to cerebral circulation (paresis, aphasia, fainting). Patients with IHD, in turn, face angina attacks.
Extracorpia: major complications
Extracorporeal group-type manifestations tend to transform into far more significant disturbances in rhythm. So, atrial disorders go into atrial flutter, ventricular disturbances are transformed into paroxysmal tachycardia. Patients with dilation or atrial overload may experience extrasystole transition to a ciliary arrhythmia.
In the case of frequent occurrence, extrasystole provokes the occurrence of chronic failure of renal, cerebral and coronary circulation. The most dangerous are ventricular extrasystoles, because the peculiarities of their course can lead to the development of fibrillation of the ventricles, which, in turn, leads to a sudden lethal outcome.
Diagnosis of the extrasystole
The main objective method for diagnosing extrasystole lies in the ECG study, meanwhile, it is possible to assume the possibility of having this kind of arrhythmia also during the physical examination. In addition, a complaint from the patient also plays a role in diagnosing the disease.
Treatment of extrasystole
In determining the appropriate treatment tactics, the form of the extrasystole and the area of its localization are taken into account. Not caused by cardiac pathology, single extrasystoles do not require any therapy in their relationship. If the development of extrasystoles due to diseases of the endocrine or digestive system, as well as diseases of the heart muscle, it is necessary to begin treatment with therapy focused on the underlying disease.
Extrasystolia, arising on the background of neurogenic factors, requires additional consultation of a neurologist. In addition, special sedation or sedation medications are prescribed. The extrasystole that has arisen as a side effect of taking medication requires immediate cancellation.
The ventricular form of the extrasystole requires treatment with the radiofrequency ablation method (or RFA of the heart). This method is also indicated for use in the absence of efficacy of antiarrhythmic therapy, severe tolerability, or in the presence of unfavorable predictions for this type of treatment.
If you suspect that you have an extrasystole, you need to seek advice from a cardiologist who, given the urgency of this diagnosis, will determine the necessary treatment based on your complaints and the relevant studies. In addition, as we have already noted, it is possible that you will need a consultation with a neurologist.