What is the purpose of ventricular couplets

Ventricular arrhythmias - ventricular fibrillation, ventricular flutter, ventricular extrasystoles, ventricular tachycardia

Ventricular Cardiac arrhythmias (Heart stumbling caused by the ventricle): Too fast or irregular heartbeat due to disorders in the muscles of the ventricles. Structural damage to the heart muscle, genetic diseases, and medication or luxury foods are possible causes. The symptoms range from harmless heart stumbling to cardiac arrest caused by ventricular fibrillation.

Emergency measures for life-threatening cardiac arrhythmias are resuscitation and defibrillation. Drugs and ICDs (implantable defibrillators, see below) are used for long-term therapy, and in some cases catheter ablation is also an option. The prognosis is closely related to the cause of the arrhythmia present.

Leading complaints

  • Palpitations, palpitations, palpitations
  • Shortness of breath, seizures, loss of consciousness
  • Cardiovascular arrest.

When to the doctor

In the next few days if

  • repeated palpitations, palpitations, or palpitations occur.

Call the ambulance immediately, if

  • the palpitations, palpitations or palpitations no longer stop or are associated with anxiety, dizziness or shortness of breath
  • Disturbances in consciousness occur, even if they are only temporary.

The illness

causes

The electrical phenomena that enable the heart to function properly take place in the sinus node and in other parts of the heart's conduction system. (For more on these processes, see Electrical Phenomena in Our Heart: Electric Surges, Clocks, and Distribution Lines). Ventricular arrhythmias occur when normal electrical excitation in the heart is disturbed. Possible causes for this are:

  • Acquired damage to the heart muscle tissue (fibrosis, infarct scars, inflammation) in CHD, myocardial infarction, cardiomyopathy, aortic valve stenosis, myocarditis
  • Degenerative changes
  • Medicines (cardiac glycosides, antiarrhythmics, beta blockers, diuretics)
  • Luxury foods (coffee, nicotine, alcohol, psychostimulants)
  • Electrolyte imbalances (e.g., hypokalaemia)
  • Tissue damage after heart surgery
  • Rare hereditary diseases such as Brugada syndrome, which is caused by a gene mutation and leads to defects in the area of ​​voltage-controlled sodium channels on the heart muscle cells.

Ventricular extrasystoles

The generation of excitation is not limited to the sinus node, but can also take place in other muscle cells of the heart and from there spread over the whole heart. That is a good thing, because these replacement clocks (almost) always step in when the sinus node fails, which would otherwise lead to certain death. The contractions of the heart thus arising out of sequence become Extrasystoles (Extra beats of the heart) called. This is often perceived as stumbling the heart. If the excitation comes from the heart chambers (ventricles), one speaks of a ventricular extrasystole. Entricular extrasystoles occur in patients with and without heart disease. They can be neglected in people with healthy hearts. However, if they increase significantly in advanced heart failure or after a heart attack, there is a risk of sudden cardiac death.

Ventricular extrasystoles that occur regularly after every normal heart action are called the bigeminus, and two connected ones are called the couplet. Ventricular extrasystoles occurring in groups are called volleys. If ventricular extrasystoles appear frequently, a cause must always be searched for, which must then be treated.

Various forms of ventricular extrasystoles in the ECG, see text for an explanation.
Georg Thieme Verlag, Stuttgart

Ventricular tachycardia, ventricular flutter and ventricular fibrillation

Are the normal routes of propagation of electrical excitation in the heart z. B. disrupted by structural tissue damage, it comes (similar to atrial flutter) to circling excitations in the muscle cells of the heart chambers. Regardless of the sinus node, these can lead to very high ventricular frequencies (ventricular tachycardias) to lead. Typical changes in the QRS complex can be seen in the ECG. The cause is usually a heart disease, e.g. B. a circulatory disorder of the heart. In contrast to atrial tachycardia, in which the AV node protects the ventricle from an excessive heart rate, every ventricular tachycardia has a negative effect on the blood flow to the organs.

