After the diagnosis is made, the doctor will tell the patient who has a VES (ventricular extrasystole) what it is. The consequences of a pathological condition can be most deplorable if the correct treatment is not started under the supervision of a specialist. The term is used to denote such extraordinary cardiac contractions, the reason for which is the impulses arriving earlier than the prescribed, initiated by the walls of the ventricle on the right, left, nerve fibers.
Anatomy Features
Ventricular extrasystole, whose ICD code is I49.4, occurs if the normal impulse patency of the sinus node located in the heart in the upper region above the ventricles is impaired. Extrasystoles that characterize the pathological condition affect the rhythm of the ventricles, without affecting the upper parts of the organ. If pathological contractions are initiated in the atria, septum, they speak of extrasystole over the ventricles. These can cause a housing problem.
Categories and Risks
Currently, VES is most often detected in people over the age of fifty. On average, according to medical statistics, this age group accounts for half of all patients with ZHES up to 75% of cases.
A classification system has been developed that allows dividing all patients into several groups. This simplifies the selection of the optimal treatment format. One of the famous and popular systems is called RYAN. Ventricular extrasystole according to this categorization involves the allocation of mono-, polymorphic cases of paired, as well as three or more impulses initiated at the stage of atrial rest. If we pay attention to the qualifications according to Laun, then such cases belong to categories 4A, 4B, 5. The current gradation of ventricular extrasystole according to RYAN involves the assessment of the source of pulse initiation. If there is only one such one, they speak of a monomorphic form, a polymorphic one is revealed if there are several foci of emitting pulses.
Another case classification system has been named after its author, Dr. Mayerburg, an outstanding author and cardiologist. He suggested dividing all cases by frequency into very rarely manifested ones, noticeable rarely and infrequently. It was also proposed to highlight the level of moderate rarity, frequent and very frequent. An additional classification according to Mayerburg involves an assessment of the type of violations: single or paired, poly- or monomorphic, stable or not having such a feature.
Continuing the topic
In our country, at present, any practicing good doctor knows the code for ventricular extrasystole in the ICD (I49.4). It is this system of classification, dividing all patients into categories that is most often used in medical practice in our country. Filling out the patient’s card, the doctor must indicate the disease code according to ICD 10 in it. Ventricular extrasystole will not be an exception - for any patient with a similar diagnosis, the personal card will contain a mention of pathology I49.4.
Several causes of the pathological condition, as well as possible complications and consequences that arise in the absence of adequate treatment, have been identified. In ICD 10, ventricular extrasystole is fixed by code I49.4, which includes only this pathology. If other health disorders have developed against her background, for them the doctor must choose other encodings that are more suitable for the case. The diagnosis will include several ciphers at the same time.
Where did the trouble come from?
For all degrees of gradation of ventricular extrasystole, the main reason is heart disease, malfunctioning of this organ. Sometimes ZhES is observed if a person is forced to physically strain for a long time. Certain risks are associated with the chronic influence of stress factors and other negative external conditions.
A fairly common cause is the lack of functioning of the heart muscle, associated with negative tissue changes. This provokes a failure of blood flow, tissues do not receive the necessary nutrition and oxygen, local starvation begins, and an improper metabolism leads to acidosis.
Among all the reasons, cardiac ischemia is no less frequent in ventricular extrasystole. The term is used to denote a pathological condition provoked by a failure of coronary blood flow. In the acute form, ischemia is called a heart attack; in a chronic patient, angina attacks regularly appear.
Diseases and their consequences
The occurrence of a paired, single ventricular extrasystole against a background of cardiomyopathy. The term is used to denote such a primary violation of the integrity and health of the body, which initiates the failure of the muscles. With cardiac myopathy, there is a high probability of organ hypertrophy. The patient is prone to atypical arrhythmia.
Certain risks are associated with heart defects. The term denote the presence in the body, large vessels emerging from it, of significant defects. These can be single or present in several areas at once. Defects are congenital, but it is possible to acquire during life.
The above ventricular extrasystole code can also hide underneath a case caused by myocarditis. In this case, the occurrence of atypical impulses is associated with the focus of inflammation in the muscle tissue of the heart. Such a process becomes the cause of impulse conduction failures, the processes of contraction, myocardial excitation are disrupted.
