26.06.2019

Extrasystoles. Atrial extrasystole - description Treatment of atrial fibrillation

Extrasystoles are episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular regions and ventricles.

An extraordinary contraction of the heart is usually recorded against the background of normal sinus rhythm without arrhythmia.

It is important to know that ventricular extrasystole in ICD 10 has code 149.

The presence of extrasystoles is observed in% of the entire world population, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other heart rhythm disorders, but the following exceptions are also provided:

rare myocardial contractions (bradycardia R1);
extrasystole caused by obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
irregularities in work cardiovascular systems s in a newborn (P29.1).

The extrasystole code according to ICD 10 determines the plan diagnostic measures and, according to the survey data, a set of therapeutic methods used throughout the world.

Etiological factor for the presence of extrasystoles according to ICD 10

Worldwide nosological data confirm the prevalence of episodic pathologies in the work of the heart in the majority of the adult population after 30 years of age, which is typical in the presence of the following organic pathologies:

heart disease caused by inflammatory processes (myocarditis, pericarditis, bacterial endocarditis);
development and progression coronary disease hearts;
dystrophic changes in the myocardium;
oxygen starvation of the myocardium due to processes of acute or chronic decompensation.

In most cases, episodic interruptions in the work of the heart are not associated with damage to the myocardium itself and are only functional in nature, that is, extrasystoles occur due to severe stress, excessive smoking, coffee and alcohol abuse.

Ventricular extrasystole in the international classification of diseases has the following types of clinical course:

premature contraction of the myocardium, occurring after each normal one, is called bigeminy;
trigeminy is the process of a pathological impulse after several normal myocardial contractions;
quadrigeminy is characterized by the appearance of extrasystole after three myocardial contractions.

In the presence of any type of this pathology, a person feels a sinking heart, and then strong tremors in the chest and dizziness.

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Gradation of ventricular extrasystole according to Ryan and Laun, code according to ICD 10

1 – rare, monotopic ventricular arrhythmia– no more than thirty housing units per hour;

2 – frequent, monotopic ventricular arrhythmia – more than thirty VES per hour;

3 – polytopic ZhES;

4a – monomorphic paired VES;

4b – polymorphic paired VES;

5 – ventricular tachycardia, three or more ZhES in a row.

2 – infrequent (from one to nine per hour);

3 – moderately frequent (from ten to thirty per hour);

4 – frequent (from thirty-one to sixty per hour);

5 – very frequent (more than sixty per hour).

B – single, polymorphic;

D – unstable VT (less than 30s);

E – sustained VT (more than 30 s).

Absence of structural heart lesions;

Absence of scar or cardiac hypertrophy;

Normal left ventricular ejection fraction (LVEF) – more than 55%;

Slight or moderate frequency of ventricular extrasystole;

Absence of paired ventricular extrasystoles and unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia.

The presence of a scar or cardiac hypertrophy;

Moderate decrease in LVEF – from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia or their insignificant presence.

Presence of structural heart lesions;

Presence of scar or cardiac hypertrophy;

Significant decrease in LVEF – less than 30%;

Moderate or significant ventricular extrasystole;

Paired ventricular extrasystoles or unstable ventricular tachycardia;

Persistent ventricular tachycardia;

Moderate or severe hemodynamic consequences of arrhythmia.

Place of ventricular extrasystole in the ICD system - 10

Ventricular extrasystole is one of the types of cardiac arrhythmia. And it is characterized by an extraordinary contraction of the heart muscle.

Ventricular extrasystole, according to the International Classification of Diseases (ICD - 10), has code 149.4. and is included in the list of heart rhythm disorders in the heart disease section.

Nature of the disease

Based on the international classification of diseases, tenth revision, doctors distinguish several types of extrasystole, the main ones being: atrial and ventricular.

In case of an extraordinary cardiac contraction, which was caused by an impulse emanating from the ventricular conduction system, ventricular extrasystole is diagnosed. The attack manifests itself as a feeling of interruptions in the heart rhythm followed by freezing. The disease is accompanied by weakness and dizziness.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). A 24-hour ECG showed positive results in 50% of the people studied.

Thus, it can be noted that the disease is common and can affect even healthy people. The cause of the functional nature of the disease can be stress.

Drinking energy drinks, alcohol, and smoking can also provoke extrasystoles in the heart. This type of illness is harmless and goes away quickly.

Pathological ventricular arrhythmia has more serious consequences for the health of the body. It develops against the background of serious diseases.

Classification

According to daily monitoring of the electrocardiogram, doctors consider six classes of ventricular extrasystoles.

Extrasystoles belonging to the first class may not manifest themselves in any way. The remaining classes are associated with health risks and the possibility of dangerous complication: Ventricular fibrillation, which can be fatal.

Extrasystoles can vary in frequency; they can be rare, medium and frequent. On the electrocardiogram they are diagnosed as single and paired - two pulses in a row. Impulses can occur in both the right and left ventricles.

The source of extrasystoles can be different: they can come from one source - monotopic, or they can arise in different areas - polytopic.

Disease prognosis

Based on prognostic indications, the arrhythmias under consideration are classified into several types:

arrhythmias are benign, are not accompanied by heart damage and various pathologies, their prognosis is positive, and the risk of death is minimal;
ventricular extrasystoles of a potentially malignant direction occur against the background of heart damage, blood output is reduced by an average of 30%, and a health risk is noted;
ventricular extrasystoles pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to begin treatment, a diagnosis of the disease is required in order to determine its causes.

Other heart rhythm disorders (I49)

Excluded:

bradycardia:
- NOS (R00.1)
- sinoatrial (R00.1)
- sinus (R00.1)
- vagal (R00.1)
conditions complicating:
- abortion, ectopic or molar pregnancy (O00-O07, O08.8)
- obstetric surgical interventions and procedures (O75.4)
cardiac arrhythmia in the newborn (P29.1)

Ectopic systoles
Extrasystoles
Extrasystolic arrhythmia
Premature:
- abbreviations NOS
- compression

Brugada syndrome
Long QT syndrome
Rhythm disturbance:
- coronary sinus
- ectopic
- nodal

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single regulatory document to take into account morbidity, reasons for the population’s visits to medical institutions all departments, causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Ventricular extrasystole ICD 10

Extrasystole (ES) is premature arousal the entire heart or any part of it, caused by an extraordinary impulse emanating from the atria, AV junction or ventricles.

The causes of extrasystole are varied. There are extrasystoles of a functional, organic and toxic nature. Clinically, patients may be asymptomatic or complain of sensations of interruptions in cardiac function. Diagnosis of extrasystoles is based on ECG data and physical examination.

The clinical significance of different types of extrasystoles varies critically; Ventricular extrasystole in organic heart lesions has exceptional prognostic significance, and therefore special attention is devoted to this aspect.

Sinus extrasystoles.
Atrial extrasystoles.
Extrasystoles from the AV connection.
Ventricular extrasystoles.

Early extrasystoles.
Average extrasystoles.
Late extrasystoles.

Rare extrasystoles - less than 5 per 1 minute.
Average extrasystoles - from 6 to 15 per minute.
Frequent extrasystoles - more than 15 per minute.

Single extrasystoles.
Paired extrasystoles.

Sporadic extrasystoles.
Allorhythmic extrasystoles - bigeminy, trigeminy, etc.

Read more: General ECG signs of extrasystoles and morphological types of extrasystoles.

Explicit extrasystoles.
Hidden extrasystoles.

Conduction block (antero- and retrograde).
"Gap" in conduction.
Supernormal conduction.

Due to the high clinical and prognostic significance of ventricular extrasystoles in organic heart diseases, its classification according to the morphological principle has been developed, based on the idea of the connection between certain forms of ventricular extrasystoles and risk sudden death- classification of ventricular extrasystoles according to B. Lown, M. Wolf (1971):

0. Absence of ventricular extrasystoles within 24 hours of monitoring.
1. Rare, monotopic (no more than 30 ventricular extrasystoles in any hour of monitoring).
2. Frequent, monotopic (more than 30 ventricular extrasystoles in any hour of monitoring).
3. Polytopic (polymorphic).
4.A. - Pairs.
4.B. - Salvo - runs of ventricular tachycardia (more than 3 extrasystoles in a row).
5. Early (R to T).

As the class of extrasystole increases, the risk of sudden death increases.

4.A. - Monomorphic paired ventricular extrasystoles.
4.B. - Polymorphic paired ventricular extrasystoles.
5. Ventricular tachycardia (more than 3 extrasystoles in a row) - the meaning of “early” extrasystoles in terms of the time of appearance in diastole is disputed.

Extrasystole of a functional nature.
Extrasystole of organic origin.
Extrasystole of toxic origin.

Single supraventricular ES (SSES) or ventricular ES (VE) occur at some time in life in all people.

Extrasystole often accompanies the course of various heart diseases.

Etiology and pathogenesis

Etiology of extrasystoles
- Etiology of extrasystoles of a functional (dysregulatory) nature.
Functional extrasystole occurs as a result of a vegetative reaction in the human body to one of the following influences:
- Emotional stress.
- Smoking.
- Abuse of coffee.
- Alcohol abuse.
- In patients with neurocirculatory dystonia.
- Also, functional extrasystole can be observed in healthy individuals for no apparent reason (so-called idiopathic extrasystole).
Etiology of extrasystoles of organic origin.
Extrasystole of organic origin, as a rule, occurs as a result of morphological changes in the heart muscle in the form of foci of necrosis, dystrophy, cardiosclerosis or metabolic disorders. These organic changes in the myocardium can be observed in the following diseases:
- IHD, acute myocardial infarction.
- Arterial hypertension.
- Myocarditis.
- Postmyocaditic cardiosclerosis.
- Cardiomyopathies.
- Congestive circulatory failure.
- Pericarditis.
- Heart defects (primarily with mitral valve prolapse).
- Chronic pulmonary heart disease.
- Heart damage due to amyloidosis, sarcoidosis, hemochromatosis.
- Surgical interventions on the heart.
- "The Heart of an Athlete"
Etiology of extrasystoles of toxic origin.
Extrasystoles of toxic origin occur in the following pathological conditions:
- Feverish states.
- Digitalis intoxication.
- Exposure to antiarrhythmic drugs (proarrhythmic side effect).
- Thyrotoxicosis.
- Taking aminophylline, inhaling betamimetics.
Features of the etiology of ventricular extrasystoles.
Ventricular extrasystoles in more than 2/3 of patients develop due to various forms of IHD.
The most common causes of the development of ventricular extrasystoles are the following forms of ischemic heart disease:
Ventricular rhythm disturbances (the appearance or increase in ventricular extrasystoles, the first paroxysm of ventricular tachycardia or ventricular fibrillation with the development of clinical death) may be the earliest clinical manifestation of acute myocardial infarction and always require exclusion of this diagnosis. Reperfusion arrhythmias (developed after successful thrombolysis) are practically untreatable and are relatively benign in nature.
Ventricular extrasystoles emanating from the left ventricular aneurysm may resemble infarction QRS in shape (QR in V1, ST elevation and “coronary” T).
The appearance of paired ventricular extrasystoles during a treadmill test at a heart rate less than 130 beats/min has a poor prognostic value. The prognosis is especially poor when paired ventricular extrasystoles are combined with ischemic ST changes.
One can confidently speak about the non-coronary nature of ventricular arrhythmias only after coronary angioharphy. In this regard, this study is indicated for most patients over 40 years of age suffering from ventricular extrasystole.
Among the causes of non-coronarogenic ventricular extrasystoles, in addition to those mentioned above, there is a group of genetically determined diseases. In these diseases, ventricular extrasystole and ventricular tachycardia are the main clinical manifestations. In terms of the degree of malignancy of ventricular arrhythmias, this group of diseases is close to ischemic heart disease. Taking into account the nature of the genetic defect, these diseases are classified as channelopathies. These include:
1. Arrhythmogenic left ventricular dysplasia.
2. Long QT syndrome.
3. Brugada syndrome.
4. Short QT syndrome.
5. WPW syndrome.
6. Catecholamine-induced trigger polymorphic ventricular tachycardia.

Pathogenesis of extrasystoles
The morphological substrate of extrasystole (and some other rhythm disturbances) is the electrical inhomogeneity of the heart muscle of various origins.
The main mechanisms for the development of extrasystole:
- Repeated entry of an excitation wave (re-entry) in areas of the myocardium or conduction system of the heart, characterized by unequal speed of impulse conduction and the development of unidirectional blockade of conduction.
- Increased oscillatory (trigger) activity cell membranes specific areas of the atria, AV junction or ventricles.
- The ectopic impulse from the atria spreads from top to bottom along the conduction system of the heart.
- The ectopic impulse arising at the AV junction propagates in two directions: from top to bottom along the conduction system of the ventricles and from bottom to top (retrograde) through the atria.
Features of the pathogenesis of ventricular extrasystole:
- Single monomorphic ventricular extrasystoles can arise as a result of both the formation of re-entry of the excitation wave (re-entry) and the functioning of the post-depolarization mechanism.
- Repeated ectopic activity in the form of several successive ventricular extrasystoles is usually due to the re-entry mechanism.
- The source of ventricular extrasystoles in most cases are the branches of the His bundle and Purkinje fibers. This leads to a significant disruption of the process of propagation of the excitation wave through the right and left ventricles, which leads to a significant increase in the total duration of the extrasystolic ventricular QRS complex.
- With ventricular extrasystole, the sequence of repolarization also changes.

Clinic and complications

Extrasystole is not always felt by patients. The tolerance of extrasystoles varies significantly in different patients and does not always depend on the number of extrasystoles (possibly complete absence complaints even in the presence of stable bi- and trigemy).

In some cases, at the moment of extrasystole, there is a feeling of interruptions in the work of the heart, “tumbling”, “turning the heart over”. If they occur at night, these sensations cause you to wake up, accompanied by anxiety.

Less often, the patient complains of attacks of rapid, irregular heartbeat, which requires excluding the presence of paroxysmal atrial fibrillation.

Sometimes extrasystole is perceived by patients as a “stopping” or “fading” of the heart, which corresponds to a long compensatory pause following the extrasystole. Often after this short period When the heart “stops”, patients feel a strong push in the chest, caused by the first increased contraction of the ventricles of sinus origin after the extrasystole. The increase in stroke output in the first post-extrasystolic complex is mainly due to an increase in diastolic filling of the ventricles during a long compensatory pause (increased preload).

Supraventricular premature beats are not associated with an increased risk of sudden death. In relatively in rare cases falling into the “vulnerable window” of the cardiac cycle and the presence of other conditions for the occurrence of re-entry, it can cause supraventricular tachycardia.

Objectively, the most serious consequence of supraventricular extrasystole is atrial fibrillation, which can develop in patients with supraventricular extrasystole and atrial overload/dilatation. The risk of developing atrial fibrillation can serve as a criterion for the malignancy of supraventricular extrasystole, similar to the risk of sudden death with ventricular extrasystole.

The main complication of ventricular extrasystole, which determines its clinical significance, is sudden death. To assess the risk of sudden death with ventricular extrasystole, a number of special criteria have been developed to determine the required amount of treatment.

