Drain complexes on ecg what. Aberrant conduction (Confluent contractions)

Parasystole is an arrhythmia of the heart muscle, in the myocardium of which, in addition to the sinus node, there is another (in some cases there may be several of them) - a node competing with it - that produces its own electrical impulses.

Parasystole is most often observed in people suffering from diseases of the heart, blood, nervous and endocrine systems. It is much less common in completely healthy people and even among athletes.

About development mechanisms

The sinus node, a bundle of cardiomuscular tissue located in the wall of the right atrium, is responsible for the rhythm frequency of a normally functioning heart muscle.

Not being a constant value, frequency heart rate changes depending on the needs of the body: signals regulating the functioning of the sinus node come from the autonomic nervous system and internal organs that release specific substances into the blood.

If the body experiences increased stress, the sinus node is commanded to produce more impulses within one minute; during rest, the intensity of his work decreases. In case of any failures, you can normalize the operation of the sinus node using a number of medical supplies, to the action of which he is extremely sensitive.

All of the above is a sign of the norm.

What is parasystole? This condition is caused by the presence in the heart muscle of an additional source of electrical impulses that operates in its own rhythm and is not subject to either brain signals or the action of blood hormones and medications.

As a result, the heart muscle begins to contract under the influence of impulses received either from the sinus node or from the competitive node, obeying the area that was the first to send a signal. This phenomenon, called double rhythm formation, is accompanied by either tachycardia (rapid heartbeat) or extrasystole (a type of arrhythmia).

If impulses from competing areas enter the heart muscle alternately, a person experiences arrhythmia, manifested in “stops,” “tumbling,” “shocks,” “interruptions,” and “reversals” of the heart.

Daily ECG monitoring showed that the patient’s heart muscle makes over 30,000 “unplanned” contractions during the day.

Parasystole often remains unrecognized.

A patient with double rhythm formation may be given an erroneous diagnosis: extrasystole type (a condition in which the initiator of every second contraction of the heart muscle is a parasystole site) or trigeminy (“unplanned” is every third contraction).

An erroneous diagnosis entails an equally erroneous treatment tactic: attempts to heal the patient from a non-existent extrasystole are unsuccessful, although they make the arrhythmia somewhat easier to bear.

What are the differences between parasystole and extrasystole?

• If additional unplanned impulses come from any one zone, the interval between the extrasystole and the normal contraction of the heart (the so-called coupling interval) is equal to the same period of time. This type of heartbeat disturbance is characteristic of extrasystole.
• If the sources of extraordinary impulses are two (or more) sections of the conduction system of the heart muscle, the duration of the coupling interval will be inconsistent and unstable. This picture is typical for parasystole.

However, both extrasystole and parasystole are varieties of the same pathology: this is what explains the similarity of symptoms, causes, methods of therapy and prevention.

About the causes

The reasons contributing to the development of parasystole can be cardiac and extracardiac.

Cardiac causes include the presence of:

• coronary heart disease;
• cardiomyopathy (a disease leading to transformation of the structure and functioning of the heart muscle);
• inflammation of the heart muscle;
• heart failure;
• myocardial infarction (a disease leading to the death of a significant number of contractile cells of the heart muscle);
• mitral valve prolapse (pathological sagging of the leaflets of this valve at the time of contraction of the heart ventricle).

Parasystole caused by the action of extracardiac factors can develop due to:

• hormonal disorders;
• elevated blood sugar levels;
• diseases thyroid gland(hyperthyroidism and hypothyroidism, characterized by insufficient or excessive production of hormones of this organ);
• anemia;
• disruptions in the functioning of the autonomic nervous system;
• adrenal diseases;
• changes in the electrolyte composition of the blood;
• overdose of certain medications (mostly those that stimulate cardiac activity).

Parasystole, the reasons for the sudden occurrence of which have not been established, is called idiopathic.

Known forms

Depending on the location of the additional source of electrical impulses, parasystole is divided into:

1. ventricular (ventricular parasystole is characterized by the fact that the competitive node is localized in one of the ventricles of the heart);
2. atrial (the pacemaker of the heart is located in the atrium);
3. combined (foci of additional impulses are located in different parts of the heart muscle);
4. multiple (several competitive nodes are concentrated in one chamber of the heart muscle);
5. a disease emanating from the atrioventricular node.

Features of symptoms

Parasystole can manifest itself:

• attacks of sudden heart palpitations;
• sensations of turning over, jolts and short-term freezing of the heart muscle;
• impotence, fatigue, decreased performance, constant dizziness;
• pain in the heart accompanied by a feeling of fear;
• pre-fainting states, accompanied by attacks of rapid heartbeat and coughing movements.

