Extrasystole

• Synonyms
• introduction

Synonyms

Stumbling of the heart, dropouts of the heart, palpitations, racing heart, palpitation,

English: premature ventricular contractionn (PVC), extrasystole

definition

An extrasystole is an action of the heart that aoutside the normal beat rhythm of the heart occurs. The term is derived from the Greek word for contraction and describes in medical terminology the contraction of a hollow organ. Hence an extrasystole denotes one additional heart actionthat occurs outside of the heart's normal beating rhythm. Extrasystoles are very common even in healthy people and are sometimes not even noticed. Only some of those affected consider the extrasystoles as "Palpitations or Heart failure“Perceive, feel sick because of it. Therefore should Cardiac arrhythmias and the possible cause of existing complaints always checked by a doctor become. There are generally extrasystoles more common in young people in front.

introduction

The heart's conduction system normally receives its impulse for the heartbeat from Sinus node, which in right atrium of the heart lies. If the heart rhythm is normal, it starts from the sinus node and is therefore also called Sinus rhythm designated.

The electrical excitation of the heart is transferred to the heart muscle cells in the atrium AV node (Atrioventricular node), which exactly on Transition from atria to ventricles lies. The AV node then conducts the excitation via the His bundle in the two Tawara thigh further, from where the heart chambers are electrically excited and the heartbeat is complete.
This complicated electrical system of the heart can get out of balance for a number of reasons, for example extra heartbeats (Extrasystoles) that arise outside the normal rhythm.

Because of the anatomy of the heart's electrical conduction system, one can depending on the place of origin of the extrasystoles distinguish between extrasystoles that occur in the Auricles (Herzatria) arise (Supraventricular extrasystoles, SVES for short) and extrasystoles that occur in the Chambers of the heart (Heart ventricles) arise (ventricular extrasystoles, VES for short).

The actual rhythm of the heart can either be set by the extrasystoles remain unaffected or postponed become. This depends on the point at which extrasystole occurs in the normal beat rhythm.

Forms of extrasystoles

1. Supraventricular extrasystoles (SVES, atrial extrasystoles)

A supraventricular extrasystole arises in the Auricles, more precisely before the electrical impulse of the heartbeat reaches the bundle of His, a special type of fiber in the heart. Thus, supraventricular extrasystoles arise in the upper part of the heart.

They can arise either in the heart muscle cells of the atrium and are therefore also called atrial extrasystoles or they arise in the AV node (atrioventricular node) and are then called nodal extrasystoles designated.

Supraventricular extrasystoles usually do not produce any symptoms and are therefore used by the patient often not noticed. Occasionally the supraventricular extrasystoles are also called PalpitationsPalpitations or racing heart noticed and it can in rare cases too

• dizziness
• fear
• Nervousness or
• Faint (Syncope) come.

Often, however, supraventricular extrasystoles only become apparent during a EKG examination of the heart discovered and then not treated further in otherwise healthy people.

2. Ventricular extrasystoles (VES, ventricular extrasystoles)

In the case of a ventricular extrasystole, the extrasystole occurs in the tissue of the heart chambers. It is also said that these additional heartbeats im ectopic tissue arise. (Ectopic means that of this tissue normally no electrical impulses because this tissue is outside the heart's normal pacemaker structure.)

So this extrasystole has one other place of origin than with one normal heartbeatthat arises in the sinus node. Ventricular extrasystoles are divided into different categories depending on the type of expression. Monomorphic (monotopic) Extrasystoles denote such ventricular extrasystoles that always look the same in the ECG lead. This form of ventricular extrasystoles often occurs in healthy people, but can also have a disease value.

Polymorphic Extrasystoles denote those ventricular extrasystoles that take on different forms in the ECG lead, so that none Regularities are recognizable. Doctors then often speak of an irregularly deformed QRS complex, a technical term for the cardiac excitation visible in the ECG. These different chamber complexes always have one Heart muscle damage as the cause.