Diagnostics

The presence of extrasystole can be suspected if the patient complains of interruptions in the functioning of the heart. The main diagnostic method is an ECG, but certain information can also be obtained from a physical examination of the patient.

When collecting anamnesis, it is necessary to clarify the circumstances under which arrhythmia occurs (during emotional or physical stress, at rest, during sleep).

It is important to clarify the duration and frequency of episodes, the presence of signs of hemodynamic disorders and their nature, the effect of non-drug tests and drug therapy.

Close attention should be paid to the history of indications of previous diseases that may cause organic heart damage, as well as their possible undiagnosed manifestations.

At clinical examination it is important to form at least a rough idea of the etiology of extrasystoles, since extrasystoles in the absence and presence of organic heart damage require different approach to treatment.

Arterial pulse examination.

When examining the arterial pulse, extrasystoles correspond to prematurely occurring pulse waves of small amplitude, which indicates insufficient diastolic filling of the ventricles during a short pre-extrasystolic period.

Pulse waves corresponding to the first post-extrasystolic ventricular complex, which occurs after a long compensatory pause, usually have a large amplitude.

In cases of bi- or trigeminy, as well as frequent extrasystole, a pulse deficiency is detected; with persistent bigeminy, the pulse can sharply decrease (less than 40/min), remaining rhythmic and accompanied by symptoms of bradyarrhythmia.

During an extrasystolic contraction, slightly weakened premature I and II (or only one) extrasystolic sounds are heard, and after them, loud I and II heart sounds, corresponding to the first post-extrasystolic ventricular complex.

Distinctive features of extrasystolic arrhythmia in the presence of organic heart disease and in its absence.

The main electrocardiographic sign of extrasystole is the premature occurrence of the ventricular QRST complex and/or P wave, that is, shortening of the coupling interval.

The coupling interval is the distance from the previous extrasystole of the next P–QRST cycle of the main rhythm to the extrasystole.

Compensatory pause - the distance from the extrasystole to the following P–QRST cycle of the main rhythm. There are incomplete and complete compensatory pauses:

Incomplete compensatory pause.

An incomplete compensatory pause is a pause that occurs after an atrial extrasystole or extrasystole from the AV junction, the duration of which is slightly longer than the usual P–P (R–R) interval of the main rhythm.

An incomplete compensatory pause includes the time required for the ectopic impulse to reach the SA node and “discharge” it, as well as the time required to prepare the next sinus impulse in it.

A complete compensatory pause is a pause that occurs after a ventricular extrasystole, and the distance between the two sinus P-QRST complexes (pre-extrasystolic and post-extrasystolic) is equal to twice the R-R interval of the main rhythm.

Allorhythmia is the correct alternation of extrasystoles and normal contractions. Depending on the frequency of occurrence of extrasystoles, the following types of allorhythmias are distinguished:

Bigeminy - each normal contraction is followed by an extrasystole.
Trigeminy - extrasystoles occur after every two normal contractions.
Quadrihymenia - extrasystoles occur after every three normal contractions, etc.
A couplet is the occurrence of two extrasystoles in a row.
Three or more extrasystoles in a row are regarded as a run of supraventricular tachycardia.

The following types of extrasystoles are also distinguished:

Monotopic extrasystoles are extrasystoles emanating from one ectopic source and, accordingly, having a constant coupling interval and the shape of the ventricular complex.
Polytopic extrasystoles are extrasystoles emanating from different ectopic foci and differing from each other in the coupling interval and the shape of the ventricular complex.
Group (volley) extrasystole - the presence of three or more extrasystoles in a row on the ECG.

Premature extraordinary appearance of the P wave and the following QRST complex ( R-R interval less than the main one).

The constancy of the coupling interval (from the P wave of the previous normal complex to the P wave of the extrasystole) is a sign of the monotopy of supraventricular extrasystole. With “early” supraventricular extrasystole, the P wave is characteristically superimposed on the preceding T wave, which can complicate diagnosis.

With extrasystole from the upper parts of the atria, the P wave differs little from the norm. With extrasystole from the middle sections, the P wave is deformed, and with extrasystole from the lower sections, it is negative. The need for more accurate topical diagnosis arises when surgical treatment is necessary, which is preceded by an electrophysiological study.

It should be remembered that sometimes with atrial and atrioventricular extrasystoles, the ventricular QRS complex can acquire a so-called aberrant form due to the occurrence of functional blockade of the right bundle branch or its other branches. In this case, the extrasystolic QRS complex becomes wide (≥0.12 sec), split and deformed, reminiscent of the QRS complex with bundle branch block or ventricular extrasystole.

Blocked atrial extrasystoles are extrasystoles emanating from the atria, which are represented on the ECG only by the P wave, after which there is no extrasystolic ventricular QRST complex.

Premature extraordinary appearance on the ECG of an unchanged ventricular QRS complex (without a preceding P wave!), similar in shape to other QRS complexes of sinus origin. The exception is in cases of QRS complex aberration.

It should be remembered that sometimes with atrial and atrioventricular extrasystoles, the ventricular QRS complex can acquire a so-called aberrant form due to the occurrence of functional blockade of the right bundle branch or its other branches. In this case, the extrasystolic QRS complex becomes wide, split and deformed, reminiscent of the QRS complex with bundle branch block or ventricular extrasystole.

If the ectopic impulse reaches the ventricles faster than the atria, the negative P wave is located after the extrasystolic P-QRST complex. If the atria and ventricles are excited simultaneously, the P wave merges with the QRS complex and is not detected on the ECG.

Trunk extrasystoles differ in their occurrence complete blockade retrograde extrasystolic impulse to the atria. Therefore, a narrow extrasystolic QRS complex is recorded on the ECG, after which there is no negative P wave. Instead, a positive P wave is recorded. This is another atrial P wave of sinus origin, which usually falls on the RS-T segment or the T wave of the extrasystolic complex.

Premature appearance on the ECG of an altered ventricular QRS complex, in front of which there is no P wave (with the exception of late ventricular extrasystoles, in front of which there is a P. But the PQ is shortened compared to sinus cycles).
Significant expansion (up to 0.12 s or more) and deformation of the extrasystolic QRS complex (the shape resembles a bundle branch block opposite to the side of the occurrence of extrasystoles - the location of the RS-T segment and the T wave of the extrasystole is discordant with the direction of the main wave of the QRS complex).
The presence of a complete compensatory pause after the ventricular extrasystole (it complements the coupling interval of the extrasystoles until the RR of the main rhythm is doubled).

With ventricular extrasystole, there is usually no “discharge” of the SA node, since the ectopic impulse arising in the ventricles, as a rule, cannot retrogradely pass through the AV node and reach the atria and the SA node. In this case, the next sinus impulse unhinderedly excites the atria, passes through the AV node, but in most cases cannot cause another depolarization of the ventricles, since after the ventricular extrasystole they are still in a state of refractory.

Normal normal excitation of the ventricles will occur only after the next (second after the ventricular extrasystole) sinus impulse. Therefore, the duration of the compensatory pause during ventricular extrasystole is noticeably longer than the duration of the incomplete compensatory pause. The distance between the normal (sinus origin) ventricular QRS complex preceding the ventricular extrasystole and the first normal sinus QRS complex recorded after the extrasystole is equal to twice the R-R interval and indicates a complete compensatory pause.

Occasionally, ventricular extrasystoles can be carried out retrogradely to the atria and, upon reaching the sinus node, discharge it; in these cases, the compensatory pause will be incomplete.

Only sometimes, usually against the background of a relatively rare main sinus rhythm, a compensatory pause after a ventricular extrasystole may be absent. This is explained by the fact that the next (first after the extrasystole) sinus impulse reaches the ventricles at the moment when they have already emerged from the refractory state. In this case, the rhythm is not disturbed and ventricular extrasystoles are called “intercalated”.

A compensatory pause may also be absent with ventricular extrasystole against the background of atrial fibrillation.

It should be emphasized that none of the listed ECG signs has 100% sensitivity and specificity.

To assess the prognostic significance of ventricular extrasystole, it may be useful to evaluate the characteristics of the ventricular complexes:

In the presence of organic damage to the heart, extrasystoles are often low-amplitude, wide, jagged; The ST segment and T wave may be directed in the same direction as the QRS complex.
Relatively “favorable” ventricular extrasystoles have an amplitude of more than 2 mV, are not deformed, their duration is about 0.12 seconds, the ST segment and T wave are directed in the direction opposite to the QRS.

Of clinical importance is the determination of mono-/polytopic ventricular extrasystole, which is carried out taking into account the constancy of the coupling interval and the shape of the ventricular complex.

Monotopy indicates the presence of a specific arrhythmogenic focus. The location of which can be determined by the shape of the ventricular extrasystole:

Left ventricular extrasystoles – R dominates in leads V1-V2 and S in V5-V6.
Extrasystoles from the outflow tract of the left ventricle: the electrical axis of the heart is located vertically, rS (with their constant ratio) in leads V1-V3 and abrupt transition to R-type in leads V4-V6.
Right ventricular extrasystoles - S dominates in leads V1-V2 and R in leads V5-V6.
Extrasystoles from the outflow tract of the right ventricle – high R in II III aVF, transition zone in V2-V3.
Septal extrasystoles - the QRS complex is slightly widened and resembles WPW syndrome.
Concordant apical extrasystoles (up both ventricles) – S dominates in leads V1-V6.
Concordant basal extrasystoles (down both ventricles) - R dominates in leads V1-V6.

With a monomorphic ventricular extrasystole with an inconsistent coupling interval, one should think about parasystole - the simultaneous work of the main (sinus, less often atrial fibrillation/flutter) and an additional pacemaker located in the ventricles.

Parasystoles follow each other at different intervals, but the intervals between parasystoles are a multiple of the smallest of them. Characteristic are confluent complexes, which may be preceded by a P wave.

Holter ECG monitoring is a long-term recording (up to 48 hours) of an ECG. For this purpose, a miniature recording device with leads is used, which are attached to the patient’s body. When recording indicators during his daily activities, the patient records in a special diary all the symptoms that appear and the nature of the activity. The results obtained are then analyzed.

Holter ECG monitoring is indicated not only in the presence of ventricular extrasystole on the ECG or in the anamnesis, but also in all patients with organic heart diseases, regardless of the presence of a clinical picture of ventricular arrhythmias and their detection on standard ECGs.

Holter ECG monitoring should be performed before the start of treatment, and subsequently to assess the adequacy of the therapy.

In the presence of extrasystole, Holter monitoring makes it possible to evaluate the following parameters:

Frequency of extrasystoles.
Duration of extrasystole.
Mono-/polytopic ventricular extrasystole.
Dependence of extrasystole on the time of day.
Dependence of extrasystole on physical activity.
Relationship between extrasystole and ST segment changes.
Relationship between extrasystole and rhythm frequency.

Treatment

Treatment tactics depend on the location and form of extrasystole.

In the absence of clinical manifestations, supraventricular extrasystole does not require treatment.

In case of supraventricular extrasystole, which has developed against the background of heart disease or non-cardiac disease, therapy for the underlying disease/condition is necessary (treatment of endocrine disorders, correction of disorders electrolyte balance, treatment of ischemic heart disease or myocarditis, discontinuation of medications that can cause arrhythmia, cessation of alcohol, smoking, excess coffee consumption).

Indications for drug therapy for supraventricular extrasystole
- Subjectively poor tolerance of supraventricular extrasystole.
It is useful to identify situations and times of day in which the sensations of interruptions predominantly occur, and time the intake of medications to this time.
Supraventricular extrasystole in these cases serves as a harbinger of the appearance of atrial fibrillation, which is objectively the most serious consequence of supraventricular extrasystole.
The lack of antiarrhythmic treatment (along with etiotropic) increases the risk of perpetuating supraventricular extrasystole. Frequent supraventricular extrasystole in similar cases is “potentially malignant” with respect to the development of atrial fibrillation.

The choice of antiarrhythmic is determined by the tropism of its action, side effects and partly the etiology of supraventricular extrasystole.
It should be remembered that patients with coronary artery disease who have recently suffered a myocardial infarction are not advised to prescribe class I drugs due to their arrhythmogenic effect on the ventricles.
Treatment is carried out sequentially with the following medications:
- β-blockers (Anaprilin 30-60 mg/day, atenolol (Atenolol-nikomed, Atenolol) mg/day, bisoprolol (Concor, Bisocard) 5-10 mg/day, metoprolol (Egilok, Vazocardin) mg/day, Nebilet 5- 10 mg/day, Lokrenmg/day - long-term or until the cause of supraventricular extrasystole is eliminated) or calcium antagonists (Verapamilmg/day, diltiazem (Cardil, Diltiazem-Teva) mg/day, long-term or until the cause of supraventricular extrasystole is eliminated).
Taking into account possible side effects, treatment with retard drugs should not be started due to the need for rapid withdrawal if bradycardia and sinoatrial and/or atrioventricular conduction disturbances occur.
Supraventricular extrasystoles, along with paroxysmal supraventricular tachycardias, are rhythm disturbances in which beta-blockers and blockers, which are otherwise ineffective in other situations, are often ineffective calcium channels(for example, verapamil (Isoptin, Finoptin)), especially in patients with a tendency to tachycardia without serious organic heart damage and severe atrial dilatation.
These groups of drugs are not indicated for patients with vagal-mediated supraventricular extrasystole, which develops against the background of bradycardia, mainly at night. Such patients are prescribed Belloid, small doses of Teopek or Corinfar, taking into account their rhythm-increasing effect.
Disopyramide (Ritmilen) mg/day, Quinidine-durules mg/day, allapinin mg/day. ( additional indication to their prescription - a tendency to bradycardia), propafenone (Ritionorm, Propanorm) mg/day, Etatsizinmg/day.
Taking drugs in this group is often accompanied by side effects. There may be disturbances in SA and AV conduction, as well as an arrhythmogenic effect. In the case of taking quinidine, there is a prolongation of the QT interval, a decrease in contractility and myocardial dystrophy (negative T waves appear in the chest leads). Quinidine should not be prescribed in the presence of ventricular extrasystole. Caution is also necessary in the presence of thrombocytopenia.
Prescribing these drugs makes sense in patients with a high prognostic significance of supraventricular extrasystole - in the presence of an active inflammatory process in the myocardium, a high frequency of supraventricular extrasystole in patients with organic heart damage, atrial dilatation, “threatened” by the development of atrial fibrillation.
Class IA or IC drugs should not be used for supraventricular extrasystole, as well as for other forms of cardiac arrhythmias, in patients who have had myocardial infarction, as well as for other types of organic damage to the heart muscle due to the high risk of proarrhythmic action and the associated deterioration in life prognosis .
It should be noted that a moderate and non-progressive increase in the duration of the PQ interval (up to 0.22-0.24 s), with also a moderate sinus bradycardia(up to 50) are not an indication for discontinuation of therapy, subject to regular ECG monitoring.
When treating patients with an undulating course of supraventricular extrasystole, one should strive for the complete abolition of drugs during periods of remission (excluding cases of severe organic damage to the myocardium).
Along with the prescription of antiarrhythmics, it is necessary to remember about the treatment of the cause of supraventricular extrasystole, as well as about drugs that can improve the subjective tolerability of supraventricular extrasystole: benzodiazepines (Phenazepam 0.5-1 mg, clonazepam 0.5-1 mg), hawthorn tincture, motherwort.
The basic principle for choosing therapy for ventricular extrasystoles is to assess their prognostic significance.
The Lown-Wolf classification is not exhaustive. Bigger (1984) proposed a prognostic classification that provides characteristics of benign, potentially malignant and malignant ventricular arrhythmias.
Prognostic significance of ventricular arrhythmias.
A brief description of ventricular extrasystoles can also be presented as follows:
- Benign ventricular extrasystoles - any ventricular extrasystoles in patients without cardiac damage (including myocardial hypertrophy) with a frequency of less than 10 per hour, without fainting or cardiac arrest in history.
- Potentially malignant ventricular extrasystoles - any ventricular extrasystoles with a frequency of more than 10 per hour or ventricular tachycardia in patients with left ventricular dysfunction, without a history of syncope or cardiac arrest.
- Malignant ventricular extrasystoles - any ventricular extrasystoles with a frequency of more than 10 per hour in patients with severe myocardial pathology (most often with a LV ejection fraction of less than 40%), a history of fainting or cardiac arrest; Sustained ventricular tachycardia is often detected.
- Within the groups of potentially malignant and malignant ventricular extrasystoles, the potential risk is also determined by the gradation of ventricular extrasystoles (According to the Laun-Wolff classification).
To increase the accuracy of the prognosis, in addition to the fundamental signs, a complex of clinical and instrumental predictors of sudden death is used, each of which individually is not of decisive importance:
- Left ventricular ejection fraction. If, with coronary artery disease, the left ventricular ejection fraction decreases to less than 40%, the risk increases 3 times. With non-coronarogenic ventricular extrasystole, the significance of this criterion may decrease).
- The presence of late ventricular potentials – an indicator of areas of slow conduction in the myocardium detected on the ECG high resolution. Late ventricular potentials reflect the presence of a substrate for re-entry and, in the presence of ventricular extrasystole, force one to take its treatment more seriously, although the sensitivity of the method depends on the underlying disease; the ability to monitor therapy using late ventricular potentials is questionable.
- Increased QT interval dispersion.
- Reduced heart rate variability.

