Overview
Prematurebeat is also known as preterm contraction, extrasystole, or premature beat. It is an early ectopic heartbeat and can be classified as sinus, atrial, atrioventricular junctional or ventricular according to the site of origin. It can occur on the basis of sinus or ectopic (e.g., atrial fibrillation) rhythms. They may occur sporadically or frequently, and may occur irregularly or regularly after each or several normal beats, forming a diphasic or codal premature beat.
Symptoms
Premature beats may be asymptomatic or may be associated with palpitations or pause in heartbeat. Frequent premature beats may cause symptoms such as weakness and dizziness (due to reduced cardiac output), which may trigger or aggravate angina or heart failure in patients with pre-existing heart disease. On auscultation, irregular heart rhythms can be detected, with a long compensatory interval after premature beats. The first heart sound of premature beats is often enhanced, and the second heart sound is often diminished or absent. In duple or triple rhythm premature beats, a long interval may be heard after every two or three beats. Premature beats inserted between two regular heartbeats may appear as three consecutive heartbeats. Pulse palpation may reveal intermittent pulse deficits.
Etiology
Abnormal impulse formation due to abnormal autoregulation (25%).
Under certain conditions, such as a decrease in the threshold potential and a change in the diastolic depolarization slope when the sinus impulse reaches the ectopic pacing point due to the Weidenski phenomenon, a change in the membrane permeability of the diseased atria, ventricles or Purkinje fibroblasts to different ions, a change in the fast-response fibers to slow-response fibers, an acceleration of diastolic automatic depolarization, and an increase in autoregulation, resulting in a premature beat.
Foldback phenomenon (20%).
If the pathways are the same, the premature beat pattern is the same; if the conduction velocity is the same, the pairing time between the premature beat and the previous beat is fixed.
Triggeredactivity.
Premature beats can occur in normal people, but are more likely to occur in patients with cardiac neurosis and organic heart disease. They can be caused by emotional stress, nervousness, fatigue, indigestion, excessive smoking, alcohol or strong tea, or by no apparent cause. It is often caused by coronary artery disease, advanced mitral valve lesions, heart disease, myocarditis, hyperthyroid heart disease, mitral valve prolapse, etc. Premature beats are often likely to occur. It may arise in several ways.
Diagnosis
1. Medical history, symptoms
Due to the different sensitivities of patients, there may be no obvious discomfort or only palpitations, precordial discomfort or a feeling of cardiac arrest. History of hypertension, coronary artery disease, cardiomyopathy and rheumatic heart disease can help to understand the cause of premature beats and guide treatment. The use of digitalis, anti-arrhythmic drugs and diuretics can sometimes trigger the onset of premature beats.
2. Physical examination findings
In addition to the positive signs of underlying heart disease, an early heartbeat followed by a long interval (compensatory interval) may be detected during cardiac auscultation in the midst of a regular rhythm, with an increased early first heart sound and a decreased second heart sound, which may be accompanied by a weakened or absent pulse.
Differential diagnosis
1. Functional premature beats
Functional premature beats are not uncommon among young people, and most of them cannot be found to be caused by pathological causes, often caused by mental tension, overwork, smoking, alcoholism, strong tea and coffee. However, we should pay attention to the combination of work and rest, avoid excessive tension and fatigue, be optimistic, have a regular life, do not overeat, drink too much alcohol, and do appropriate physical exercise every day.
2.Pathological premature beats
Premature beats often appear when suffering from myocarditis, coronary artery atherosclerosis, rheumatic heart disease, hyperthyroid heart disease, mitral valve prolapse and digitalis poisoning, which are pathological premature beats, commonly occurring in the following cases: in the elderly or children, the number of premature beats increases after exercise, and in those who have been diagnosed with heart disease, in addition to premature beats, there are often other abnormal ECG changes in the ECG examination. For pathological premature beats, we should pay great attention to them, go to the hospital for ECG examination as soon as possible, and treat them with medication under the guidance of a doctor.
Treatment
Western medical treatment for premature beats
The main goal of treatment of premature ventricular contractions is to prevent ventricular tachycardia, ventricular fibrillation and sudden cardiac death.
I. Ventricular prematureness does not increase mortality in patients without heart disease. No drug therapy is required for asymptomatic isolated ventricular premature contractions, regardless of their form and frequency.
Second, for ventricular premature with organic heart disease, the original disease should be treated. Ventricular premature that requires urgent treatment can be treated with 50-100 mg of lidocaine by sedation until the premature beats disappear or the total amount reaches 250 mg. After the arrhythmia is corrected, 1-3mg per minute can be titrated as needed, and after stabilization, oral medication can be switched for maintenance. Lidocaine acts within minutes of intravenous injection and lasts 15-20 minutes. Therapeutic doses have little effect on myocardial contractility, blood pressure, and atrioventricular or intraventricular conduction. Side effects include dizziness and drowsiness. High doses may cause convulsions, respiratory or pacing depression and may aggravate existing AV or intraventricular conduction block. Use with caution if you have liver or kidney dysfunction or severe heart failure.
Premature ventricular contractions caused by digitalis poisoning. In addition to discontinuing the drug, intravenous phenytoin sodium or intravenous potassium chloride infusion is often effective. For premature beats caused by low potassium, the cause should be actively removed and the low potassium should be corrected.
IV. Ventricular premature contractions arising from quinidine syncope or antimony therapy should be discontinued immediately with quinidine or antimony. Oral medications are available for.
1, slow heart rhythm.
2.β-blockers.
3, Digitalis; for ventricular premature beats caused by heart failure rather than digitalis toxicity.
