What do extrasystoles lead to? Extrasystole - what is it, causes and methods of treatment

Symptoms of extrasystole
Diagnostics and treatment
Prevention recommendations

Extrasystole, the causes of which may be associated with an unstable emotional state, can also occur against the background of existing diseases and is one of the common types of heart rhythm disorders.This type of arrhythmia is determined by one or a pair of extraordinary contractions of the heart or its chambers. Extrasystoles (premature impulses) disrupt the normal sequence of heart impulses and are observed in 60-70% of people, and among people over 50-55 years old, this figure rises to 90%.

Types and causes of extrasystole

According to the pathogenesis and clinical picture, extrasystoles can be of three types. Extrasystoles can also be observed in completely healthy people, they are of the so-called functional nature. Their appearance can be caused by the following factors:

overwork;
stress;
emotional and physical stress;
the use of drugs and alcoholic beverages;
abuse of strong tea, coffee;
smoking (including passive smoking);
the presence of neurocirculatory dystonia in patients.

Another type is due to organic origin and assumes the presence of the following diseases as the cause of extrasystole:

ischemic heart disease;
cardiosclerosis;
myocarditis;
heart defects;
arterial hypertension;
pericarditis;
chronic circulatory failure;
myocardial infarction;
cardiological operations.

The occurrence of toxic extrasystole is associated with the side effects of certain drugs (caffeine, ephedrine, antidepressants), increased secretion of thyroid hormones, and febrile conditions.

The causes of extrasystole are differentiated according to the location of the impulse foci. Allocate ventricular, atrioventricular, and various combinations of the above types.

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Symptoms of extrasystole

Symptoms of this type of arrhythmia may be completely absent, the presence of this pathology is not always felt by patients. As a rule, the disease is detected at random during a routine medical examination.

Feelings of patients with extrasystole can vary significantly. In some cases, when a heart rhythm disorder occurs, there is a sensation of a jolt or pressure in the chest. Also, with attacks, the following symptoms are observed:

anxiety;
an attack of fear;
feeling of "stopping" or "sinking" of the heart;
feeling of a "tumbling" or "overturning" heart;
pallor of the skin;
increased sweating;
lack of air;
weakness;
dizziness;
headaches after physical exertion inadequate for a particular person;
dyspnea.

Frequent extrasystoles cause reduced cardiac output of blood and cause disturbances in cerebral circulation, which often leads to fainting, aphasia (speech impairment), paresis. Moreover, patients with coronary artery disease are at risk of having an attack of angina pectoris.

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Diagnostics and treatment

The main way to diagnose this disease is an electrocardiographic study (ECG). Extrasystole can be detected based on the patient's complaints. In the physical diagnosis of extrasystole, the doctor must certainly refer to the patient's history: previous illnesses can serve as the main cause and impetus for the development of extrasystole. In the course of a conversation with a patient, the pathogenesis of the disease is found out, how physically active the patient is, what his emotional state is, what medications he uses and how often the manifestation of arrhythmia symptoms is observed. When examining the patient, pulsating and prominent veins in the neck area can be seen, which is a consequence of circulatory failure in the small circle. On palpation of the pulse, an emerging extraordinary wave is observed, followed by an interval.

The diagnosis is confirmed only after an ECG study. If the doctor has doubts, daily ECG monitoring is prescribed (). This study is a continuous ECG recording (24-48 hours). A compact portable device is attached to the patient's body, which records the ECG readings for one or two days. In this case, the patient keeps a diary of activity, his observations and feelings. As a rule, he is asked to record the time of sleep, activity. Also given the task, for example, to climb the stairs at a fast pace.

Often, rare attacks of extrasystole caused by stress, physical and emotional stress, alcohol abuse and not having clinical manifestations do not need to be corrected. In the event that extrasystole occurs against the background of an already existing disease of the gastrointestinal tract, endocrine system, heart muscle, first attention is paid to the underlying disease. Thorough treatment of the conditions that provoked arrhythmia is carried out and factors that can cause repeated attacks are eliminated. In the event of seizures against the background of nervous shocks, it is recommended first of all to visit a neurologist. In this case, various sedative fees are prescribed. It can be tincture of valerian, motherwort, or peppermint. If toxic extrasystoles occur while taking a certain drug, you should immediately stop using it.

Be that as it may, first of all, you should start with the normalization of work and rest, with the preparation of a competent nutrition plan and complete cessation of smoking and alcohol consumption.

The diet is adjusted by avoiding fried foods, drinks containing caffeine, and adding foods rich in potassium and magnesium to the diet. With this ailment, it is necessary to establish a sleep regimen, 8 hours a day are required.

As for drug treatment, it is purely individual and carefully selected by a specialist in each case. An indication for treatment with pharmacological drugs may be the patient's complaints of poor health and the presence of the symptoms described above, sleep disturbances, the daily number of extrasystoles is more than 200 impulses.

The results of ECG and Holter monitoring monitor the appropriateness of the use of a particular therapy and assess the adequacy of the treatment. Prescription of the drug and dosage depends on the type of extrasystole. This type of arrhythmia responds well enough to the following drugs:

lidocaine;
mexylene;
cordaron;
sotalol;
sinopril;
hood;
propafenone;
cinnorizine.

As a rule, drug treatment is carried out for a rather long time, and in case of a poor-quality form of extrasystole, drugs are required for life. If there is a decrease in the number of extrasystoles, the doctor gradually reduces the dosage. And if the results of the ECG and daily monitoring allow, after a while the specialist can cancel the medication completely.

Extrasystole is a type of arrhythmia, which is characterized by extraordinary contractions of the entire myocardium or its individual parts. This abnormal phenomenon is accompanied by a sensation of an intense push in the chest, sudden anxiety, lack of air, it seems to the patient that the heart just stopped. In the absence of treatment for extrasystole, its symptoms can cause angina pectoris, lead to transient circulatory disorders of the brain (fainting, paresis of the extremities, dizziness, etc.).

Classification

Types of extrasystole (criterion - the place of formation of ectopic foci):

ventricular;
atrial;
atrioventricular;
various combinations of the above extrasystoles.

Sometimes (no more than 0.2% of the total) extraordinary impulses come from the sinus-atrial node.

The focus of the ectopic rhythm can function independently of the main (sinus) one - this phenomenon is called parasystole.

Another classification of extrasystole (criterion is the time of onset of arrhythmia on the electrocardiogram):

early;
medium;
late.

Regularity of appearance:

rare (single) (less than 5 / minute);
medium (multiple) (5-15 / minute);
frequent extrasystole (group) (more than 15 / minute);
steam room (two in a row).