Treatment tactics for ventricular extrasystole
Once a patient is classified into a particular risk category, the choice of treatment can be decided.
As in the treatment of supraventricular extrasystoles, the main method of monitoring the effectiveness of therapy is Holter monitoring: a decrease in the number of ventricular extrasystoles by 75-80% indicates the effectiveness of treatment.
Treatment tactics for patients with ventricular extrasystoles of different prognosis:
- In patients with benign ventricular extrasystole, which is subjectively well tolerated by the patient, it is possible to refuse antiarrhythmic therapy.
- For patients with benign ventricular extrasystole, which is subjectively poorly tolerated, as well as for patients with potentially malignant arrhythmias of non-ischemic etiology, it is preferable to prescribe class I antiarrhythmics.
If they are ineffective, use amiodarone or d,l-sotalol. These drugs are prescribed only for non-ischemic etiology of ventricular extrasystole - in post-infarction patients, according to evidence-based studies, the pronounced proarrhythmic effect of flecainide, encainide and ethmosin is associated with a 2.5-fold increase in the risk of death! The risk of proarrhythmic effects is also increased with active myocarditis.
Of class I anitiarrhythmics, the following are effective:
- Propafenone (Propanorm, Ritmonorm) orally mg/day, or retard forms (propafenone SR 325 and 425 mg, prescribed twice a day). Therapy is usually well tolerated. Possible combinations with beta blockers, d,l-sotalol (Sotahexal, Sotalex), verapamil (Isoptin, Finoptin) (under the control of heart rate and AV conduction!), as well as with amiodarone (Cordarone, Amiodarone) up to a day.
- Etacizin orally mg/day. Therapy begins with the appointment of half doses (0.5 tablets 3-4 times a day) to assess tolerability. Combinations with class III drugs can be arrhythmogenic. Combination with beta blockers is advisable for myocardial hypertrophy (under heart rate control, in a small dose!).
- Ethmozin orally mg/day. Therapy begins with the appointment of smaller doses - 50 mg 4 times a day. Ethmozin does not prolong the QT interval and is usually well tolerated.
- Flecainide intramg/day. Quite effective, somewhat reduces myocardial contractility. In some patients it causes paresthesia.
- Disopyramide intramg/day. It can provoke sinus tachycardia, and therefore combinations with beta blockers or d,l-sotalol are advisable.
- Allapinin is the drug of choice for a tendency to bradycardia. Prescribed as monotherapy at a dose of 75 mg/day. as monotherapy or 50 mg/day. in combination with beta blockers or d,l-sotalol (not more than 80 mg/day). This combination is often advisable because it increases the antiarrhythmic effect, reducing the effect of drugs on heart rate and allows you to prescribe lower doses if each drug is poorly tolerated separately.
- Less commonly used are drugs such as Difenin (for ventricular extrasystole due to digitalis intoxication), mexiletine (for intolerance to other antiarrhythmics), ajmaline (for WPW syndrome accompanied by paroxysmal supraventricular tachycardia), Novocainamide (for ineffectiveness or intolerance to other antiarrhythmics; the drug is quite effective , however, it is extremely inconvenient to use and, with prolonged use, can lead to agranulocytosis).
- It should be noted that in most cases of ventricular extrasystole, verapamil and beta blockers are ineffective. The effectiveness of first class drugs reaches 70%, but strict consideration of contraindications is necessary. The use of quinidine (Kinidin Durules) for ventricular extrasystole is undesirable.
It is advisable to give up alcohol, smoking, and excessive coffee consumption.
In patients with benign ventricular extrasystoles, an antiarrhythmic can be prescribed only at the time of day when manifestations of extrasystoles are subjectively felt.
In some cases, you can get by with the use of Valocordin and Corvalol.
In some patients, it is advisable to use psychotropic and/or vegetotropic therapy (Phenazepam, Diazepam, Clonazepam).
d,l-sotalolol (Sotalex, Sotahexal) is used only if amiodarone is intolerant or ineffective. The risk of developing an arrhythmogenic effect (ventricular tachycardia of the “pirouette” type against the background of QT prolongation beyond MS) increases significantly when moving to doses above 160 mg/day. and most often manifests itself in the first 3 days.
Amiodarone (Amiodarone, Cordarone) is effective in approximately 50% of cases. Careful addition of beta blockers, especially in cases of coronary artery disease, reduces both arrhythmic and overall mortality. Abrupt replacement of beta blockers with amiodarone is contraindicated! Moreover, the higher the initial heart rate, the higher the effectiveness of the combination.
Only amiodarone simultaneously suppresses ventricular extrasystole and improves the prognosis of life in patients who have suffered myocardial infarction and suffering from other organic lesions of the heart muscle. Treatment is carried out under ECG control - once every 2-3 days. After reaching amiodarone saturation (increasing the duration of the Q-T interval, widening and thickening of the T wave, especially in leads V5 and V6), the drug is prescribed in a maintenance dose (mg 1 time / day for a long time, usually from the 3rd week). The maintenance dose is determined individually. Treatment is carried out under ECG control - once every 4-6 weeks. If the duration of the Q-T interval increases by more than 25% of the initial value or up to 500 ms, temporary discontinuation of the drug and subsequent use of it in a reduced dose are required.
In patients with life-threatening ventricular extrasystoles, the development of thyroid dysfunction is not an indication for discontinuation of amiodarone. Monitoring of thyroid function with appropriate correction of disorders is mandatory.
“Pure” class III antiarrhythmics, like class I drugs, are not recommended due to their pronounced proarrhythmic effect. A meta-analysis of 138 randomized placebo-controlled studies on the use of antiarrhythmic therapy in patients with ventricular extrasystole after myocardial infarction (total number of patients) shows that the prescription of class I drugs in this category of patients is always associated with an increased risk of death, especially if these are class IC drugs. The risk of death is reduced by β-blockers (class II).
The question of the duration of antiarrhythmic therapy is practically important. In patients with malignant ventricular extrasystole, antiarrhythmic therapy should be continued indefinitely. For less malignant arrhythmias, treatment should be quite long (up to several months), after which an attempt to gradually discontinue the drug is possible.
In some cases - with frequent ventricular extrasystoles (up to a thousand per day) with an arrhythmogenic focus identified during an electrophysiological study and ineffectiveness, or if long-term use of antiarrhythmics is impossible in combination with poor tolerance or poor prognosis - radiofrequency ablation is used.
Forecast
Organic extrasystole, which develops in patients with acute myocardial infarction, myocarditis, cardiomyopathy, chronic heart failure, arterial hypertension, etc., has a more serious prognostic significance.
In fact, the prognosis of extrasystoles depends more on the presence or absence of organic heart disease and its severity than on the characteristics of the extrasystoles themselves; Accordingly, in the broadest sense, the main method of preventing extrasystoles is the timely treatment of these diseases.
Organic atrial extrasystoles that occur in patients with coronary artery disease, acute myocardial infarction, arterial hypertension against the background of pronounced morphological changes in the atria can be harbingers of paroxysmal atrial fibrillation or supraventricular tachycardia.
The criterion for the malignancy of supraventricular extrasystoles is the risk of developing atrial fibrillation, and ventricular extrasystoles is the risk of sudden death.
Assessing the prognostic value of ventricular extrasystoles, it should be emphasized that in approximately 65–70% of people with a healthy heart, individual ventricular extrasystoles are recorded during Holter monitoring, the source of which in most cases is localized in the right ventricle. Such monomorphic isolated ventricular extrasystoles, usually belonging to class 1 according to the classification of B. Lown and M. Wolf, are not accompanied by clinical and echocardiographic signs of organic heart pathology and hemodynamic changes. Therefore, they are called “functional ventricular extrasystoles.”
The main complication of ventricular extrasystole, which determines its clinical significance, is sudden death. Ventricular arrhythmias are associated with the likelihood of developing fatal arrhythmias, i.e., sudden arrhythmic death. To determine the degree of its risk in real clinical practice, the classification according to B. Lown, M. Wolf, as modified by M. Ryan, and the risk stratification of ventricular arrhythmias by J. T. Bigger are used. It involves analyzing not only the nature of ventricular ectopic activity, but also its clinical manifestations, as well as the presence or absence of organic heart damage as the cause of its occurrence. In accordance with these signs, 3 categories of patients are distinguished.
Benign ventricular arrhythmias include extrasystole, often single (there may be other forms), asymptomatic or asymptomatic, but most importantly, it occurs in individuals who do not have signs of heart disease. The prognosis for the life of these patients is favorable, due to the very low probability of fatal ventricular arrhythmias, which does not differ from that in the general population, and from the standpoint of preventing sudden death, they do not require any treatment. All that is necessary is dynamic monitoring of them, because, at least in some patients, ventricular extrasystole may be the debut of cardiac pathology.
The only fundamental difference between potentially malignant ventricular arrhythmias and the previous category is the presence of organic heart disease. Most often this is various shapes IHD (the most significant is previous myocardial infarction), heart damage due to arterial hypertension, primary myocardial diseases, etc. These patients with ventricular extrasystole of various grades (a potential triggering factor for ventricular tachyarrhythmias) have not yet had paroxysms of ventricular tachycardia, flutter or ventricular fibrillation, but the likelihood their occurrence is quite high, and the risk of sudden death is characterized as significant. Patients with potentially malignant ventricular arrhythmias require treatment aimed at reducing mortality, treatment based on the principle of primary prevention of sudden death.

Ectopic systoles
Extrasystoles
Extrasystolic arrhythmia
Premature:
- abbreviations NOS
- compression

Brugada syndrome
Long QT syndrome
Rhythm disturbance:
- coronary sinus
- ectopic
- nodal

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Place of ventricular extrasystole in the ICD system - 10

Ventricular extrasystole is one of the types of cardiac arrhythmia. And it is characterized by an extraordinary contraction of the heart muscle.

Ventricular extrasystole, according to the International Classification of Diseases (ICD - 10), has code 149.4. and is included in the list of heart rhythm disorders in the heart disease section.

Nature of the disease

Based on the international classification of diseases, tenth revision, doctors distinguish several types of extrasystole, the main ones being: atrial and ventricular.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). A 24-hour ECG showed positive results in 50% of the people studied.

Thus, it can be noted that the disease is common and can affect even healthy people. The cause of the functional nature of the disease can be stress.

Drinking energy drinks, alcohol, and smoking can also provoke extrasystoles in the heart. This type of illness is harmless and goes away quickly.

Pathological ventricular arrhythmia has more serious consequences for the health of the body. It develops against the background of serious diseases.

Classification

According to daily monitoring of the electrocardiogram, doctors consider six classes of ventricular extrasystoles.

Extrasystoles belonging to the first class may not manifest themselves in any way. The remaining classes are associated with health risks and the possibility of a dangerous complication: ventricular fibrillation, which can be fatal.

The source of extrasystoles can be different: they can come from one source - monotopic, or they can arise in different areas - polytopic.

Disease prognosis

Based on prognostic indications, the arrhythmias under consideration are classified into several types:

arrhythmias are benign, are not accompanied by heart damage and various pathologies, their prognosis is positive, and the risk of death is minimal;
ventricular extrasystoles of a potentially malignant direction occur against the background of heart damage, blood output is reduced by an average of 30%, and a health risk is noted;
ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to begin treatment, a diagnosis of the disease is required in order to determine its causes.

Characteristics of supraventricular extrasystole

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Gradation of ventricular extrasystole according to Ryan and Laun, code according to ICD 10

1 – rare, monotopic ventricular arrhythmia – no more than thirty VES per hour;

2 – frequent, monotopic ventricular arrhythmia – more than thirty VES per hour;

3 – polytopic ZhES;

4a – monomorphic paired VES;

4b – polymorphic paired VES;

5 – ventricular tachycardia, three or more VES in a row.

2 – infrequent (from one to nine per hour);

3 – moderately frequent (from ten to thirty per hour);

4 – frequent (from thirty-one to sixty per hour);

5 – very frequent (more than sixty per hour).

B – single, polymorphic;

D – unstable VT (less than 30s);

E – sustained VT (more than 30 s).

Absence of structural heart lesions;

Absence of scar or cardiac hypertrophy;

Normal left ventricular ejection fraction (LVEF) – more than 55%;

Slight or moderate frequency of ventricular extrasystole;

Absence of paired ventricular extrasystoles and unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia.

The presence of a scar or cardiac hypertrophy;

Moderate decrease in LVEF – from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia or their insignificant presence.

Presence of structural heart lesions;

Presence of scar or cardiac hypertrophy;

Significant decrease in LVEF – less than 30%;

Moderate or significant ventricular extrasystole;

Paired ventricular extrasystoles or unstable ventricular tachycardia;

Persistent ventricular tachycardia;

Moderate or severe hemodynamic consequences of arrhythmia.

