After making a diagnosis, the doctor will definitely tell the patient who has a PVC (ventricular extrasystole) what it is. The consequences of a pathological condition can be the most deplorable if you do not start the correct treatment under the supervision of a specialist. The term is used to denote such extraordinary heart contractions, the cause of which is the impulses arriving earlier than expected, initiated by the walls of the ventricle on the right, on the left, and nerve fibers.
Features of anatomy
Ventricular extrasystole, whose ICD code is I49.4, occurs if the normal impulse patency of the sinus node located in the heart in the upper region, above the ventricles, is disturbed. Extrasystoles, characterizing the pathological condition, affect the rhythm of the ventricles without affecting the upper parts of the organ. If pathological contractionsinitiated in the atria, septum, talking about extrasystoles over the ventricles. These can cause PVCs.
Categories and risks
Currently, PVCs are most often detected in people over the age of fifty. On average, according to medical statistics, this age group accounts for from half of all patients with PVC to 75% of cases.
A classification system has been developed that allows dividing all patients into several groups. This simplifies the choice of the optimal treatment format. One of the well-known and popular systems is called RYAN. Ventricular extrasystole according to this categorization involves the allocation of mono-, polymorphic cases of paired, as well as three or more impulses initiated at the stage of atrial rest. If you pay attention to the qualification according to Lown, then such cases belong to categories 4A, 4B, 5. The current gradation of ventricular extrasystole according to RYAN involves an assessment of the focus of impulse initiation. If there is only one such, they speak of a monomorphic form, a polymorphic form is detected if there are several centers of emission of impulses.
Another case classification system is named after Dr. Mayerburg, an eminent author and cardiologist who developed it. He proposed to divide all cases by frequency into very rarely manifesting themselves, rarely noticeable and infrequently. It was also proposed to distinguish the level of moderate rarity, frequent occurrences and very frequent. Additional classification according to Mayerburg involves an assessment of the type of violations: single or paired, poly- ormonomorphic, stable, or not.
Continuing the theme
In our country, at present, any practicing good doctor knows the code for ventricular extrasystole in the ICD (I49.4). It is this system of classification, dividing all patients into categories that is most often used in medical practice in our country. When filling out the patient's card, the doctor must indicate the disease code according to ICD 10 in it. Ventricular extrasystole will not be an exception - in any patient with a similar diagnosis, the personal card will contain a mention of the pathology I49.4.
Several causes have been identified that provoke a pathological condition, as well as possible complications and consequences that occur in the absence of adequate treatment. In ICD 10, ventricular extrasystole is fixed by code I49.4, which includes only this pathology. If other he alth disorders have developed against its background, for them the doctor must choose other encodings that are more suitable for the case. The diagnosis will include several ciphers at the same time.
Where did the trouble come from?
For all degrees of gradation of ventricular extrasystole, the main reason is heart disease, malfunctions of this organ. Sometimes PVC is observed if a person is forced to physically overstrain for a long time. Certain risks are associated with the chronic influence of stress factors and other negative external conditions.
A fairly common cause is the insufficiency of the functioning of the heart muscle, associated with negative changes in tissues. This isprovokes a failure of blood flow, tissues do not receive the necessary nutrition and oxygen, local starvation begins, improperly flowing metabolism leads to acidosis.
Among all the causes, no less frequent in ventricular extrasystoles is cardiac ischemia. The term is used to denote a pathological condition provoked by a failure of the coronary blood flow. In the acute form, ischemia is called a heart attack, in a chronic patient, regularly occurring angina attacks are disturbed.
Diseases and their consequences
It is possible the occurrence of a paired, single ventricular extrasystole on the background of cardiomyopathy. The term is used to denote such a primary violation of the integrity and he alth of the organ, which initiates the insufficiency of the muscle. With cardiac myopathy, there is a high probability of hypertrophy of the organ. The patient is prone to atypical arrhythmias.
Certain risks are associated with heart defects. The term refers to the presence in the body, large vessels emerging from it, significant defects. These may be single or present in several areas at once. Defects are congenital, but acquisition during life is possible.