The heart muscle tissue of the heart is through the Scars damagedthereby increasing the normal conduction of excitation no longer spread unhindered can. These irregularities in the electrical conduction can occur in the ectopic tissue new electrical impulses arise which then a ventricular extrasystole can trigger.

In addition to the origin of the extrasystoles, ventricular extrasystoles are also classified according to their relationship to normal heartbeat. One differentiates Bigeminus or. Trigeminal nerve such as Volleys. The bigeminus is followed by one normal heart action always an extrasystole, in which Trigeminal nerve A normal heart action is always followed by two Extrasystoles. These two extrasystoles that follow normal heart action are also known as Couplets.

Follow normal heart action three or more extrasystoles without normal heart action in between, one speaks of one volley. Due to these types of extrasystoles it can become a Pulse deficit come. This happens when the extrasystole is still during the actual heartbeat occurs. This allows the heart not filling properly with blood and the stroke volume of the heart is less. Because of the low stroke volume, the pulse wave no longer arrives at the patient's arm, so that there no pulse felt can be. Then one speaks of a pulse deficit because it more heartbeats per minute gives as measurable pulse waves on the extremities.

Depending on the time at which the ventricular extrasystoles occur, the rhythm of the heartbeat can remain the same or be shifted. If an extrasystole is close to the following heartbeat, it can Heartbeat not executed become. The heart is not yet ready to be aroused again, it is still in the refractory period. Thereby missing a heartbeat and there is one so-called compensatory pausethat although no disease value must have, but is often perceived by the patient as a heart stumble or a heart failure.

Ventricular extrasystoles are after the Lown classification assigned. This classification is based on the occurrence of ventricular extrasystoles in the 24h long-term ECG and divides the ventricular extrasystoles into simple and complex VES. In the so-called R-on-T phenomenon, the extrasystole falls into one dangerous phase of normal heartbeat and it can too Ventricular fibrillation come, which is why this form of extrasystole is the most dangerous of all forms.

LOWN classification

• Simple VES
  • Grade I: Monomorphic PVCs less than 30 times per hour
  • Grade II: Monomorphic PVCs over 30 times per hour
• Complex VES
  • Grade III: Polymorphic VES
  • Grade IVa: trigeminal nerve / couplets
  • Grade IVb: volleys
  • Grade V: "R-on-T phenomenon"

Symptoms

The symptoms of ventricular extrasystoles are similar to those of supraventricular extrasystoles, so those affected have often no symptoms. Depending on the severity of the ventricular extrasystoles, those affected often notice a heart stumbling or stopping, especially if the extrasystole leads to one compensatory break comes. With more pronounced ventricular extrasystoles, it can increase

• Impaired consciousness
• dizziness
• Weakness or fainting (Syncope)

come, because the heart's irregular beating action is sufficient Supply of the organism can no longer be guaranteed with blood. In very rare cases, ventricular extrasystoles can also lead to ventricular fibrillation and sudden cardiac death lead, but this is more common with previously occurring Heart attacks or other heart diseases.

causes

As mentioned earlier, extrasystoles are common in healthy people, so one exact explanation of the causes often difficult to do is. In people with healthy hearts, for example

• emotional excitement or instability
• severe fatigue
• Luxury foods such as alcohol, nicotine or caffeine
• drug consumption (Cocaine, amphetamines)

to increased extrasystoles.

Also increased activity of the Vagus nervewhich innervates the heart can lead to extrasystoles. This can be especially true for very active people occur.

In addition to these factors, extrasystoles can also occur organic causes to have at heart. It often occurs in connection with diseases of the coronary arteries (coronary heart disease), such as heart attacks, lead to increased activity of extrasystoles.

A previous heart attack is common Scar tissue on the heart originated which the normal electrical excitation line of the heart blocked and thus can lead to extrasystoles. Heart muscle diseases (Cardiomyopathies) and inflammation of the heart muscle (Myocarditis) can be a cause of extrasystoles.