The main electrocardiographic signs of parasystole are characterized by:

• full multiplicity of long interectopic intervals;
• parasystolic frequency, ranging from 25 to 65 contractions per minute;
• violation of the regularity of sinus rhythm due to lack of connection with parasystoles;
• instability of adhesion intervals;
• the presence of confluent ventricular complexes (provided that the sinus and parasystolic complexes coincide).

In a number of patients the disease has almost no clinical manifestations. It can be detected by chance when taking an ECG.

Diagnostic methods

Diagnosis of parasystole is carried out using the following methods:

• Collection and analysis of medical history. By interviewing the patient, the specialist collects information about the presence of complaints (when there is a feeling of interruptions in heart rate, dizziness, loss of strength, pain in the heart and attacks of rapid heartbeat); analyzes family history (information about the presence of close relatives suffering from cardiovascular diseases) and the patient’s life history (does he have chronic diseases, have he had any surgeries, is he taking medications).
• Physical examination. The doctor pays attention to appearance and the color of the skin, hair and nail plates, breathing rate, heart murmurs and the presence of wheezing in the lungs.
• Laboratory tests. The patient’s blood is taken for general and biochemical analysis, and general analysis urine.
• Establishing a hormonal profile. Information about the amount of thyroid hormones makes it possible to exclude diseases of this organ that can cause parasystole.
• Electrocardiography.
• 24-hour Holter ECG monitoring. An ECG recording is performed over 1-3 days. If parasystole is detected on an ECG, this recording is used to establish its nature and the location of the source of additional impulses.
• Echocardiography, which allows you to detect pathological changes in the septa, valves and walls of the heart muscle.
• Treadmill test or: tests carried out using a special treadmill or exercise bike. Applying gradually increasing physical activity, the presence of ischemia of the heart muscle is detected, provoking the development of parasystole. At the same time, they find out the nature of the change in parasystole as the load changes.
• Magnetic resonance imaging of the heart muscle. The indication for this procedure, which allows obtaining a three-dimensional image of the heart muscle, is ventricular parasystole.
• An electrophysiological study consisting of inserting a thin probe into the heart muscle (through the femoral vein). Using this highly informative method, it is possible to accurately determine the nature of the heart rhythm disturbance and the localization of the paracentre.

Treatment options

Treatment of parasystole can be carried out using drug, non-drug and surgical therapy.

Non-drug therapy

Boils down to:

• Quitting alcohol and smoking.
• Maintaining a proper sleep schedule.
• Reviewing the diet and including foods containing a huge amount of plant fiber (fruits, herbs, vegetables), and avoiding fatty and spicy foods.

Drug therapy

Consists of prescribing and receiving:

• metabolics (medicines that help improve metabolic processes);
• beta-blockers (medicines that reduce the strength and frequency of heart contractions and inhibit cardiac conduction);
• omega-3 fatty acid preparations;
• antiarrhythmic medications that prevent the development of arrhythmia.

Surgery

Surgical intervention for parasystole consists of radiofrequency ablation of the source of additional impulses. The surgical technique is as follows: a thin tube (conductor) is inserted into the heart muscle through a vessel on the thigh.

After applying a radio frequency pulse passing through the conductor, the detected paracenter is destroyed.

Possible consequences and complications

The consequences of parasystole (as a rule, they occur against the background of diseases of the heart muscle and its vessels) are often associated with very serious complications:

• fibrillation (arrhythmic contractions) of the ventricles: a very dangerous disruption of the heart rhythm, which in 80% of cases leads to death;
• heart failure (the cause of the disorder is a significant decrease in the contractility of the heart muscle).

Prevention of disease

To prevent parasystole, the patient should:

• avoid any psycho-emotional shocks;
• get a good night's sleep;
• give up bad habits;
• Healthy food;
• control body weight;
• lead an active lifestyle, devoting physical exercise to at least half an hour a day.

The heart is an organ with a complex structure. With any disruption of its functioning, various diseases arise. Most diseases pose a potential threat to human life. It is very important to monitor the condition and prevent any problems.

Myocardial repolarization is a membrane restoration procedure nerve cell through which the nerve impulse passed. As it moves, the structure of the membrane changes, allowing ions to easily move through it. Diffuse ions moving in reverse side restore electric charge membranes. This process puts the nerve in a state of readiness so that it can continue transmitting impulses.

Disruption of repolarization processes occurs in adults over fifty years of age who complain of pain in the heart area. These processes are regarded as a manifestation of coronary or hypertensive heart disease. They identify problems with such actions when taking an ECG.

Causes

Repolarization disorders can be caused by various factors. There are three groups of reasons:

1. Pathologies of the neuroendocrine system. It regulates the functioning of the heart and blood vessels.
2. Heart diseases: hypertrophy, ischemia and electrolyte imbalance.
3. Taking medications that negatively affect the functioning of the heart.

