With extrasystole, a person feels interruptions in the heartbeat and symptoms characteristic of disruptions in hemodynamics. Arrhythmia manifests itself as extraordinary (intercalated) contractions, whose source is localized in the ventricular (ventricular) or supraventricular (supraventricular) region. Signs of extrasystole are clearly visible on the electrocardiogram (ECG). A cardiologist deciphers the information received. To independently analyze the complexes and intervals in each of the leads, you need to familiarize yourself with acceptable standards and examples of deviations.

Extrasystoles on the ECG are displayed quite clearly, which allows you to quickly differentiate them from other types of arrhythmias. Additionally, other examinations may be prescribed to find the cause of the failure and evaluate the functioning of the heart under the influence of irritating factors. For independent decoding, you need to find out the meaning of the leads, the features of the propagation of electrical impulses throughout the myocardium and the designation of the waves in the cardiogram.

On the tape displaying the results of electrocardiography, Latin symbols and numbers are drawn on the side. They are leads whose purpose is to record the propagation of electrical signals throughout the body. Each of them corresponds to a specific applied electrode. Most sensors are fixed in the chest area. The rest are on the upper and lower extremities. Leads are divided into standard (I-III, AVL, AVF, AVR) and chest (V1-V6). They visualize the passage of a signal through a certain fragment of the heart.

Data obtained from studying the electrical activity of the myocardium will help the doctor determine or refute the presence of certain abnormalities:

• location of the electrical axis of the heart;
• structural features of the myocardium;
• coherence of contractions of the ventricles and atria;
• functionality of the sinus node
• the degree of passage of impulses through the myocardium.

Due to structural differences in the cardiac sections (wall thickness, cavity size), electrical signals travel with a certain time difference. If not for this feature, in the conclusion the doctor could have characterized only 1 tooth. To obtain a complete picture of what is happening, all teeth, intervals and complexes must be described. An accurate diagnosis can be made after studying each fragment. It is also important to pay attention to the intervals between contractions. They are represented by a flat line called an isoline.

Teeth designation

Each wave will be characterized by a certain stage of contraction of the ventricles and atria:

• The impulse coming from the natural pacemaker (sinus node) moves through the right atrium to the left. Contraction of the upper sections occurs with a slight delay due to the localization of the signal source. The cardiogram displays the atrial rhythm with a positive (upward) P wave.
• After contraction (systole) of the atria, the impulse moves to the atrioventricular (atrioventricular) node. In composition, it is a cluster of myocardial nerve cells, thanks to which the signal does not stay in one place and continues to spread quickly. On the electrocardiogram, the segment is characterized by P-Q waves. There is an isoline between them.
• Descending into the His bundle, the signal enters the gastric space. The left leg leads it into the left ventricle, and the right leg into the right. The impulse takes longer to travel in the ventricular space than in the supraventricular space due to the thickness of the myocardial layer. This area is displayed on the cardiogram as a high positive R wave. It is preceded by a negative (downward facing) Q wave.

• After contraction of the ventricles, the relaxation phase (diastole) begins. It is displayed on the ECG as a negative S wave. Next comes the isoline, and then a positive T wave. S-T segment indicates the readiness of the myocardium for a new cycle of contractions.

When deciphering the cardiogram, attention should be paid to the U wave, which follows the T wave. Normally, it is positive and is displayed only in some leads (V1–V4, II, III, AVF). The clinical role is not known for certain.

The contraction frequency is determined by dividing the R-R segment by 60, which represents the complete cardiac cycle. In the presence of severe forms of arrhythmia (atrial or ventricular fibrillation), you will have to limit yourself not to a single cycle, but to ten, from which the average value will have to be calculated.

Objective indicators of extrasystole

The reason for contacting a doctor and further electrocardiography is the occurrence of symptoms of extrasystole. The patient feels interruptions in the work of the heart associated with the inferiority of extraordinary contractions. The atria and ventricles do not have time to fill with blood, which leads to disruptions in hemodynamics. Single extrasystoles are not particularly noticeable, but their increase provokes the following clinical picture:

• panic attack;
• dyspnea;

• weakness;
• excessive sweating;
• dizziness;
• hot flashes.

Signs of extrasystole are a consequence of impaired heart function and resulting brain hypoxia. If left untreated, arrhythmia can eventually develop into more severe forms and provoke the development of ischemia, myocardial infarction and heart failure.

A visit to a doctor begins with a questioning of the patient to clarify the necessary nuances. Then an inspection is carried out. During auscultation, the doctor will hear premature weak tones, followed by a distinct murmur characteristic of the ventricular complex. The diagnosis is confirmed by electrocardiography. With its help, the doctor will be able to achieve the following goals:

• detect extrasystoles;
• localize the focus of ectopic (replacement) impulses;
• determine the frequency of extraordinary contractions.

To obtain reliable data, the patient should prepare for the procedure, since certain actions are prohibited before it is carried out:

• binge eating;
• smoking;
• drinking coffee and energy drinks;
• alcohol consumption;
• physical overload;
• stress.

If all recommendations are followed, the final result will reflect the real picture of what is happening. The left ventricular and right ventricular forms of extrasystole on the ECG differ in the size of the QRS complex in certain leads. The difference between extraordinary and normal atrial contractions is more difficult to see. Doctors only note different intercalary segments in the middle of regular systoles.

Single extrasystoles occur after 15 or more normal contractions. Group insertion contractions follow 2-3 at a time. False signals come from one or more sources. In the first case we are talking about a monotopic form of arrhythmia, and in the second – about a polytopic one. Extrasystoles can be early (after systole), middle (between systoles) and late (before systole). If there is a certain rhythm, we are talking about alloarrhythmia:

• bigeminy appears after 1 systole;
• trigemyny occurs after 2 contractions;
• quadrigeminia is detected after 3 systoles.