Extrasystole - causes and treatment of the disease

Cardiac extrasystole is a type of heart rhythm disturbance based on improper contraction of the entire heart or its individual parts. Contractions are of an extraordinary nature under the influence of any impulse or excitation of the myocardium. This is the most common type of arrhythmia, affecting both adults and children, and is extremely difficult to get rid of. Practiced drug treatment and treatment with folk remedies. Gastric extrasystole is registered in ICD 10 (code 149.3).

Ventricular extrasystole is a fairly common disease. It affects completely healthy people.

Causes of extrasystole

overwork;
binge eating;
Availability bad habits(alcohol, drugs and smoking);
drinking caffeine in large quantities;
stressful situations;
heart disease;
toxic poisoning;
osteochondrosis;
diseases of internal organs (stomach).

Gastric extrasystole is a consequence of various myocardial lesions (ischemic heart disease, cardiosclerosis, myocardial infarction, chronic circulatory failure, heart defects). Its development is possible during febrile conditions and VSD. It is also a side effect of some medications (Euphelin, Caffeine, glucocorticosteroids and some antidepressants) and can be observed with improper treatment with folk remedies.

The reason for the development of extrasystole in people actively involved in sports is myocardial dystrophy associated with intense physical activity. In some cases, this disease is closely associated with changes in the amount of sodium, potassium, magnesium and calcium ions in the myocardium itself, which adversely affects its functioning and does not allow getting rid of attacks.

Often, gastric extrasystole can occur during or immediately after a meal, especially in patients with VSD. This is due to the characteristics of the heart during such periods: the heart rate decreases, so extraordinary contractions occur (before or after the next one). There is no need to treat such extrasystoles, since they are functional in nature. In order to get rid of extraordinary heart contractions after eating, you should not take horizontal position write immediately after taking it. It's better to sit in a comfortable chair and relax.

Classification

Depending on the location of the impulse and its cause, the following types of extrasystole are distinguished:

ventricular extrasystole;
atrioventricular extrasystole;
supraventricular extrasystole (supraventricular extrasystole);
atrial extrasystole;
atrioventricular extrasystole;
stem and sinus extrasystoles.

A combination of several types of impulse is possible (for example, a supraventricular extrasystole is combined with a stem one, a gastric extrasystole occurs together with a sinus one), which is characterized as parasystole.

Gastric extrasystole is the most common type of disturbance in the functioning of the cardiac system, characterized by the appearance of an additional contraction (extrasystole) of the heart muscle before its normal contraction. Extrasystole can be single or double. If three or more extrasystoles appear in a row, then we are talking about tachycardia (ICD code - 10: 147.x).

Supraventricular extrasystole differs from ventricular localization of the source of arrhythmia. Supraventricular extrasystole (supraventricular extrasystole) is characterized by the occurrence of premature impulses in upper sections heart (atria or in the septum between the atria and ventricles).

There is also the concept of bigeminy, when extrasystole occurs after normal contraction of the heart muscle. It is believed that the development of bigeminy is provoked by disturbances in the functioning of the autonomic nervous system, that is, the trigger for the development of bigeminy can be VSD.

There are also 5 degrees of extrasystole, which are determined by a certain number of impulses per hour:

the first degree is characterized by no more than 30 impulses per hour;
for the second - more than 30;
the third degree is represented by polymorphic extrasystoles.
the fourth degree is when 2 or more types of impulse appear alternately;
the fifth degree is characterized by the presence of 3 or more extrasystoles one after another.

The symptoms of this disease are in most cases invisible to the patient. The surest signs are sensations of a sharp blow in the heart, cardiac arrest, and freezing in the chest. Supraventricular extrasystole can manifest itself as VSD or neurosis and is accompanied by a feeling of fear, profuse sweating, anxiety, lack of air.

Diagnosis and treatment

Before treating any extrasystole, it is important to correctly determine its type. The most revealing method is electrocardiography (ECG), especially for ventricular impulses. An ECG can detect the presence of extrasystole and its location. However, a resting ECG does not always reveal the disease. Diagnosis becomes more complicated in patients suffering from VSD.

If this method does not show adequate results, ECG monitoring is used, during which the patient wears a special device that monitors the work of the heart throughout the day and records the progress of the study. This ECG diagnosis allows you to identify the disease, even if the patient has no complaints. A special portable device attached to the patient’s body records ECG readings within 24 or 48 hours. At the same time, the patient’s actions are recorded at the time of ECG diagnosis. The daily activity data and ECG are then compared, which allows the disease to be identified and treated correctly.

Some literature indicates the norms for the occurrence of extrasystoles: for healthy person The norm is considered to be ventricular and extraventricular extrasystoles per day, detected on an ECG. If after ECG research no deviations were detected, the specialist may prescribe special additional tests with a load (treadmill test)

To treat correctly this disease it is necessary to take into account the type and degree of extrasystole, as well as its location. Single impulses do not require specific treatment, they do not pose any threat to human health and life only if they are caused by a serious heart disease.

Features of treatment

To cure a disease caused by neurological disorders, they are prescribed sedatives(relanium) and herbal teas(valerian, motherwort, mint).

If the patient has a history of serious heart disease, the extrasystole is supraventricular in nature, and the frequency of impulses per day exceeds 200, individually selected drug therapy is necessary. To treat extrasystalia in such cases, drugs such as Propanorm, Cordarone, Lidocaine, Diltiazem, Panangin, as well as beta-blockers (Atenolol, Metoprolol) are used. Sometimes these means can get rid of the manifestations of VSD.

A drug such as Propafenone, which is an antiarrhythmic drug, is currently the most effective and allows you to treat even the advanced stage of the disease. It is quite well tolerated and absolutely safe for health. That is why it was classified as a first-line drug.

Enough effective method To cure extrasystole forever, is to cauterize its source. This is a fairly simple surgical intervention with virtually no consequences, but it cannot be performed on children; there is an age limit.

If gastric extrasystole is present in the later stages, then it is recommended to treat it using the method radiofrequency ablation. This is a method of surgical intervention with the help of which the source of arrhythmia is destroyed under the influence of physical factors. The procedure is easily tolerated for the patient, the risk of complications is minimized. In most cases, gastric extrasystole goes away irrevocably.

Treatment of children

In most cases, treatment for the disease in children is not necessary. Many experts claim that in children the disease goes away without treatment. If desired, you can stop severe attacks with safe folk remedies. However, it is recommended to undergo an examination to determine the extent of the disease.

Extrasystole in children can be congenital or acquired (after nervous shock). The presence of mitral valve prolapse and the occurrence of impulses in children are closely related. As a rule, supraventricular extrasystole (or gastric extrasystole) does not require special treatment However, it is necessary to undergo examination at least once a year. Children suffering from VSD are at risk.

It is important to limit children from provoking factors that contribute to the development of this disease (healthy lifestyle and sleep, lack of stressful situations). For children, it is recommended to eat foods enriched with elements such as potassium and magnesium, for example, dried fruits.

In the treatment of extrasystole and VSD in children, drugs such as Noofen, Aminalon, Phenibut, Mildronate, Panangin, Asparkam and others are used. Treatment with folk remedies is effective.

Fighting with folk remedies

Get rid of severe attacks possible using folk remedies. At home, you can use the same remedies as in the treatment of VSD: soothing infusions and herbal decoctions.

Valerian. If the attack is classified by emotional type, then pharmaceutical infusion Valerian root will help get rid of anxiety. It is enough to take 10 - 15 drops of infusion once, preferably after a meal.
Cornflower infusion will save you during an attack. It is recommended to drink the infusion 10 minutes before meals, 3 times a day (only on the day when the attack occurs).
An infusion of calendula flowers will help get rid of frequent attacks.

Treatment with such traditional methods should be practiced only after consultation with a doctor. If you use them incorrectly, you may simply not get rid of the disease, but may also worsen it.

Prevention

To get rid of the risk of developing extrasystole, timely examination and treatment of heart disease is necessary. Following a diet with plenty of potassium and magnesium salts prevents the development of exacerbations. It is also necessary to give up bad habits (smoking, alcohol, coffee). In some cases, treatment with folk remedies is effective.

Consequences

If the impulses are sporadic and not burdened by anamnesis, then the consequences for the body can be avoided. When the patient already has heart disease, has had a myocardial infarction in the past, frequent extrasystole can cause tachycardia, atrial fibrillation and fibrillation of the atria and ventricles.

Gastric extrasystole is considered the most dangerous, since ventricular impulses can lead to sudden death through the development of their fibrillation. Gastric extrasystole requires careful treatment, as it is very difficult to get rid of.

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Coding of ventricular extrasystole according to ICD 10

Extrasystoles are episodes of premature contraction of the heart due to an impulse that comes from the atria, atrioventricular regions and ventricles. An extraordinary contraction of the heart is usually recorded against the background of normal sinus rhythm without arrhythmia.

It is important to know that ventricular extrasystole in ICD 10 has code 149.

The presence of extrasystoles is observed in% of the entire world population, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other heart rhythm disorders, but the following exceptions are also provided:

rare myocardial contractions (bradycardia R1);
extrasystole caused by obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
disturbances in the functioning of the cardiovascular system in a newborn (P29.1).

The extrasystole code according to ICD 10 determines the plan of diagnostic measures and, in accordance with the examination data obtained, a set of therapeutic methods used throughout the world.

Etiological factor for the presence of extrasystoles according to ICD 10

heart disease caused by inflammatory processes (myocarditis, pericarditis, bacterial endocarditis);
development and progression of coronary heart disease;
dystrophic changes in the myocardium;
oxygen starvation of the myocardium due to processes of acute or chronic decompensation.

In most cases, episodic interruptions in the functioning of the heart are not associated with damage to the myocardium itself and are only functional in nature, that is, extrasystoles occur due to severe stress, excessive smoking, coffee and alcohol abuse.

Ventricular extrasystole in the international classification of diseases has the following types of clinical course:

premature contraction of the myocardium, occurring after each normal one, is called bigeminy;
trigeminy is the process of a pathological impulse after several normal myocardial contractions;
quadrigeminy is characterized by the appearance of extrasystole after three myocardial contractions.

In the presence of any type of this pathology, a person feels a sinking heart, and then strong tremors in the chest and dizziness.

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Self-medication can be dangerous to your health. At the first sign of disease, consult a doctor.

Extrasystole is an untimely contraction of the heart or its chambers individually. In fact, this is one of the types of arrhythmias. The pathology is quite common - from 60 to 70% of people are related to it to one degree or another. Moreover, we ourselves provoke the development of extrasystole through the abuse of coffee or strong tea, excessive drinking of alcohol, and smoking.

Extrasystoles can also occur due to myocardial damage under the influence of a number of pathologies (cardiosclerosis, acute infarction, coronary heart disease, dystrophy, etc.). In addition to pathologies, various options Heart rhythm disturbances (for example, allorhythmias such as bigeminy) can be caused by excessive (overdose) use of medications, for example, cardiac glycosides can play a bad role.

In the international classification, extrasystole code according to ICD-10 is classified in the section “Other heart rhythm disorders” (I49).

Important! The occurrence of isolated cases can be observed in healthy people against the background of overwork, physical and mental stress, drinking strong coffee, alcohol and smoking.

This suggests that extrasystole can occur not only in persons with pathology of the cardiovascular system. Medical research and observations indicate that up to 75% of the healthy population experience extrasystoles at certain periods of time. Up to 250 such episodes per day are considered normal.
But if a person has any disease of the heart or blood vessels, then such rhythm disturbances can cause serious life-threatening conditions.

Classification

In order to understand extrasystoles and the sources of their occurrence, it is necessary to remember that the physiological pacemaker is the sinoatrial node.

Important! In rare cases, even the sinoatrial node can be the source of generation of extraordinary impulses.

First of all, all extrasystoles are divided according to the etiological factor:

Functional – occur in absolutely healthy people due to various factors, which have already been mentioned above. Also, such extrasystoles can occur for no apparent reason.
Organic – typical for patients with cardiac pathology. More often observed with developmental defects and after heart surgery.
Psychogenic – characteristic of individuals who are prone to depression, neurasthenia, anxiety, and frequent stressful situations.
Toxic – often accompany various diseases endocrine system, taking narcotic drugs, certain medications (caffeine, glucocorticosteroids, ephedrine).
Idiopathic - extrasystole is recorded on the ECG, but objective reasons cannot be identified. Often a hereditary process.

Atrial (supraventricular, supraventricular extrasystole) - foci of excitation do not arise in the conduction system of the heart, but in the atria or atrioventricular septum, then are transmitted to the sinus node and to the ventricles, i.e., supraventricular extrasystole is characterized by ectopic foci of excitation.
Atrioventricular (atrioventricular, nodal) - the origin of the impulse is noted between the atria and ventricles, spreading down and up. In some cases, it can cause blood to flow back into the heart. In turn, depending on the localization of ectopic foci in the node, they are divided into:
- Upper.
- Average.
- Lower ones.
Sinoatrial - an excitation impulse arises in the sinoatrial node.
Stem - originate from the bundle of His, do not spread to the atria, but are transmitted only to the ventricles.
Ventricular is the most common type of extrasystoles that occur in the ventricles of the heart. In such cases, there is no impulse transmission to the atria, and extraordinary contractions alternate with compensatory pauses. Ventricular extrasystole is classified into 5 classes and is diagnosed only after daily monitoring:
- Class I - extrasystoles are not recorded - the process is considered physiological.
- Class II – up to 30 monotopic extrasystoles are recorded within an hour.
- Class III – per hour is determined from 30 monotopic extrasystoles at any time of the day.
- Class IV - in addition to monotopic ones, polytopic ones are also recorded:
  - IV “a” class - monotoponic extrasystoles become paired.
  - IV “b” class – paired polytopic extrasystoles appear.
- Class V – group polytopic extrasystoles are detected on the ECG. Moreover, within 30 seconds they can occur up to 5 in a row.

Also, ventricular extrasystoles can be right ventricular and left ventricular.

Extrasystoles from grades 2 to 5 are characterized by persistent hemodynamic disturbances and can cause ventricular fibrillation and death.

By age factor:

Congenital extrasystoles are combined with malformations of the heart and impaired structure of the walls of the ventricles.
Acquired - those failures that develop under the influence of pathological factors on the human body - infectious diseases, heart damage.

According to the place where the abbreviations occur:

Monotopic - extraordinary impulses originate from one focus.
Polytopic - impulses originate from different sources.

By time of occurrence during diastole:

Early - those extrasystoles that occur at the beginning of diastole; the ECG is recorded simultaneously with the T wave or no later than 0.05 seconds after the end of the previous heart contraction cycle.
Medium - determined on the ECG 0.45 - 0.5 seconds after the T wave.
Late - such extrasystoles are determined at the end or in the middle of diastole, before the subsequent P wave of normal heart contraction.