However, causes outside the heart can also be responsible for extrasystoles. A Hyperthyroidism (Hyperthyreosis) For example, an increased amount of thyroid hormones in the bloodstream can cause more extrasystoles, as this status is associated with a permanent arousal of the organism is comparable.

Another cause of extrasystoles can be a Electrolyte disorder his, especially the potassium and magnesium balance should be checked. At Potassium deficiency should especially have therapy with diuretic drugs (Diuretics) as this therapy often leads to a Loss of potassium can lead and thus also cause the development of extrasystoles.

Other drugs that can trigger extrasystoles are, for example digitalis, Sympathomimetics, Antiarrhythmics or tricyclic antidepressants. If medication-indicated extrasystoles are suspected, the medications used should always be checked for possible side effects on the heart and, if necessary, after consulting the attending physician. differently dosed or discontinued become.

diagnosis

The diagnosis of extrasystoles is made almost exclusively via ECG and long-term (24-hour) ECG. The possible organic cause of extrasystoles can only be clarified through an EKG. Exercise ECGs are also often used to verify whether the extrasystoles only occur during exercise or whether they are independent of it.

Similar observations can be made in a 24-hour long-term EKG. The heart activity is recorded over 24 hours and the patients are also asked to write down exactly what they did at what time and when and whether they noticed extrasystoles, for example as a heart stumbling or racing heart. In this way, statements can be made as to whether extrasystoles and certain behaviors, for example drinking coffee in the morning, are causally related to one another.

This article might also interest you: Extrasystoles in the ECG in the case of myocarditis

On the basis of the long-term ECG, the ventricular extrasystoles can be classified according to the LOWN classification. Furthermore, the diagnosis can be further confirmed by ergometry or an ultrasound examination of the heart (echocardiography).

However, the exact diagnosis of extrasystoles is only aimed for under certain criteria. If extrasystoles occur particularly frequently (more than 30 times an hour), if there is an underlying heart disease, or if the extrasystoles cause symptoms, it makes sense to examine the extrasystoles more closely.

In the ECG, extrasystoles can appear differently, depending on the point in time at which they occur relative to normal cardiac excitation. Usually, extrasystoles can be recognized in the ECG by the fact that another QRS complex, i.e. another heartbeat, is clearly outside the normal heart rhythm.

Depending on whether these are monomorphic or polymorphic ventricular extrasystoles, the additional QRS complexes can be changed and distorted differently. If an extrasystole follows shortly after the actual heartbeat, there is often a compensatory pause afterwards, which means that a normal heartbeat cannot take place because the heart is still excited by the extrasystole. This can be recognized in the ECG by a larger gap between two normal excitations and an extrasystole in between compared to the actual rhythm.

Extrasystole during exercise

Exercise is healthy, keeps the body and mind fit and prevents many diseases of civilization. Nevertheless, these additional heart beats can occur during physical exertion.

Lots People experience extrasystoles only while exercising, because the extra strokes are favored by the sport. There are two reasons:

On the one hand, it prevails during exercise relative lack of oxygen in the tissue, as more oxygen is consumed through physical exertion than at rest. This lack of oxygen can cause more extrasystoles because it causes the Cardiac muscle cells triggered fluctuations in potential can be.

The second reason for the increased occurrence of extrasystoles during exercise is that Release of adrenalinethat is needed by the body to adapt to physical activity. Adrenaline causes over that activation of sympathetic nervous system at heart one Increase in heart rate and Contractility of the heart muscle as well as a Accelerated stimulus transmission and Lowering the arousal threshold. The lower excitation threshold makes the occurrence of extrasystoles more likely, since possible fluctuations in potential at the end of a cardiac action now simplify the necessary Exceed the threshold potential can.

Extrasystoles are thus favored by physical activity, but are perfect in people with healthy hearts harmless.

Post exercise extrasystole

In many cases the exact temporal connection the occurrence of an extrasystole already help to narrow down its possible causes. For example, a pronounced lack of sleep, respectively severe fatigue, actually with one too perfectly healthy people lead to the development of an extrasystole.