Variants of manifestation of extraordinary contractions on the cardiogram

Depending on the location of the ectopic focus and the number of intercalary contractions, extrasystole on the cardiogram may appear as follows:

Name of deviation	Main features
The false impulse is localized in the atrium (lower, middle or upper part).	A slightly modified P wave appears ahead of time. It is characterized by a negative (middle part), positive (upper part) and biphasic (lower part) arrangement. There is no diastolic (compensatory) pause.
The intercalary contraction is provoked by a signal from the atrioventricular node.	The extraordinary P wave is directed downward. Sometimes it appears behind the QRS complex. The PQ segment is actually missing. The ventricular complex remains unchanged.
Single ectopic signals arrive from the ventricle.	The QRS intercalary complex is widened and deformed. A false P wave does not occur.
Paired signals come from the ventricle or atrium.	There are 2 intercalary complexes in a row next to each other.
Impulses come from several foci of replacement signals	Extrasystoles differ in the length of the interval and the shape of the teeth, depending on the location of the ectopic focus.

ECG signs of atrial extrasystoles

Intercalary contractions that occur in the atria are displayed on the cardiogram in the form of premature P waves, which can overlap the T wave. The false impulse moves along the signal route of the sinus node (through the atrioventricular node). R-R interval remains within the normal range, and the ventricular complex is not deformed. Changes occur if the bundle branches are blocked.

Lengthening of the P-R segment or blocking of a false signal occurs when an ectopic impulse enters the atrioventricular node or His bundle until their patency is restored. Sometimes the process is accompanied by signs of heart block. The ventricular complexes expand against the background of the resulting deviation. If it is not possible to see an extraordinary P wave before the QRS segment, then the doctor may mistakenly diagnose ventricular extrasystole instead of supraventricular.

Atrioventricular (nodal) form of extrasystole

Nodal extrasystole is manifested by a premature, but not altered QRS complex. The excitation wave from the atrioventricular node can diverge to both the atria and the ventricles. Such an impulse provokes the formation of a negative P wave, localized before, after, or together with the ventricular complex. The deviation depends on the speed of propagation of the ectopic signal.

Ventricular extrasystole on ECG

Ventricular extrasystoles are characterized by a wide intercalary ventricular complex. Before the QRS segment, the intercalary P wave does not appear. Early intercalary contractions of the ventricles can be combined with previous T waves, especially when the extrasystole transitions into tachyarrhythmia and fibrillation. Late extrasystoles appear immediately behind the normal P wave.

After the intercalary contraction, in most cases there is a short pause. In its absence, the ECG shows a sandwiched extraordinary QRS complex between 2 normal ones. Such an extrasystole is called interpolated.

The ventricular form of arrhythmia affects the atria as the signal propagates through the atrioventricular node. On the cardiogram you can see a deformed P wave, combined with a ventricular extrasystole. If the ectopic impulse is not transmitted from the ventricle to the atrioventricular node, then the atria work in their usual rhythm. There are cases when the impulse does not completely enter the ventricular space into the supraventricular space (at the moment of incomplete restoration of the His bundle). The ECG displays such a deviation by widening the P-R interval.

Detailed ECG diagnostics

Functional extrasystoles that occur after stress and overload are difficult to detect during electrocardiography. Doctors prescribe additional examination methods:

• Daily Holter monitoring will allow you to see how the heart works over a 24-hour period.
• Bicycle ergometry is prescribed to assess heart rate during physical activity.

The results obtained may be characteristic of several pathological processes. For a more accurate diagnosis, it is recommended to undergo echocardiography (EchoCG) and donate blood for tests. Based on the final data, the doctor will make a diagnosis for the patient. It will be necessary to treat not the failure of the heartbeat, but the underlying disease causing it. If extrasystoles occur under the influence of irritating factors, then you should try to avoid them.

On the ECG, extrasystoles are displayed as premature ventricular or atrial complexes. From them, the doctor can understand where the focus of ectopic impulses is located and what the shape of the arrhythmia is. If cardiac symptoms are detected, the patient will only need to go to the clinic for an electrocardiogram. Additionally, other examination methods may be prescribed to accurately differentiate the pathological process that causes an abnormal heartbeat.

Extrasystole on an ECG indicates the display on film of premature extraordinary contractions of the heart muscle along with normal and regular contractions. Depending on the number and type of extrasystoles, the type of disease is determined. An electrocardiogram makes it possible to identify associated disorders.

How is an ECG performed during extrasystole?

Electrocardiography refers to an objective method for diagnosing extrasystole. This is a kind of non-invasive electrophysiological test, thanks to which the doctor records the bioelectric potential of the heart. The method has no contraindications or adverse reactions.

During the examination, the patient must take a supine position and remain motionless. The doctor attaches special electrode sensors to the area of ​​the chest, ankles and wrists, which transmit readings to the ECG equipment monitor, after which the information is displayed on a sheet of paper in the form of a graphic image.

What does an electrocardiogram evaluate:

• degree of excitability and conductivity;
• level of automaticity of contractions;
• repolarization and depolarization.

What the registration tape contains:

1. Personal information of the patient:

• surname, first name, patronymic;
• gender and age;

1. Research indicators – electrical axis, heart rate, etc.
2. Equipment data:

• device sensitivity level;
• speed of movement of a sheet of paper.

Is advance preparation necessary?

Preliminary preparation for an ECG is not difficult, but it is necessary to obtain reliable information.

What not to do:

• drink strong tea and coffee;
• drink alcoholic beverages;
• engage in physical exercise;
• smoke;
• be nervous;
• overeat

What should be done:

• calm the psycho-emotional state;
• relax;
• think about something pleasant.

Decoding

The interpretation of the electrocardiogram is carried out exclusively by a specialist. Depending on the length of the compensatory pause (CP), extrasystole may have the following indicators:

1. Full– double or more CP distance between post-extrasystoles and pre-extrasystoles (R-R waves).
2. Incomplete– the length of the CP is less than twice the normal distance, but more than one normal distance between R-R.