Depending on the number of ectopic foci, extraordinary impulses are divided into mono- and polytopic.

By nature (etiology), there are also several types of extrasystole:

organic;
functional;
toxic origin.

The most dangerous type of arrhythmia - ventricular - is usually divided into 5 classes (determined only after a 24-hour ECG):

I - transient extrasystoles are not registered.
II - up to 30 monotopic extraordinary impulses are recorded in 60 minutes.
III - 30 or more extrasystoles per hour (time of day is not taken into account).
IV - both mono- and polytopic impulses are noted (subclass "a" - there are paired ventricular extrasystoles, subclass "b" - runs of ventricular tachycardia).
V - early ventricular extrasystoles.

Important: rhythm disruptions belonging to the first class are considered to be physiologically conditioned. They do not affect the patient's health and well-being, do not threaten his life, and do not require drug therapy. Why are ventricular extrasystoles II - V classes dangerous: they lead to a deterioration in coronary, cerebral circulation, can cause ventricular fibrillation and even provoke death.

There are also such types of ventricular arrhythmias:

benign (not associated with the risk of cardiac arrest, the muscle is not damaged);
potentially malignant (it is accompanied by circulatory problems, as well as organic myocardial damage);
malignant (numerous extrasystoles, a significant probability of the patient's death).

Why is the problem

Single cardiac extrasystoles can occur even in practically healthy people. So, according to research results, such rhythm disruptions are present in 70–80% of men and women who have already crossed the 50-year age line.

The causes of extrasystole are foci of excessive activity of the heart muscle located outside the sinus node (ventricles, atria). Such impulses pass throughout the myocardium, "provoking" its premature contraction.

Important: the portions of the ejection of blood with extrasystoles are less than normal, therefore, frequent arrhythmias lead to a decrease in the minute volume of blood circulation.

Functional (psychogenic) heart rhythm disruptions are explained by food, chemical factors, smoking, frequent alcohol intake, drug use, etc. The causes of functional type extrasystole are neuroses, cervical osteochondrosis, vegetative-vascular dystonia, etc.
Extraordinary heart rhythm disruptions are a common occurrence, including among athletes who exercise regularly and do not have special health problems.

Important: in a number of professional athletes, extrasystoles are caused by myocardial dystrophy - a consequence of regular physical overstrain (this phenomenon is called the "athlete's heart").

The causes of female extrasystole can be hormonal imbalance in the body that accompanies menstruation. Single functional extrasystoles are caused by emotional overstrain, occur after drinking a large amount of coffee, tea.

Other reasons for the appearance of functional extrasystoles:

severe stress;
overwork;

Symptoms of organic-type extrasystole are a consequence of various disorders of the myocardium:

ischemic disease;
cardiosclerosis;
heart attack;
pericarditis;
myocarditis;
heart defects;
sarcoidosis;
the transferred surgical intervention on the myocardium.

The emergence of toxic types of extrasystoles is explained by febrile conditions, thyrotoxicosis (disruption of the thyroid gland). This abnormal phenomenon can occur after taking certain medications (Novodrin, Euphyllin, glucocorticoids, diuretics, sympatholytics, etc.).

Violation of the ratio of minerals and trace elements (in particular, magnesium, calcium, potassium ions) in the heart cells also causes frequent extrasystoles (affects the myocardial conduction system).

This type of arrhythmia in pregnant women occurs with anemia, may be the result of overwork or diseases of the thyroid gland, bronchopulmonary or cardiovascular systems.
Some patients experience extrasystole after eating - this phenomenon is associated with the parasympathetic nervous system, it occurs when a person who has just taken food puts the body in a horizontal position.

Clinical picture

As such, the subjective sensations accompanying extrasystole are not always present. Such an abnormal phenomenon is worse tolerated by patients with vegetative-vascular dystonia, but patients with organic myocardial lesions practically do not feel changes in their own body.

People who, from their own experience, have felt what extrasystoles are, complain of tremors or strokes of the heart muscle (these symptoms are a consequence of the increased contraction of the ventricles after a compensatory pause).

Other signs of extraordinary myocardial impulses:

the so-called overturning or tumbling of the muscle;
malfunctions, heart sinking;
functional extrasystoles (symptoms: weakness, lethargy, frequent hot flashes, unreasonable anxiety, hyperhidrosis, shortness of breath, a person may not have enough air, deterioration in general health).

Features of pediatric extrasystole

Previously, doctors believed that children mainly experience ventricular arrhythmias. But the results of modern research prove that all types of extrasystoles occur with almost identical frequency. The reason for this phenomenon is quite simple: the child's body is growing rapidly, developing, the heart cannot cope with the additional functional load, therefore it begins to compensate for the "lag" with extrasystoles.

As a rule, only the period of active growth ends, the arrhythmia disappears without medical intervention.

What is the danger of extrasystole in children: this pathological phenomenon can be the result of various pathologies of the thyroid gland, lungs, myocardium. At the same time, young patients complain of the same manifestations as adults - frequent dizziness, weakness, heart "tremors" in the chest.
Important: drug treatment of ventricular arrhythmia is indicated only when the daily number of extrasystoles reaches 15,000 (children are prescribed metabolic, antiarrhythmic therapy). Such patients must be registered with a dispensary; they are comprehensively examined at least once a year.

Possible complications

Frequent group extrasystoles entail a decrease in cardiac output, and hence a decrease in blood circulation by 8-25% (both cerebral and coronary, renal). They can also flow into more dangerous forms of arrhythmias:

atrial leads to atrial flutter;
ventricular causes ventricular paroxysmal tachycardia.

Important: in patients with atrial overload, even single extrasystoles over time can provoke attacks of atrial fibrillation.

It is noteworthy that the systolic rhythm with multiple extraordinary impulses of the heart can not only accelerate (tachycardia), but also slow down (bradycardia). The heart rate in this situation decreases to 30 times / minute - this is a life-threatening phenomenon, since it is associated with conduction disturbances and a significant risk of the formation of myocardial blockages.

The most dangerous type of extrasystole - complicated ventricular - can be fatal.

Diagnostics

The main method by which this type of arrhythmia can be detected is ECG. It is possible to suspect extrasystole during the physical examination of the patient, as well as during the analysis of his complaints.
During a conversation with a patient, the doctor should find out when and how often arrhythmia attacks occurred (intense physical activity, stressful situations, sleep period), what medications he is taking. The specialist pays special attention to anamnesis (a list of ailments suffered), because a number of pathologies can lead to organic damage to the heart.

To clarify the diagnosis, the doctor may prescribe Holter ECG monitoring to the patient - this is a continuous recording of the electrocardiogram using a special device (attached to the patient's body).