Above (a): Electrical recording of a ventricular tachycardia. Broad QRS complexes can be seen in the ECG. These can change into ventricular flutter or ventricular fibrillation. The middle (b) and lower (c) images correspond to cardiac arrest because the electrical activity is ineffective and the heart can no longer produce regular blood.
Georg Thieme Verlag, Stuttgart

With heart rates of up to around 200 beats per minute, you can feel palpitations, palpitations and malaise. At higher heart rates, the pumped blood volume decreases because the heart chambers no longer have time to fill the blood. The result is increasing circulatory weakness up to unconsciousness and sudden cardiac death. Life-threatening ventricular tachycardias require immediate intravenous medication or defibrillation.

The transitions from ventricular tachycardia to ventricular flutter and fibrillation are fluid. From a ventricular frequency of around 250 beats per minute, one speaks of Ventricular flutter. At the Ventricular fibrillation Similar to atrial fibrillation, chaotic, ineffective twitching of the ventricular muscles occurs without blood being transported further. For the body, this is like cardiac arrest. Only irregular trembling movements with ventricular frequencies of more than 350 beats per minute can be seen in the ECG.

Diagnostic assurance

The most important instrument for diagnosing acute ventricular cardiac arrhythmias is the ECG - especially in the often present emergency situation with ventricular fibrillation, ventricular flutter or persistent ventricular tachycardia.

Non-sustained ventricular tachycardias (ventricular tachycardias with episodes of less than 30 seconds) and extrasystoles are often difficult to diagnose. In order to detect these arrhythmias, the doctor usually needs a long-term ECG or an event recorder.

With such an event or also Event recorder arrhythmias are recorded that cannot be detected in the practice or in the long-term ECG. The doctor can then use the data to determine the nature and extent of such events. Event recorders are particularly helpful if the patient repeatedly experiences discomfort and rhythm disturbances.

Several systems are available:

  • External, temporary monitoring: In the event of a perceived stumbling of the heart, the patient presses a credit card-sized recorder onto the chest so that the ECG can be recorded for a few minutes.
  • External, continuous monitoring: Here, like an EKG, adhesive electrodes are attached and these are connected to a small external recorder that the patient carries with him or that is also glued on. This recorder continuously records the EKG, so the patient does not have to "watch" whether his heart stumbles or becomes arrhythmic.
  • Implanted continuous monitoring. If the doctor suspects serious, difficult to determine arrhythmias, he often advises implanting an event recorder under the skin. These devices record the heart's actions for up to 3 years. If rhythm disturbances occur, the device saves these events. In addition, the patient can start the recording manually using a handheld device as soon as he notices a palpitations.

treatment

Ventricular extrasystoles: Accidentally discovered ventricular extrasystoles in people with healthy hearts are harmless and do not require treatment. However, if this affects those affected in their everyday life (for example due to recurring attacks of dizziness), the doctor usually prescribes beta blockers or other antiarrhythmics. In patients with heart disease and symptoms caused by extrasystoles, therapy with amiodarone or a beta blocker is usually initiated.

Ventricular tachycardias: Here the doctor injects ajmaline or amiodarone while monitoring the ECG. If this does not stop the tachycardia, cardioversion must be performed.

Ventricular flutter and ventricular fibrillation: The acute measure for these life-threatening, chaotically circling excitation waves is immediate resuscitation, usually including defibrillation. During defibrillation, a massive electric shock is administered from the outside via two plate electrodes placed on the chest. For a short moment it excites all myocardial cells at the same time, which stops all electrical and mechanical actions in the heart. As the first stimulation center, the sinus node recovers, the excitation waves of which can now spread over the entire heart and thus determine the heart rhythm again.

After an acute event

After surviving ventricular tachycardias and ventricular fibrillation, the triggering cause is always sought. If this cannot be eliminated by improving the blood flow to the heart muscle or by changing the medication, an implantation comes about ICD (implantable cardioverter defibrillator, also AICD) into consideration, which recognizes dangerous cardiac arrhythmias and automatically terminates them by delivering electric shocks.