According to the time of occurrence of extraordinary extrasystoles:

1. Early view characterized by an extraordinary impulse in diastole along with the T wave. The formation of an early extrasystole after the previous cycle for 0.05 seconds is possible.
2. Medium type extrasystole - the occurrence of an impulse 0.45-0.50 seconds after the T wave.
3. Late view– an extraordinary rhythm is noted before the R or P waves.

Electric axis

The parameter is based on the excitation of the ventricles. The S, R, Q waves in leads 1 and 3 are analyzed. Thanks to this, the excitation vector is calculated and the functioning of the branches of the His bundle is established. The result is an angle of inclination, which is assessed according to the following criteria:

• normal – 50-70 degrees;
• right-side deviation - from 70 to 90 degrees;
• left-side deviation – 0-50°;
• serious disturbances in the His bundle: tilt more than 90 degrees and less than 30.

Prongs

Each tooth has its own purpose and lies above the isoline:

1. R– contraction and relaxation occur in the atrium.
2. Q, S– negative waves, reflecting excitation in the interventricular septum.
3. R– contraction occurs in the ventricle, refers to the positive wave.
4. T– repolarization is observed in the ventricle.

If a complex of positive and negative waves is noted, for example, QRS, one can talk about displaying the moment of systole in the ventricles.

Intervals

Intervals include ECG sections that are located on an isoline. The pulse propagation time, indicated by PQ, is displayed.

Conducting pathways:

• AV node;
• trunk of the His bundle;
• bundle branches;
• Purkinje fibers.

Segments

Segments include ECG sections that combine a wave and an interval:

1. TR denotes diastole time.
2. ST- a period of complete excitation in the ventricles.
3. QRST– duration of ventricular contraction.

How are different types of extrasystoles displayed on an ECG?

Each type of extrasystole is characterized by certain displays on the electrocardiogram, since all forms of the disease have distinctive features.

Atrial extrasystole

It is characterized by the occurrence of an electrical impulse in the atrium, that is, an ectopic focus. Differs in the following signs on the electrocardiogram:

1. When the signal is generated in the atrium, a premature P wave begins to form, which is significantly different from the same wave, but in a normal rhythm. This happens due to the propagation of active waves in different directions. In some cases, the P wave is superimposed on the T after the QRS complex, transforming it.
2. The direction of the extraordinary atrial impulse is through the bundle branches and the atrioventricular junction. In this case, the ventricular complex and PR interval do not change. In cases where the bundle branch is blocked, pathological changes occur in the ventricles, against which the QRS complex is disrupted with premature atrial rhythms.
3. Sometimes impulses from the ectopic focus of the atrium reach the atrioventricular junction or bundle branches. After this, complete restoration of conduction occurs, but after the previous atrial impulse. To put it simply, they partially or completely do not perceive arousal. Against this background, an extension of the PR interval is noted or an extraordinary atrial extrasystole is blocked.
4. If unresponsiveness is observed in the bundle branches, a block is formed. And in the ventricular complexes expansion occurs.
5. If early P waves do not appear before the QRS complex, then an erroneous diagnosis is possible, since premature atrial impulses are often confused with ventricular extrasystoles.

This is what an ectopic right atrial impulse with a negative P wave looks like on a cardiogram:

Atrioventricular extrasystole

Atrioventricular or nodal extrasystole is characterized by the appearance of extraordinary impulses that come from the sinus node. More often occurs with an early ventricular complex that has a normal configuration. Electrocardiography shows extraordinary QRS complexes that appear prematurely.

A negative P wave is detected - aVF, 2 and 3, which occurs after a premature QRS complex. Sometimes the P wave appears along with the ventricular complex, but in this case the compensatory pause is incomplete.

Distinctive feature– the generation focus, located in the atrioventricular junction, transmits excitation to both the ventricles and atria, against the background of which a negative P wave is formed. Depending on the speed of transmission of the early impulse, the focus can be recorded before or after the ventricular complex. Sometimes it is combined with it.

The photo shows an electrocardiogram with a negative P-wave in front of the ventricular complex:

Ventricular extrasystole

When they occur in the ventricles, but the excitation does not pass through the His bundle, but is directed through the heart muscle with minimal conductivity. Due to this disrupted sequence and delayed activation of the ventricles, the QRS complex widens and becomes deformed. Feature - if early widened ventricular complexes are noted, the appearance of an early P-wave is impossible.

Other features on the ECG:

1. Excessively early ventricular impulses are combined with the T wave from the previous extrasystole. This is the most common initiation of such extraordinary signals in ventricular fibrillation.
2. When a premature gastric impulse is formed for a short time after a normal contraction, the extrasystole appears immediately after the P wave (normal). In this case, premature ventricular impulses are called end-diastolic.
3. Often, immediately after a premature ventricular contraction there is a pause. When it is absent, the electrocardiogram shows the compression of the pathological impulse between 2 normal extrasystoles. This is called an interpolated view of the extrasystole.
4. Atrial activity after ventricular contractions may vary depending on the direction of the premature impulse. When the excitation is directed to the atria (through the atrioventricular node), the P wave appears in a transformed form, as it combines with the ventricular extrasystole.
5. When excitation does not pass through the atrioventricular node, the activity of the extrasystoles continues, but a compensatory pause occurs after each extraordinary ventricular impulse.
6. In some cases, ventricular premature impulses penetrate partially into the atrioventricular junction, which is characterized by the achievement of normal AC signals at a time when partial susceptibility to excitation occurs. Conduction is slightly slower, which is reflected on the ECG monitor as an extended PR interval. This often occurs after interpolated ventricular signals.