To determine that it was extrasystoles that provoked certain deterioration in general well-being, modern diagnostic methods such as bicycle ergometry, treadmill test also help. Their main task is to detect arrhythmias under stress.

With concomitant extrasystole, cardiac abnormalities, the examination includes ultrasound, MRI of the myocardium, stress ECHO-KG.

Principles of treating extrasystole of the heart

The reasons, form and localization of extrasystoles are the main criteria influencing the choice of therapy. So, with single arrhythmias not caused by cardiac pathologies, special therapeutic measures are not required. When the causes of the problem are malfunctions of the digestive system, hormonal imbalance and directly damage to the myocardium, the fight is, first of all, with the underlying disease.

With the neurogenic nature of extrasystole, the patient must be sent for a consultation with a neurologist. The doctor will prescribe natural sedatives (tinctures of hawthorn, motherwort) or sedatives (Relanium, Rudotel). If arrhythmia is a consequence of taking certain medications, they are canceled (analogues are selected).

Indications for drug treatment of extrasystole:

deterioration of the patient's general well-being, some symptoms of arrhythmia affect the patient's quality of life;
heart disease;
the number of extrasystoles / day exceeds 1000.

The doctor selects drugs depending on the type of arrhythmia and heart rate.

Important: atrial extrasystole is fought with beta-blockers (Metoprolol, Bisoprolol), Verapamil, Amiodarone and Etacizin, and with ventricular arrhythmia - with Propafenone, Amiodarone, Etacizin and beta-blockers (Metoprolol, Bisoprolol).

The standard duration of the course of treatment is up to 2 months, but patients with a malignant form of ventricular extrasystole are shown lifelong intake of antiarrhythmic drugs.

If drug therapy is ineffective, poorly tolerated, and the daily frequency of extrasystoles is up to 20-30 thousand, then patients are prescribed radiofrequency ablation of the heart. If there is a high risk of developing ventricular fibrillation, implantation of a cardioverter-defibrillator is possible - this is a small device that delivers an electric shock to the heart at the time of a life-threatening arrhythmia.

Traditional therapy

When the course of extrasystole is not associated with serious hemodynamic disturbances and does not pose a danger to the patient's life, you can cope with the symptoms of arrhythmia on your own. So, while taking diuretics, calcium and magnesium are actively washed out of the patient's body, therefore, it is necessary to introduce food products containing these valuable substances (for example, chocolate or raisins) into the daily diet.

At home, you can prepare a medicinal tincture with antiarrhythmic, sedative, cardiotonic properties (it is taken three times a day, 1 tablespoon / time).

Prescription of the drug:

Combine 5 parts of motherwort and lemon balm grass, add 4 parts of heather, 3 - hawthorn, 2 - hop cones to them.
Dry shredded plant mass (2 tbsp. L.) Is poured with two glasses of boiling water, left for 1 hour, after straining they drink according to the scheme described above.

Important: since most medicinal herbs are potential allergens, you should consult a doctor before starting a home fight with extrasystole. In addition, folk remedies can affect the action of various medicines, weakening or enhancing their effects.

Forecast and prevention

The presence of organic lesions of the heart muscle and the degree of ventricular dysfunction are the factors that determine the prognostic assessment of extrasystole. Arrhythmias that develop during myocardial infarction and other severe pathological processes lead to the most serious consequences.

Functional extrasystoles are benign and do not pose a serious health hazard.

Prevention of arrhythmia development - prevention of abnormal conditions that can cause it (heart disease), and their exacerbations.

Adherence to a virtually salt-free, potassium and magnesium-fortified diet with a minimum of saturated fat;
it is necessary to completely abandon drinking strong alcoholic beverages, do not drink tea, coffee, quit smoking;
regular physical activity of moderate intensity;
normalization of weight.

So, extrasystole is a dysfunction of the heart muscle, which can be the result of abnormal processes in the body. An increased number of systoles is often disguised as a number of pathologies of the endocrine, cardiovascular, bronchopulmonary systems; they can be detected only on an ECG. Establishing the true causes and correct treatment of extrasystoles will help to avoid the consequences of this form of arrhythmia (heart problems, circulatory disorders), and in case of complicated forms of the phenomenon, even save the patient's life.

A certain number of extrasystoles per day is considered quite normal. In the absence of pathologies, this type of arrhythmia is not dangerous and develops under the influence of irritating factors. The clinical picture becomes noticeable when the blood flow is disturbed against the background of an increase in the number of extraordinary (intercalated) contractions. To draw up a treatment regimen, you will have to be fully examined. Focusing on the cause of the heartbeat failure, the doctor will be able to advise on effective methods to alleviate the condition.

Extrasystole is a type of abnormality in the heartbeat. In humans, against the background of the usual cycles of contractions (systoles) of the atria and ventricles, extraordinary complexes appear. The signal comes from the ectopic (replacement) focus. The patient during an attack feels interruptions in the work of the heart and is subjected to panic attacks.

The release of blood due to intercalated contractions is reduced, which is associated with insufficient diastolic filling of the heart. The arising hemodynamic disruptions provoke neurological symptoms due to cerebral hypoxia and attacks of angina pectoris (pain in the heart) against the background of the development of ischemia.

According to the ICD 10 revision of extrasystoles in the heart, they received the code I49. The category "Other cardiac arrhythmias" is encrypted under it. The sub-item is selected depending on the localization of the focus of false impulses:

atrial - 1;
atrioventricular - I49.2;
ventricular - I49.3.

Extrasystolic rhythm can appear even in the absence of health problems. According to statistics collected thanks to an electrographic study, intercalated contractions are recorded in fact in 2/3 of people over 55 years old. This trend is due to age-related changes and a decrease in tolerance to stress and physical exertion.

Classification

Extrasystole is usually divided into certain groups according to the following criteria:

Name	Description
By localizing the source of ectopic signals	supraventricular (supraventricular): o atrial:  in the right atrium;  in the left atrium. o atrioventricular. ventricular (ventricular): o right ventricular; o left ventricular.
By the number of insertion reductions	1 - single; 2 - steam room; 3 and more - group.
By the presence of rhythm	chaotic contractions that do not have a clear order of occurrence; alloarrhythmia manifests itself with a certain rhythm through 1 (bigeminia), 2 (trigeminia) and 3 (quadrigyminia) contractions.
By the period of manifestation	an early contraction on the electrocardiogram (ECG) follows along with the T wave; the middle systole is 0.5 seconds later than the T wave; late intercalary contraction occurs during relaxation of the heart (diastole) in front of the usual P wave.
By the frequency of manifestation (for 1 minute)	rare cases occur no more than 5-7 times; the average number of extrasystoles starts from 10-15; frequent extraordinary reductions are characterized by an indicator of 15 and above.
By the number of false foci	monomorphic (monotopic) - impulses create 1 additional focus; polymorphic (polytopic) - signals come from 2 or more false sources.
By causal factor	organic (pathological); functional (physiological).