By frequency of occurrence:

Single.
Paired - ectopic foci generate extrasystoles in a row.
Multiple - the development of extrasystoles is recorded more than 5 per minute.
Salvo (group) - extrasystoles occurring several times in a row in the amount of more than two.

By frequency of formation:

Rare - up to 5 are formed per minute.
Medium - extrasystoles are recorded up to 6 - 15 per minute.
Frequent – recorded from 15 per minute or more often.

According to the pattern of occurrence of extraordinary contractions (allorhythmia):

- Occurs after each normal contraction of the heart muscle.
Trigymenia - extrasystoles are recorded after every second contraction.
Quadrihymenia - after every third contraction of the heart, extraordinary impulses are formed.

Life prognosis:

Extrasystoles that are not life-threatening develop without the presence of heart disease.
Potentially dangerous extrasystoles - detected against the background of acute myocardial infarction, hypertensive crisis.
Extrasystoles that are dangerous to human life are difficult to treat, accompany severe heart pathology, and often lead to the development of life-threatening conditions.

Important! There is another type of extrasystoles, in which abnormal impulses are generated independently of the main ones. In this case, two pairs of parallel rhythms are formed, which are sinus and extrasystolic. This type of extrasystole is called parasystole.

Causes

Causes of functional extrasystoles:

Stress.
Smoking.
Consumption of alcohol, coffee, strong tea in large quantities.
Overwork.
Menses.
Vegetative-vascular dystonia.
Infectious and inflammatory diseases that are accompanied by high body temperature.
Neuroses.
Osteochondrosis of the cervical and thoracic spine.

Causes of organic extrasystoles:

Infectious diseases of the cardiovascular system (myocarditis).
Chronic cardiovascular failure.
Congenital and acquired heart defects.
Thyrotoxicosis and other diseases of the thyroid gland.
Pericarditis.
Pulmonary heart.
Sarcoidosis.
Amyloidosis.
Heart operations.
Hemochromatosis.
Pathology of the gastrointestinal tract.
Oncological diseases.
Allergic reactions.
Electrolyte metabolism disorders.

Causes of toxic extrasystoles:

Chemical poisoning.
Intoxication with infectious diseases and pathologies of the endocrine system.

Pathogenesis

As mentioned above, extrasystole is extraordinary and premature contractions of the heart.

Normally, contraction of the heart muscle occurs when a nerve impulse passes from the sinus node, located in the left atrium, through the atrioventricular node, located between the atria and ventricles in two nerve bundles into both ventricles.

In this case, there should be no deviations along the path of the impulse. This process of passing an impulse is strictly limited in time.
This is necessary so that the myocardium has time to rest during the filling period, so that it can then release a portion of blood into the vessels with sufficient force.

If at any of these stages any obstacles or failures arise, or foci of excitation arise in places other than the typical ones, then in such cases the heart muscle fails to completely relax, the force of contraction weakens, and it almost completely drops out of the blood circulation cycle.

For reference. In order for an extraordinary contraction of the heart to occur, i.e., extrasystole, it is necessary to block the sinus node, the main role in the regulation of which is played by the vagus nerve.

It is through the vagus nerve that signals from the brain come from the brain about a slowdown in the heart rate, and through the sympathetic nerves - signals about the need to increase it. If the vagus nerve predominates in the sinus node, impulse transmission is delayed. The accumulation of energy in other parts of the conduction system tries to generate contractions on its own. This is how extrasystole develops in healthy people.

In addition, extrasystoles can occur reflexively when the diaphragm rises, which entails irritation of the vagus nerve. Such phenomena are observed after generous intake food, diseases of the digestive tract.

The sympathetic effect on the heart muscle leads to its overexcitation. This manifestation can be caused by smoking, insomnia, stress, and mental overload. According to this mechanism, extrasystole develops in children.

In the case of an existing heart pathology, ectopic (pathological) foci are formed outside the conduction system of the heart with increased automaticity. This is how extrasystoles develop in cardiosclerosis, heart defects, myocarditis, and coronary heart disease.

Very often, when the ratio of potassium, magnesium, sodium and calcium ions in the myocardial cells is disturbed, a negative effect occurs on the conduction system of the heart, which is transformed into the appearance of extrasystoles.

With the development of extrasystoles, extraordinary impulses spread throughout the myocardium. This causes early, premature contractions of the heart in diastole. At the same time, the volume of blood ejection decreases, which entails changes in minute volume blood circulation The earlier the extrasystole is formed, the smaller the blood volume will be during extrasystolic ejection. Thus, coronary blood flow deteriorates in heart pathology.

Important! The most life-threatening are ventricular extrasystoles, which develop against the background of organic pathology of the cardiovascular system.

Clinical manifestations

Very often, extrasystole is completely invisible to patients and there are no symptoms. But, most patients, on the contrary, characterize their feelings as:

Stop.
Freezing of the heart.
A blow from the inside.
Failure.

Such sensations of cardiac arrest are due to the fact that these feelings depend on the pause that is generated after an extraordinary contraction. This is followed by a cardiac impulse, which is stronger. This is clinically expressed as a sensation of shock.

Most frequent symptoms in patients with extrasystole are:

Pain in the heart area.
Weakness.
Dizziness.
Cough.
Sweating.
Feeling of fullness chest.
Pallor.
Feeling short of air.
Anxiety.
Fear of death.
Panic.
Loss of the pulse wave when palpating the pulse, which further increases the fear of patients.
Paresis.
Fainting.
Transient speech disorders.

Important! With the development of extrasystoles, the feeling of fear and panic further enhances the release of adrenaline, which, in turn, aggravates the course of the arrhythmia and its symptoms.

It should be noted that the tolerance of cardiac failures in persons who suffer from vegetative-vascular dystonia is much more severe, which does not correspond to the clinical manifestations. But with patients who have a pathology of the cardiovascular system, the opposite is true - they tolerate arrhythmia more easily, since the heart is already “trained” to various types failures, and morally such patients are more stable.

Extrasystole in children

In children, disruptions can occur at any age, even while still in the womb. The reasons for the development of this pathology in childhood are the same factors as in adults.

A special type includes genetic processes for which ventricular extrasystole and tachycardia are the main manifestations. This anomaly lies in the fact that, against the background of arrhythmogenic dysplasia of the right ventricle, the myocardium develops incorrectly. The danger of this pathology is that sudden death often develops.

This type of heart rhythm disorder often does not manifest itself clinically and is determined by chance in 70% of cases.

As the child grows up, he has the same complaints as adults, which may intensify during puberty.

Important! If a child, in addition to complaints of failure, shock, or cardiac arrest, indicates symptoms such as general severe weakness and dizziness, this indicates the development of severe damage to the cardiovascular system and a disorder of hemodynamic processes.

Since extrasystoles of vegetative origin are more typical for children, such extrasystoles are divided into several types:

Vago-dependence is more common in older children in the form of group, allorhythmic manifestations.
Combined-dependent – typical for younger children and schoolchildren.
Sympathetic dependent - most often occurs in puberty. Distinctive feature such extrasystoles are their intensification in an upright position, predominance during the daytime and decrease during sleep.

If a child is diagnosed with ventricular extrasystole, it is necessary to monitor him, since in many cases treatment is not required, and the extrasystole itself goes away by the time puberty is completed. But if the number of extrasystoles per day is 15,000 or more, treatment must be started immediately.

Diagnosis and treatment in children are completely identical to those in adults.

Diagnostics

To do this, it is necessary to conduct 24-hour Holter monitoring, during which all possible extrasystoles that occur both day and night are recorded during the day.

Extrasystole on the ECG will have the following signs:

Early appearance of the QRST complex or P wave, which indicates a shortening of the pre-extrasystolic coupling interval - with atrial extrasystoles, normal and extrasystolic P waves are taken into account, and with ventricular and atrioventricular extrasystoles, QRS complexes are taken into account.
Expansion, deformation, high amplitude of the extrasystolic QRS complex during ventricular extrasystole.
Absence of the P wave before the ventricular extrasystole.
Complete compensatory pause after ventricular extrasystoles.

The following manipulations are also used for diagnostic purposes:

Bicycle ergometry is an ECG study during physical activity. This method is used to clarify the presence of extrasystoles and signs of ischemia.
Ultrasound of the heart - allows you to determine the activity of the entire heart muscle and heart valves.
Transesophageal examination.
MRI of the heart and blood vessels.

As a rule, diagnosing extrasystole does not take much time, so if all necessary procedures are carried out, treatment should begin as early as possible.

Extrasystole. Treatment

You should not self-medicate, since any heart rhythm disturbance in combination with incorrectly selected medications
drugs can easily cause harm and lead to very disastrous consequences.

Currently, the following therapeutic measures are used in the treatment of extrasystole:

In the case of functional extrasystole, treatment is unlikely to be necessary. However, there is still some risk, so it is recommended to reduce the consumption of cigarettes, alcohol and coffee.
If extrasystoles have developed against the background of a stressful situation, you need to take soothing herbal drops - valerian, hawthorn, motherwort. The use of Corvalol is also recommended to relieve symptoms of general anxiety and agitation.
When the cause of the pathology is osteochondrosis, first of all it is necessary to consult a neurologist or vertebrologist, who will prescribe appropriate treatment.
Since the cause of heart failure is often chronic fatigue, in such cases you just need to adjust your day and stick to the regime. It is recommended to go to bed no later than 23:00 and ensure yourself a full, healthy sleep of at least 8 hours. As the body strengthens, the symptoms of the disease disappear.
If an organic cause of failure is diagnosed, then first of all its sources are clarified, additional examinations are carried out and only then treatment proceeds. First of all, a number of beta blockers are prescribed, which reduce the pulse (metoprolol, bisoprolol), but strictly individually in each individual case.
When the process is pronounced, apply antiarrhythmic drugs– diltiazem, cordarone, anaprilin, novocainamide.
If there is no effect from treatment, they resort to a method such as radiofrequency catheter ablation - installation of an artificial pacemaker.

Surgery eliminates arrhythmia and significantly improves the prognosis and quality of life of patients.

Complications

Ventricular fibrillation.
Atrial fibrillation.
Paroxysmal tachycardia.
Atrial fibrillation.
Cardiogenic shock.
Sudden cardiac death.

As you can see, extrasystole can lead to dangerous complications, so timely diagnosis and treatment will help improve both the patient’s condition and the prognosis for future life.

Forecast

The most dangerous are those extrasystoles that occur against the background of myocardial infarction, cardiomyopathies and myocarditis. Naturally, in such cases the prognosis will be the most unfavorable, since changes in the structure of the heart during such processes often lead to the development of atrial or ventricular fibrillation.

If no pronounced changes in the structure of the myocardium are noted, then the prognosis in such cases is the most favorable.

For reference. The prognosis is also favorable for functional extrasystole if all the doctor’s requirements are met.

Ectopic systoles
Extrasystoles
Extrasystolic arrhythmia
Premature:
- abbreviations NOS
- compression

Brugada syndrome
Long QT syndrome
Rhythm disturbance:
- coronary sinus
- ectopic
- nodal

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Gradation of ventricular extrasystole according to Ryan and Laun, code according to ICD 10

1 – rare, monotopic ventricular arrhythmia – no more than thirty VES per hour;

2 – frequent, monotopic ventricular arrhythmia – more than thirty VES per hour;

3 – polytopic ZhES;

4a – monomorphic paired VES;

4b – polymorphic paired VES;

5 – ventricular tachycardia, three or more VES in a row.

2 – infrequent (from one to nine per hour);

3 – moderately frequent (from ten to thirty per hour);

4 – frequent (from thirty-one to sixty per hour);

5 – very frequent (more than sixty per hour).

B – single, polymorphic;

D – unstable VT (less than 30s);

E – sustained VT (more than 30 s).

Absence of structural heart lesions;

Absence of scar or cardiac hypertrophy;

Normal left ventricular ejection fraction (LVEF) – more than 55%;

Slight or moderate frequency of ventricular extrasystole;

Absence of paired ventricular extrasystoles and unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia.

The presence of a scar or cardiac hypertrophy;

Moderate decrease in LVEF – from 30 to 55%;

Moderate or significant ventricular extrasystole;

The presence of paired ventricular extrasystoles or unstable ventricular tachycardia;

Absence of persistent ventricular tachycardia;

Absence of hemodynamic consequences of arrhythmia or their insignificant presence.

Presence of structural heart lesions;

Presence of scar or cardiac hypertrophy;

Significant decrease in LVEF – less than 30%;

Moderate or significant ventricular extrasystole;

Paired ventricular extrasystoles or unstable ventricular tachycardia;

Persistent ventricular tachycardia;

Moderate or severe hemodynamic consequences of arrhythmia.

Coding of ventricular extrasystole according to ICD 10

It is important to know that ventricular extrasystole in ICD 10 has code 149.

The presence of extrasystoles is observed in% of the entire world population, which determines the prevalence and a number of varieties of this pathology.

Code 149 in the International Classification of Diseases is defined as other heart rhythm disorders, but the following exceptions are also provided:

rare myocardial contractions (bradycardia R1);
extrasystole caused by obstetric and gynecological surgical interventions (abortion O00-O007, ectopic pregnancy O008.8);
disturbances in the functioning of the cardiovascular system in a newborn (P29.1).

The extrasystole code according to ICD 10 determines the plan of diagnostic measures and, in accordance with the examination data obtained, a set of therapeutic methods used throughout the world.

Etiological factor for the presence of extrasystoles according to ICD 10

heart disease caused by inflammatory processes (myocarditis, pericarditis, bacterial endocarditis);
development and progression of coronary heart disease;
dystrophic changes in the myocardium;
oxygen starvation of the myocardium due to processes of acute or chronic decompensation.

Ventricular extrasystole in the international classification of diseases has the following types of clinical course:

premature contraction of the myocardium, occurring after each normal one, is called bigeminy;
trigeminy is the process of a pathological impulse after several normal myocardial contractions;
quadrigeminy is characterized by the appearance of extrasystole after three myocardial contractions.

In the presence of any type of this pathology, a person feels a sinking heart, and then strong tremors in the chest and dizziness.

Ventricular extrasystole - description.

Short description

Ventricular extrasystole (VC) is premature excitation and contraction of the ventricles caused by a heterotopic focus of automatism in the ventricular myocardium. Ventricular extrasystole is based on the mechanisms of re-entry and post-depolarization in ectopic foci of the branches of the His bundle and Purkinje fibers.

Etiology. See Extrasystole.

ECG - identification There is no P wave in front of the QRS complex. The QRS complex is widened and deformed, duration is 0.12 s. The shortened ST segment and T wave are located discordantly with respect to the main wave of the QRS complex. Full compensatory pause (the sum of the pre-ectopic and post-ectopic intervals is equal to two R-R intervals sinus rhythm)

Gradation of ventricular extrasystoles (according to Lown, 1977) I - rare monotopic extrasystoles (up to 30 extrasystoles in any hour of monitoring) II - frequent monotopic PVCs (over 30 extrasystoles) III - polytopic PVCs IVa - paired extrasystoles IVb - group PVCs V - early PVCs " R to T."