The presented ECG fragment is characterized by a deformed and dilated ventricular complex, as a result of which a complete extended diastolic pause can be detected:

Advanced Diagnostics

Extrasystole can occur in a hidden, latent form, which does not appear on a 7-minute electrocardiography. Therefore, an additional Holter ECG is performed. Holter diagnostics involves attaching electrode sensors to the patient’s body for a day or longer.

Measurements are carried out automatically at rest and during physical activity of the patient. The device independently records all the data, which the doctor then transfers to the monitor of the electrocardiographic device. While wearing the device, the patient must clearly record in a diary the time of physical activity, sleep and rest, and other activities.

If these two methods do not provide complete information, the doctor recommends additional heart tests - treadmill test, bicycle ergometry.

An abnormal heart rhythm can be fatal, so seek help promptly.

In many cases, extrasystole on an ECG is detected immediately, since the method is considered objective and highly informative. But only a highly specialized doctor can correctly decipher the electrocardiogram indicators.

A common sign for all extrasystoles: premature appearance of the extrasystolic complex.

ECG signs atrial extrasystole:

- premature appearance of the P wave and the following QRST complex;

- deformation and change in the polarity of the P wave of the extrasystole;

— the presence of an unchanged extrasystolic ventricular QRS complex;

— the presence of a compensatory pause is the distance from the extrasystole to the PQRST cycle of the main rhythm that follows it.

At extrasystoles from the AV junction the impulse arising at the AV junction propagates in two directions: from top to bottom along the conduction system to the ventricles (in this regard, the ventricular complex of extrasystole does not differ from ventricular complexes of sinus origin) and from bottom to top along the AV node and atria.

ECG signs extrasystoles from the AV junction:

— premature appearance on the ECG of an unchanged ventricular QRST complex;

- a negative P wave after an extrasystolic QRS complex (if the ectopic impulse reaches the ventricles faster than the atria) or the absence of a P wave (with simultaneous excitation of the atria and ventricles (fusion of P and QRS).

ECG signs ventricular extrasystole:

- premature, extraordinary appearance on the ECG of an altered dilated and deformed ventricular QRS complex;

- absence of a P wave before the ventricular extrasystole;

— presence of a compensatory pause.

Treatment. Treatment is carried out in case of subjective intolerance to the feeling of interruptions in the heart, deterioration of the patient’s well-being, signs of hemodynamic disturbances, very frequent, group extrasystoles.

Exclusion of external arrhythmogenic factors (strong tea, coffee, alcohol, smoking) is required.

Drug therapy:

— For atrial extrasystoles, novocainamide, beta-blockers in combination with sedatives (Corvalol, valerian, motherwort), verapamil, etacizin are effective.

- For ventricular extrasystoles - amiodarone, procainamide, etacizine. For emergency relief of ventricular extrasystoles (for example, during myocardial infarction), lidocaine is administered intravenously.

Paroxysmal tachycardia .

Paroxysmal tachycardia is an attack of increased heart rate (heart rate more than 140-220 per minute), lasting from several seconds to several hours, with a sudden onset (the patient feels it as a “push” in the heart) and end.

In this case, the rhythm does not obey the sinus node, but the focus of automatism outside the sinus node.

Depending on the source of the rhythm, paroxysmal tachycardias are:

1) supraventricular (supraventricular) - can occur not only in heart pathology, but also in healthy individuals:

a) atrial;

b) atrioventricular;

2) ventricular - only with severe heart pathology.

All variants of paroxysmal tachycardia significantly worsen hemodynamics: diastolic filling of the ventricles, coronary blood flow decreases, and cardiac stroke volume (SV) decreases, which can lead to acute left ventricular failure. The higher the heart rate, the greater the hemodynamic disturbances.

Clinical picture of paroxysmal tachycardias.

During an attack, patients may experience rapid heartbeat, shortness of breath, pain in the heart area, dizziness, and general weakness. On examination, swelling of the neck veins, motor restlessness, pale skin are noted; it is almost impossible to count the pulse during an attack, and blood pressure decreases.

Diagnosis of supraventricular paroxysmal tachycardia .

ECG signs:

Ventricular extrasystole: causes, signs, treatment

Ventricular extrasystoles (VES) are extraordinary contractions of the heart that occur under the influence of premature impulses that originate from the intraventricular conduction system.

Under the influence of an impulse generated in the trunk of the His bundle, its branches, branching branches or Purkinje fibers, the myocardium of one of the ventricles contracts, and then the second ventricle without previous contraction of the atria. This explains the main electrocardiographic signs of PVCs: premature dilated and deformed ventricular complex and the absence of a normal P wave preceding it, indicating atrial contraction.

In this article, we will consider the causes of ventricular extrasystole, its symptoms and signs, and talk about the principles of diagnosis and treatment of this pathology.

Causes

Ventricular extrasystole can be observed in healthy people, especially with daily monitoring of the electrocardiogram (Holter-ECG). Functional PVCs are more common in people under 50 years of age. It can be triggered by physical or emotional fatigue, stress, hypothermia or overheating, acute infectious diseases, taking stimulants (caffeine, alcohol, tannin, nicotine) or certain medications.

Functional PVCs are often detected when the activity of the vagus nerve increases. In this case, they are accompanied by a rare pulse, increased salivation, cold wet extremities, and arterial hypotension.

Functional PVCs do not have a pathological course. When the provoking factors are eliminated, they most often go away on their own.

In other cases, ventricular extrasystole is caused by organic heart disease. For its occurrence, even against the background of heart disease, additional exposure to toxic, mechanical or autonomic factors is often required.

Often PVCs accompany chronic ischemic heart disease (angina pectoris). With daily ECG monitoring, they occur in almost 100% of such patients. Arterial hypertension, heart defects, myocarditis. heart failure and myocardial infarction are also often accompanied by ventricular extrasystole.

This symptom is observed in patients with chronic lung diseases and alcoholic cardiomyopathy. rheumatism. Extrasystole of reflex origin occurs, associated with diseases of the abdominal organs: cholecystitis, gastric and duodenal ulcers, pancreatitis, colitis.