The appearance of extrasystoles in the heart is not always associated with pathological processes in the body, so whether this condition is dangerous will tell the cause of the anomaly. Doctors prefer to divide arrhythmia into functional and organic forms. The first of these does not require treatment. It is enough to avoid irritating factors and stay at rest for a couple of hours. The second type of extrasystole threatens with dangerous consequences and can remain on an ongoing basis. The attack is stopped with pills with antiarrhythmic action. In severe cases, it is required to provide the patient with emergency care.

Etiology and pathogenesis of arrhythmia

You can see why extrasystole occurs in the table:

View	Scroll
Functional	neuroses caused by frequent stress; smoking; disruptions in hormonal balance (menopause, pregnancy, puberty); non-observance of the rules of healthy eating; drinking alcohol; the body's reaction to an increase in temperature; the influence of caffeine and energy drinks; constant physical overload; vegetative disruptions; osteochondrosis.
Organic	heart failure; ischemic disease; pathologies caused by infections; malformations of the heart; diseases of the adrenal glands and thyroid gland; diabetes; autoimmune disruptions; inflammatory diseases of the heart muscle.

Osteochondrosis provokes various failures of the cardiovascular system. The reason lies in the clamping of blood vessels and nerves by the deformed vertebrae. It is possible to get rid of the problem by taking anti-inflammatory drugs and physical therapy. Some cardiologists allocate toxic and idiopathic extrasystoles. In the first case, arrhythmia occurs due to exposure to certain substances (drugs, chemicals, the environment). The cause of the idiopathic failure cannot be identified. In the absence of organic lesions, it is equated to functional forms of extrasystole.

Extrasystole in many cases is the result of overeating, especially if a person will lie on the bed immediately after eating. This situation enhances the predominance of the parasympathetic division of the nervous system. The patient has a mild form of bradycardia (pulse slows down). Extrasystoles appear against its background as compensation.

You can divide the main irritating factors by age and current situation:

Extraordinary contractions in a child are often the result of heart defects. They can only be cured by surgery.
Children in adolescence are faced with extrasystole against the background of the development of vegetative vascular dystonia (VVD). It is characterized by an abundance of neurological and cardiac signs. As a treatment, medications are used to relieve nervous tension and improve blood circulation. Closer to adulthood, the disease usually goes away on its own.
In pregnant women, arrhythmias occur due to an increase in blood volume and hormonal surges. A treatment regimen is usually not drawn up. It is enough to follow the rules of prevention.
Heartbeat failure in sports fans develops due to an incorrectly drawn up exercise program. It can be removed by correcting the loads. An experienced coach will help you solve the problem.

Clinical picture

Single extrasystoles do not have a significant effect on hemodynamics. Group and frequent intercalary contractions are more pronounced. The patient has a feeling of interruptions in the work of the heart (a sharp jolt followed by fading), because of which it becomes scary, and a panic attack begins to develop. Arrhythmia is accompanied by the following symptoms:

growing weakness;
lack of air;
increased sweating;
dizziness.

Consequences of arrhythmia

If you do not start the treatment of extrasystole in a timely manner, then complications will gradually appear:

atrial or ventricular fibrillation;
heart failure;
paroxysmal tachycardia;
ischemia of the heart;
myocardial infarction.

It will be virtually impossible to recover completely and return to sinus rhythm. Certain consequences will remain forever. The cause of complications lies in the gradation of the main pathological process and the aggravation of hemodynamic failures.

Diagnostic methods

If symptoms of a characteristic intercalary contraction are detected, it is necessary to consult a cardiologist. He will interview the patient to find out about the disturbing signs of failure and the presence of other pathologies. Then the specialist will proceed to the examination. The systolic and diastolic pressure thresholds will be measured, the pulse will be felt and auscultation (listening) will be performed. The last method is the most informative, as it allows you to hear abnormal tones associated with the occurrence of extrasystoles.

The data obtained is not enough to make a diagnosis, but it is enough to suspect arrhythmia and prescribe an electrocardiography (ECG):

For atrial forms of arrhythmia, a decrease in the distance from the planned P wave to the premature P wave is characteristic.
The ventricular and atrioventricular views are characterized by a shortening of the segment from the main QRS complex to the pathological QRS complex.
There is a compensatory pause after the intercalated ventricular complex and there is no P wave in front of it.
There are pathological changes in the premature QRS complex.

Due to the variable nature of the arrhythmia, other ECG monitoring methods may be required:

Bicycle ergometry is performed to study the work of the heart at the time of physical overload.
Daily monitoring according to the Holter method is prescribed for a comprehensive assessment of the heartbeat over a period of 24 hours.

To differentiate the causative factor, additional diagnostic methods can be recommended:

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

The course of therapy

With extrasystole, symptoms and treatment have a definite connection. The therapy regimen is drawn up depending on the severity of the arrhythmia and the cause of the development:

Single extrasystoles do not require treatment. You can remove them by adjusting your lifestyle and avoiding annoying factors.
Organic forms of a failure in the heartbeat are eliminated by stopping the main pathological process.
The development of neurogenic extrasystoles will help stop a neurologist. As a treatment, he will prescribe sedatives and folk remedies with a sedative and diuretic effect.
Intercalated contractions resulting from medication can only be stopped by canceling drug therapy. The doctor will adjust the dosage or recommend other medications.

Drug therapy is due to the presence of more than 200 extrasystoles per day, a clinical picture of hemodynamic failure and heart disease. For home use, the doctor may recommend the following groups of medicines:

beta-blockers (Flestrolol, Concor);
calcium antagonists (Nitrendipine, Diltiazem);
sodium channel blockers:
- IA ("Disopyramid", "Giluritmal");
- IB ("Trimekain", "Tokainid");
- IC (Bonnecor, Propanorm).
cardiac glycosides ("Digoxin", "Korglikon").

The attending physician selects the tablets, focusing on the diagnostic results and the patient's condition. A dose reduction is permissible after 1-2 months, but subject to a decrease in the frequency of intercalated contractions. Lifelong pills are essential for the treatment of malignant arrhythmias.

The operation is performed in the absence of a result from drug therapy and a high likelihood of complications:

Radiofrequency ablation is prescribed to cauterize the source of false pulses.
Installation of a pacemaker is recommended when extrasystole is combined with atrial fibrillation and other serious types of heartbeat failures.