Another particularly common cause of extrasystole occurring in an actually healthy person is one increased activity of the Vagus nerve. That nerve is for them Innervation of the Heart muscle responsible and can during and after exercise lead to extrasystole. The vagust nerve is considered to be biggest nerve the so-called parasympathetic nervous system (Rest system) and can therefore have a particularly strong effect on the heart rate during and after exercise.

root cause this phenomenon is one excessive increase the one leading from the nerves to the heart Impulses. After exercising, the body tries from activated state (Sympathetic) into sleep mode (Parasympathetic nervous system) switch. The main nerve of the rest system becomes accordingly increasingly activated.

People who are prone to extrasystoles after exercise can be recommended slow down physical activity allow. In this way, the changeover from the sympathetic to the parasympathetic system can take place in a much more orderly manner and the risk of developing an extrasystole is reduced.

Extrasystole and stress

Physical, psychological or social stress can all those Development of extrasystoles favor. Stress is an alarm reaction of the body to certain situations. The body often responds with increased activity of the autonomic nervous system and also increased activity of the endocrine organs. This also affects the body's electrolyte and hormone balance, which is why negative feelings such as fear, depression and suppressed aggression lead to increased extrasystoles.

But also positive stress (eustress), for example before birth of a child, can through the increased arousal cause extrasystoles in the body. In general, one can summarize that any type of stress, be it positive stress (eustress) or negative stress (dysstress), can lead to extrasystoles through various mechanisms.

Patients with heart neuroses in particular often have problems with extrasystoles because they pay particular attention to their own heartbeat and at the same time notice extrasystoles more than non-neurotic patients, but on the other hand are constantly under stress due to the neurosis, which can cause further extrasystoles.

Extrasystole in pregnancy

Especially during the pregnancy there may be an increased occurrence of extrasystoles. These can make you feel uncomfortable, but they're here too usually harmlessespecially if they don't cause symptoms such as dizziness.

As mentioned above, extrasystoles can be caused by various things like little sleep, stress or hormonal fluctuations to be triggered. All of these factors can occur and during pregnancy favor the occurrence of extrasystoles.

Extrasystoles occur relatively often, especially at the beginning and towards the end of pregnancy. Nevertheless, one can also often with extrasystoles during pregnancy no clear cause Find.

If the extrasystoles last longer or are accompanied by an uncomfortable feeling, they can Thyroid levels and Electrolyte levels can be determined as well as an EKG written to a Electrolyte derailment or one Hyperthyroidism identify the cause of the extrasystoles and rule out an organic cause.

These could then be treated with medication, but the therapeutic window during pregnancy is small, which is why each Re-prescribing medication should be carefully examined. To step several extrasystoles directly one after the other, so should be a precaution an EKG at the family doctor to be written. Extrasystoles often go away after pregnancy again, but can also continue to exist, but then often weaker and less frequent.

You can also find more information under our topic: Heart palpitations and pregnancy.

Extrasystole and alcohol

In addition to other luxury foods such as Caffeine or nicotine Increased consumption of alcohol can also lead to extrasystoles. There is a suspicion that the extrasystoles especially by increased consumption of alcohol caused, alcohol should be avoided for some time.

Next to the excessive alcohol consumption Alcohol withdrawal can also trigger extrasystoles in addicts due to stress. It is important to examine any extrasystoles that occur in the withdrawal clinic in order to rule out an organic cause.

therapy

For both supraventricular and ventricular extrasystoles, a Avoidance of substances aimed at triggering these extrasystoles. Is the development of the extrasystoles associated with the enjoyment of Caffeine, nicotine, alcohol, or drugs, these luxury foods should be avoided. Situations that could be identified as the causes of extrasystoles after appropriate self-observation should also be avoided.

1. Therapy of supraventricular extrasystoles (SVES)

The supraventricular extrasystoles do not require treatment as long as the patient is healthy and over no further complaints complains. If a Heart disease as the cause for the supraventricular extrasystoles can be made out, so the goal should be that Causal heart disease to be treated so that the extrasystoles disappear again.