Another common cause ventricular extrasystole is a metabolic disorder in the myocardium, especially associated with the loss of potassium by cells. These diseases include pheochromocytoma (a hormone-producing tumor of the adrenal gland) and hyperthyroidism. PVCs can occur in the third trimester of pregnancy.

Drugs that can cause ventricular arrhythmias include primarily cardiac glycosides. They also occur when using sympathomimetics, tricyclic antidepressants, quinidine, and anesthetics.

Most often, PVCs are recorded in patients who have serious changes on the resting ECG: signs of left ventricular hypertrophy. myocardial ischemia, rhythm and conduction disturbances. The frequency of this symptom increases with age and is more common in men.

Clinical signs

With a certain degree of convention, we can talk about different symptoms for functional and “organic” PVCs. Extrasystoles in the absence of severe heart disease are usually single, but are poorly tolerated by patients. They may be accompanied by a feeling of freezing, interruptions in heart function, and isolated strong beats in the chest. These extrasystoles often appear at rest, in a lying position, or during emotional stress. Physical tension or even a simple transition from a horizontal to a vertical position leads to their disappearance. They often occur against the background of a rare pulse (bradycardia).

Organic PVCs are often multiple, but patients usually do not notice them. They appear during physical activity and go away with rest, in a lying position. In many cases, such PVCs are accompanied by rapid heartbeat (tachycardia).

Diagnostics

The main methods of instrumental diagnosis of ventricular extrasystole are ECG at rest and 24-hour Holter ECG monitoring.

Signs of PVC on ECG:

Interpolated PVCs are distinguished, in which the extrasystolic complex is inserted, as it were, between two normal contractions without a compensatory pause.

If PVCs come from the same pathological focus and have the same shape, they are called monomorphic. Polymorphic PVCs emanating from different ectopic foci have different shapes and different coupling intervals (the distance from the previous contraction to the R wave of the extrasystole). Polymorphic PVCs are associated with severe cardiac damage and a more serious prognosis.

Early PVCs (“R to T”) are classified into a separate group. The criterion for prematurity is the shortening of the interval between the end of the T wave of sinus contraction and the beginning of the extrasystole complex. There are also late PVCs that occur at the end of diastole, which may be preceded by a normal sinus P wave, superimposed on the beginning of the extrasystolic complex.

VES can be single, paired or group. Quite often they form episodes of allorhythmia: bigeminy, trigeminy, quadrigeminy. With bigeminy, a VES is recorded through every normal sinus complex; with trigeminy, a VES is recorded every third complex, and so on.

During daily ECG monitoring, the number and morphology of extrasystoles, their distribution during the day, and dependence on load, sleep, and medication are specified. This important information helps determine the prognosis, clarify the diagnosis and prescribe treatment.

The most dangerous in terms of prognosis are considered to be frequent, polymorphic and polytopic, paired and group VES, as well as early extrasystoles.

The differential diagnosis of ventricular extrasystoles is carried out with supraventricular extrasystoles, complete block of the bundle branches, and escaped ventricular contractions.

If ventricular extrasystole is detected, the patient should be examined by a cardiologist. Additionally, general and biochemical blood tests, an electrocardiographic test with dosed physical activity, and echocardiography may be prescribed.

Treatment

Treatment of ventricular extrasystole depends on its causes. For functional PVCs, it is recommended to normalize the daily routine, reduce the use of stimulants, and reduce emotional stress. A diet enriched with potassium or drugs containing this trace element (Panangin) is prescribed.

For rare extrasystoles, special antiarrhythmic treatment is not prescribed. Herbal sedatives (valerian, motherwort) are prescribed in combination with beta-blockers. In case of JS against the background of vagotonia, sympathomimetics and anticholinergic drugs, for example, Bellataminal, are effective.

If the extrasystoles are organic, treatment depends on the number of extrasystoles. If there are few of them, ethmosin, etacizin or allapinin can be used. The use of these drugs is limited due to the possibility of their arrhythmogenic effects.

If extrasystole occurs in the acute period of myocardial infarction, it can be stopped with lidocaine or trimecaine.

Cordarone (amiodarone) is currently considered the main drug for suppressing ventricular extrasystole. It is prescribed according to a scheme with a gradual reduction in dosage. When treating with cordarone, it is necessary to periodically monitor the function of the liver, thyroid gland, external respiration and the level of electrolytes in the blood, as well as undergo an examination by an ophthalmologist.

In some cases, persistent ventricular premature beats from a known ectopic focus are well treated with radiofrequency ablation surgery. During such an intervention, cells that produce pathological impulses are destroyed.

The presence of ventricular extrasystole, especially its severe forms, worsens the prognosis in people with organic heart disease. On the other hand, functional VES most often do not affect the quality of life and prognosis of patients.

Video course “Everyone can do an ECG”, lesson 4 - “Heart rhythm disturbances: sinus arrhythmias, extrasystole” (VES - from 20:14)

ECG signs of sinus bradycardia

1. V4-6, negative in aVR);

2. prolongation of intervals R-R compared to normal (heart rate less than 60 beats/min.)

3. difference between intervalsР-Р does not exceed 0.15 s;

ECG signs of sinus tachycardia

1. P wave of sinus origin (positive in I, II, aVF, V4-6, negative in aVR);

2. shortening intervals R-R compared to the norm (heart rate more than 80 beats/min.);

3. difference between intervalsР-Р does not exceed 0.15 s;

4. correct alternation of the P wave and the QRS complex in all cycles;

5. the presence of an unchanged QRS complex.

ECG signs of sinus arrhythmia

1. P wave of sinus origin (positive in I, II, aVF, V4-6, negative in aVR);

2. difference between intervals P-P exceeds 0.15 s;

3. correct alternation of the P wave and the QRS complex in all cycles;

4. the presence of an unchanged QRS complex.