Forecast

The forecast is given based on the reason for the extraordinary reductions. The situation is unfavorable in the presence of organic lesions associated with necrosis or inflammation of the membranes of the heart muscle. Such structural changes increase the likelihood of atrial fibrillation and severe hemodynamic disruptions. The functional forms of extrasystole are not particularly dangerous and rarely cause complications. The chances of full recovery increase significantly with timely detection of arrhythmias and adherence to all doctor's recommendations.

Prophylaxis

To prevent the development of extrasystole, it is recommended to avoid diseases, irritating factors and pathological conditions that can disrupt the work of the heart. Lifestyle correction will be a reliable preventive measure:

strengthen the heart by getting moderate cardio loads;
to refuse from bad habits;
get enough sleep (7-8 hours a day);
saturate the diet with foods rich in magnesium and potassium;
avoid stress;
reduce consumption of coffee and strong tea;
reduce physical activity;
undergo a complete examination every year.

Extrasystole is manifested by extraordinary contractions of certain parts of the heart muscle. According to the causal factor, it is divided into organic and functional forms. The first type is characterized by a severe course and a high probability of complications. The course of therapy for such a failure in the heartbeat is aimed at eliminating the main pathological process and normalizing hemodynamics. Functional arrhythmia resolves on its own and does not require treatment. Avoiding irritating factors is enough to prevent seizures.

Heart rhythm disorders can be of a different nature, nature and prognosis for life. Extrasystole is a form of arrhythmia. The disease has several types of course, each of which is characterized by the appearance of specific symptoms and signs on the electrocardiogram. The disease is susceptible to drug and non-drug treatment.

Extrasystole is a variant of a heart rhythm disorder, which is characterized by the occurrence of extraordinary contractions. The disease can be of a physiological and pathological nature. In some cases, extrasystoles are a variant of the norm and do not pose a danger to life.

However, frequent extrasystoles in the heart are dangerous, especially if they occur in the ventricles. This condition increases the risk of death by several times.

Classifications

The main classification of the disease is based on the location of the lesion. Taking this factor into account, the following forms of extrasystole are distinguished:

Separately, there is a classification of ventricular extrasystoles according to RYAN:

The 1st grade is characterized by the occurrence of up to 30 extrasystoles.
The 2nd grade is manifested by the occurrence of over 30 extrasystoles, which are of a monomorphic nature.
With the 3rd grade, polymorphic foci appear.
With 4a-gradation according to RYAN, extrasystoles are paired, but from one focus of excitation, with 4b - polymorphic.
The 5th gradation is manifested by group extrasystoles.

In this case, all foci arise in the ventricles. Accordingly, the greater the gradation of the disease, the higher the risk of paroxysmal tachycardia.

Causes

The disease can have both functional and organic causes. The supraventricular form is more often caused by functional disorders. In this case, there are often autonomic disorders or disorders of the central nervous system. The causes of supraventricular extrasystole of the disease can be:

vegetative dystonia. With VSD, there are disorders of the autonomic nervous system;
smoking, drinking alcohol;
drinking a lot of coffee;
neuroses, anxiety disorders;
emotional stress, prolonged exposure to stress.

The ventricular form is more often organic in nature. In most cases, arrhythmias are caused by damage to the heart of a different etiology. The most common causes of ventricular premature beats are the following diseases:

postinfarction condition. Replacement of the necrosis focus with connective tissue leads to disruption of the normal structure of the myocardium. As a result of this, pathological foci of excitation may arise;
heart damage on the background of arterial hypertension;
inflammatory diseases of the myocardium, cardiomyopathy;
various heart defects, especially of the valvular apparatus;
heart failure of a different etiology.

Also, extrasystole can be caused by taking medications (especially often, the disease occurs when the dose of cardiac glycosides is exceeded).

The mechanism of development of the disease

The pathogenesis of the disease is associated with the emergence of pathological foci of excitation. Normally, the sinus node generates impulses, it is this rhythm that is physiological. With extrasystole, additional, pathological foci appear that are capable of generating impulses.

Pathological impulses occur against the background of a normal contraction of the heart. Thus, the extraordinary excitement is superimposed on the normal work of the heart. With frequent extrasystoles, the blood does not have time to accumulate in the ventricles. Accordingly, during the next reduction, the emission is significantly less than the norm. Clinically, this is accompanied by signs of hypoxia of internal organs.

Extrasystoles can also occur in a healthy person. The key point that separates pathology from the norm is the number of extraordinary contractions. The rate per day should not exceed 100 extrasystoles.

Symptoms

The severity of clinical symptoms with extrasystole is determined by the type and form of the disease. Ventricular extrasystole is often asymptomatic, especially in cases where there are few extrasystoles during the day. The supraventricular form is accompanied by clinical signs much more often. The most common symptoms of the disease are as follows:

Discomfort behind the breastbone. An extraordinary contraction of the heart may be accompanied by a feeling of squeezing, soreness.
Unreasonable feeling of fear, anxiety.
Excessive sweating.
Pallor of the skin.
General weakness, increased fatigue.

Symptoms of pathology are more pronounced with concomitant autonomic disorders. For example, with vegetative dystonia, neurotic disorders, anxiety disorder.

With frequent extrasystoles, the symptoms of circulatory failure come to the fore. This occurs when the ventricles do not have time to fill with blood during diastole. During the next heartbeat, an insufficient volume of blood is thrown into the vessels. Clinically, this can manifest itself as dizziness, darkening of the eyes, imbalance, and loss of consciousness.

Diagnostics

The presence of the disease can be suspected by the clinical picture. However, for further diagnosis, determination of the form and type of the disease, additional examination is necessary. It includes the appointment of the following instrumental diagnostic methods:

To determine arrhythmia, these studies are sufficient. However, sometimes additional methods are required, for example, echocardiography, angiography, radiographs. Research is necessary to determine the concomitant organic pathology that could lead to the occurrence of extrasystoles.

Laboratory research methods are not indicative for this pathology. Blood tests (general, biochemical, etc.) can be prescribed to assess the general condition of the body.

Treatment

In the presence of single extrasystoles, especially with supraventricular localization, treatment is not carried out. Usually this condition is not dangerous and does not require medical attention. In this case, it is recommended to undergo regular medical examinations.

Treatment of extrasystole often has an integrated approach. Non-drug methods, medication and surgery can be used. The choice of treatment tactics is determined by the form of pathology, the severity and general condition of the patient.