Disruption of repolarization processes in the myocardium can also be caused by nonspecific reasons. This phenomenon occurs in adolescents and in many cases disappears spontaneously, without the use of medications. Sometimes treatment is required.

Nonspecific disorders can also occur due to physical overload (from sports or at work), stress, changes in hormonal levels(pregnancy or menopause).

ECG changes

Violation of myocardial repolarization is often asymptomatic, which is extremely dangerous for human life. Pathology can be detected by chance during an ECG examination.

Changes that can be used to establish a diagnosis are visible on the cardiogram; it is possible to distinguish between disturbances in the repolarization of the ventricles and atria.

1. The presence of atrial depolarization is indicated by the P wave.
2. On the cardiogram, the Q and S waves are lowered down (negative), and R, on the contrary, is up (positive), this indicates depolarization of the ventricular myocardium. In this case, there may be several positive R waves.
3. The deviation of the T wave position is characteristic feature ventricular repolarization.

The form of the pathology is early repolarization syndrome, when the processes of restoration of electrical charge occur ahead of schedule. On the cardiogram this syndrome is displayed as follows:

• from point J, the ST segment begins to rise upward;
• unusual notches appear in the descending part of the R wave;
• on the rise of ST, a concavity is formed in the cardiogram, which is directed upward;
• The T wave becomes narrow and asymmetrical.

Only a qualified doctor who can prescribe appropriate treatment can understand the intricacies of the ECG result.

A course without symptoms is not observed in all cases of disruption of the repolarization process. Sometimes the pathology can manifest itself during vigorous physical activity. In this case, the patient experiences a change in heart rhythm.

The disease may also be accompanied by:

• headaches;
• fast fatiguability;
• dizziness.

After some time, heart pain comes, the heart rate increases, and sweating increases. These symptoms are not specific, and when they occur, it is necessary to differentiate the disease from other heart diseases.

In addition to the listed symptoms, the patient experiences excessive irritability and tearfulness. Pain in the heart is characterized by stabbing or cutting sensations with increasing intensity. When repolarizing the inferior wall of the left ventricle in a person from severe physical labor feeling dizzy, spots appearing in the eyes, increased arterial pressure.

If treatment is not started on time, the symptoms become more pronounced and last longer. The patient begins to experience shortness of breath, and swelling occurs in the legs.

Treatment

Treatment for repolarization disorders depends on the cause of the pathology. If such a cause is not identified, the following is used in treatment:

1. Complexes of vitamins and minerals. They help restore heart activity by providing useful substances and microelements.
2. Beta blockers (Anaprilin, Panangin).
3. Corticotropic hormones. They have a positive effect on the activity of the heart.
4. Cocarboxylase hydrochloride. Helps restore carbohydrate metabolism and has a positive effect on the cardiovascular system.

The patient is registered at the dispensary, periodically monitoring the results of treatment by repeating an ECG.

Blood pressure 130 over 70: is this normal or not?

Chronic stress, conflict, lack of sleep, severe mental or physical fatigue, consumption of alcoholic beverages and other factors can increase blood pressure to 130/70. After a short time, blood pressure returns to normal.

Blood pressure 130/70 – is this normal or not? In medical practice arterial values are considered one of the variants of the norm. Provided that the patient feels well, there are no alarming symptoms such as headaches, dizziness, or constant fatigue.

During pregnancy, increased blood pressure requires special attention. If the expectant mother’s blood pressure increases, she will be hospitalized. In reality, the situation is not dangerous; doctors are simply playing it safe.

Values ​​above normal may be permanently elevated. Sometimes there is a decrease to 120/80 mm mercury- ideal indicators. When the numbers begin to rise sharply, treatment is required.

Blood pressure 130/70, what does this mean?

When a person feels well, the indicators are high. If your health worsens, then a diagnosis of prehypertension or prehypotension is made, since the upper parameter is increased and the lower value is less than normal.

Blood pressure 132-133/70 indicates a large pulse difference, which can indicate abnormal processes in the human body. DM 130 and DD 70 are absolutely normal for adult men who are not obese. In this case, the pulse should be 70 beats per minute.

Also, the indicators are within normal limits for hypertensive patients, people involved in sports professionally, and patients in the elderly age group.

The parameters are alarming for the following people:

• Hypotonics.
• Pregnant women.
• Children.
• Teenagers.

Blood pressure of 130 over 70 can be interpreted in different ways. Often the norm, rarely – pathology. Other nuances of the clinical picture, concomitant diseases, the patient’s age, and other factors are important.

Causes of high blood pressure

If the reading is 130 over 70, the pressure can be interpreted as normal or pathological. In the first option, this may be the person’s “working” blood pressure. And its decrease will lead to a deterioration in well-being, headache, ringing in the ears, increased sweating.