An ICD monitors the heartbeat sequence and can detect and stop sudden ventricular tachycardias and ventricular fibrillation (antitachycardia function) by forcing the heart muscle excitation back into the normal (sinus) rhythm using high-frequency electrical surges. This makes the ICD a treatment option for patients who have survived cardiovascular arrest due to ventricular fibrillation or for whom drug therapy has not shown lasting success.

An ICD is somewhat larger than a pacemaker, but like this, it is implanted in the chest muscles and connected to the right heart via a pacemaker electrode. In addition to its life-saving defibrillator function, it can also act like a simple pacemaker and pace the heart. In addition, like an EKG computer, it records and saves the heart's actions. With each check-up, the cardiologist checks whether cardiac arrhythmias have occurred since the last check-up and whether the ICD has reacted correctly.

Doctors also treat ventricular tachycardias or extrasystoles with catheter ablation.

forecast

The prognosis of ventricular arrhythmias depends largely on the underlying disease and the speed of treatment.

Untreated ventricular fibrillation is fatal. Will however within the first 3 to 5 minutes after cardiovascular arrest cardiopulmonary resuscitation including defibrillation - for example with an automatic external defibrillator (AED), which can also be operated by laypeople - survive around 50–75%. Unfortunately, the reality looks different, usually too much time passes before those affected are helped (often only by the emergency services), which significantly worsens the prognosis and the survival rate drops to around 10%.

Ventricular tachycardias in the first 3 months after a heart attack also have a poor prognosis: 85% of affected patients die within the first year after a heart attack.

Your pharmacy recommends

What you can do yourself

Exercise therapy. Light exercise is helpful in most cases. However, avoid sports that require you to perform at your best. If necessary, regular training in a cardio group is also a good option.

Nutrition. According to evidence, a diet rich in omega-3 fatty acids such as eicospentaenoic acid has a positive influence on the further course of the disease. Since flatulence can lead to cardiac arrhythmias, you should avoid foods that cause gas if you are prone to flatulence.

Complementary medicine

Natural and complementary medicine cannot replace the prescribed heart medication, but rather supplement it. The treatment of cardiac arrhythmias belongs in the hands of specialists.

Homeopathy.Homeopathic constitutional remedies for cardiac arrhythmias include: Argentum nitricum, Ferrum metallicum, Natrum muriaticum, Nux vomica and Sulfur. In addition, homeopathic complex remedies (e.g. Spigelia N® drops Synergon No. 161, Arrhythmie-Gastreu® N R66 drops) are available.

Relaxation procedure.Relaxation methods such as autogenic training, progressive muscle relaxation according to Jacobson, yoga or Qi Gong can help to reduce accompanying vegetative complaints such as nervousness or tension or trigger factors such as psychological excitement, e.g. B. through stress to mitigate.

Herbal medicine. Phytopharmaceuticals are only an option for mild cardiac arrhythmias. They are by no means an alternative to the prescribed chemical medication, but in some cases a combination can be useful. Depending on the cause and symptoms, various medicinal plants can be considered, e.g. B. Wolfstrappkraut for cardiac arrhythmias as a side effect of an overactive thyroid or medicinal herbs with a calming effect z. B. valerian root, hop cones, lemon balm leaves, if the cardiac arrhythmias are associated with restlessness and tension and / or insomnia.

In contrast, the common broom (Cytisus scoparius, e.g. Spartiol®) is characterized by its direct effect on the conduction system. Since it can lead to symptoms of poisoning when used as tea due to incorrect dosage, ready-made preparations are usually used today. Hawthorn is also suitable for the treatment of cardiac arrhythmias. However, the preparations (e.g. Crataegutt Novo 450®) must be dosed in high amounts in order to develop their effect.

Because of the risk of a blood pressure crisis, broom and MAO inhibitors for the treatment of depression must not be taken at the same time. High blood pressure and cardiac arrhythmias such as an AV block are also contraindications.

Further information

  • The Bundesverband Defibrillator (ICD) Germany is a network for people with an implanted defibrillator and their self-help groups. The website www.defibrillator-deutschland.de offers those affected and their relatives information and help. There is also a list of Defi self-help groups in Germany.

Authors

Dr. med. Dieter Simon, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:19


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.