Treatment Treatment of the underlying disease Indications for drug therapy - see Extrasystole Correction of electrolyte levels (potassium, magnesium) Drug therapy Propafenone 150 mg 3 times a day Etatsizin 1 tablet 3 times a day Sotalol 80 mg 2 times a day (up to 240–320 mg/day) Lappaconitine hydrobromide 25 mg 3 times/day Amiodarone 800–1600 mg/day for 1–3 weeks until the effect is achieved; maintenance dose - usually 200 mg/day Propranolol 10–40 mg 3–4 times/day Class IC antiarrhythmic drugs, when taken for a long time, increase mortality in patients after a MI and with low myocardial contractile function.

Reduction. PVC - ventricular extrasystole.

ICD-10 I49.3 Premature ventricular depolarization

Place of ventricular extrasystole in the ICD system - 10

Ventricular extrasystole is one of the types of cardiac arrhythmia. And it is characterized by an extraordinary contraction of the heart muscle.

Ventricular extrasystole, according to the International Classification of Diseases (ICD - 10), has code 149.4. and is included in the list of heart rhythm disorders in the heart disease section.

Nature of the disease

Based on the international classification of diseases, tenth revision, doctors distinguish several types of extrasystole, the main ones being: atrial and ventricular.

According to ECG data, single extrasystoles can periodically occur even in healthy young people (5%). A 24-hour ECG showed positive results in 50% of the people studied.

Thus, it can be noted that the disease is common and can affect even healthy people. The cause of the functional nature of the disease can be stress.

Drinking energy drinks, alcohol, and smoking can also provoke extrasystoles in the heart. This type of illness is harmless and goes away quickly.

Pathological ventricular arrhythmia has more serious consequences for the health of the body. It develops against the background of serious diseases.

Classification

According to daily monitoring of the electrocardiogram, doctors consider six classes of ventricular extrasystoles.

The source of extrasystoles can be different: they can come from one source - monotopic, or they can arise in different areas - polytopic.

Disease prognosis

Based on prognostic indications, the arrhythmias under consideration are classified into several types:

arrhythmias are benign, are not accompanied by heart damage and various pathologies, their prognosis is positive, and the risk of death is minimal;
ventricular extrasystoles of a potentially malignant direction occur against the background of heart damage, blood output is reduced by an average of 30%, and a health risk is noted;
ventricular extrasystoles of a pathological nature develop against the background of severe heart disease, the risk of death is very high.

In order to begin treatment, a diagnosis of the disease is required in order to determine its causes.

Ventricular extrasystole

Ventricular extrasystole (VES) is a single ventricular impulse that occurs as a result of re-entry involving the ventricles or abnormal automaticity of ventricular cells. Ventricular extrasystole is often found in healthy people and in patients with heart pathology. Ventricular extrasystoles may be asymptomatic or cause palpitations. The diagnosis is made based on ECG data. Treatment is most often not necessary.

ICD-10 code

Causes of ventricular extrasystole

Ventricular extrasystoles (PVCs), also called premature ventricular contractions (PVCs), can appear suddenly or at regular intervals (for example, every third contraction is trihymenia, the second is bigymenia). The rate of ventricular premature beats may be increased by stimulation (eg, anxiety, stress, alcohol, caffeine, sympathomimetic drugs), hypoxia, or electrolyte imbalance.

Symptoms of ventricular extrasystole

Patients can characterize ventricular extrasystoles as missed or “jumping” contractions. It is not the ventricular extrasystole itself that is felt, but the sinus contraction that follows it. If ventricular extrasystoles are very frequent, especially if they appear instead of every second contraction, mild hemodynamic symptoms are possible, since sinus rhythm is significantly affected. Existing ejection murmurs may increase in intensity as ventricular filling and contraction increase after the compensatory pause.

The diagnosis is made by ECG data: a wide complex appears without a preceding P wave, usually accompanied by a complete compensatory pause.

Where does it hurt?

What needs to be examined?

How to examine?

Who to contact?

Forecast and treatment of ventricular extrasystole

Ventricular extrasystole is not considered significant in patients without cardiac pathology, and there is no need for special treatment, with the exception of pathology that can potentially trigger the occurrence of ventricular extrasystole. If the patient does not tolerate the symptoms well, b-blockers are prescribed. Other antiarrhythmic drugs that suppress ventricular premature beats may lead to more severe arrhythmias.

In patients with organic heart disease (for example, aortic stenosis or after myocardial infarction), the choice of treatment is a controversial issue, even taking into account the fact that frequent ventricular premature beats (more than 10 per hour) correlate with increased mortality, since no studies have shown that pharmacological suppression of ventricular extrasystoles reduces mortality. In patients after myocardial infarction, class I antiarrhythmic drugs cause an increase in mortality compared with placebo. This fact may reflect the side effects of antiarrhythmic drugs. b-Adrenergic blockers are effective in heart failure accompanied by clinical symptoms, and after myocardial infarction. If the number of ventricular extrasystoles increases with physical activity in patients with coronary artery disease, percutaneous intra-arterial coronary angioplasty or coronary artery bypass grafting may be necessary.

Ventricular extrasystole: symptoms and treatment

Ventricular extrasystole - main symptoms:

Headache
Weakness
Dizziness
Dyspnea
Fainting
Lack of air
Increased fatigue
Irritability
Heart sinking
Heartache
Heart rhythm disturbance
Increased sweating
Pale skin
Interruptions in heart function
Panic attacks
Moodiness
Fear of death
Feeling broken

Ventricular extrasystole is one of the forms of cardiac arrhythmia, which is characterized by the occurrence of extraordinary or premature contractions of the ventricles. Both adults and children can suffer from this disease.

Today it is known a large number of predisposing factors leading to the development of such a pathological process, which is why they are usually divided into several large groups. The cause may be other illnesses, drug overdose or toxic effects on the body.

The symptoms of the disease are nonspecific and are characteristic of almost all cardiac ailments. The clinical picture includes sensations of impaired heart function, a feeling of lack of air and shortness of breath, as well as dizziness and pain in the sternum.

Diagnosis is based on a physical examination of the patient and a wide range of specific instrumental examinations. Laboratory studies are of an auxiliary nature.

Treatment of ventricular extrasystole in the vast majority of situations is conservative, however, if such methods are ineffective, surgical intervention is indicated.

The International Classification of Diseases, Tenth Revision, defines a separate code for such pathology. Thus, the ICD-10 code is I49.3.

Etiology

Ventricular extrasystole in children and adults is considered one of the most common types of arrhythmias. Among all types of the disease, this form is diagnosed most often, namely in 62% of situations.

The causes are so diverse that they are divided into several groups, which also determine the course of the disease.

Cardiac disorders leading to organic extrasystole are presented:

The functional type of ventricular extrasystole is determined by:

long-term addiction to bad habits, in particular, smoking cigarettes;
chronic stress or severe nervous tension;
drinking large amounts of strong coffee;
neurocirculatory dystonia;
osteochondrosis cervical region spine;
vagotonia.

In addition, the development of this type of arrhythmia is influenced by:

hormonal imbalance;
overdose of drugs, in particular diuretics, cardiac glycosides, beta-agonists, antidepressants and antiarrhythmic substances;
the occurrence of VSD is the main cause of ventricular extrasystole in children;
chronic oxygen starvation;
electrolyte disturbances.

It is also worth noting that in approximately 5% of cases, such a disease is diagnosed in a completely healthy person.

In addition, specialists from the field of cardiology note the occurrence of such a form of the disease as idiopathic ventricular extrasystole. In such situations, arrhythmia in a child or adult develops for no apparent reason, i.e., the etiological factor is established only during diagnosis.

Classification

In addition to the fact that the type of pathology will differ in predisposing factors, there are several more classifications of the disease.

Depending on the time of formation, the disease can be:

early - occurs when the atria, which are the upper parts of the heart, contract;
interpolated - develops at the border of the time interval between contraction of the atria and ventricles;
late - observed during contraction of the ventricles, protruding from the lower parts of the heart. Less commonly formed in diastole - this is the stage of complete relaxation of the heart.

Based on the number of sources of excitability, the following are distinguished:

monotopic extrasystole - in this case there is one pathological focus, leading to additional cardiac impulses;
polytopic extrasystole - in such cases several ectopic sources are detected.

Classification of ventricular extrasystole by frequency:

single - characterized by the appearance of 5 extraordinary heartbeats per minute;
multiple - more than 5 extrasystoles occur per minute;
steam room - this form is distinguished by the fact that 2 extrasystoles are formed in a row in the interval between normal heart contractions;
group - these are several extrasystoles coming one after another between normal contractions.

According to its ordering, pathology is divided into:

disordered - there is no pattern between normal contractions and extrasystoles;
ordered. In turn, it exists in the form of bigeminy - it is an alternation of normal and extraordinary contractions, trigeminy - an alternation of two normal contractions and an extrasystole, quadrigeminy - there is an alternation of 3 normal contractions and an extrasystole.

According to the nature of the course and forecasts, extrasystole in women, men and children can be:

benign course - differs in that the presence of organic damage to the heart and improper functioning of the myocardium is not observed. This means that the risk of sudden death is minimized;
potentially malignant course- ventricular extrasystoles are observed due to organic damage to the heart, and the ejection fraction decreases by 30%, while the likelihood of sudden cardiac death increases compared to the previous form;
malignant course - severe organic damage to the heart is formed, which is dangerous with a high chance of sudden cardiac death.

A separate type is intercalary ventricular extrasystole - in such cases there is no formation of a compensatory pause.

Symptoms

A rare arrhythmia in a healthy person is completely asymptomatic, but in some cases there is a feeling of cardiac arrest, “interruptions” in functioning or a kind of “push”. Such clinical manifestations are a consequence of increased post-extrasystolic contraction.

The main symptoms of ventricular extrasystole are presented:

severe dizziness;
pale skin;
pain in the heart;
increased fatigue and irritability;
periodic headaches;
weakness and weakness;
feeling of lack of air;
fainting states;
shortness of breath;
causeless panic and fear of dying;
heart rate disturbance;
increased sweating;
capriciousness - this symptom is characteristic of children.

It is worth noting that the occurrence of ventricular extrasystole against the background of organic heart diseases can go unnoticed for a long period of time.

Diagnostics

The basis of diagnostic measures are instrumental procedures, which are necessarily supplemented by laboratory studies. Nevertheless, the first stage of diagnosis will be the cardiologist’s independent implementation of the following manipulations:

studying the medical history will indicate the main pathological etiological factor;
collection and analysis of life history - this can help in finding the causes of ventricular extrasystole of an idiopathic nature;
a thorough examination of the patient, namely palpation and percussion of the chest, determining the heart rate by listening to the person using a phonendoscope, as well as palpating the pulse;
a detailed survey of the patient - to compile a complete symptomatic picture and determine rare or frequent ventricular extrasystole.

Laboratory studies are limited to only general clinical analysis and blood biochemistry.

Instrumental diagnosis of cardiac extrasystole involves the following:

ECG and EchoCG;
daily monitoring of electrocardiography;
load tests, in particular bicycle ergometry;
X-rays and MRI of the chest;
rhythmocardiography;
polycardiography;
sphygmography;
TEE and CT.

In addition, consultation with a therapist, pediatrician (if the patient is a child) and obstetrician-gynecologist (in cases where extrasystole has formed during pregnancy) is necessary.

Treatment

In situations where such a disease has developed without the occurrence of cardiac pathologies or VSD, specific therapy for patients is not provided. To relieve symptoms, it is enough to follow clinical guidelines attending physician, including:

normalization of the daily routine - people are advised to rest more;
maintaining a proper and balanced diet;
avoidance of stressful situations;
performing breathing exercises;
spending a lot of time outdoors.

In other cases, it is first necessary to cure the underlying disease, which is why therapy will be individualized. However, there are several general aspects, namely the treatment of ventricular extrasystole by taking the following medications:

antiarrhythmic substances;
omega-3 drugs;
antihypertensive drugs;
anticholinergics;
tranquilizers;
beta blockers;
herbal medicines - in cases of the disease in a pregnant woman;
antihistamines;
vitamins and restorative medications;
drugs aimed at eliminating the clinical manifestations of such heart disease.

Surgical intervention for ventricular or ventricular extrasystole is carried out only according to indications, including the ineffectiveness of conservative treatment methods or the malignant nature of the pathology. In such cases, resort to:

radiofrequency catheter ablation of ectopic foci;
open intervention, which involves excision of damaged areas of the heart.

There are no other ways to treat such a disease, in particular folk remedies.

Possible complications

Ventricular extrasystole is fraught with the development of:

sudden onset of cardiac death;
heart failure;
changes in the structure of the ventricles;
worsening the course of the underlying disease;
ventricular fibrillation.

Prevention and prognosis

You can avoid the occurrence of extraordinary contractions of the ventricles by following the following preventive recommendations:

complete renunciation of addictions;
limiting the consumption of strong coffee;
avoiding physical and emotional fatigue;
rationalization of the work and rest regime, namely full, long sleep;
use of medications only under the supervision of a physician;
complete and vitamin-enriched nutrition;
early diagnosis and elimination of pathologies leading to ventricular extrasystole;
Regularly undergoing a complete preventive examination by clinicians.

The outcome of the disease depends on its course. For example, functional extrasystole has a favorable prognosis, and pathology developing against the background of organic heart damage has a high risk of sudden cardiac death and other complications. However, the fatality rate is quite low.

If you think that you have ventricular extrasystole and the symptoms characteristic of this disease, then a cardiologist can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

What you need to know about extraordinary ventricular contractions

Heart rhythm disturbances of the ventricular extrasystole type are characterized by extraordinary (intercalated) contractions of the ventricles. During an attack, the patient feels pronounced tremors in the chest area. Accompanying their signs panic attack and hemodynamic failure. To make a diagnosis and identify the cause of the arrhythmia, you will have to undergo a full examination. Electrocardiography (ECG) plays a key role in it. Based on the diagnostic results, the doctor will be able to select an effective treatment regimen and give recommendations for lifestyle correction.

Ventricular extrasystole: what is it?

Intraventricular extrasystole is the most common form of this arrhythmia. It is diagnosed in 60-65% of cases. An abnormal heartbeat develops due to the occurrence of a focus of ectopic (replacement) impulses. In this situation, it is localized in the ventricular space (ventricles, Purkinje fibers, bundle of His). The formation of a source of false signals is influenced by organic and functional reasons.

During electrocardiography, single ventricular extrasystoles are detected in 5% of people who do not have health problems.

At daily monitoring the figure increases to 50%. The situation is getting worse after the summer. In 80% of elderly patients, intercalary contractions are recorded.

The greatest danger is posed by organic frequent ventricular extrasystole. The intercalary contractions characteristic of arrhythmia are incomplete. The ventricle does not have time to fill with blood, which causes a hemodynamic failure, against the background of which certain complications gradually develop:

Ventricular extrasystole according to the ICD 10 revision has code I49.3. The supraventricular (supraventricular) form of arrhythmia is characterized by values of I49.1 and I49.2. In the first case, the focus of false impulses is localized in the atria, and in the second - in the atrioventricular node. Doctors use similar codes when filling out medical forms.