An increase may be temporary under the influence of a negative factor. Severe stress, lack of sleep, rest, excessive stress (physical or mental). It normalizes on its own within a short time.

If the SD is 134-135, and the DD is 70-72, the indicators are not “working”, there are no harmful factors, we can talk about a malfunction in the body. There are many reasons that lead to increased blood pressure:

1. Wrong diet – abuse of salt, alcohol.
2. Weakening the tone of blood vessels.
3. Kidney pathologies.
4. Obesity, metabolic disorders in the body.
5. Hormonal imbalance.
6. Heart diseases.
7. Deficiency of useful components.

Primary hypertension involves multiple causes. In most cases, they cannot be determined. Secondary hypertension is caused by the progression of a disease and acts as a symptom.

If the patient has negative factors at 130/70, he is included in the risk group for hypertension.

Blood pressure and pregnancy

While carrying a child, the female body is subjected to double stress and hormonal changes are detected. As a result, heart rate, blood pressure, etc. may vary periodically.

If the pressure is 130 over 70 during pregnancy, then expectant mother hospitalized. There is no health hazard, so most often this is unfounded.

The patient's complaints become a prerequisite for hospitalization. The temples and the back of the head hurt, there are fainting, and a sharp deterioration in health. Let us note that malaise can be caused by other circumstances, so it is necessary to determine that it is the pressure that is “to blame.”

To do this, the following indicators are measured:

• If the first measurement showed a pressure of 133 over 77, then a second measurement is taken after 15 minutes. The patient is not told about the suspicions in order to exclude a nervous condition that leads to an even greater increase in the numbers on the tonometer.
• After four and six hours, successive measurements of SD and DD are carried out.

If during pregnancy 4 measurements showed increased blood pressure, then they speak of arterial hypertension.

An increase in values ​​during pregnancy increases the risk of placental abruption and poor circulation between mother and child.

When are values ​​of 130/70 dangerous?

When the systolic value varies from 124 to 130 and the diastolic value from 70 to 75, causing a significant deterioration in the condition, you need to consult a doctor. When the body is highly sensitive to an increase in blood pressure, patients may experience pain, dizziness, and nausea.

In most clinical pictures, such values ​​do not affect the human condition. Symptoms are detected in cases where the indicators begin to jump or grow rapidly. Mild weakness is often attributed to lack of sleep and rest, although blood pressure is to blame.

Heart pain at such values ​​is extremely rare. An increase in DM and DD increases the risk of pathologies of the heart and blood vessels, eye diseases and urinary system.

Numbers 130/70 are dangerous if accompanied by the following symptoms:

1. Frequent headaches and dizziness.
2. Noise and ringing in the ears.
3. Nausea, vomiting.
4. Loss of coordination.
5. Periodic fainting and clouding of consciousness.

The doctor will tell you what to do in this situation after diagnosis. It includes blood and urine tests, ultrasound, ECG and other methods in accordance with the clinic.

Is it necessary to lower blood pressure?

Blood pressure of 130 over 71-75 can indicate normal or pathology. When the lower value increases to 100 or even to 110, we speak of isolated diastolic hypertension. Often the causes of the disorder are related to the functioning of the kidneys and adrenal glands.

Most often, drug treatment is not required. A slight increase rarely makes a person feel worse. The doctor may recommend reviewing your menu and giving up bad habits.

Such activities help maintain blood pressure at the desired level. If it begins to grow rapidly, then they look for the reasons. If this is a secondary form of the disease, then therapy is aimed at curing the “source”.

When primary hypertension is diagnosed, antihypertensive pills are prescribed that affect the mechanisms of increasing numbers on the tonometer.

How to prevent hypertension?

You need to be careful about your health. A small increase can develop into a rapid jump in blood pressure up to a hypertensive crisis.

There is a high probability that a slight increase in diabetes will soon develop into “full-fledged” hypertension. 130 to 70 is already a signal from the body that requires correction.

Stress and neurosis are factors affecting blood pressure. You need to avoid stressful situations and normalize your emotional background. At night you can drink tea with mint or lemon balm - they have a mild sedative effect.

It is possible to prevent the disease. You must follow the rules:

• Review your diet. Limit consumption of fatty, salty, spicy, flour foods.
• Reduce coffee consumption. Chicory lowers blood pressure, so it is an excellent alternative.
• Physical activity. You can go to the gym if there are no medical contraindications. Walk around fresh air every day. Sport prevents oxygen starvation and improves the condition of blood vessels.
• Smoking and alcohol, even with existing prerequisites for hypertension, aggravate the course of the disease. It is better to refuse them.
• Monitor your blood counts and pulse. You can record the results obtained in a notebook, which will allow you to track the dynamics of changes.
• Normalize your weight if you have extra pounds.
• Take vitamin and mineral complexes.

