What is supraventricular (supraventricular) extrasystole and how to treat it

The symptom complex of vegetative-vascular dystonia includes many manifestations that affect the functioning of almost all organs. Extrasystole with VSD is a very common symptom and accompanies almost every VSD patient. It is exclusively neurological in nature and in most cases does not threaten the patient’s life, but it brings a lot of inconvenience and leads to an exacerbation of the disease.

Causes

NVEs develop due to many reasons.
Even a simple sneeze or fear can cause extraordinary contraction of the myocardium. The most common culprits of extrasystoles are various heart diseases: coronary disease, cardiomyopathy, congenital and acquired defects, myocarditis, pericarditis, chronic heart failure, etc. Also, supraventricular extrasystole develops with the following factors, conditions and diseases:

• violation of autonomic regulation (autonomous dysfunction syndrome);
• physical and emotional stress;
• neurotic disorders;
• reflex irritation of the cardiac nerves in diseases of the gastrointestinal tract: duodenal ulcer, cholelithiasis;
• presence of bad habits;
• coffee addiction;
• taking pills: antidepressants, psychostimulants to reduce appetite, vasoconstrictor nasal drops, medications for high blood pressure. Even some antiarrhythmic drugs in some cases cause EVE;
• infectious diseases;
• severe diseases of the respiratory system: bronchial asthma, chronic broncho-obstructive pulmonary disease;
• pathology of endocrine organs: Graves' disease, Hashimoto's thyroiditis, diabetes mellitus;
• excess or deficiency of minerals in the body (calcium, magnesium, sodium);
• chest injuries.

In some cases, the cause of the rhythm disturbance cannot be identified. Then a diagnosis of “NVE of unknown etiology” is made.

Classification and types

There are many types of NLEs, divided according to different characteristics.

Depending on the source of the impulse, atrial extrasystoles and extrasystoles (ES) from the atrioventricular (AV) connection are distinguished. Based on the number, they distinguish between single and double. Three or more ES in a row is already considered an episode of tachycardia (also called a “jog”).

In my patients, I often observe such an ECG phenomenon as allorhythmia - the regular occurrence of extrasystoles. There are the following types:

• bigeminy - the appearance of ES on the cardiogram after each normal contraction of the heart (read more about this phenomenon here)
• trigeminy - after every second complex;
• quadrigeminy - after every third complex.

Depending on the cause, the following types of NVEs are distinguished:

• functional - during physical activity, reflex effects;
• organic - for heart diseases;
• toxic - in case of drug overdose;
• mechanical - for injuries.

Single extrasystoles

The most benign variant of NVE, mainly found in healthy individuals, are single supraventricular extrasystoles. They almost always go unnoticed by humans and do not pose a threat to health.

Symptoms

Symptoms of extrasystole, regardless of the causes of the disease, are not always pronounced. Most often, patients complain of:

• Malfunctions of the heart (you may feel as if the heart is turning over in the chest);
• Weakness, discomfort;
• Increased sweating;
• Hot flashes;
• Lack of air;
• Irritability, feelings of fear and anxiety;
• Dizziness. Frequent extrasystoles may be accompanied by dizziness
  . This occurs due to a decrease in the volume of blood ejected by the heart muscle and, as a result, oxygen starvation in the brain cells.

Extrasystole may be a sign of other diseases. For example, extrasystole in vegetative-vascular dystonia (VSD) is caused by a violation of the autonomic regulation of the heart muscle, increased activity of the parasympathetic nervous system, and therefore can occur both during physical exertion and in a calm state. It is accompanied precisely by symptoms of a nervous system disorder, that is, anxiety, fear, irritability.

The extrasystole that occurs with osteochondrosis is due to the fact that, during the disease, compression of the nerve endings and blood vessels occurs between the vertebral discs.

In pregnant women, the appearance of extrasystoles is also quite often recorded. Usually, extrasystoles during pregnancy occur due to fatigue or anemia, as well as if the woman had problems with the thyroid gland, cardiovascular and bronchopulmonary systems. If the pregnant woman feels well and has no complaints, then no treatment is required.

Extrasystole after eating is also not uncommon. It is functional and usually does not require treatment. This extrasystole is associated with the parasympathetic nervous system and occurs if a person, after eating food, takes a horizontal position. After eating, the heart rate decreases, and the heart begins to turn on its compensatory capabilities. This happens precisely due to extra, extraordinary heart beats.

Signs on ECG

Supraventricular extrasystole is very easy to recognize on a cardiogram. Main features:

• extraordinary (extrasystolic) appearance of a pathological deformed P wave and the following unchanged QRST complex;
• the presence of a compensatory pause, i.e. a straight line on the film.

If the P wave has a different shape in different leads, this phenomenon is called polytopic atrial extrasystole. Its detection is highly likely to indicate a heart or lung disease and requires a more thorough diagnosis.