Causes of irregular heartbeat

Extrasystoles (atrial, atrioventricular, gastric) are conventionally divided into organic, arising under the influence of pathologies, and functional, resulting from irritant factors. You can see the list of reasons in the table:

Heart defects (stretched valve leaflets, septal defect, coarctation of the aorta);

Inflammation of the membranes of the heart muscle;

Dystrophic changes in the myocardium;

Availability of additional conductive bundles;

Infectious diseases affecting the heart muscle;

Pathologies of the endocrine glands;

Failures in electrolyte balance.

Abuse of caffeine, strong tea and energy drinks;

Impact of bad habits;

Side effects from taking medications;

Changes in hormonal balance(puberty, pregnancy, menopause).

IN medical practice There are cases when doctors identify ventricular extrasystoles, but cannot find the cause. In this situation we are talking about an idiopathic form of arrhythmia.

If the patient feels normal, then in the absence of disruptions in hemodynamics, treatment is not prescribed.

The following situations need to be highlighted separately:

Physiological arrhythmias in children can occur due to the immaturity of the nervous and cardiovascular systems. Organic failure options are associated with birth defects and hypoxia.
A child in adolescence may suffer from arrhythmia due to the development of vegetative-vascular dystonia (VSD). The disease is a consequence of hormonal surges characteristic of puberty.

In women during pregnancy, intercalary contractions are observed against the background of an increase in circulating blood volume.
Athletes feel single shocks in the chest area due to an incorrectly designed training program.
After overeating, extrasystole manifests itself as a compensatory reaction of the body to a mild form of bradycardia that has arisen.

Classification

Ventricular extrasystole is characterized by an extensive classification:

Intercalary reductions of medium frequency - up to 15;

Rapid extrasystoles - over 15.

Groups – 3 or more.

Polytopic - from 2 foci or more.

Polymorphic – complexes are deformed.

Alloarrhythmia is characterized by the occurrence of extrasystoles through a certain number of physiological contractions:

o after 1 - bigeminy;

o after 2 trigeminy;

o after 3 – quadrigeminy.

The Laun-Wolf classification is of particular importance. This will require Holter ECG monitoring. The patient will walk around the whole day with a device that records any abnormalities in the functioning of the heart. The results obtained will allow you to determine the severity of the arrhythmia:

The first class is considered functional. There are no disturbances in the blood flow, so there are no clinical manifestations. Severity grades 2-5 are characterized by a high chance of complications. People may need emergency treatment during an attack.

Predictive classification allows you to assess possible risks and prevent consequences:

Benign extrasystole has minimal risk development of complications. There are no signs characteristic of organic forms of arrhythmia. The blood flow is not impaired.

Potentially malignant arrhythmia is a consequence of organic lesions of the heart muscle. Blood output is reduced by 1/3. The likelihood of death due to complications increases several times.

Malignant forms of heart failure appear due to pronounced organic lesions. The chance of death is extremely high.

Symptoms of arrhythmia

Rare extrasystoles do not cause disturbances in the functioning of the heart. When they become more frequent, tremors in the chest begin to be felt, after which there is a short pause (freezing). Against the background of the development of disruptions in blood flow, their characteristic clinical picture appears:

general weakness;
chest pain;
dyspnea;
pre-fainting state.

If ventricular extrasystole is a consequence of VSD, then signs of autonomic failure may be added to the main symptoms:

dizziness;

fast fatiguability;

panic attack;

groundless irritability;

headache.

Diagnostics

Immediately after detecting signs of hemodynamic failure, you should contact a cardiologist. During the examination, the doctor can detect pulsation of the neck veins characteristic of extrasystoles and an abnormal pulse rate. By auscultation, it will be possible to hear the deformation of the first tone and the fragmentation of the second. The data obtained is sufficient to refer the patient for examination:

Electrocardiography (ECG) will allow you to evaluate the conduction of impulses through the myocardium and identify disturbances in the functioning of the heart. Extrasystole can be recognized by certain signs:
- A modified intercalary wide ventricular complex is present.
- The multidirectionality of the extrasystole (ST segment, QRS complex) is noticeable.
- The P wave does not appear before the intercalary contraction.
- A complete diastolic pause is recorded.
ECG monitoring using the Holter method is carried out throughout the day. The device will record the work of the heart, which will allow the doctor to evaluate it under the influence of irritating factors. This study is useful in the presence of functional arrhythmias.
Bicycle ergometry allows you to visualize your heartbeat during physical activity. It is prescribed for accurate classification of arrhythmia.

In order to determine the cause of organic lesions, other diagnostic methods may be required:

radiography;
echocardiography;
blood and urine tests;
Magnetic resonance imaging.

Treatment regimen

Treatment of ventricular extrasystole is carried out at home. The patient is obliged to follow the doctor’s recommendations for lifestyle correction, take prescribed medications and come for examination within the specified period. The hospital provides a course of treatment for dangerous organic forms of arrhythmia. Functional failures do not require such control.

During the course of therapy, you must follow certain rules regarding food intake and lifestyle in general:

saturate your diet with foods rich in potassium and magnesium;
refuse fried and smoked foods;
cook only by steaming or boiling;

sleep at least 7-8 hours a day;
to refuse from bad habits;
eat 5-6 times a day in small portions;
reduce consumption of salt, sweets and preserves;
replace coffee and energy drinks with sedative infusions and green tea;
engage in physical therapy;
try not to get into stressful situations;
walk in the fresh air more often;
Take breaks during work to avoid overload.

Drugs are prescribed to eliminate the underlying pathological process causing arrhythmia and restore normal operation hearts. The following medications have the necessary medicinal properties:

Beta blockers (Betalok, Concor) reduce the activity of the sympathoadrenal system. With long-term use, these tablets can reduce heart rate and myocardial oxygen demand.
Calcium channel blockers (Nitrendipine, Riodipine) prevent calcium from entering the heart cells (cardiomyocytes). Against the background of the effect, vasodilation, a decrease in pressure and a decrease in the frequency of contractions are observed.
Sodium blockers are designed to slow down the wave of excitation propagating throughout the myocardium, which eliminates the conditions for the circulation of ectopic impulses. Tablets are divided into 3 classes:
- IA (“Gilurythmal”, “Quinidine”);
- IB (“Aprindin”, “Lidocaine”);
- IC (“Indecainide”, “Etacizin”).

The selection of the required dose of the drug is carried out by the attending physician. He will weigh the possible risks (other pathologies, age, individual tolerance) and draw up the most appropriate drug therapy regimen. You can supplement the course of treatment with folk remedies. Recipes usually use herbs with diuretic and sedative effects (valerian, thyme, lemon balm) to relieve nervous tension and reduce stress on the heart.

Surgical intervention

It is not always possible to recover only with the help of medications. Some pathological processes that cause arrhythmia can only be eliminated through surgery:

Radiofrequency ablation is recommended for severe hemodynamic disturbances. The essence of the procedure is to cauterize the source of false impulses.
The installation of a pacemaker is carried out when the extrasystole transitions to atrial fibrillation. An artificial pacemaker will prevent irregular heartbeats.
Restoration of blood vessels or valves is required for congenital or acquired heart defects. Against the background of elimination causative factor extrasystole will no longer appear.

The recovery period depends on the type of surgery. Minimally invasive forms (installation of a pacemaker, radiofrequency ablation) actually do not require long-term rehabilitation. After a full-scale intervention (heart transplant, valve replacement), the recovery period can range from several months to a year.

Forecast

The first and second classes of ventricular extrasystole have a positive prognosis. Arrhythmia rarely provokes serious disruptions in hemodynamics and does not require special treatment. The patient's quality of life does not decrease. The third class of severity and higher is given a less favorable prognosis. Extrasystole often causes complications and is difficult to control with medication.

Extrasystoles that occur in the ventricular space may be the result of an organic lesion or manifest against the background of the influence of irritating factors. Arrhythmia, which represents the first group, is severe and requires drug treatment. Functional forms pass on their own. It is enough for the patient to rest a little and adjust his lifestyle.

Extrasystole - causes and treatment of the disease

Cardiac extrasystole is a type of heart rhythm disturbance based on improper contraction of the entire heart or its individual parts. Contractions are of an extraordinary nature under the influence of any impulse or excitation of the myocardium. This is the most common type of arrhythmia, affecting both adults and children, and is extremely difficult to get rid of. Medication and folk remedies are used. Gastric extrasystole is registered in ICD 10 (code 149.3).

Ventricular extrasystole is a fairly common disease. It affects completely healthy people.

Causes of extrasystole

overwork;
binge eating;
presence of bad habits (alcohol, drugs and smoking);
drinking caffeine in large quantities;
stressful situations;
heart disease;
toxic poisoning;
osteochondrosis;
diseases of internal organs (stomach).

Gastric extrasystole is a consequence of various myocardial lesions (ischemic heart disease, cardiosclerosis, myocardial infarction, chronic circulatory failure, heart defects). Its development is possible during febrile conditions and VSD. It is also a side effect of some medications (Euphelin, Caffeine, glucocorticosteroids and some antidepressants) and can be observed with improper treatment with folk remedies.

Often, gastric extrasystole can occur during or immediately after a meal, especially in patients with VSD. This is due to the characteristics of the heart during such periods: the heart rate decreases, so extraordinary contractions occur (before or after the next one). There is no need to treat such extrasystoles, since they are functional in nature. In order to get rid of extraordinary contractions of the heart after eating, you should not take a horizontal position immediately after eating. It's better to sit in a comfortable chair and relax.

Classification

Depending on the location of the impulse and its cause, the following types of extrasystole are distinguished:

ventricular extrasystole;
atrioventricular extrasystole;
supraventricular extrasystole (supraventricular extrasystole);
atrial extrasystole;
atrioventricular extrasystole;
stem and sinus extrasystoles.

Supraventricular extrasystole differs from ventricular localization of the source of arrhythmia. Supraventricular extrasystole (supraventricular extrasystole) is characterized by the occurrence of premature impulses in the upper parts of the heart (atria or in the septum between the atria and ventricles).

There are also 5 degrees of extrasystole, which are determined by a certain number of impulses per hour:

the first degree is characterized by no more than 30 impulses per hour;
for the second - more than 30;
the third degree is represented by polymorphic extrasystoles.
the fourth degree is when 2 or more types of impulse appear alternately;
the fifth degree is characterized by the presence of 3 or more extrasystoles one after another.

Diagnosis and treatment

If this method does not show adequate results, ECG monitoring is used, during which the patient wears a special device that monitors the work of the heart throughout the day and records the progress of the study. This ECG diagnosis allows you to identify the disease, even if the patient has no complaints. A special portable device attached to the patient's body records ECG readings for 24 or 48 hours. At the same time, the patient’s actions are recorded at the time of ECG diagnosis. The daily activity data and ECG are then compared, which allows the disease to be identified and treated correctly.

Some literature indicates the norms for the occurrence of extrasystoles: for a healthy person, the norm is considered to be ventricular and extraventricular extrasystoles per day, detected on an ECG. If after ECG studies no abnormalities are revealed, the specialist may prescribe special additional tests with stress (treadmill test)

In order to properly treat this disease, it is necessary to take into account the type and degree of extrasystole, as well as its location. Single impulses do not require specific treatment; they do not pose any threat to human health and life only if they are caused by a serious heart disease.

Features of treatment

To cure a disease caused by neurological disorders, sedatives (Relanium) and herbal preparations (valerian, motherwort, mint) are prescribed.

A fairly effective method to cure extrasystole forever is to cauterize its source. This is a fairly simple surgical intervention with virtually no consequences, but it cannot be performed on children; there is an age limit.

If gastric extrasystole is present in the later stages, then it is recommended to treat it with radiofrequency ablation. This is a method of surgical intervention with the help of which the source of arrhythmia is destroyed under the influence of physical factors. The procedure is easily tolerated for the patient, the risk of complications is minimized. In most cases, gastric extrasystole goes away irrevocably.

Treatment of children

Extrasystole in children can be congenital or acquired (after nervous shock). The presence of mitral valve prolapse and the occurrence of impulses in children are closely related. As a rule, supraventricular extrasystole (or gastric extrasystole) does not require special treatment, but it is necessary to be examined at least once a year. Children suffering from VSD are at risk.

It is important to limit children from provoking factors that contribute to the development of this disease (healthy lifestyle and sleep, absence of stressful situations). For children, it is recommended to eat foods enriched with elements such as potassium and magnesium, for example, dried fruits.

In the treatment of extrasystole and VSD in children, drugs such as Noofen, Aminalon, Phenibut, Mildronate, Panangin, Asparkam and others are used. Treatment with folk remedies is effective.

Fighting with folk remedies

You can get rid of severe attacks using folk remedies. At home, you can use the same remedies as in the treatment of VSD: soothing infusions and herbal decoctions.

Valerian. If the attack is classified according to the emotional type, then a pharmaceutical infusion of valerian root will help get rid of anxiety. It is enough to take 10 - 15 drops of infusion once, preferably after a meal.
Cornflower infusion will save you during an attack. It is recommended to drink the infusion 10 minutes before meals, 3 times a day (only on the day when the attack occurs).
An infusion of calendula flowers will help get rid of frequent attacks.

Treatment with such traditional methods should be practiced only after consultation with a doctor. If you use them incorrectly, you may simply not get rid of the disease, but may also worsen it.

Prevention

Consequences

For the first time, such an electrocardiographic phenomenon as early ventricular repolarization syndrome was discovered in the middle of the 20th century. Long years it was considered by cardiologists only as an ECG phenomenon that does not have any effect on the functioning of the heart. But in recent years, this syndrome has begun to be increasingly detected in young people, adolescents and children.

According to world statistics, it is observed in 1-8.2% of the population, and the risk group includes patients with heart pathologies, which are accompanied by cardiac disorders, patients with dysplastic collagenosis and dark-skinned men under 35 years of age. It was also revealed that this ECG phenomenon is detected in most cases in people who are actively involved in sports.

A number of studies have confirmed the fact that early ventricular repolarization syndrome, especially if it is accompanied by episodes of fainting cardiac origin, increases the risk of sudden coronary death. Also, this phenomenon is often combined with the development of supraventricular arrhythmias, deterioration of hemodynamics and, with progression, leads to heart failure. That is why early ventricular repolarization syndrome has attracted the attention of cardiologists.

In our article we will introduce you to the causes, symptoms, methods of diagnosis and treatment of early ventricular repolarization syndrome. This knowledge will help you respond adequately to its identification and accept it. necessary measures to prevent complications.

What is early ventricular repolarization syndrome?

This ECG phenomenon is accompanied by the appearance of the following uncharacteristic changes in the ECG curve:

pseudocoronary elevation (elevation) of the ST segment above the isoline in the chest leads;
additional J waves at the end of the QRS complex;

Based on the presence of concomitant pathologies, early repolarization syndrome can be:

with damage to the heart, blood vessels and other systems;
without damage to the heart, blood vessels and other systems.