Drugs and Health Problems
Clinical practice has shown: sometimes it occurs while taking medications for the heart, ventricular extrasystole and supraventricular. With certain dangers, for example, a course of diuretics is associated, under the influence of which urine is more actively generated and excreted. The process may be accompanied by leaching of potassium, which is necessary for normal pulse generation. Cardiac glycosides, which are actively used in cardiology, can play a role - they help lower the frequency of contraction of the heart muscle, making each act stronger. The use of such drugs is associated with the risk of fibrillation, flicker. Heart rate may become too high, loss of rhythm is possible.
ZhES is possible against the background of drugs against heart block. They are characterized by a complex of side effects, including excitation of the nervous system, increased pressure. This affects the rhythm of the heart.
Diagnoses and Complications
Ventricular extrasystole, as can be seen from medical statistics, is highly likely to haunt diabetics with a second type of disease. Against the background of diabetes, the risks of disturbing the metabolism of carbohydrates in the body in a serious form are especially high, which leads to neuropathy, a malfunction of the fibers of the nervous system. As a result, cardiac functionality is disturbed, arrhythmia occurs.
There is a risk of ventricular extrasystole due to excessive activity of the pancreas. The most significant risks for people with thyrotoxicosis in moderate and severe form. Doctors know the phenomenon of thyrotoxic heart. The condition manifests itself as sclerotic processes, lack of functioning, extrasystole and hypofunction of the organ.
Perhaps the appearance of ventricular extrasystole in violation of the adrenal gland. This is due to the excessive generation of aldosterone, which provokes high blood pressure. At the same time, metabolism is disrupted, which in total has a depressing effect on the myocardium, knocking down its work.
The inorganic nature of ventricular extrasystole is possible. This condition is diagnosed if additional patient heart diseases cannot be detected. In an impressive percentage of cases, a functional form is found. If a dangerous phenomenon is localized and eliminated, the rhythm and heartbeat frequency return to normal.
Symptoms of the condition
If you organize Holter monitoring, with a probability of 50%, any young person will be able to detect at least one premature heart beat per day. This phenomenon does not in any way affect the general state of health and is not considered a pathology. If the frequency of atypical reactions increases, this corrects the rhythm of the heartbeat. If there are no concomitant diseases, ZhES is difficult to tolerate. Often the condition appears with bradycardia, when the pulse is rare, the patient feels as if the heart is stopping, after which a volley of frequent strokes begins. From time to time, the feeling of strong contractions disturbs. Especially high probability of ZhES after a meal. Unpleasant sensations are possible even in complete calmness, in a dream. There is a high risk of activation of ZhES on the background of emotional overstrain. But physical activity rarely leads to symptoms of VES, not accompanied by other pathologies.
If ZhES is observed in organic diseases, the nature of the manifestations in an impressive percentage is multiple, while the patient does not pay attention to this. Manifestations become more pronounced in conditions of physical activity. Arrhythmia is frequent, disturbing simultaneously with tachycardia.
With a high proportion, the probability of ZhES appears during the period of bearing a child. At the same time, the woman suffers from a rapid rhythm of the heartbeat, it hurts in the chest on the left. The cause of the failures is an increased load on the heart and circulatory system, accompanied by a change in the hormonal background, which also corrects cardiac activity. ZhES is not considered malignant, quickly passes soon after the birth of the child.
Diagnosis
If there is a suspicion of ZhES, it is necessary to organize daily monitoring of the heart, following the recommendations of Holter. The diagnosis is made if the study shows specific changes, including deformation, expansion of the ventricular complex, the appearance of a compensatory pause, the absence of a P-wave in front of an extraordinary impulse. Another typical manifestation is a kind of impulse that separates two typical contractions from each other.
To clarify the condition, echocardiography can be prescribed. Such a study helps to determine the causes of the pathology, to identify the nuances of the failure of the functionality of the heart. An ECG will be beneficial, in which the muscle is stimulated by external impulses, tracking the reaction of tissues. An electrocardiogram, taken in a calm state and under load, allows you to establish how the rhythm of heart contractions depends on the activity of a person as a whole.
