Premature pulsationIt is called premature beat for short.MeansEctopic pacemakerHeart beat caused by premature impulse is the most commonArrhythmia。Can occur in sinus orHeterotopia(such as atrial fibrillation)RhythmOn the basis of.It can occur occasionally or frequently, and can occur irregularly or regularly after each or several normal beats, formingBinary lawOr rhythmic premature beats.It can be divided into sinus, atrialAtriumThere are four types of junction and room.Among themVentricular premature beatThe most common is atrial sex, followed by nodal sex.Premature sinus beats are rare.Premature beats can be seen in normal people or organicheart diseasePatients, common incoronary heart disease、Rheumatic heart disease、hypertensionSexual heart diseaseCardiomyopathyEtc.Premature beats can also be seen inQuinidine、Procaine amide, digitalis or antimony poisoning;Hypokalemia;Heart surgery orCardiac catheterizationMechanical stimulation to the heart.
TCM disease name
Premature beat
Foreign name
premature beat
alias
Premature contraction
Visiting department
Internal Medicine-Cardiovascular Department
Common causes
Functional premature beats, drugs and systemic diseases can all cause
common symptom
Palpitation, chest tightness, fatigue, dizziness
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Hu Dayi|Chief physician
Heart Center of Peking University People's Hospitalto examine
Premature pulsationIt can be asymptomatic orpalpitationOr cardiac arrest.Frequent premature beats may cause (due toCardiac output(caused by reduction) fatiguedizzyEtc., originalheart diseaseIt can be induced or aggravatedangina pectorisorheart failure。The auscultation can find irregular rhythm, and there are longerCompensatory intermission。The first heart sound of premature beats is more enhanced,Second heart soundMore weakened or disappeared.Premature systole presents two orTriad lawA long interval can be heard after every two or three heart beats.Premature beats are inserted between two regular heart beats, which can be shown as three consecutive heart beats.It can be found by pulse palpationIntermittent pulse。
classification
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The common ECG characteristics of premature beats are one or more times earlier than the basic rhythm P-QRS complex。
1. Atrial premature beats
The P wave appears earlier, and its shape is different from the P wave of the basic rhythm,P-R interval>0.12s。QRS waves are mostly associated withSinus rhythmThe same, sometimes slightly widened or deformed, with corresponding changes in ST and T waves is called intraventricular differential conduction, which needs to be compared withVentricular premature beatidentify.Atrial premature beats with heartIndoor differential conductionAn early abnormal P wave can be seen in front of the abnormal QRS wave group.There may be no corresponding QRS wave after the early abnormal P wave, which is called blocking atrial premature beat.Need andSinus arrhythmiaorSinus quiescenceidentify.In the previous heart beatST segmentOr if abnormality is found on T wave and P wave is found earlier, blocking atrial premature beat can be diagnosed.The impulse of atrial premature beats often invadesSinoatrial nodeSo that the latter can be depolarized in advance, and the sinoatrial node can be depolarized spontaneously and then started again according to the original cycle, resulting in noCompletenessCompensatory interval: complete compensatory interval is occasionally seen after atrial premature beats.
Frequent atrial premature beats(Mark A) Early malformation P On the T wave of the previous heart beat, the downward QRS wave is different from the sinus wave for indoor differential conduction, and no QRS wave after the first and eighth mark A is blocking atrial premature beat.
2. Premature beats at atrioventricular junction
The ECG characteristics were similar to those of atrioventricular junction escape beats except for early occurrence.The incomplete compensatory interval is formed when the premature impulse invades the sinus node, and the complete compensatory interval is formed when it does not interfere with the spontaneous depolarization of the sinus node.
3. Ventricular premature beats
QRS complex appeared earlier, its morphology was abnormal, the time limit was mostly>0.12s, the direction of T wave and QRS wave was opposite, ST shifted with T wave, and there was no P wave before it.When ventricular premature beats occur at the proximal end of the bundle branch, the QRS wave group may not be widened.Most of the ventricular premature beats have complete compensatory intervals.When the basic rhythm is slow, ventricular premature beats can be inserted between two sinus beats, forming an inserted ventricular premature beat.Occasionally, ventricular premature beats are transmitted back to the atriumRetrograde P-waveIt often appears on the ST segment of ventricular premature beats.
Atrial or ventricular premature beats sometimes consist of more than twoEctopic pacemakerThe ECG shows two or two different forms of premature beats with different pairing intervals, which is called multiple premature beats.Continuous premature beats of two or more times are called continuous premature beats and short premature beatsTachycardia。
diagnosis
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1. Medical history and symptoms
Due to the patient'ssusceptibilityDifferent, no obvious discomfort or feelingpalpitation、Precordial regionDiscomfort or cardiac arrest.hypertension, coronary heart diseaseCardiomyopathy、Rheumatic heart diseaseThe inquiry of medical history helps to understand the cause of premature beats and guide treatment. Pay attention to whether there is any premature beats in the near futurecold、fever. Diarrhea history helps to prevent acute diseaseViral myocarditisJudgment.Digitalis drugs, antiarrhythmic drugs anddiureticPremature beats can sometimes be induced by the application of.
electrocardiogramIt has diagnostic significance for premature beats.Atrial premature beatThere is an abnormal shape in front of the QRS wave that appears earlierP-waveAfter that, there was an incomplete compensation period, and the QRS waveform was mostly consistent with the normal QRS waveform.The QRS wave that appears earlier in nodal premature beats is consistent with the normal QRS wave. There is no P wave before it, and the compensatory period is complete.Ventricular premature beatThe QRS wave width abnormality appeared earlier, and the compensatory period was complete.24-hour dynamic electrocardiogramIt can record the number, regularity and treatment effect of premature beats in detail.doubtmyocarditisViable blood myocardiumEnzymological examination。heartUltrasonic examinationCardiomyopathy and some coronary heart disease patients can be found.Long term use of diuretics and suspicionDigitalis poisoningBlood should be measuredelectrolyteIf necessary, measure the blood digitalis concentration.
It should be referred to whether there is organic heart disease, whether it affects cardiac output and develops into seriousArrhythmiaThe principle of treatment depends on the possibility.
Premature pulsation without organic heart disease basis is mostly unnecessarySpecial treatment。Those with symptoms should be relieved of worry, and premature beats induced by excessive tension, emotional excitement or exercise can be triedsedativeAnd β-Receptor blocker。
For those with frequent attacks, obvious symptoms or organic heart disease, it is advisable to find out the cause and inducement of premature beats as soon as possible, give corresponding treatment for the cause and inducement, correctly identify the potential fatal possibility, and actively treat the cause and inducementSymptomatic treatment。
exceptEtiological treatmentIn addition, antiArrhythmiaPharmacotherapy, atrial andAtriumClass Ia, Ic, II and IV drugs acting on the atrium and atrioventricular junction are mostly selected for premature beats at the junctionVentricular premature beatClass I and Class III drugs acting on the ventricle are preferred.Ventricular premature beats with potentially fatal risks often require emergency veinsAdministration。Class Ib is preferred.acutemyocardial infarctionIntravenous is still the first choice at the initial stagelidocaine。If there is no contraindication after myocardial infarction, β-blockertreatment.Original orsecondaryQT prolongation syndromePatient, Class I drug is prohibited,Primaryβ - blockerPhenytoinorcarbamazepine。For secondary patients, remove the cause and useIsoproterenolOr atrial or ventricular pacing.