Non-drug treatment is about maintaining a healthy lifestyle. This is especially true for the supraventricular form of pathology. It is recommended to adhere to the following rules:

proper nutrition with a sufficient intake of vitamins and minerals;
to give up smoking;
refusal to drink alcohol;
healthy 8-hour sleep;

In addition, with the supraventricular form caused by functional disorders, folk remedies can be used. Chamomile tea, valerian, mint tea have a good calming effect. Essential oils with a sedative effect are also used.

In cases where the onset of the disease is of a functional nature and is associated with stress, emotional overstrain, psychotherapy is prescribed. The psychotherapist, working with the patient, reduces the feeling of anxiety and fear.

In more severe cases, with a ventricular form, medications are used for treatment.

The mainstay of treatment is taking antiarrhythmic drugs. They allow you to restore the normal rhythm, prevent the emergence of new pathological impulses. The most commonly used antiarrhythmic drugs are:

Procainamide.
Amiodarone.
Lidocaine.

In addition, you may need to take medications that affect the underlying disease. In the case of the organic nature of extrasystole, the drug therapy scheme is determined by the primary pathology of the heart. Beta-blockers, cardiac glycosides, and diuretics may be prescribed. Specific medications are prescribed by the attending physician after a complete examination.

Surgery can also be used for treatment. The surgical method is used in cases of malignant treatment, when the number of extrasystoles per day reaches several thousand. This form of the disease is accompanied by severe clinical manifestations that reduce the quality of life.

Surgical intervention is performed with a ventricular form, when conservative therapy has been ineffective. The method consists in the destruction of myocardial foci that generate pathological impulses. This method is called radiofrequency ablation.

Predictions and consequences: answers from cardiologists

The prognosis for this disease is relatively poor and depends on many factors. Whether it is dangerous is determined, first of all, by the form of the disease and the presence of organic pathology of the heart.

The answers of cardiologists about the prognosis also depend on the variant of the disease. Doctors say that the supraventricular form of the disease is harmless in most cases. Even a permanent form can be controlled by taking medication.

Complications in this case are extremely rare. Doctors explain this by the fact that the causes of the occurrence of the supraventricular form are more often functional (that is, arrhythmia is not accompanied by an organic pathology of the heart).

The prognosis of cardiologists about ventricular extrasystole is less reassuring. It has been proven that the presence of ventricular extrasystoles increases the risk of sudden death several times. The risk of the transition of the disease to paroxysmal tachycardia or other, more severe variants of arrhythmia is also dangerous. However, even in this case, the prognosis can be different and depends on the progression of the disease.

Extrasystole is a form of arrhythmia, which can be both physiological and pathological in nature. The occurrence of up to 100 extrasystoles per day is the norm and does not require medical intervention. With frequent extrasystoles, especially ventricular localization, medical attention is required.

Pathology is dangerous by the transition of extrasystole to other, more dangerous forms of arrhythmia. To prevent the development of pathology and reduce the risk of sudden cardiac death, you need to undergo regular medical examinations, be monitored by a cardiologist and follow medical recommendations.

Arrhythmias of the heart are a disorder of the function of excitability with a violation of the sequence, frequency and rhythm of heart contractions. Extrasystole is considered the most common form of pathology. Extrasystole is called a premature extraordinary contraction of the heart or its individual chambers, prompted by an impulse formed outside the sinoatrial node. The causes and mechanisms of the occurrence of extrasystole are varied, as are the manifestations of seizures associated with a violation of the rhythm of heart contractions.

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General information

Extrasystole is an untimely process of depolarization and contraction of the heart or its parts. It is caused by the appearance of one or several impulses of an ectopic nature with a violation of the sequence of heart contractions. Extrasystoles are premature, that is, ahead of the normal sinus impulse, and popping out, formed in connection with the activation of the centers of the 2nd and 3rd orders and inhibition of the main pacemaker.

Pathology is found in 60-70% of people. In children, it is mainly of a functional (neurogenic) nature; its detection occurs during visits to medical commissions in front of a kindergarten or school. In adults, the appearance of functional extrasystoles is provoked by stress, smoking, alcohol abuse, strong tea and coffee.

Normally, an absolutely healthy person can experience up to 100-110 extrasystoles throughout the day, in some cases, in the absence of an organic pathology of the heart, their occurrence in an amount of up to 500 per day will not be considered a violation.

Extrasystole of organic origin is formed as a result of myocardial damage (with inflammation, dystrophy, cardiosclerosis, coronary heart disease, etc.). In this case, a premature impulse can occur in the atria, atrioventricular junction or ventricles. The appearance of extrasystoles is explained by the formation of an ectopic focus of trigger activity, as well as the spread of the re-entry mechanism (re-entry of the excitation wave).

Extrasystole is one of the most common cardiac arrhythmias.

Classification

On the etiological basis, the following forms of extrasystoles can be distinguished:

functional (dysregulatory)- observed in people without heart disease (with various autonomic reactions, vegetative vascular dystonia, osteochondrosis of the cervical spine, emotional stress, smoking, alcohol abuse, coffee, strong tea, etc.);
organic- the occurrence of extrasystoles is due to damage to the valve apparatus of the heart and cardiac muscle; their appearance indicates gross changes in the myocardium in the form of foci of dystrophy, ischemia, necrosis or cardiosclerosis, contributing to the formation of electrical heterogeneity of the heart muscle (most often observed in ischemic heart disease (IHD), acute myocardial infarction, arterial hypertension, myocarditis, rheumatic heart diseases, chronic heart failure, etc.);
toxic- observed in case of intoxication, overdose of cardiac glycosides (allorhythmias), thyrotoxicosis, febrile conditions, toxic effects of antiarrhythmic drugs (AS).

Among the options for functional extrasystole, 2 subgroups can be distinguished:

1. Neurogenic - common in neurosis with autonomic dystonia (arrhythmic form of dysregulatory cardiopathy).
2. Neuro-reflex - due to the presence of a focus of irritation in any internal organ, more often - in the gastrointestinal tract (with stomach ulcers and duodenal ulcers, pancreatitis, cholelithiasis and urolithiasis, kidney prolapse, abdominal distention, etc.) .). Excitation is realized through the vagus nerve through the viscero-visceral reflex mechanism.

Depending on the occurrence of a heterotopic focus, extrasystoles are divided into ventricular and supraventricular (supraventricular) - atrial and atrioventricular. Single and paired varieties are noted, when 2 extrasystoles are recorded in a row. If 3 or more follow in a row, they talk about group extrasystoles. Separate also monotopic, emanating from one ectopic focus, and polytopic, due to the excitation of several ectopic sources of formation. Classification of ventricular extrasystoles according to Laun-Wolf-Rayyan:

I - up to 30 extrasystoles per hour of monitoring (rare monotopic).
II - more than 30 per hour of monitoring (frequent monotope).
III - polytopic extrasystoles.
IVa - paired monotopic.
IVb - paired polytopic extrasystoles.
V - ventricular tachycardia (3 or more complexes in a row).