At an early stage, blood pressure can be brought back to normal by simple ways. If you do not follow the rules, over time a slight increase will lead to disastrous results.

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Cardiovisor - what are you paying money for?

Let's start with the fact that a cardiovisor is a truly existing medical device and most likely it has even passed all the necessary certification. And there is nothing surprising here, because the device’s operating principle is no different from the electrocardiograph of the 1946 era, why wouldn’t it be certified?

Why time 1946? But because it has only four leads (clothespins that fit on the arms and legs). It was until 1946 that the standard cardiograph had the same number of leads, then it was improved and 6 additional chest leads were added to it, remember, those that are located on the chest. And they were introduced for a reason, but specifically to make it possible to assess the state of the myocardium not only its lateral and back wall, and also the front one. It is in the area of ​​the anterior wall that changes most often occur, but the cardiovisor, please note, does not have them.

Thus, we figured out that a cardiovisor is, in fact, an ECG device that lacks a number of very important leads. But here’s what’s captivating: the data obtained during the survey is processed by a computer using some kind of algorithm.

Then the result is presented in the form of a picture - beautiful, colorful, which is, as it were, “understandable” to the patient, and to all this is attached some kind of abstract description of what was found there. This is a well-thought-out psychological moment, everything is designed for doubting patients, it seems that the person himself can understand what is happening to him. These are not the usual mysterious squiggles on paper, but a picture of a heart, and in color at that! Green, yellow, red, a little here and there... but it’s hard for a cardiologist to understand what you’ll understand from it.

Even more alarming is the statement that the cardiovisor can notice the slightest changes? occurring in the heart muscle. Any doctor will confirm to you that the ECG of many patients does not change for years and even decades, but this stability is always assessed by a doctor. When analyzing a cardiogram, you almost always have to deal with various recording errors: artifacts, interference, isoline drift, poorly placed electrodes, and much more. In the case of a cardiovisor, all this is done by a computer, and it does not take any of this into account; even the most serious companies specializing in the production of professional equipment have not come up with an ideal algorithm. Moreover, even a qualified specialist periodically encounters difficulties. Therefore, in view of all these nuances, the cardiovisor produces different results each time, thus creating the impression of changes supposedly occurring in the heart: sometimes good, sometimes bad.

Go ahead. The picture provided to the patient does not stand up to any criticism at all: from the point of view of electrophysiology, this device is not able to assess the condition of the anterior wall of the heart (there are no chest leads, we talked about this earlier), and it is so colorfully painted on the demonstration materials!

The situation is even more bleak with the practical meaning of this “unique” device: The cardiovisor does not appear in any of the currently existing recommendations on cardiology, both in our country and abroad! Therefore, the results of this study cannot be used by a doctor for diagnosis and treatment. This is a completely useless device. If you are offered to undergo an examination on it within the walls of a medical institution, then I recommend running away from there as soon as possible - this is clean water pumping out money. I repeat once again: the data obtained during this study cannot influence the diagnosis and treatment tactics, so why do it then!? Think logically!

But those complexes that are proposed to be used at home, in general, can be beneficial. Having a portable ECG machine at home can be useful for those patients who have arrhythmia that is not noticeable during visits to the doctor. If I felt bad, I registered an ECG, took it to the doctor, and a lot of things might become clearer. But the cardiovisor registers only one lead (only it is recorded on the recording), and for that matter, the cardiovisor costs almost the same as a regular portable ECG device, so maybe it’s better to buy it and learn how to use it?

Finally, I would like to note that this article was written only so that people far from medicine understand what they are paying money for, since from a legal point of view there is no fraud in this: you are buying a device that shows what was stated, and the fact that it is impossible to use this data in practice is your problem.

In medical practice, the term “parasystole” is practically not used. Translated from Latin, it means independent contraction of the heart, independent of the main pacemaker.

The fact is that any extraordinary sources require clarification. Arrhythmias have their own origin and mechanism of development. The word “parasystole” is also found in popular literature as a collective name for rhythm disturbances associated with additional ectopic (heterotopic) foci.

Where should parasystole be classified in the classification of arrhythmias?

Classifications of arrhythmias are based on different characteristics, each with its own disadvantages:

• according to the anatomical location of the ectopic focus - the mechanism of development of disorders is not taken into account;
• according to the mechanism of violation of automaticity, conductivity or excitability - in most cases there is a violation of all functions at once;
• by rhythm frequency - with the diagnosis of normo-, tachy- and bradyarrhythmia, the algorithm for determining the type begins, but it requires further clarification using electrocardiographic (ECG) studies;
• depending on the mechanism of impulse occurrence (in a normal and ectopic focus) - separate identification of conduction disorders and combined disorders.

