Causes of ventricular premature beats and its significance
Ventricular premature beats are a very common phenomenon, and the frequency of its detection in the general adult population increases with age. Causes of ventricular premature beats include acute myocardial infarction or myocardial ischemia, arterial hypertension; myocardial damage due to previous myocardial infarction, myocarditis or cardiomyopathy; mitral valve prolapse, valvular heart disease, digitalis intoxication. However, often no signs of heart disease are found.
In patients with symptomatic and / or frequent ventricular extrasystoles, its cause should be sought using non-invasive examination methods, including a thorough analysis of the 12-lead ECG, echocardiography and, if necessary, an exercise test.
Single ventricular extrasystoles registered on a normal ECG, and even complex forms of extrasystoles (i.e., extrasystoles frequent, multifocal, “R on T” or salvo) recorded during outpatient ECG monitoring, can be detected by chance in people with a healthy heart and necessarily are pathologies or have any predictive value.
On the other hand, in some observational studies involving adults (mostly men) who underwent physical exercise testing, it was shown that the occurrence of frequent ventricular extrasystole during exercise and especially immediately after its termination is associated with an increase in mortality times) over the next 5-15 years.
In patients with irreversible structural myocardial damage due to coronary heart disease (CHD), there is a correlation between the severity of the damage and the frequency of ventricular extrasystoles. According to the latest data, ventricular premature beats should be considered as an additional and independent risk factor, however there is no evidence that its suppression with antiarrhythmic therapy improves the prognosis.
Indeed, some antiarrhythmic drugs have been shown to increase mortality in patients with ventricular extrasystole after myocardial infarction.
Usually extrasystoles are asymptomatic. Nevertheless, some patients still experience discomfort. They may be concerned about the sense of heart failure due to its premature contraction or the subsequent compensatory pause, as well as the feeling of “heavy blows” caused by the increased strength of the post-extrasystolic contraction.
Patients may be worried that the irregularity of the heart activity is a precursor to a heart attack or other serious heart problems.
In some cases, patients with a structurally healthy heart, experiencing discomfort due to ventricular extrasystole, it is difficult to clarify the situation and calm them down. In such situations, therapy may be required to reduce symptoms. BABs can be effective, especially in the treatment of patients whose symptoms are associated with exercise.
For patients with a structurally normal heart and no signs of coronary artery disease, flekainid may be useful. It is generally recommended to avoid caffeine, but this is rarely effective.