Allocate the so-called allorhythmias, characterized by the alternation of the main normal rhythm and extrasystole in a certain repetitive sequence:

Bigeminia - behind each basic normal complex, one extrasystole occurs.
Trigeminia - for every 2 normal contractions, one extrasystole follows, or after one main complex, 2 extrasystoles appear.
Quadrigeminia - for every 3 normal complexes, one extrasystole occurs.

Bigger classification of ventricular arrhythmias:

Index	Benign	Potentially malignant	Malignant
The risk of developing sudden cardiac death	Minor
Clinical manifestations	Palpitations	Palpitations	Heartbeat + syncope
Ventricular premature beats	Rare or medium	Medium or rapid	Medium or rapid
Organic damage to the heart	Absent	Present	Present
Purpose of therapy	Relief of symptoms	Relief of symptoms, reduction of mortality	Relief of symptoms, reduction of mortality, treatment of arrhythmias

Clinical manifestations

Often extrasystoles are not subjectively felt, especially when they are of organic origin. Sometimes there is discomfort or a feeling of a jolt in the chest, "sinking", a feeling of fading, cardiac arrest, pulsation in the head, overflow in the neck, which is associated with hemodynamic disturbances due to a decrease in coronary or cerebral blood flow, which are accompanied by weakness, paleness, nausea, dizziness and extremely rarely - attacks of angina pectoris, loss of consciousness, transient aphasia and hemiparesis (more often observed with stenosing atherosclerosis of the coronary and cerebral arteries).

For extrasystoles of functional origin, symptoms of dysfunction of the autonomic nervous system are most characteristic: anxiety, pallor, sweating, lack of air, fear of death, insanity.

Complication of extrasystole

Frequent extrasystoles can lead to chronic insufficiency of cerebral, coronary or renal circulation. Group extrasystoles can be modified into more dangerous rhythm disturbances: atrial - into atrial fibrillation or flutter (especially in patients with dilatation and atrial overload), ventricular - into paroxysmal tachycardia, fibrillation or flutter of the ventricles.

Ventricular extrasystoles cause serious concern, since in addition to the development of rhythm disturbances, they increase the risk of sudden death.

Diagnostics

If symptoms similar to the clinical manifestations of extrasystole are detected, patients should consult a therapist or cardiologist. The doctors of these specialties are competent in the diagnosis and treatment of cardiac arrhythmias.

An important point in the study of rhythm disturbances, depending on whether there is heart damage or not, is the determination of the neurogenic nature of extrasystole. In this case, a carefully collected anamnesis and the exclusion of cardiac pathology play a key role.

In favor of the neurogenic origin of extrasystole, the presence of neurotic symptoms speaks - the connection of rhythm disturbances with a nervous shock or the appearance of anxious-depressive thoughts, increased irritability, psychoemotional lability, hypochondria, tearfulness, vegetative symptoms of dysfunction of the autonomic nervous system.

Physical examination and analysis of complaints are performed... Some patients do not feel the appearance of extrasystoles, other patients perceive their occurrence very painfully - as a sudden blow or shock in the chest, a short-term feeling of "emptiness", etc. overstrain, during sleep, etc.), the frequency of episodes of extrasystoles, the effectiveness of drug therapy. Particular attention is paid to clarifying the anamnesis of past diseases that predispose to organic heart damage.

During auscultation, periodically arising accelerated contractions are heard, followed by long pauses against the background of a regular rhythm, an increase in the 1st tone of the extrasystole.

The main functional method for diagnosing extrasystole is considered to be electrocardiography and Holter ECG monitoring.

Additional techniques are also used, for example, treadmill test, bicycle ergometry. These tests allow you to determine violations of the heart rhythm, manifested only during exercise. It is recommended to diagnose concomitant cardiac pathology of an organic nature using ultrasound, stress ECHO-KG, MRI of the heart, etc.

ECG criteria

The ECG registers the fact of the presence of extrasystole, specifies its variants and shape. A common property of the varieties of pathology is the premature contraction of the heart, which is manifested on the ECG by a shortening of the R-R interval. The interval between the sinus complex and the extrasystole is called the pre-extrasystolic interval, or the adhesion interval. The extracomplex is followed by a compensatory pause, which is manifested by the lengthening of the R-R interval (there is no pause with interpolated or interpolated extrasystoles).

The compensatory pause characterizes the duration of the period of electrical diastole after systole. It is divided into:

Incomplete - observed when extrasystole occurs in the atria or AV connection. It is usually equal to the duration of a normal heartbeat (slightly longer than the usual R-R interval). The condition for its occurrence is the discharge of the sinoatrial node.
Full - observed with ventricular extrasystole, equal to the duration of 2 normal cardiac complexes.

ECG symptoms of extrasystoles are:

the appearance of a premature P wave or QRST complex, indicating a shortening of the pre-extrasystolic interval: with atrial extrasystoles, the adhesion interval between the P wave of the main complex and the P wave of the extrasystole decreases; with ventricular and atrioventricular extrasystoles - between the QRS complex of the normal contraction and the QRS of the extrasystolic complex;
the absence of a P wave in front of a ventricular premature beats;
significant expansion, high amplitude and deformation of the extrasystolic QRS complex with ventricular extrasystole;
the appearance of a complete compensatory pause with ventricular extrasystoles and incomplete with supraventricular extrasystoles.

The most characteristic distinctiveECG- signsextrasystoles depending on the localization of the impulse:

Atrialextrasystole

Extrasystole from the atrioventricular junction

Ventricularextrasystole

With atrial extrasystoles, an altered P wave follows the QRS complex, the deformation amplitude of which depends on the degree of remoteness of the ectopic focus from the sinoatrial node. With retrograde excitation of the atria (lower atrial extrasystoles), a negative P wave appears in leads II, III, aVF.

The QRST complex is not changed and does not differ at all from the normal sinus one, since the depolarization of the ventricles occurs in the usual (anterograde) way

With atrioventricular extrasystoles, the P wave can be layered on the QRS complex and therefore be absent on the ECG or recorded as a negative wave on the RS-T segment. Characterized by the appearance of a premature and unchanged ventricular QRS complex, similar to normal sinus complexes, as well as the presence of an incomplete compensatory pause.