Parasystole is closest to the last option. Let us clarify that we understand the term as additional contractions of the heart muscle in response to impulses coming from the “paracenter” located in any part of the heart.

Education mechanism

Automatic generation of impulses is a physiological function of myocardial cells. This is how they differ from ordinary muscle tissue. Typically the impulses originate in the sinus node. From here they spread to all parts of the heart and cause the correct rhythm.

The parasystolic center may arise elsewhere and contribute to premature contractions, extrasystoles, or a more complex disorder - atrial fibrillation.

The main reasons for such changes should be sought in the suppression of the main sinus node, its damage (A - normal, B - abbreviation from the underlying node)

Increased tone of the vagus nerve is important. This mechanism predominates in healthy people and athletes.

It is important that in prognostic terms, additional contractions do not contribute, but hinder normal operation myocardium, since they do not allow complete relaxation during the diastole phase. Parasystolic contractions are premature and do not create the necessary volume of blood to nourish the body.

There is a possibility of internal blockade of the propagation of ectopic waves. But with a weak sinus node, the parasystolic focus turns out to be active. Usually the impulse with the highest frequency “wins”.

Types of parasystoles

Depending on the location of the source of the second rhythm, the following types are distinguished:

• ventricular parasystole;
• atrial;
• from the atrioventricular node;
• polytopic (from different places).

In addition, in relation to the normal contraction, extrasystole can be:

• early and late;
• single, group and allorhythmic (constant rhythmic alternation).

According to the frequency of the ectopic rhythm:

• rare (up to 10 per minute);
• medium (10–30);
• frequent (more than 30).

There are temporary and permanent forms. The type of parasystole can be clarified using the ECG picture.

A serious type of parasystole is atrial fibrillation in the form of atrial flutter or fibrillation. With this pathology, there are either many foci of excitation, or the process forms a vicious circle.

Why do parasystole centers appear?

There are cardiac and extracardiac causes. In some cases, it is impossible to establish a connection with any cause, then the extrasystole is called idiopathic.

Cardiac ones include:

• ischemia or necrosis in the sinus node area and other places with coronary heart disease, which forces different areas to become active and “survive” on their own;
• inflammation of a focal or diffuse nature in acute and chronic myocarditis (rheumatic carditis, acute infectious diseases, sepsis);
• metabolic changes during dystrophy;
• replacement of myocytes with connective tissue cells with disruption of their functions (cardiomyopathies, cardiosclerosis);
• loss of ability to recover required level energy (circulatory insufficiency);
• hypertrophy of myocardial tissue (hypertension, decompensation in heart failure, cardiomyopathies);
• disruption of the valves (congenital malformations, acquired changes in the valves due to inflammatory processes, injuries).

Non-cardiac causes include concomitant diseases leading secondary to myocardial dysfunction. Most often, these changes are “guided” by endocrine organs when:

• diseases of the thyroid gland (hypothyroidism or hyperthyroidism associated with deficiency or excess synthesis of thyroid hormones);
• diseases of the adrenal glands;
• diabetes mellitus

Activation of parasystolic foci is detected on the ECG when:

• vegetative-vascular dystonia, neuroses;
• anemia (anemia) of various origins;
• overdose of drugs (cardiac glycosides);
• violation of the necessary balance in the electrolyte composition of the blood between potassium, sodium, magnesium and calcium, they are necessary for the implementation of the normal process of excitation and contraction of myocardial cells.

How do additional contractions manifest clinically?

Clinical signs of parasystole are felt by a person as:

• strong "blows or jolts" in chest;
• “heart stop”, “fading”;
• attacks of sudden heart palpitations.

Common symptoms include: dizziness, weakness, fainting, coughing movements.

Extrasystoles may not give any symptoms and are detected during examination by chance.

Primary diagnosis

The patient must undergo a general appointment with a therapist. The doctor will try to find out the connection between parasystole and other diseases and will discover a hidden course. It is necessary to talk about your feelings and their dependence on a specific reason.

If the patient is taking medications, it is necessary to reconsider their appropriateness and the possibility of affecting the heart rhythm.

Family history is always taken into account - the tendency of relatives to similar diseases.

Auscultation of the patient allows you to identify arrhythmia and calculate the number of heartbeats. Hypertension at the appointment indicates the role of elevated pressure in myocardial tension.

The Holter monitoring method has expanded the search for intermittent arrhythmias and other disorders in time

General blood tests and biochemical tests are carried out to more accurately identify the mechanism of disorders:

• Reduced hemoglobin and red blood cells indicate anemia.
• An altered balance of cholesterol, triglycerides and lipoproteins suggests the development of atherosclerosis in the vessels of the heart.
• Blood glucose level - primary diagnosis diabetes mellitus.
• Determination of electrolyte composition shows nutritional deficiencies.