It happens that after an extraordinary P wave there is no QRST complex. This happens when atrial extrasystole is blocked. ES from the atrioventricular junction differs in that the P wave is negative or not recorded at all due to overlap with the T wave.

When taking an ECG at rest, extrasystoles may not be detected. Therefore, in order to “catch” them and find out how often they occur, I prescribe Holter monitoring to my patients. In case of concomitant diseases, a person undergoes a cardiac ultrasound (EchoCG).

After supraventricular ES, the pause lasts less than with ventricular ES.

Ventricular extrasystole

The most common type of arrhythmia is ventricular extrasystole. In this case, a heart rhythm disturbance occurs in the ventricular conduction system. There are right ventricular extrasystole and left ventricular extrasystole.

There are many causes of ventricular arrhythmia. These include diseases of the heart and cardiovascular system, post-infarction cardiosclerosis, heart failure (chronic type), coronary artery disease, pericarditis, arterial hypertension, myocarditis. Ventricular extrasystole can also occur with osteochondrosis of the spine (most often cervical) and with vegetative-vascular dystonia.

Ventricular arrhythmia has its own classification. It is customary to distinguish 5 classes of extrasystoles (they are placed only after a 24-hour observation using an ECG):

• Class I – extrasystoles are not registered;
• Class II – up to 30 monotopic extrasystoles were recorded per hour;
• Class III – 30 or more monotopic extrasystoles were detected per hour, regardless of the time of day;
• Class IV – not only monotopic extrasystoles are recorded, but also polytopic ones;
• IV “a” class - monotopic, but already paired extrasystoles are recorded on film;
• IV “b” class – there are polytopic paired extrasystoles;
• Class V – group polytopic ventricular extrasystoles are recorded on film. There can be up to five of them in a row within 30 seconds.

Class I ventricular arrhythmias are classified as physiological. They are not dangerous to the life and health of the patient. But extrasystoles from class II to V are accompanied by persistent hemodynamic disturbances and can lead to ventricular fibrillation and even death of the patient.

Types of ventricular extrasystoles

1. A single ventricular extrasystole (or, as it is also called, rare) - 5 or less extrasystoles occur within a minute. May be asymptomatic;
2. Average extrasystole – up to 15 per minute;
3. Frequent ventricular extrasystoles - more than 15 extrasystoles per minute.

The more extrasystoles occur in one minute, the stronger the pulse becomes, the patient begins to feel worse. This means that if treatment is not required for single extrasystoles, then for frequent ones, the patient’s condition worsens significantly and he simply needs treatment.

The following subtypes of arrhythmia are also distinguished:

• Benign ventricular arrhythmias. There is no sign of damage to the heart muscle, and there is virtually no risk of sudden cardiac arrest;
• Potentially malignant extrasystole. In this case, any organic damage to the heart and hemodynamic disorders are already present. The risk of sudden cardiac arrest increases.
• Arrhythmia of malignant type. Due to serious organic damage to cardiac tissue and persistent hemodynamic disturbances, there are numerous extrasystoles. High risk of mortality.

Symptoms

Right ventricular extrasystole, in its clinical signs, resembles right bundle branch block and occurs in the right ventricle, and left ventricular extrasystole, respectively, vice versa. The symptoms of ventricular extrasystole are practically no different from atrial extrasystole, unless the cause is VSD (weakness, irritability may occur, the patient notes fatigue).

Diagnostics

The most popular and accessible diagnostic method is an electrocardiographic study - ECG. Techniques such as bicycle ergometry and trimedyl test are also widely used. With their help, you can determine whether extrasystole is associated with physical activity.

Treatment: when, how and with what

Supraventricular extrasystoles are almost always benign. If extraordinary contractions of the heart are single, are not accompanied by any symptoms and do not provoke the occurrence of severe rhythm disturbances, treatment of supraventricular extrasystole is not required. The main thing is to fight its cause.

When EVE worsens the patient's condition, I prescribe drug therapy. The most effective drugs for stopping SE are beta-blockers - Bisoprolol, Metoprolol. If there are contraindications to their use (for example, severe bronchial asthma), I transfer the patient to slow calcium channel blockers - Verapamil, Diltiazem. Read about how extrasystole is treated with medications here.

As for traditional methods, to date there is no convincing evidence of their effectiveness. In my practice, I recommend that patients under no circumstances replace traditional treatment with traditional medicine. But if you have a different opinion, we invite you to read the material here.

If the development of NVE is associated with emotional stress or a neurotic disorder, you can take sedatives and make an appointment with a psychotherapist.

The main criteria for the success of therapy are the cessation of symptoms and normalization of the patient’s condition.

In rare cases, when drug treatment does not have the expected positive effect, surgical intervention is used, in particular, a technique such as radiofrequency catheter ablation. I usually prescribe this operation to young patients, since with age the risk of developing severe complications, including death, increases.