In addition to this, the Potassium balance be checked, as deviations from the norm can also trigger supraventricular extrasystoles (SVES). Also drugs that work on the heart, such as Digitalis preparations, should possibly be readjusted if the patient complains of extrasystoles.

In rare cases, supraventricular extrasystoles can also cause palpitations (Tachycardias) or trigger atrial fibrillation. If so, treatment with Verpamil or Beta blockers necessary.

2. Ventricular extrasystoles

Ventricular extrasystoles in healthy people also need no treatment. Especially one form of ventricular extrasystoles, which disappear again with increased stress (overdrive suppression) is classified as particularly harmless and therefore does not require any treatment. If the patient complains, despite the lack of an organic cause, that the pumping function of the heart is restricted by the extrasystoles or feels subjectively impaired as a result, drug therapy is indicated.

Will the ventricular extrasystoles however organic heart disease caused, it needs one causal therapy the underlying disease. So after a heart attack should be a quick one Revascularization measure be taken, for example, by rapid intervention in the cardiac catheterization laboratory, so that no permanent damage with scar tissue remain on the heart muscle, which could trigger ventricular extrasystoles.

Similar to the supraventricular extrasystoles, the ventricular extrasystoles can also result from derailments in the magnesium and potassium balance. If this is identified as the cause, the magnesium and potassium values ​​should be adjusted to a highly normal serum value, i.e. a value close to the upper limit of the norm lies. In addition to this, drugs must also be used as Cause of ventricular extrasystoles that work on the heart are excluded.

Especially with the Therapy with digitalis preparations it often occurs pre-damaged heart to an overdose, which can then trigger extrasystoles again. It should be borne in mind here that the less the heart can tolerate digitalis preparations, the more damaged it already is. So it can help you Reduce digitalis doseso that the ventricular extrasystoles disappear.

A therapy with Antiarrhythmics is only indicated if the patient is at increased risk for one sudden cardiac death owns. This can happen if the patient has ventricular fibrillation. The drug group of choice are included Beta blockers. In addition, a Defibrillator (ICD) to reduce the risk of ventricular fibrillation or sudden cardiac death. Usually implantation is one Pacemaker but only necessary for very severe arrhythmias, under which ventricular extrasystoles usually do not count.

Connection with magnesium

magnesium regulates together with Calcium and potassium the electrical excitability of the muscle cells thus also has an influence on the processes in the heart muscle.

A level of magnesium in the blood Normal range of 0.75-1.05mmol / l prevents excessive electrical excitability and thus contributes to electrical stability the heart muscle cells, thus bends a magnesium level in that range Cardiac arrhythmias in front.

A too lower Magnesium levels consequently lead to a increased electrical excitabilitywhich in the simplest case turn into harmless Extrasystoles expresses, but also dangerous arrhythmias such as Ventricular fibrillation can cause. Even so, nobody should be afraid of magnesium deficiency Food supplements take with magnesium.

Only one actually confirmed by the doctor Magnesium deficiency should be used for taking medicines containing magnesium to lead. Diuretics (Drugs that promote water excretion via the kidneys) and some Blood pressure medication can lead to a magnesium deficiency. Patients taking these supplements should twice a year Have your magnesium balance checked to prevent extrasystoles. Also heart disease patients becomes a regular control recommended because your heart muscle can be much more sensitive to electrolyte fluctuations.

forecast

In general, the prognosis for extrasystoles is very good because they often no disease value and are very common in healthy people and do not cause any complaints. However, if more than 20 extrasystoles occur during one hour, an as yet undetected heart condition should be excluded as the cause, even without further symptoms.

However, there is already one organic cause on the basis of the extrasystoles, these should be identified and treated causally in order to prevent the very strong and frequent extrasystoles from occurring in one pre-damaged heart leads to ventricular fibrillation or sudden cardiac death.