A study of venous blood is shown. The fluid is checked for tropic hormones, potassium, cardiac enzymes, globulins, protein inflammatory markers. If all of the above measures did not allow identifying the initiating ZhES factors, the person is generally healthy, the idiopathic form of the disease is diagnosed, the genesis of which cannot be clarified.
What to do?
Treatment of ventricular extrasystole begins with the choice of a safe diet and adherence to a clear sparing regimen of the day. The patient will have to exclude alcohol, tobacco products, strong coffee, tea from everyday life. Potassium-fortified foods are beneficial. The menu will have to introduce oatmeal, nuts, raisins, bananas. Dietitians or therapist will give specific recommendations, assessing the state of health, weight problems and other features. Often prescribed "Panangin", which ensures the entry into the body of essential minerals for the work of the heart.
Treatment of ventricular extrasystole involves the rejection of difficult tasks, training. Strict diets, dietary restrictions are prohibited. With the frequent influence of stress factors and poor quality of sleep, it is necessary to use fees with herbal herbs and mild sedatives.
Patient Care
If the number of atypical systoles per day is more than two hundred, drug correction of the condition is indicated. Schemes are selected strictly individually, assessing the morphology of the phenomenon, the frequency and strength of arrhythmias, the presence of background diseases.
They may recommend means to inhibit the activity of sodium channels. Most often, if necessary, urgent care is used Novokainamid. A good reputation is distinguished by the compositions of Lidocaine, Giluritmal. If necessary, stop the activity of potassium channels prescribe Amiodarone, Sotalol. Calcium channels can be blocked with the help of Amlodipine and Cinnarizine preparations. The Verapamil remedy is popular.
In the pathological condition complicated by high blood pressure, means are used to correct it. Reliable have shown themselves “Captopril” and “Ramipril”. Sometimes they stop at Enaprilin. In some cases, the doctor recommends a course of beta-blockers. Often resort to the well-known drugs "Atenolol" and "Cordinorm." Anaprilin, Carvedilol medicines are known for their good reputation. If the likelihood of blood clots is estimated as high enough, it is recommended to take "Aspirin", "Clopidogrel."
Two months after the start of the therapeutic course, it is necessary to undergo control studies in order to monitor the effectiveness of the selected funds. With the reduction and disappearance of additional systoles, they refuse to continue using drugs. If the indicators have become better, but the housing and communal services remains, the program is extended for a few more months. With a malignant form of the disease, therapy will have to be practiced all my life.
Operation shown!
If the drug course does not give any result, the patient can be referred for surgery. This is often recommended in organic form. One of the most proven methods is radiofrequency ablation. Using a small catheter, a source of radio waves is introduced through the blood vessel into the heart cavities, through which the diseased area is cauterized. To localize areas requiring influence, an electrophysical study is practiced. The level of effectiveness is estimated at 75-90%.
An alternative is the setting of a stimulator of cardiac work. This is a kind of small box with electronic filling and a battery that has been functioning for a decade. The stimulator is equipped with electrodes fixed to the atrium, ventricle. The mechanism initiates impulses, under the influence of which the myocardium contracts. In fact, the device is an artificial sinus node that ensures the rhythm of heart contraction. The patient gets rid of extrasystole and can live a normal, full, healthy life.
Doctors advise resorting to mechanical stimulants of the heart, so that you do not have to take medications all your life. More often, pacemakers are put to the elderly.
And if not treated?
The prognosis of a pathological condition depends on the severity of failures, the level of impaired ventricular functionality. The stronger the myocardial changes, the higher the risk of flickering, persistent tachycardia. This is associated with a risk of death. If the atypical contraction falls on the atrial contraction, blood cannot leave the upper heart regions, gradually flows to the lower parts, provoking the generation of blood clots. A clot formed by blood cells initiates thromboembolism. With vascular obstruction, a heart attack, stroke, ischemia are possible. In order to minimize the risk of such consequences, if you suspect a ZhES, you should contact a qualified doctor and clearly follow the program recommended by him.