It is extremely rare, for health reasons, that an open access operation is performed, with dissection of the chest and removal of the portion of the myocardium where extraordinary impulses are formed.

Traditional methods of treating extrasystole

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If the extrasystole is not life-threatening and is not accompanied by hemodynamic disturbances, you can try to defeat the disease on your own. For example, when taking diuretics, potassium and magnesium are removed from the patient’s body. In this case, it is recommended to eat foods containing these minerals (but only in the absence of kidney disease) - dried apricots, raisins, potatoes, bananas, pumpkin, chocolate.

Also, to treat extrasystole, you can use an infusion of medicinal herbs. It has cardiotonic, antiarrhythmic, sedative and mild sedative effects. It should be taken one tablespoon 3-4 times a day. For this you will need hawthorn flowers, lemon balm, motherwort, heather and hop cones. They need to be mixed in the following proportions:

1. 5 parts each of lemon balm and motherwort;
2. 4 parts heather;
3. 3 parts hawthorn;
4. 2 parts hops.

Important!

Before starting treatment with folk remedies, you should consult your doctor, because many herbs can cause allergic reactions.

Why are supraventricular extrasystoles dangerous and what are their consequences?

Extraordinary supraventricular extrasystoles themselves do not pose a threat to human life and often go unnoticed. However, they can provoke the appearance of more severe rhythm disturbances: supraventricular tachycardia, atrial fibrillation and flutter, which lead to a sharp decrease in blood pressure, deterioration of blood supply to the myocardium and an increased risk of blood clots in the heart. A combination is often observed .

Long-term polytopic and blocked ES are considered the most unfavorable.

The consequences of supraventricular extrasystole are determined by the presence of: coronary heart disease, chronic heart failure, etc. The rhythm disturbance itself almost does not cause any complications.

Supraventricular extrasystole

Supraventricular extrasystole is a type of arrhythmia in which the heart rhythm disturbance occurs not in the cardiac conduction system, but in the atria or in the atrioventricular septum. As a result of such a violation, additional heart contractions appear (they are caused by extraordinary, incomplete contractions). This type of arrhythmia is also known as supraventricular extrasystole.

Symptoms of supraventricular extrasystole: shortness of breath, feeling of lack of air, cardiac arrest, dizziness.

Classification of supraventricular extrasystoles

By localization:

• Atrial (the focus is localized in the area of ​​the atria);
• Atrioventricular (the location of the focus is in the septum separating the ventricles from the atria);

supraventricular extrasystoles on ECG

By number of outbreaks:

• One focus (monotopic extrasystole);
• Two or more foci (polytopic extrasystole);

By time of occurrence:

• Early (formed by contraction of the atria);
• Interpolated (localization point - on the border between contractions of the ventricles and atria);
• Late (can occur during contraction of the ventricles or during complete relaxation of the heart muscle - during diastole).

By frequency (per minute):

• Single (five or less extrasystoles);
• Multiple (more than five);
• Group (several in a row);
• Paired – (two at a time).

Expert advice

Despite the fact that most often EVEs are relatively harmless, if they occur frequently and are accompanied by symptoms (feelings of freezing, interruptions in heart function, dizziness, feeling of lightheadedness), you should consult a doctor to find out the cause, including examination for cardiac problems. and other diseases. I try to explain to my patients that eliminating the causative factor is of no small importance in the treatment of EVE. Therefore, I give recommendations for lifestyle changes: you need to quit smoking, try to avoid severe stress, and significantly limit the consumption of alcohol and coffee. If a person develops signs of EVE while taking medications, be sure to tell the doctor about it. Reducing the dosage or changing the medication often helps get rid of extrasystoles.

Clinical case

A 33-year-old man came to see me with complaints of rapid heartbeat, periodic sensations of “fading” and interruptions in heart function over the past 3 weeks. He does not take any medications on his own. Doesn't smoke, doesn't drink alcohol. A general examination revealed a high heart rate (105 beats per minute) and increased blood pressure - 140/80 mmHg. Art. During the conversation, I noticed the patient’s uncharacteristic irritability and bulging eyes. When questioning about the presence of diseases in relatives, the man noted that his father suffered from Graves' disease. Holter ECG monitoring was prescribed. Sinus tachycardia, atrial extrasystole of the bigeminy type, and a large number of single extraordinary contractions (967) were detected. A referral was issued to an endocrinologist to check the thyroid gland. On the recommendation of a specialist, an ultrasound examination was performed and blood was taken for hormonal tests. The results obtained: diffuse enlargement of the thyroid gland, decreased TSH levels, increased concentrations of free T4, high titers of antibodies to the TSH receptor. Diffuse toxic goiter was confirmed . Mercazolil therapy was prescribed with subsequent monitoring of hormone levels. To slow down the heartbeat and combat extrasystole, beta-blockers (Bisoprolol) are recommended.