Sometimes the patient is prescribed more in-depth studies of hormonal levels, and consultation with an endocrinologist is recommended.

Methods to rule out heart disease

To identify cardiac causes, a complete examination is necessary, including differential diagnosis of defects, physiological abnormalities, and the consequences of vascular atherosclerosis.

1. The ECG quite accurately shows the localization of the second pacemaker, allows you to distinguish the ventricular type from others, and identify allorhythmia. This method is available at the outpatient and clinic level. Allows you to identify signs of heart disease that cause rhythm changes. Conducting stress tests is recommended to identify a latent form (asymptomatic), associated with physical activity and the influence of nervous regulation. Bicycle ergometry tests, treadmill walking, and stair tests are used.
2. If parasystoles appear rarely, then the Holter monitoring method helps: the patient is fitted with electrodes for a day, from which information is recorded even during night sleep. Decoding allows you to determine the cause of extrasystole.
3. Dopplerography is a very informative method for identifying heart defects, the degree of mitral valve prolapse, and myocardial reserve reserves. The image on the screen visualizes the contraction process and its phases. At the same time, a quantitative analysis of indicators is carried out.
4. Magnetic resonance imaging (MRI) is the method of choice for diagnosing the correct functioning of all parts of the heart muscle and identifying replacement with scar tissue.

An ECG recording records different distances between the ventricular complexes, a violation of their shape, and the direction of the teeth

Treatment

After identifying the disease that caused parasystole, you should carefully follow the cardiologist’s recommendations on regimen and treatment. In each specific case, different medications are prescribed, so you should not adopt the experience of neighbors or acquaintances.

In your daily routine, it is imperative to allocate enough time for rest, relaxation, physical exercise, sleep.

Treatment will not be successful if you abuse alcoholic beverages (including beer) or smoke. You will have to get rid of these habits.

There is no special diet in nutrition, but nutritionists recommend eliminating strong irritants from food:

• fried and smoked meat dishes;
• high-fat dairy products;
• butter and animal fats;
• strong tea and coffee;
• spicy seasonings and sauces.

You should not overeat; it is better to eat often, but in small portions. Preference is given to boiled and steamed fish, poultry, fresh vegetables and fruits.

For drug treatment use:

1. Soothing herbal remedies made from mint, valerian, motherwort. If necessary, the doctor prescribes sedatives.
2. To improve metabolism in myocardial cells, Retabolil, Panangin, Riboxin are prescribed.
3. For high concentrations of low-density lipoproteins, statins and nicotinic acid injections are recommended.
4. β-blockers (Isoptin, Obzidan) are prescribed for organic changes to suppress impulse transmission from paracentres.

The ablation procedure is carried out under X-ray or ultrasound scanning control

Surgical methods are used when drug therapy is unsuccessful or it is impossible to use them (pregnancy). The least dangerous method is radiofrequency ablation of the source of excitation. A catheter with a radiofrequency emitter at the end is brought to the heart through large vessels. The end of the catheter is placed in the area of ​​suspected heterotopic foci and their targeted destruction is carried out. A scar forms at the site of exposure.

Consequences of parasystole

The most dangerous consequences of uncontrolled parasystole can be:

• ventricular fibrillation, leading to death;
• the formation of chronic heart failure with a gradual decline in the ability of the heart muscle to contract and push blood.

Clinicians and scientists study heterotopic foci (parasystolic) in the heart. The impact of altered neurohormonal regulation on the heart is well recognized. This process is especially important during the period of child growth, adolescence, and menopause. A person should pay the most attention to health during these sensitive periods of life.

During parasystole there are confluent contractions- these are combined complexes formed with the simultaneous occurrence of impulses from the main and ectopic pacemakers. In this case, one part of the myocardium is excited from one source, the other from the second, and a complex having an intermediate form is recorded on the ECG. These confluent contractions are one of the diagnostic signs of parasystole.

M. S. Kushakovsky (1981) distinguishes bradycardic and tachycardic forms of parasystole. In addition, atrial, atrioventricular and ventricular parasystole are distinguished. The bradycardic form, according to clinical and electrocardiographic signs, has much in common with extrasystole, and tachycardic forms - with non-paroxysmal or paroxysmal tachycardia.

In this regard, the following classification of parasystole seems appropriate:

By clinical manifestations- parasystolic extrasystole, parasystolic paroxysmal tachycardia, parasystolic non-paroxysmal tachycardia, parasystolic accelerated ectopic rhythm;

according to the localization of the ectopic focus - atrial, atrioventricular, ventricular, combined.

The most common type is ventricular parasystole.