ECG signs of atrial extrasystole

1. premature appearance of the P wave and the complex following it

2. the distance from the P wave to the QRST complex is from 0.08 to 0.12 s;

3. deformation and change in the polarity of the P wave of the extrasystole;

4. presence of unchanged extrasystolic ventricular complex

5. incomplete compensatory pause.

ECG signs of extrasystole and AV connections

1. premature appearance on the ECG of an unchanged ventricular QRS complex";

2. negative P wave in leads II, III and aVF after the extrasystolic QRS complex (if the ectopic impulse reaches the ventricles faster than the atria) or the absence of a P wave (with simultaneous excitation of the atria and ventricles (fusion of P and QRS);

3. incomplete or complete compensatory pause.

ECG signs of ventricular extrasystole

1. premature extraordinary appearance on the ECG of an altered ventricular QRS complex";

2. significant expansion and deformation of the extrasystolic complex

3. segment location S(R)-T" and the T wave of the extrasystole are discordant to the direction of the main wave of the QRS complex";

4. absence of a P wave before the ventricular extrasystole;

5. the presence of a complete compensatory pause after the ventricular extrasystole.

ECG signs of supraventricular tachycardia

1. 140-250 per minute while maintaining the correct rhythm;

2. normal unchanged ventricular QRS complexes, similar to the QRS complexes recorded before the attack of paroxysmal tachycardia;

3. the absence of a P wave on the ECG or its presence before or after each QRS complex.

ECG signs of ventricular tachycardia

1. a sudden onset and also suddenly ending attack of increased heart rate up to 140-250 per minute at

maintaining the correct rhythm in most cases;

2. deformation and widening of the QRS complex more than 0.12 s with a discordant segment location RS-T and T waves;

3. the presence of atrioventricular dissociation, i.e. complete separation of the rapid ventricular rhythm (QRS complex) and the normal atrial rhythm (P wave) with occasionally recorded single normal unchanged QRST complexes of sinus origin (“captured” ventricular contractions).

ECG signs of atrial flutter

1. absence of P waves on the ECG;

2. presence of frequent - up to 200-400 per minute - regular, similar atrial F waves, having a characteristic sawtooth shape

(leads II, III, aVF, V1, V2);

3. the presence of normal unchanged ventricular complexes;

4. each gastric complex is preceded by a certain number of atrial F waves (2:1, 3:1, 4:1, etc.) with a regular form of atrial flutter; with an irregular shape, the number of these waves may vary.

ECG signs of atrial fibrillation

1. absence of P wave in all electrocardiographic leads;

2. the presence throughout the entire cardiac cycle of random f waves having different shapes and amplitudes. F waves are better recorded in leads V1, V2, II, III and aVF.

3. irregularity of ventricular QRS complexes (intervals of varying duration R-R).

4. the presence of QRS complexes, which in most cases have a normal, unchanged appearance without deformation or widening.

ECG signs of ventricular flutter

1. Instead of the usual P waves, the ECG shows ventricular flutter waves - high and wide, almost the same amplitude and shape

2. Ventricular firing rate 250-350 per minute

3. The intervals between flutter waves are the same or almost the same

ECG signs of ventricular fibrillation

1. Instead of the usual P waves, the ECG shows waves of ventricular fibrillation - low, of varying heights and widths, of unequal shape

2. Frequency of ventricular fibrillation waves 250-600 per minute

3. The distances between individual waves of ventricular fibrillation are characterized by large differences

4. No isoelectric interval

Task No. 1

Sinus bradycardia.

Task No. 2

Nodal rhythm. ECG signs of overdose of cardiac glycosides.

Task No. 3

Ventricular tachycardia

Task No. 4

Sinus bradycardia. Atrial extrasystole. AV block of the first degree.

Problem #5

Problem #6

Atrial flutter, irregular form

Problem No. 7

Atrial fibrillation

Problem No. 8

Atrial fibrillation, ventricular pacemaker rhythm

Problem No. 9

Paroxysmal ventricular tachycardia followed by asystole

Problem No. 10

Atrial fibrillation. Left ventricular hypertrophy.

Problem No. 11

Atrial fibrillation

Problem No. 12

Ventricular fibrillation Problem No. 13

Asystole and subsequent endocardial stimulation of the heart with a frequency of 86 beats/min.

Problem No. 14

Atrial fibrillation, ventricular extrasystole

Problem No. 15

Paroxysmal form of ventricular tachycardia

Problem No. 16

Paroxysmal supraventricular tachycardia

Problem No. 17

Paroxysmal atrial tachycardia (continuously relapsing form)

Problem No. 18

Bradysystolic atrial fibrillation. Ventricular extrasystole.

Problem No. 19

Ventricular extrasystole. Dilatation of the left atrium (P wave = 0.12 sec.)

Problem No. 20

Ventricular fibrillation

Problem No. 21

Ventricular fibrillation

Problem No. 22

Ventricular fibrillation followed by idioventricular rhythm after EIT

Problem No. 23

Ventricular bigeminy

Problem No. 24

Atrial flutter 2:1

Problem No. 25

Ventricular fibrillation

Problem No. 26

Atrial fibrillation

And an adequate rhythm of work of a muscular organ is a heart rate at the level of 80-90 beats per minute, even periods of time between each contraction. In the case of extrasystole, pathological activity of cardiac structures is observed: beats occur earlier than they should, the heart slows down, then speeds up its work.

There are several varieties of the pathological phenomenon under consideration, depending on the location.

Ventricular extrasystole is a disturbance of the heart rhythm in the form of the occurrence of additional contractions outside the main activity of the organ. They are different in nature, but arise in the ventricles.

This type of pathology is the most dangerous Because the ventricles are responsible for adequate blood release, tissue hypoxia occurs and organs cannot function normally. Generalized disturbances in the operation of systems are noted.

Death as a result of cardiac arrest or other complications of non-cardiac origin is the most likely outcome.