The above code for ventricular extrasystole can also hide a case caused by myocarditis. In this case, the occurrence of atypical impulses is associated with a focus of inflammation in the muscle tissues of the heart. Such a process causes failures in impulse conduction, the processes of contraction and excitation of the myocardium are disrupted.
Drugs and drug problemshe alth
Clinical practice has shown that sometimes ventricular and supraventricular extrasystoles occur while taking medications for the heart. With certain dangers, for example, a course of diuretics is associated, under the influence of which urine is more actively generated and excreted. The process may be accompanied by a leaching of potassium, which is necessary for the normal generation of impulses. Cardiac glycosides, actively used in cardiology, can play their role - they help to lower the frequency of contraction of the heart muscle, making each act stronger. Taking such drugs is associated with the risk of fibrillation, flicker. The heart rate may become too fast, and rhythm may be lost.
PVC possible with anti-heart block drugs. They have a complex of side effects, including excitation of the nervous system, an increase in pressure. This affects the rhythm of the heart.
Diagnoses and complications
Ventricular extrasystole, as can be seen from medical statistics, with a high degree of probability can pursue diabetics with a second type of disease. Against the background of diabetes, the risks of a violation of the metabolism of carbohydrates in the body in a serious form are especially high, which leads to neuropathy, a malfunction of the fibers of the nervous system. As a result, cardiac functionality is disturbed, arrhythmia occurs.
There is a risk of ventricular extrasystole due to excessive activity of the pancreas. The most significant risks are for people with moderate and severe thyrotoxicosis. Physicians know the phenomenonthyrotoxic heart. The condition manifests itself as sclerotic processes, insufficiency of functioning, extrasystole and hypofunction of the organ.
Ventricular extrasystoles may occur in violation of the adrenal glands. This is due to the excessive generation of aldosterone, which provokes high blood pressure. At the same time, metabolism is disturbed, which in total has a depressing effect on the myocardium, disrupting its work.
Possible inorganic nature of ventricular extrasystole. This condition is diagnosed if no additional heart disease can be identified in a patient. In an impressive percentage of cases, a functional form is found. If you localize and exclude a dangerous phenomenon, the rhythm and frequency of the heartbeat return to normal.
Symptoms of the condition
If Holter monitoring is organized, with a probability of 50%, any young person will be able to detect at least one premature heartbeat per day. This phenomenon in no way affects the general well-being and is not considered a pathology. If the frequency of atypical reactions increases, this corrects the rhythm of the heartbeat. If there are no concomitant diseases, PVC is difficult to tolerate. Often the condition appears with bradycardia, when the pulse is rare, the patient feels as if the heart stops, after which a volley of frequent beats begins. From time to time, the feeling of strong contractions worries. The probability of VPC is especially high after a meal. Unpleasant sensations are possible even in complete calmness, in a dream. There is a high risk of activation of PVC against the background ofemotional overstrain. However, physical activity rarely leads to symptoms of PVCs that are not accompanied by other pathologies.
If PVC is observed in organic diseases, the nature of the manifestations in an impressive percentage is multiple, while the patient does not pay attention to this. Manifestations become more pronounced in conditions of physical activity. Often arrhythmia, disturbing at the same time as tachycardia.
With a high degree of probability, PVC appears during the period of bearing a child. At the same time, the woman suffers from a rapid heartbeat, her chest hurts on the left. The reason for the failures is the increased load on the heart and circulatory system, accompanied by a change in the hormonal background, which also corrects cardiac activity. PVC is not considered cancerous and resolves quickly after the baby is born.
Clarification of the diagnosis
If PVC is suspected, it is necessary to organize a daily monitoring of the work of the heart, following Holter's recommendations. The diagnosis is made if the study shows specific changes, including deformation, expansion of the ventricular complex, the appearance of a compensatory pause, the absence of a P-wave before an extraordinary impulse. Another typical manifestation is a kind of impulse that separates two typical contractions from each other.
Echocardiography may be prescribed to clarify the condition. Such a study helps to determine the causes of the pathology, to identify the nuances of a failure in the functionality of the heart. An ECG will be beneficial, in which the muscle is stimulated by external impulses, trackingtissue reaction. An electrocardiogram taken at rest and during exercise allows you to establish how the rhythm of heart contractions depends on the activity of a person as a whole.