According to its severity, the ECG phenomenon can be:

minimal – 2-3 ECG leads with signs of the syndrome;
moderate – 4-5 ECG leads with signs of the syndrome;
maximum – 6 or more ECG leads with signs of the syndrome.

In terms of its persistence, early ventricular repolarization syndrome can be:

permanent;
transient.

Causes

While cardiologists do not know the exact cause of the development of early ventricular repolarization syndrome. It is detected both in absolutely healthy people and in persons with various pathologies. But many doctors identify some nonspecific factors that may contribute to the appearance of this ECG phenomenon:

overdose or long-term use adrenergic agonists;
dysplastic collagenoses, accompanied by the appearance of additional chords in the ventricles;
congenital (familial) hyperlipidemia, leading to atherosclerosis of the heart;
hypertrophic obstructive cardiomyopathy;
congenital or acquired heart defects;
hypothermia.

Research is currently underway on the possible hereditary nature of this ECG phenomenon, but so far no data on a possible genetic cause have been identified.

The pathogenesis of early ventricular repolarization is the activation of additional abnormal pathways that transmit electrical impulses and disruption of the conduction of impulses along the pathways that are directed from the atria to the ventricles. The notch at the end of the QRS complex is a delayed delta wave, and the contraction P-Q interval observed in most patients, indicates the activation of abnormal nerve impulse transmission pathways.

In addition, early ventricular repolarization develops due to an imbalance between depolarization and repolarization in the myocardial structures of the basal sections and apex of the heart. With this ECG phenomenon, repolarization becomes significantly accelerated.

Cardiologists have identified a clear relationship between early ventricular repolarization syndrome and nervous system dysfunction. When carrying out dosed physical activity and a drug test with Isoproterenol, the patient experiences normalization of the ECG curve, and during night sleep the ECG indicators worsen.

Also during the tests it was revealed that early repolarization syndrome progresses with hypercalcemia and hyperkalemia. This fact indicates that electrolyte imbalance in the body can provoke this ECG phenomenon.

Symptoms

This ECG phenomenon may exist long time and not cause any symptoms. However, this background often contributes to the occurrence of life-threatening arrhythmias.

Many large-scale studies have been carried out to identify specific symptoms of early ventricular repolarization, but all of them have been inconclusive. Characteristic of the phenomenon ECG abnormalities are detected both in absolutely healthy people who do not make any complaints, and among patients with cardiac and other pathologies who make complaints only about the underlying disease.

In many patients with early ventricular repolarization, changes in the conduction system provoke various arrhythmias:

ventricular fibrillation;
ventricular extrasystole;
supraventricular tachyarrhythmia;
other forms of tachyarrhythmias.

Such arrhythmogenic complications of this ECG phenomenon pose a significant threat to the health and life of the patient and often provoke death. According to world statistics, a large number of deaths caused by asystole during ventricular fibrillation occurred precisely against the background of early ventricular repolarization.

Half of the patients with this syndrome experience systolic and diastolic cardiac dysfunction, which leads to central hemodynamic disturbances. The patient may develop shortness of breath, pulmonary edema, hypertensive crisis or cardiogenic shock.

The syndrome of early ventricular repolarization, especially in children and adolescents with neurocirculatory dystonia, is often combined with syndromes (tachycardial, vagotonic, dystrophic or hyperamphotonic) caused by the influence of humoral factors on the hypothalamic-pituitary system.

ECG phenomenon in children and adolescents

In recent years, the number of children and adolescents with early ventricular repolarization syndrome has been increasing. Despite the fact that the syndrome itself does not cause significant cardiac abnormalities, such children must undergo a comprehensive examination, which will identify the cause of the ECG phenomenon and possible accompanying illnesses. For diagnosis, the child is prescribed:

urine and blood tests;
ECHO-KG.

In the absence of heart pathologies, drug therapy is not prescribed. The child's parents are advised to:

clinical observation by a cardiologist with ECG and ECHO-CG once every six months;
eliminate stressful situations;
limit excessive physical activity;
Enrich your daily menu with foods rich in heart-healthy vitamins and minerals.

If arrhythmias are detected, the child, in addition to the above recommendations, is prescribed antiarrhythmic, energy-tropic and magnesium-containing drugs.

Diagnostics

Electrocardiography is the main method for diagnosing early ventricular repolarization syndrome.

The diagnosis of “early ventricular repolarization syndrome” can be made on the basis of an ECG study. The main signs of this phenomenon are the following deviations:

displacement above the isoline by more than 3 mm of the ST segment;
prolongation of the QRS complex;
in the chest leads, simultaneous leveling of the S wave and increase in the R wave;
asymmetrical high T waves;
shift to the left of the electrical axis.

For a more detailed examination, patients are prescribed:

ECG with physical and drug stress;
24-hour Holter monitoring;
ECHO-KG;
urine and blood tests.

Once early repolarization syndrome is identified, patients are advised to continually provide their doctor with past ECG results, because ECG changes may be mistaken for an episode coronary insufficiency. This phenomenon can be distinguished from myocardial infarction by the consistency of characteristic changes in the electrocardiogram and the absence of typical radiating chest pain.

Treatment

If early repolarization syndrome is detected, which is not accompanied by heart pathologies, the patient is not prescribed drug therapy. It is recommended for such people:

Avoiding intense physical activity.
Prevention of stressful situations.
Introduction to the daily menu of foods rich in potassium, magnesium and B vitamins (nuts, raw vegetables and fruits, soybeans and sea fish).

If a patient with this ECG phenomenon has cardiac pathologies (coronary syndrome, arrhythmias), then the following medications are prescribed:

energy-tropic agents: Carnitine, Kudesan, Neurovitan;
antiarrhythmic drugs: Ethmozin, Quinidine sulfate, Novocainamide.

If drug therapy is ineffective, the patient may be recommended to undergo minimally invasive surgery using catheter radiofrequency ablation. This surgical technique eliminates the bundle of abnormal pathways that cause arrhythmia in early ventricular repolarization syndrome. Such an operation should be prescribed with caution and after eliminating all risks, since it may be accompanied by severe complications (PE, damage to the coronary vessels, cardiac tamponade).

In some cases, early ventricular repolarization is accompanied by repeated episodes of ventricular fibrillation. Such life-threatening complications become the reason for an operation to implant a cardioverter-defibrillator. Thanks to progress in cardiac surgery, the operation can be performed using a minimally invasive technique, and implantation of a cardioverter-defibrillator III generation does not cause any adverse reactions and is well tolerated by all patients.

Detection of early ventricular repolarization syndrome always requires a comprehensive diagnosis and dispensary observation from a cardiologist. Compliance with a number of restrictions in physical activity, correction of the daily menu and exclusion of psycho-emotional stress is indicated for all patients with this ECG phenomenon. When concomitant pathologies and life-threatening arrhythmias are identified, patients are prescribed drug therapy to prevent the development of severe complications. In some cases, the patient may be indicated for surgical treatment.

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Main causes, types, classification and symptoms of ventricular extrasystole

Untimely cardiac excitation, provoked by exciting impulses, is defined in medicine as ventricular extrasystole. This anomaly may be functional or organic in nature.

general information

In the group of arrhythmias of the extrasystolic type, ventricular extrasystole has one of the most significant places. Untimely contractions of the heart muscle are provoked by a signal from an additional source of excitation.

This pathological condition has its own ICD 10 code - 149.4. The prevalence of extrasystoles both among people suffering from cardiac arrhythmias and among completely healthy individuals was established with prolonged Holter monitoring of heart rhythm.

Detection of extrasystoles from the ventricles is observed in 40-75 percent of cases of examination of persons who have crossed the thirty-year threshold.

How is the anomaly classified?

Ventricular extrasystole according to Lown is classified as follows:

0 — no PVCs.
1 - infrequent, monomorphic (up to 30/60 sec.).
2 - frequent, monotopic (30/60 sec. or more).
3 - polymorphic.
4A - paired.
4B - salvo.
5 - not late.

Grade 1 extrasystole is not accompanied by specific symptoms of organic cardiac pathology, as well as hemodynamic changes. There is also no extrasystole on the ECG in this case. This anomaly is of a functional nature.

Grade 2 extrasystole has a more serious prognosis. In this condition there is serious risk development of ventricular fibrillation. Also, against this background, cardiac death of the patient often occurs. This condition is organic in nature.

According to Bigger, this pathological condition is classified into benign, malignant and potentially malignant. In the first case, cardiac pathologies are most often absent. VT is not observed either.

In the second case, the appearance of fainting is observed. There is a history of cardiac arrest. Paroxysms of VT are usually frequent and quite stable. In the third case, there are attacks of not very stable VT. There is almost always no history of fainting or cardiac arrest.

Why does the anomaly develop?

Ventricular extrasystole has many causes for its development. Doctors have collected all provoking factors into the following groups:

Functional.
Organic.
Toxic.

Functional triggers

The development of ventricular extrasystole is caused by frequent appearances on the ECG of single extrasystoles. This condition can be diagnosed even in a healthy person who has never complained of pain or discomfort in the heart.

The main reasons why a healthy person develops this pathological condition include:

emotional stress;
development of vegetative-vascular dystonia;
alcohol abuse;
abuse of strong tea;
coffee abuse;
abuse of energy drinks;
abuse of tobacco products.

Organic triggers

The group of factors that provoke the appearance of organic heart damage includes:

ischemia;
acute myocardial infarction;
cardiosclerosis (appears after a heart attack);
left ventricular aneurysm (appears after a heart attack);
myocarditis;
Congenital heart defect;
acquired heart defect.

Another provoking factor is chronic heart failure.

More than 60 percent of all cases of the disease are caused by ischemia.

Often the main provoking factor is a pathology of heart development such as mitral valve prolapse.

Toxic triggers

Ventricular extrasystole can also develop against the background of a toxic effect on the heart muscle. The pathological condition is observed during alcohol, drug or drug intoxication.

Often the provocateur is medications prescribed by a doctor for the treatment of bronchial asthma. Also signs pathological condition may appear against the background of thyrotoxicosis. This condition is characterized by poisoning of the body with thyroid hormones.

How does the disease manifest itself?

Ventricular extrasystole is not too different from other untimely heartbeats. The main sign that makes it possible to distinguish this pathology from similar ones is the feeling that the heart is “freezing in the chest.”

Sometimes the patient feels as if the heart is stopping. This is followed by a noticeable shock. In this case, the following symptoms are sometimes observed:

Vague dizziness.
Weakness (observed even after sleep or prolonged rest).
Vague headaches.
Very rarely this condition is accompanied by the urge to cough.

Consequences and danger of the disease

Doctors identify five classes of potentially life-threatening ventricular extrasystoles:

first class - single manifestations, the frequency of which does not reach 30 indicators per 60 seconds;
second class - frequency - more than 30/60 seconds (serious consequences are observed quite rarely);
third class (frequent ventricular extrasystole requires appropriate therapy);
fourth “a” class - paired extrasystoles following each other;
fourth “c” class - volley extrasystoles (from 3 to 5 volleys are observed at a time);
fifth class - early extrasystoles.

Class 5, as well as classes 4A and 4B, are considered the most dangerous. If a person does not ask himself how to stop the development of the pathological condition, he may develop ventricular tachycardia.

Ventricular fibrillation should be considered an equally serious consequence. Against this background, cardiac arrest may occur.

To avoid serious consequences, doctors recommend paying attention to the signs that accompany extrasystoles. This is explained by the fact that a person cannot always independently identify an extrasystole, even if it occurs every second beat.

Sometimes extrasystole appears at least two or three times in 60 minutes, and the patient’s condition is assessed as critical.

How can you help a patient?

Treatment of this pathological condition is prescribed primarily to relieve the underlying disease. Treatment is prescribed depending on whether the disease is malignant or benign.

If the pathology is benign in nature, then therapy is usually not prescribed. The risk of sudden cardiac arrest is quite low. But if the patient does not tolerate the symptoms well, the specialist prescribes him to take antiarrhythmic medications.

With a potentially malignant course of the pathological condition, a significant risk of sudden cardiac death remains. This is explained by the fact that unstable ventricular tachycardia is often diagnosed against this background. Treatment is aimed at relieving symptoms and reducing the risk of cardiac death.

With a malignant course of the anomaly, a very high risk of cardiac death remains. Treatment is aimed at reducing the risk of cardiac death.

Finally

Many people are interested in the question of whether it is possible to use the recipes of “grandmother’s” wisdom in the treatment of ventricular extrasystole.

Treatment with folk remedies is relevant only when the patient is diagnosed with functional extrasystole. Resort to methods traditional medicine This is possible only after consultation with a doctor.

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Development of a risk management program at the enterprise Risk report plan form

Reporting is generated by the RM, is agreed upon (approved) by the Risk Committee under the Management Board and transmitted to...

2024-01-28 03:22:01

Ecological tales about ladybugs

At the edge of a large, very large meadow, on a long emerald blade of grass lived a tiny Ladybug. God's little...
2024-01-27 04:33:53

Compatibility of Libra with other zodiac signs

Nowadays, it is quite common for people to turn to the stars. With the help of a horoscope a person can find out...

2024-01-27 04:33:53

Why do you dream of catching up with a man? Why do you dream of catching up with your loved one?

Business or friendly. If you were pursuing a stranger, it means your level of trust in the female sex...
2024-01-27 04:33:53

Dream Interpretation: Why do you dream about fish?

according to Freud's dream book If you dreamed about how you were fishing, it means that in real life you can hardly switch off...

2024-01-26 02:52:15
New Year's salad recipes (2016) Meat salad with prunes

The New Year's whirlwind will spin us around so quickly and rapidly that it's time to thoroughly think through the New Year's...
2024-01-26 02:52:15
Vinaigrette with homemade pickles

The article offers you some of the most delicious recipes for making vinaigrette. Vinaigrette is a delicious salad...
2024-01-26 02:52:15
Recipe: Cookies "Straws" - salted Recipes for salted straws for tea

July 4th, 2015 , 08:33 pm Lately, our Nastena has been completely giving up sweets (and thank God),...
2024-01-26 02:52:15
Soviet recipes for Negro kiss cake

Fragrant, very tasty chocolate cake, you can’t stop eating! The Negro’s Kiss cake is very easy to prepare,...
2024-01-25 01:29:08
Dream interpretation of a dead man being alive

Dream interpretation is an ancient art that allows you to at least assess the psychological status...
2024-01-25 01:29:08
Why accidentally break a mirror at home?

As soon as the first mirrors were born, people immediately endowed them with all sorts of mystical...
2024-01-31 04:57:39
What is possible and not possible during the Nativity Fast?

In 2018, the Nativity Fast will begin on November 28. During this period, Orthodox believers prepare to meet...

2024-01-31 04:57:39

A powerful prayer from her husband's mistress

Starting a family is the dream of most women. They want to have a loving husband and a bunch of kids. But it's not always...
2024-01-31 04:57:39

Prayer to prevent divorce from your husband Prayer to keep your husband before divorce

This article contains: the most powerful prayer for divorce - information taken from all over the world, electronic...