premature beats
Introduction
Introduction to premature beats Prematurebeat is also known as pre-systolic contraction, extra-systolic contraction, referred to as premature beats. It is an early ectopic heart beat. It can be divided into sinus, atrial, atrioventricular junction and ventricular according to the origin. Among them, ventricular is the most common, followed by atrial, sinus premature beat is rare. Premature beats are common ectopic rhythms. Can occur on the basis of sinus or atopic (such as atrial fibrillation) heart rhythm. It may occur occasionally or frequently, and may occur irregularly or regularly after each or every number of normal beats to form a bipolar or premature beat. basic knowledge The proportion of illness: 0.03% Susceptible people: children, the elderly Mode of infection: non-infectious Complications: sudden cardiac death syndrome, paroxysmal ventricular tachycardia, fainting shock, sudden cardiac death syndrome, ventricular flutter and ventricular fibrillation
Cause
Premature beat
Impulsive abnormalities caused by abnormal self-discipline (25%):
Under certain conditions, such as the sinus impulse to reach the ectopic pacemaker, due to the Weidensky phenomenon, the threshold potential is lowered and the diastolic phase is changed to cause premature beats. The lesion atrium, ventricle or pu The Kenye fiber cell membrane changes the permeability of different ions, transforming the fast-reacting fiber into a slow-reacting fiber, which is accelerated by the automatic depolarization during diastole, and the self-discipline is enhanced, resulting in premature beat.
Reentry phenomenon (20%):
Jujube ring reentry or focal micro-return, if the reentry pathway is the same, the premature beat pattern is consistent; if the conduction velocity is consistent in the reentry, the pairing time of the premature beat and the previous beat is fixed.
Triggered activity.
Premature beats can occur in normal people, but cardiac neurosis and organic heart disease are more likely to occur, emotional, nervous, fatigue, indigestion, excessive smoking, drinking or drinking tea can cause seizures. There is no obvious incentive, digitalis, tincture, quinidine, sympathomimetic drugs, chloroform, cyclopropane anesthetics and other toxic effects, potassium deficiency and cardiac surgery or cardiac catheterization can cause, coronary heart disease, late apex Valve disease, heart disease, myocarditis, hyperthyroidism, mitral valve prolapse, etc. are often prone to premature beats. It can be produced in a variety of ways.
Prevention
Premature beat prevention
First of all, to maintain a regular life and proper physical exercise, do not stay too late, do not watch TV for a long time or sit in front of the computer for a long time, walk, tai chi, use some fitness equipment for fitness training will bring long-lasting to your body The benefits.
1. Quit smoking and avoid heavy drinking, because smoking and drinking are the main triggers for coronary heart disease.
2, to maintain emotional stability, to correct the work, the relationship between life and learning, high emotional tension and ups and downs are the main cause of functional "premature beat".
3, to regularly go to the hospital for physical examination, once you find heart palpitations, leakage, etc., you should go to the hospital in time.
Complication
Premature beat complications Complications sudden cardiac death ventricular tachycardia fainting shock sudden cardiac death ventricular fibrillation and ventricular fibrillation
This disease can induce ventricular tachycardia, ventricular fibrillation, and in severe cases can lead to sudden cardiac death.
1, ventricular tachycardia
Ventricular tachycardia is a tachycardia composed of more than 3 to 5 wide malformed QRS waves originating from the bifurcation of the His bundle, similar to paroxysmal supraventricular tachycardia, but the symptoms are more serious. Children with irritability, paleness, shortness of breath, older children can complain of heart palpitations, pain in the precordial area, severe cases can have fainting, shock, congestive shock, etc., the episodes of transient episodes are less severe, and the episode lasts for 24 hours. The above can cause significant hemodynamic changes, physical examination found that the heart rate increased, often more than 150 beats / min, rhythm is neat, heart sounds can have strengths and weaknesses.
2, ventricular fibrillation (VF)
It is caused by many intersecting reentry electrical activity waves, and its electrocardiogram appears as a chaotic record curve. VF can often be fatal unless defibrillated with direct current (defibrillation with chest or anti-arrhythmia drugs is not effective).