Despite such a formidable genesis of the disease, single ventricular extrasystoles can occur in completely healthy people.

To understand how the disease process develops, you need to refer to a brief anatomical and physiological certificate. The heart and cardiac structures in general are unique in their kind.

Despite the fact that the organ is entirely muscular, its cells, the so-called cardiomyocytes, are capable of spontaneous excitation or generation of an electrical impulse.

A special anatomical formation is responsible for creating the signal - the sinus node or the natural pacemaker in another way. Normally, an electrical impulse is created here, transmitted through the bundles of His throughout the heart, then the cycle is repeated. Such autonomy ensures uninterrupted operation of the organ even in extreme cases.

Pathologies are possible in which a second or third signal focus is formed. It is not normal. In approximately 40% of situations, a new pacemaker develops in the ventricular region. (atria and atrioventricular node). Less often - in the ventricles themselves.

The second option is much more dangerous. As a result of pathological excitation, complete contraction does not occur, blood is not ejected to a normal extent, hence total hypoxia. Further we go, worse it becomes.

Process elimination - a big problem for cardiac surgeons. It is carried out mainly by surgical methods, less often by medication. The goal is to suppress pathological activity in the ventricles.

Classification

A pathogenic phenomenon can be classified on various grounds. Among those with the greatest clinical significance.

Depending on the number of new lesions:

• Single ventricular extrasystole (monotopic). When an impulse is produced in a single place.
• Polytopic. The opposite phenomenon. Both ventricles are involved. A much more dangerous condition.

By frequency and number:

• Single.
• Multiple (pairs, group).

While the former are found in many people (up to 80-90% of the population), the latter are found only in patients, and even then not always. Depends on the type of main process. Frequent ventricular extrasystole is associated with a high risk of complications (up to 50-60%).

The origin of the phenomenon also plays an important role. Thus, cardiac and extracardiac factors are distinguished (there are somewhat more of these, but they themselves cause the problem almost twice as often).

There are other methods of classification. But they have no clinical significance and are rather of scientific interest for specialized specialists.

Ventricular extrasystoles lead to hemodynamic disturbances in all cases, therefore treatment is carried out regardless of the nature of the problem.

Differentiation of the disease according to Lown

There is another way to delimit the process. There is a mixed classification, which is named after the main one of its creators.

Accordingly, they distinguish:

• 1 type of extrasystole. Up to 30 modified contractions per hour or about 700 per day. This is a normal or relatively acceptable phenomenon and does not indicate disease or any process. Against the background of diagnostics, organic transformations cannot be detected.
• 2nd view. Over 30 extrasystoles per hour. A complex phenomenon. May be an indication of normal functional activity. Occasionally it turns out to be a symptom of heart pathologies. Careful monitoring of the patient is required.
• Polymorphic extrasystoles or type 3. They are formed in two ventricles at once, are detected only on electrocardiography, and usually do not make themselves felt with almost any manifestations, which makes early diagnosis difficult. It speaks of the emergence of new conductive bundles in cardiac structures.
• 4a view. Development of paired pathological signals. According to specialized studies, in approximately 40% of clinical situations it is of normal origin, in 60% it is pathogenic.
• 4b type. Group extrasystole or an unstable variant of ventricular paroxysmal tachycardia with an extremely unstable course (there may be several attacks of 5-15 minutes or more during the day). It is of organic origin and requires urgent diagnosis and treatment. Complications occur frequently, the risks are approximately 65% ​​within 3-5 years.
• 5 view. Early extrasystoles of a group nature. The most dangerous form of the pathological process. It appears on the cardiogram with obvious signs, symptoms are also present. Therefore, diagnosis is not difficult. Therapy is urgent.

Ventricular extrasystole does not always have pathological features. The ratio is 40/60 or so.

Causes

The factors behind the development of the problem are diverse. In almost all situations, the disease is secondary in nature and is associated with disruptions in the functioning of any system.

Among the common points:

• Long-term arterial hypertension. Patients with a decent amount of experience usually suffer from extrasystole, regardless of stage. The reason for this is prolonged tension of the heart, the need to more actively pump blood throughout the body, overcoming the resistance of stenotic arteries. This is a kind of adaptive mechanism that has no compensatory value.
• Ischemic disease of a muscular organ. It develops independently or as a result of a myocardial infarction, which is somewhat more common. Another option is, again, hypertension. All of the problems presented require lifelong therapy, since extrasystole occurs in 100% of these situations as the first complication.

• Congenital genetic or acquired syndromes, associated with the formation of extra conducting bundles in addition to the main ones. This is a rare option, however, it is extremely difficult to eliminate such a problem. Minimally invasive or full surgical intervention is required.

• . The consequence of insufficient nutrition or improper distribution of the load on the cardiac structures. Ends with a stop in the functioning of the organ, coronary disease or serious complications. In severe cases, a transplant is required, which in itself is almost a death sentence in developing countries.

• Congenital and acquired heart defects. There are many of them. The most harmless (relatively) is the patent ductus arteriosus. The therapy is surgical. There are almost no manifestations, so you won’t be able to identify the problem yourself. An electrocardiogram and long-term monitoring of the patient are required.

• Myocardial infarction. Acute circulatory disorders in cardiac structures. It ends with the replacement of dead tissue with scar tissue. Associated with lifelong maintenance therapy. In the absence of help, a relapse occurs, this time fatal, with no prospects for resuscitation or restoration of vital functions.

• Inflammatory pathologies of the heart and its structures. Myocarditis and the like. Accompanied by total destruction of the ventricles or other anatomical structures. In such a situation, extrasystoles are not so important, although they can result in the organ stopping. The therapy is conservative.

