Hospital pediatrics. Extrasystole (most important)

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Hospital pediatrics. Extrasystole (most important)

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13. Extrasystole

Extrasystole - premature contraction of the whole heart or a separate part of it, arising under the influence of an additional focus of excitation emanating from the sinus node.

The reasons: inflammatory, dystrophic, degenerative, toxic, mechanical damage and neurogenic disorders. Depending on the place of origin, there are ventricular, atrial, atrioventricular. Extrasystoles can be single, multiple, can occur after each contraction in a certain sequence (bigemia) or after two contractions (trigemia). Extrasystoles that occur in various ectopic centers are called polytopic. Complaints are often not presented, sometimes there are unpleasant sensations in the region of the heart (fading, stopping, a strong push). Auscultation of the heart reveals additional pulse beats and additional heart sounds.

With atrial extrasystole, excitation from the ectopic focus occurs earlier than monotopic excitation, and after premature contraction of the heart, a long incomplete compensatory pause occurs. On the ECG - a deformed P wave is premature or superimposed on the previous P wave, shortening of the R-P interval, the QRS complex is not changed, the T-P interval is moderately increased.

On the ECG, ventricular extrasystoles appear:

1) premature occurrence of the QRS complex without the preceding P wave;

2) QRS complex with high voltage, broadened, split, serrated, transitional T wave without S-T interval;

3) discoordinate direction of the T wave in relation to the maximum wave of the QRS complex with high voltage, broadened, split, serrated, transitional T wave without ST interval;

3) discoordinate direction of the T wave in relation to the maximum tooth of the extrasystole ORS complex;

4) elongation of the compensatory pause after extrasystole, the distance between two RR intervals, including extrasystole, is equal to two normal cycles.

Right and left ventricular extrasystoles are distinguished: with right ventricular extrasystole in lead 1, the largest R wave of the QRS complex, extrasystoles are directed upwards, and in lead III, the S wave, directed downwards, is the largest.

With the left ventricular type, in lead 1, the largest S wave of the QRS complex of extrasystoles is directed downward, in lead III, the R wave, directed upward, is the largest. The origin of a functional extrasystole due to a violation of extracardiac, more often vegetative, regulation.

The main signs of a functional extrasystole (most common in prepubertal and pubertal age):

1) labile during the day, changes with a change in body position, with physical activity;

2) children show signs of vegetative-vascular dystonia, foci of chronic infection, endocrine disorders;

3) when using special research methods, violations of myocardial contractility are not detected.

Author: Pavlova N.V.

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