4.Procaine amide.
5. Amiodarone, diisoproterenol, cardioplegia, antacid, everolimus, ventricular antacaine, ethomorphine and inconamide.
Atrial premature beats should be treated actively. Remove the causes and use the following drugs.
1. β-adrenergic receptor blockers, such as Tretinoin.
2. Isoptin, the above two types of drugs are contraindicated for people with hypotension and heart failure.
3, digitalis, for atrial premature beats with heart failure but not due to digitalis, commonly used digoxin 0.25mg, 1 time/day.
4.Quinidine.
5.Phenytoin sodium 0.1g, 3 times/day.
6. Amiodarone. Treatment of premature atrioventricular junction is the same as atrial premature beats. If it is not effective, drugs for ventricular premature beats can be tried.
Chinese medicine treatment for premature beats
Identification and treatment
1. Heart deficiency and mental timidity
Symptoms: palpitations, nervousness, sleepiness, dizziness, weakness, forgetfulness, increased number of premature ventricular contractions when working or in a bad mood, weak and knotted pulse.
Treatment】Nourishing the heart and tranquilizing the mind
The formula] An Shen Ding Zhi Wan plus reduction (Poria Long Guo cinnamon Wu Wei Zi sour date seeds Mai Dong oyster Prince Ginseng, Yuan Zhi).
2, Heart Qi and Yin deficiency
Symptoms] Palpitations, shortness of breath, fatigue, dizziness, heartburn, difficulty sleeping, chest tightness and pain, increased number of night or labor ventricular morning, red tongue with little coating, pulse knotted and weak.
Treatment】Benefiting heart qi and nourishing heart yin
[Remedy]: Shengwai yang yang drink with flavor (red ginseng, maidenhair, wu wei zi, raw earth, fire, sour date, Zhi Mu).
3.Deficiency of heart yang
Symptoms] Palpitations, chest tightness, heart pain, dizziness, cold fear, shortness of breath, swelling of the lower extremities, ventricular morning and night, increased movement. The lips are purple, the tongue is pale, the coating is white and smooth, and the pulse is tense or knotted.
Treatment】Warm the heart and tonify the Yang.
[Formula] Bao Yuan Tang plus reduction (Astragalus ginseng roasted licorice cinnamon cinnamon Ephedra cocos ling).
4.Stasis of the heart veins
Symptoms] Palpitations, chest tightness and heart pain, ventricular prematureness increasing with disease progression, purple tongue, knotty and astringent pulse.
Treatment】Reducing blood stasis and relaxing the heart
[Formula] Blood Mansions and Stasis Soup with Addition and Subtraction (Radix Angelicae Sinensis, Peach Root, Red Flower, Radix Paeoniae Chuanxiong, Guadua Piperitum, Radix Aromaticus, Yuan Hu, Chai Hu, Radix Platycodon grandiflorus, Niubizi).
5.Phlegm-heat disturbing the heart
Symptoms] Palpitations and irritability, dry mouth, phlegm, body fat, impatience and anger, constipation, paroxysmal ventricular early. The tongue is red, the coating is yellow and greasy, and the pulse is knotted.
Treatment】Clear heat and expel phlegm
【Remedies】 Gua Pou Allium and Allium White and Sempervivum Soup combined with Yin Qiao San plus or minus (Gua Pou Fa Xia Allium and Allium White and Yin Hua Lian Qiao Zhi Mu and Rehmannia Temprandii and Scutellaria Baicalensis).
6.Deficiency of the heart and spleen
Symptoms] Palpitations, dizziness, forgetfulness, increased number of ventricular early onset with exertion, fatigue, lack of appetite, withered face, light and tender tongue, weak and knotty pulse.
Treatment】Tonicity of the heart and spleen
The prescription】Gui Shen Tang plus reduction (Radix et Rhizoma Atractylodis Macrocephalae Radix Angelicae Sinensis roasted licorice Fu Shen Yuan Zhi sour Jujube Ren Mullein Longan Jujube).
7, Heart heat and Yin deficiency
Symptoms] Palpitations, restlessness, sleeplessness, early night, aggravated by cold and fever, dry mouth, yellow urine and constipation, red tongue with little moss, thin pulse and knotted generation.
Treatment】Clear the heart and nourish Yin
The formula】Huang Lian Agaricus Tang combined with Sour Jujube Ren Tang plus reduction (Huang Lian Agaricus Scutellaria Baicalensis, White Peony, Sour Jujube Ren, Zhi Mu Yin Hua, forsythia, Radix Salviae Miltiorrhiza).
8, deficiency of Qi and blood in the heart and liver
Symptoms] Palpitations, insomnia, dullness in the chest, dizziness, weakness, mental fatigue, increased ventricular early if exertion or mood is bad, light tongue with thin coating, thin pulse string.
Treatment】Tonic for the heart and liver
The formula] eight Zhen Tang combined with consistent decoction plus reduction (Radix et Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Chuanxiong Ligustici, Fructus Lycii, Medlar, Neem, Hershey Bark).
9.Heat accumulation in the heart and spleen
Symptoms] Palpitations, insomnia, mouth sores and halitosis, easy to eat, dry mouth and irritable heart, aggravated by tea and wine in the morning, yellow urine and constipation, red tongue with yellow fur and rapid pulse.
Treatment】Clear the heart and diarrhea the spleen
【Remedies】Diarrhea Huang San plus reduction (gypsum, patchouli, gardenia, windbreak, man in the middle, scutellaria, forsythia, hawthorn, pale bamboo leaf, yellow lily of the valley).