Noncardiac causes are somewhat less common: endocrine problems, diseases of the excretory and nervous systems. Functional factors can be adjusted by the patient himself:

• Abuse of coffee, tea, energy drinks.
• Long-term uncontrolled or illiterate use of drugs to lower blood pressure, glycosides, psychotropics and the like.
• Smoking.
• Alcoholism.
• Physical inactivity.
• Obesity.
• Poor diet with too much salt or too little salt.

The diagnosis is made by exclusion. In the absence of evidence for organic pathologies, they speak of an idiopathic phenomenon.

Symptoms

Heart rhythm disturbances such as ventricular extrasystole are not always felt. In the early stages or with single altered contractions, there may be no signs at all or they are so scarce that they do not attract attention. In other cases, the clinical picture is quite informative.

An approximate list of signs is as follows:

• Feeling your own heart beat. Detected against a background of normal heart rate or slight tachycardia.
• Pressure, burning behind the sternum.
• Dizziness. Indicates a malnutrition of the brain and the entire central nervous system. It is largely caused by a deficiency of cerebellar trophism.
• Paleness of the skin.
• Excessive sweating.
• Breathing problems. Tissue hypoxia explains the need for a better oxygen supply.
• The heart skips beats or freezes, which creates a feeling that the organ has stopped working.
• Fainting conditions.
• Headache for no apparent reason.

Unstable attacks of up to 100-300 beats are possible. Duration is minimal: from 5 to 30 minutes. The process is observed against the background of extrasystoles, therefore cardiac arrest is likely, if manifestations occur, it is recommended to call an ambulance to resolve the issue of hospitalization.

Diagnostics

The examination is carried out by a cardiologist or a specialized surgeon if there are suspicions of defects or other problems. Against the background of non-cardiac etiological factors, consultation with other specialists is indicated.

Among the methods include:

• Oral questioning of the patient regarding complaints and their type. Plays the greatest role in identifying the problem.
• Anamnesis collection. Character of life, family history of diseases, bad habits, current therapy, somatic problems. Both of these studies are required to determine the vector for further diagnosis.
• Blood pressure measurement. Also count heart rate, preferably repeatedly.
• Daily Holter monitoring. Allows you to assess the state of the cardiovascular system in natural conditions for the patient. Therefore, it is better to do it on an outpatient basis.
• Electrocardiography. The main way to identify problems early. Gives you the opportunity to see the slightest deviations from the norm with your own eyes. However, significant qualifications of doctors are required. On your own it is impossible to decipher the result.
• Echocardiography. Ultrasound technique, visualization. Necessary for diagnosing organic lesions of the cardiovascular system. It doesn’t allow you to see much, so it’s not considered universal.
• Angiography. As needed.
• Load tests. Bicycle ergometry, treadmill. With great caution, since there is a high risk of cardiac arrest.

Against the background of pathologies of a different profile, laboratory methods and other techniques are used.
The study is carried out in a system under the supervision of a group of doctors.

Signs on ECG

Among the characteristic moments of ventricular extrasystole on the ECG:

• Early appearance of the QRS complex, its expansion.
• Complete compensatory pause after extrasystole.
• The appearance of interpolated, intercalated teeth on the graph (occur between full contractions).

Decoding is carried out by specialists in functional diagnostics or cardiology.

Treatment

Systemic therapy. With the use of medications and surgical techniques, lifestyle changes play some role, although this point is given less importance.

Treatment of ventricular extrasystole involves the use of drugs:

• Cardiac glycosides. Digoxin or lily of the valley tincture, but not all together.
• Antiarrhythmic drugs. Amiodarone and analogs. In strictly controlled dosages.
• Calcium antagonists. Verapamil is better.

Drug therapy is not very effective, except in the early stages there is no point in prescribing drugs.

Maintenance therapy involves lifelong prescription of certain pharmaceutical drugs, at the discretion of the specialist.

Surgical methods are much more effective in most cases, since cardiac pathologies are of organic origin.

Bypass surgery, elimination of a congenital or acquired defect of cardiac structures, open or endoscopic surgery to resection a fragment generating pathological impulses are indicated. Radiofrequency ablation is possible.

The main technique is selected by a cardiac surgeon after a long, thorough examination.

Attention:

If a doctor immediately suggests surgery, there is reason to doubt his competence.

Lifestyle changes play the greatest role only in the early stages:

• Complete cessation of bad habits.
• Normalization of the diet (everything is possible, but in moderation, there are no strict restrictions).
• Get 8 hours of full sleep per night.
• Physical activity. Walking or exercise therapy 2 hours a day.
• Drinking regimen - 2 l.
• Salt no more than 7 grams.

The correction is carried out under the supervision of a nutritionist and primary specialist.

Complications and probable prognosis

The consequences of ventricular extrasystole are monotonous:

• Heart failure. Requires urgent resuscitation. There are only a few minutes. In an inpatient setting, the chances of recovery are greater.
• Tachycardia. Significantly reduces the quality of life, worsens the outcome of the pathological process significantly.
• Ventricular arrhythmia. Joins almost instantly. Aggravates the development of the underlying disease.

All of these phenomena, one way or another, lead to the death of the patient. It's a question of time. Therefore, there is no point in delaying treatment and diagnosis.

The forecast data is something like this:

• With single extrasystoles, there are almost no risks. The likelihood of complications is about 2-5% for 5 years or more.
• The opposite phenomenon with group contractions is accompanied by severe problems in 65% of situations without therapy, one and a half to two times less with supervision.

A complete cure never occurs, but there are chances to improve the quality of life and prolong one’s existence. From a prognostic point of view, types 3,4,5 of the process are the least favorable. 1 and 2 do not pose a danger to life and health.

Finally

Extrasystole of ventricular localization is a disturbance of normal heart rhythm due to the occurrence of additional, early contractions.

Systematic use of drugs, lifestyle changes and surgical treatment are associated with a good or relatively favorable prognosis.

The more advanced the problem, the less chance of recovery. Death is the most likely outcome of the process outside of medical care. Specialist - cardiologist.