3, sudden death
Sudden death is a clinical syndrome. It refers to those who seem to be healthy or whose condition has basically recovered or stabilized. Sudden and unexpected non-human deaths occur. Most of them occur within an hour after acute onset, and the maximum is no more than 6 hours. Mainly due to primary ventricular fibrillation, ventricular arrest or electromechanical separation, causing the heart to suddenly stop effectively contracting function.
Symptom
Premature beat symptoms Common symptoms QRS wave wide deformity Frequent atrial premature beats Heart "stealing" heart palpitations Arrhythmia Precordial heart pain
Premature beats can be asymptomatic, and there can be a feeling of palpitations or heartbeat. Frequent premature beats can cause symptoms such as fatigue and dizziness due to decreased blood output. The original heart disease can induce or aggravate angina or heart failure. Auscultation can be found that the heart rhythm is irregular, and there is a long compensatory interval after the premature beat. The first heart sound of the premature beat is more enhanced, and the second heart sound is weakened or disappeared. When the premature beat is in the second or third joint, you can hear a long pause after every two or three heart beats. Premature beats are inserted between two regular heart beats, which can be expressed as three consecutive heart beats. Pulse palpation can be found in intermittent pulse.
Examine
Premature beat check
Auxiliary inspection
Electrocardiogram has a diagnostic value for premature beats. Atrial premature beats have an abnormal P wave in front of the QRS wave, and there is an incomplete compensation period. The QRS waveform is more consistent with the normal QRS waveform. The QRS wave that appears early in the premature ventricular contraction is consistent with the normal QRS wave. There is no P wave before, and the compensation period is complete. The QRS wave broad deformity that appeared early in the premature ventricular contraction was complete and the compensation period was complete. The 24-hour dynamic electrocardiogram can record in detail how much premature beats occur, the regularity of the occurrence, and the therapeutic effect. Blood myocardial enzymology is feasible in patients with suspected myocarditis. Cardiac ultrasonography can detect cardiomyopathy and some patients with coronary heart disease. Long-term use of diuretics and suspected digitalis poisoning should determine blood electrolytes, if necessary, determine the concentration of blood digitalis.
Diagnosis
Premature beat diagnosis
diagnosis
1, history, symptoms
Due to the different sensitivity of the patient, there is no obvious discomfort or only heart palpitations, precordial discomfort or cardiac arrest. Inquiries about the history of hypertension, coronary heart disease, cardiomyopathy, and rheumatic heart disease can help to understand the cause of premature beats and guide treatment. Pay attention to the question of whether there is a history of cold, fever, or diarrhea in the near future to help patients with acute viral myocarditis. The use of digitalis drugs, antiarrhythmic drugs, and diuretics sometimes induces premature beats.
2, physical examination found
In addition to the positive signs of the underlying heart disease, early heartbeats can be found in the regular heart rhythm after auscultation, followed by a longer interval (compensation interval), the first heart sound enhancement earlier, second The heart sound is weakened, which may be accompanied by a decrease or disappearance of the pulse.
Differential diagnosis
1, functional premature beats
It is not uncommon among young people. Most people can't find pathological incentives, often caused by nervousness, overwork, smoking, alcoholism, drinking tea, drinking coffee, usually before quiet or before going to sleep. After exercise, premature beats disappear, functional premature beats generally do not affect the health of the body. After a period of time, most of these premature beats will be cured, so there is no need for treatment, but usually should pay attention to work and rest, avoid excessive tension and fatigue, optimistic, life has Regular, not overeating, excessive drinking, proper physical exercise every day.
2, pathological premature beats
Premature beats often occur in patients with myocarditis, coronary atherosclerotic heart disease, rheumatic heart disease, hyperthyroidism, mitral valve prolapse and digitalis poisoning. This is a pathological premature beat, which is common in the following cases: Older people or children, the number of premature beats increased after exercise, the original diagnosis of heart disease, ECG examination in addition to the detection of premature beats, there are often other abnormal ECG changes, for pathological premature beats, should be highly valued, and the morning hospital for ECG examination, Treatment under the guidance of a doctor, if there is a serious and frequent premature beats, it is best to be hospitalized for observation and treatment.
