Extrasystoles

ExtrasystolesAURICULAR EXTRASYSTOLES

CLINICAL SIGNS:

* none or palpitations or feeling of heart failure.

* sometimes lipothymia in the elderly if in bursts.

ETIOLOGY:

* idiopathic, benign.

* hyperthyroidism.

* mitral valve prolapse, mitral stenosis, hypertension.

* atrial disease.

ADDITIONAL TESTS:

* ECG :

QRS premature and normal configuration (duration 0.08 sec).

– sometimes branch block appearance.

The wave P ‘precedes QRS, but its morphology is altered:

 if low atrial: negative P ‘wave in D2, D3, VF.

 if left atrial: negative P ‘wave in D1, VL.

 if right atrial: appearance close to the P wave.

– space P’R is normal or elongated. The space PP ‘is shorter than the space PP.

They can be isolated, twinned, trigeminal, in doublets or triplets.

– if they are numerous, they can make fear a passage in AC / FA.

Trap: P wave masked by the previous T wave followed by a ventricular aberration that resembles a VES.

– in the “wandering” pacemaker: PP ‘> PP.

* blood ionogram: look for hypokalemia.

* TSH.

echocardiography and holter ECG in a second time.

TREATMENT:

* none or sedatives if necessary: ​​benzodiazepines or Atarax or Natisedine per os.

* if badly tolerated:

– Stop digitalis, correct the cause.

– oxygen therapy.

– if there is a risk of passing into complete arrhythmia by atrial fibrillation:

 heparinotherapy.

 and antiarrhythmics: Cordarone, betablocker, Sotalex.

JUNCTION EXTRASYSTOLES

CLINICAL SIGNS:

* idem.

ETIOLOGY:

* idem.

ADDITIONAL TESTS:

* ECG :

– normal configuration QRS (duration 0.08 s).

– the P ‘wave is negative at D2, D3, VF, it precedes (P’R <0.12 s) or follows QRS (RP’ <0.12 s), sometimes P-wave absent, included in the QRS .

* blood ionogram: look for hypokalemia, TSH.

echocardiography and holter ECG in a second time.

TREATMENT:

* none or sedatives: Benzodiazepines, Atarax, Natisedine per os.

* if poorly tolerated: oxygen therapy and antiarrhythmics, beta-blockers.

VENTRICULAR EXTRASYSTOLES

CLINICAL SIGNS:

* idem.

* onset or aggravation with the effort so serious.

ETIOLOGY:

* idiopathic

* underlying cardiopathy , ischemic or not.

* hypokalemia, dysthyroidism, hypoxia, severe infection.

* abuse of alcohol, coffee, tea, narcotics.

* anxiety.

iatrogenic: digitalis, theophylline, betamimetic, antiarrhythmic.

DIAGNOSTIC TESTS:

* scope.

* ECG :

– broad QRS, not preceded by P wave and followed by a T wave opposite to that of QRS.

– may be bigeminal, trigeminal, interpolated, compensating or shifting.

– if aspect of BBD: origin in left ventricle, if aspect of BBG: origin in right ventricle.

– serious ventricular extrasystoles:

 polymorphism: more than 2 different morphologies on the same route.

 early onset with respect to the previous T wave.

 wide> 0.18 s.

 QT long.

 numerous, increasing with heart rate, or in bursts.

* blood ionogram, TSH.

* holter ECG, echocardiography in a second time.

TREATMENT:

* delete or correct the cause.

* sedatives if necessary: ​​oral benzodiazepines or Atarax 25 or Natisedine.

* if benign ventricular premature beats poorly tolerated:

– Tenorine: ½ -1 cp / day or Sotalex 160: ½ -1 cp / d.

– or Isoptine 120: 1 cp x 2-3 / d.

* if severe ventricular extrasystoles:

– Isuprel if bradycardia and long QT.

– or Xylocaine: 1 mg / kg IV slow then 1 to 2 mg / min to the electric syringe if myocardial ischemia.

– or Cordarone: 5 mg / kg IV slow then 150 mg / 6 h. to the electric syringe.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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