The study of venous blood is shown. The fluid is checked for tropic hormones, potassium content, cardiac enzymes, globulins, protein inflammatory markers. If all of the above measures failed to identify the initiating VES factors, the person is generally he althy, an idiopathic form of the disease is diagnosed, the genesis of which cannot be clarified.
What to do?
Treatment of ventricular extrasystole begins with the choice of a safe diet and adherence to a clear sparing daily routine. The patient will have to exclude alcohol, tobacco products, strong coffee, tea from everyday life. Potassium-fortified foods will help. The menu will have to include oatmeal, nuts, raisins, bananas. Specific recommendations will be given by nutritionists or a therapist, assessing the state of he alth, weight problems and other features. Often prescribed "Panangin", which ensures the entry into the body of trace elements indispensable for the work of the heart.
Treatment of ventricular extrasystole involves the rejection of heavy tasks, training. Strict diets, dietary restrictions are prohibited. With the frequent influence of stress factors and poor quality of sleep, it is necessary to use herbal preparations and mild sedatives.
Drugs to help the patient
If the number of atypical systoles per day is more than two hundred, it is shownmedical adjustment of the condition. Schemes are selected strictly individually, assessing the morphology of the phenomenon, the frequency and strength of the arrhythmia, the presence of background diseases.
May recommend means to inhibit the activity of sodium channels. Most often, if necessary, to provide urgent assistance, use "Novocainamide". The compositions "Lidocaine", "Giluritmal" will have a good reputation. If necessary, to stop the activity of potassium channels, Amiodarone, Sotalol are prescribed. Calcium channels can be blocked with the help of drugs "Amlodipine", "Cinnarizine". Popular means "Verapamil".
In a pathological condition complicated by high blood pressure, means are used to correct it. Captopril and Ramipril showed themselves to be reliable. Sometimes they stop at Enaprilin. In some cases, the doctor recommends a course of beta-blockers. More often they resort to the well-known drugs "Atenolol" and "Cordinorm". Good reputation medicines "Anaprilin", "Karvedilol" are known. If the likelihood of blood clots is assessed as high enough, it is recommended to take Aspirin, Clopidogrel.
Two months after the start of the therapeutic course, it is necessary to undergo control studies in order to control the effectiveness of the selected funds. With the reduction and disappearance of additional systoles, they refuse to continue the use of drugs. If the indicators have improved, but the ZHES is maintained, the program is extended for a few more months. With a malignant form of the diseasetherapy will have to be practiced for life.
Operation shown
If the drug course does not give any result, the patient may be referred for surgery. This is more often recommended in the organic form. One of the most proven methods is radiofrequency ablation. Using a small catheter, a source of radio waves is introduced through a blood vessel into the heart cavities, through which the diseased area is cauterized. In order to localize areas requiring influence, an electrophysical study is practiced. The efficiency level is estimated at 75-90%.
An alternative option is to set up a cardiac work stimulator. This is a kind of small box with electronic filling and a battery that has been functioning for a decade. The stimulator is equipped with electrodes attached to the atrium, ventricle. The mechanism initiates impulses, under the influence of which the myocardium contracts. In fact, the device is an artificial sinus node that provides rhythmic contraction of the heart. The patient gets rid of extrasystole and can live a normal, full, he althy life.
Doctors advise resorting to mechanical stimulators of the heart, so that you do not have to take medication all your life. More often, pacemakers are placed in the elderly.
And if not treated?
The prognosis of the pathological condition depends on the severity of failures, the level of ventricular dysfunction. The stronger the changes in the myocardium, the higher the risk of flickering, persistent tachycardia. It's coupledwith the risk of death. If the atypical contraction occurs during an atrial contraction, the blood cannot leave the upper heart regions, gradually flows into the lower parts, provoking the generation of blood clots. A clot formed by blood cells initiates thromboembolism. With vascular blockage, a heart attack, stroke, ischemia are possible. To minimize the risk of such consequences, if you suspect a PVC, you should contact a qualified doctor and strictly follow the program recommended by him.