It is not always possible to distinguish atrial extrasystoles from atrioventricular, therefore, in controversial issues, it is permissible to limit ourselves to indicating the supraventricular origin of extrasystole

With ventricular extrasystoles, there is no P wave, the QRS-T complex is sharply expanded and deformed.

For left ventricular extrasystoles, a high and wide R wave and a discordant deep T wave in 3 standard and right chest leads (V1, V2) are characteristic; deep and wide S wave and high T wave in 1 standard and left chest leads (V5, V6). For a right ventricular extrasystole - a wide and high R wave and a discordant deep T wave in 1 standard and in the left chest leads (V5, V6); wide and deep S wave and high T wave in 3 standard and right chest leads (V1, V2).

An extraordinary appearance of an altered ventricular QRS complex and a complete compensatory pause after extrasystole are observed

Supraventricular polytopic extrasystole is characterized by the following ECG signs: P waves of different shape and polarity within one lead, unequal duration of P-Q intervals of extrasystolic complexes, different pre-extrasystolic intervals. Ventricular polytopic extrasystole is accompanied by a different form of extrasystolic QRS-T complexes within one lead and the duration of the coupling intervals, despite the external similarity of extrasystoles.

Bigeminy-type allorhythmy

Trigeminy-type allorrhythmia

Group extrasystole

Holter monitoring

Holter ECG monitoring is considered an important method for diagnosing cardiac arrhythmias. This procedure lasts 24–48 hours and involves recording an ECG using a portable device attached to the subject's body. The indicators are recorded in a special diary of the patient's activity, where all the subjective feelings and actions of the patient are noted.

Treatment

Extrasystole therapy involves an integrated approach, which includes the use of basic, etiotropic and antiarrhythmic drugs proper.

elimination of risk factors;
normalization of the work and rest regime;
carrying out physiotherapy exercises and physiotherapy (electrosleep, water procedures, massage);
normalization of the psychoemotional state, including through psychotherapy;
elimination of bad habits (smoking, coffee and alcohol abuse);
treatment of concomitant somatic pathology.

The choice of tactics will mainly depend on the form and location of the extrasystole. It is usually not required to treat isolated manifestations not caused by cardiac pathology. With the development of extrasystole against the background of diseases of the heart muscle, digestive, endocrine systems, therapy begins with the underlying disease. Extrasystoles of neurogenic origin are recommended to be treated after consulting a neurologist. Indications for the appointment of drug therapy are the presence of subjective complaints in patients, the daily number of extrasystoles> 100 and the presence of cardiac pathology.

The following treatment methods are used:

To relieve stress, sedative folk remedies are prescribed (infusions of motherwort, peony, valerian, lemon balm) or sedatives (Novo-Passit, Persen). In case of extrasystole caused by taking medications, their cancellation is required.
Therapy of functional extrasystole (arising against the background of neurosis) involves the restoration of psychoemotional and vegetative balance. Psychotherapeutic techniques are used (rational, cognitive-behavioral psychotherapy aimed at displacing the patient's erroneous judgment about heart disease), course techniques of psychotropic drugs - anxiolytics (Afobazol, Atarax, Strezam), "soft" neuroleptics (Eglonil, Olanzapin).
With the organic nature of extrasystole, antiarrhythmic drugs come to the fore, which, to potentiate the action, are supplemented by the appointment of potassium-magnesium saturation as a basic therapy.

Antiarrhythmic drugs

with very frequent atrial (several times every 1 minute), especially polytopic extrasystoles in order to prevent atrial fibrillation;
with very frequent ventricular (several in 1 minute) single and polytopic, paired or group extrasystoles, regardless of the presence of cardiac pathology;
with a painful subjective sensation of extrasystoles, even if from an objective point of view they do not pose a threat.

A responsible approach to the prescription of antiarrhythmic drugs is associated with the possible development of complications after their use, including an arrhythmogenic effect, which can sometimes be more dangerous than the arrhythmia itself. The effectiveness of taking the AU is taken into account on the 2-4th day of the therapy.

The criteria for the effectiveness of the use of antiarrhythmic drugs are:

decrease in the total number of extrasystoles by 50-70%;
reduction of paired extrasystoles by 90%;
complete absence of group extrasystoles.

Also, to check the effectiveness of the AS, there is a drug test: a single dose of an antiarrhythmic drug in a dose equal to half the daily dose. The test will be positive if, after 1.5–3 hours, the number of extrasystoles decreases by 2 times or they disappear altogether.

After the appearance of the effect, the transition to maintenance therapy is carried out, which is about 2/3 of the main therapeutic dose.

Therapy for supraventricular extrasystole

Treatment for this condition consists of the following steps:

Stage	Drugs
Stage I	Drugs of choice - calcium antagonists: Verapamil (Falicard, Isoptin SR, Lekoptin, Finoptin), Diltiazem (Dilzem, Cardil, Diakordin, Altiazem RR, Cortiazem)
II stage	Near reserve drugs - beta-blockers: Anaprilin (Obzidan), Bisoprolol (Concor), Metoprolol (Betalok, Spesikor, Protein, Presolol, Lopresor), Atenolol (Tenolol, Tenormin, Atenobene, Atenol, Catenol, Lokren Nebivolol)
III stage	Long-range reserve drugs: beta-blockers, the effectiveness of which does not depend on the localization of the heterotopic source of automatism: d, l-sotalol (Sotagexal, Sotalex), the occurrence of bradycardia, hypotension, lengthening of the P-Q, Q-T interval (up to 450 ms and more) is considered a contraindication to increasing the dose; antiarrhythmic drugs IA and IC classes: Disopyramide (Ritmilen), Allapinin, Propafenone (Propanorm, Ritmonorm), depot-quinidine drugs - Kinylentin (Quinidine-durules), Etacizin
IV stage	Combinations of drugs: beta-blocker + allapinin; beta-blocker + calcium antagonist; d, l-sotalol + allapinin

Treatment for ventricular extrasystole

The therapy also includes 4 stages:

Stage	Drugs
Stage I	Selection tools: beta-blockers; Propafenone (Ritmonorm, Propranorm)
II stage	Near reserve funds: Etatsizin, Etmozin, Kinilentin, Allapinin, as well as Ritmilen (Ritmodan, Disopyramid, Korapeis, Norpase, Norpeys), Aimalin (Giluritmal), Pulsnorma (Mexocainamide (Procardil), Neogilutiluetin)
III stage	Long-range funds: Amiodarone (Sedacoron, Cordaron, Opakorden)
IV stage	Combinations of funds: beta-blocker + depot-quinidine preparation; beta-blocker + Allapinin / Etmozin; beta-blocker + Cordaron; beta-blocker + Rhythmylene; Cordaron + Ritmylene / depot-quinidine preparation