A typical example of parasystolic ventricular extrasystole The ECG shown in the figure of a 72-year-old patient with a diagnosis of coronary heart disease, post-infarction cardiosclerosis can serve as an example. In the figure you can see right ventricular extrasystoles with a changing extrasystolic interval. Some extrasystoles appear after the next P wave. The distance between extrasystoles in milliseconds is indicated under the ECG. The interectopic spaces are equal and multiple, the 4th ventricular complex is confluent, as indicated by its shape, which has signs of both sinus and ectopic complexes.

Less commonly, parasystole manifests itself in the form of accelerated ectopic rhythms, non-paroxysmal or paroxysmal tachycardia. Sometimes there is a double, or combined, parasystole with two ectopic foci.

An example of such arrhythmia is the ECG of a 67-year-old patient diagnosed with coronary heart disease, acute posterior phrenic myocardial infarction. Arrhythmia developed after electrical defibrillation performed for ventricular fibrillation. Both parasystolic centers were localized in the ventricles. On the upper segment of the curve there is a sinus rhythm of 76 per minute, polytopic ventricular extrasystoles.

The shape of extrasystolic complexes is variable, apparently due to the fact that some of them are confluent contractions (for example, the 3rd complex on the right).

On the average curve one can see three types of ventricular complexes: two types correspond to various types ectopic ventricular contractions, the third corresponds in shape to sinus ones. In the interectopic intervals of complexes of the same type, it is possible to establish common divisors indicated above and below the curve, which indicates the parasystolic origin of these complexes. In this segment of the curve, only one sinus complex (6th) can be seen, followed by an atrial extrasystole and a drain contraction. The lower segment of the ECG showed non-paroxysmal ventricular tachycardia with a frequency of 115 per minute. The shape of the ventricular complexes corresponds to the shape of the complexes of one of the parasystolic rhythms, and the interectopic intervals have a common divisor. Thus, the patient had double ventricular parasystole and non-paroxysmal tachycardia. The arrhythmia lasted for several hours and then went away on its own.

Often, parasystolic arrhythmias have a very long and persistent course, persist for many years and are difficult to treat with antiarrhythmic drugs.

“Practical electrocardiography”, V.L. Doshchitsin

Atrioventricular dissociation is the uncoordinated activity of the atria and ventricles, not associated with complete transverse block, but resulting from the fact that the ventricles are excited by ectopic impulses, more frequent than sinus impulses, and the atria are activated by another rhythm source (usually the sinus node). Just like escaped contractions, atrioventricular dissociation is not an independent type of arrhythmia, but is associated with other rhythm disturbances...

Reciprocal, recurrent, or echo contractions are explained by the fact that the atria or ventricles are excited repeatedly by the same impulse. This is a particular manifestation of the phenomenon of re-entry of excitation. A necessary condition for the occurrence of reciprocal arrhythmias is the functioning of two channels in the atrioventricular junction, conducting impulses at different speeds and in opposite directions. Reciprocal arrhythmias also occur during the functioning of additional pathways in...

Sometimes with arrhythmias, so-called drain contractions, or drain complexes, are observed [Chazov E. P., Bogolyubov V. M., 1972; Doshchitsin V.L., 1979; Tomov L., Tomov P., 1979]. Possible occurrence of confluent contractions of the atria or ventricles. Confluent contractions appear when two different sources of excitation exist, synchronously causing depolarization of the atria or ventricles. Simultaneous or almost simultaneous excitation of the atria or ventricles occurs with impulses coming from different directions - from the sinus node and from the ectopic pacemaker.

The resulting complex recorded on the ECG is the result of a merger or combination of two various forms excitement. For example, with late ventricular extrasystoles, the ventricles can be excited in a normal way - through the atrioventricular node and in an unusual way - from an ectopic source of excitation located in one of the ventricles. The QRS complex, when two excitations merge, has an intermediate appearance between normal contractions and complexes caused by impulses emanating from ectopic areas.

The width of these complexes usually does not increase more than 0.06 s compared to normal QRS complexes. The PQ interval of drain complexes can be equal to its usual duration or slightly shorter. However, this shortening should not exceed 0.06 s, since the impulse emanating from the ventricles needs no more than 0.06 s to cause excitation of the ventricles and prevent the impulse from the sinus node from spreading to them.

In cases where the PQ interval of the confluent complexes is shorter than in normal contractions, the ventricles are excited first by an impulse from the ectopic focus. The initial part of the QRS complex is caused by ectopic excitation and differs in shape from ordinary sinus complexes. As for the final part of the QRS complex, it is always different from the shape of ordinary sinus complexes. This is due to the fact that the final part of the QRS complex is determined either by isolated excitation of the ventricles only from the ectopic focus, or by their depolarization under the influence of two impulses simultaneously.

“Guide to electrocardiography”, V.N. Orlov