Extrasystole and blocks

Экстрасистолия
– a prematurely occurring beat of one of the chambers of the heart that leads to momentary arrhythmia but leaves the fundamental rhythm unchanged

Extrasystole is a special case of ectopic beats.
Ectopic beat is myocardial excitation of non-sinus origin.
Premature ectopic beat - extrasystole (active rhythm disturbances)
Late ectopic beat is a replacement complex that saves from asystole – escape beat (passive)

400 мс
Atrial escape beat
Ventricular extrasystole
600 мс

Supraventricular ES

Ventricular ES
300 мс
680 мс

Compesatory pause
Preectopic interval
CP in SVES < 2RR CP in VES ≥ 2RR
1550 мс
1550 мс
Postectopic interval
QRS< 100 ms, narrow
QRS > 120 ms, wide

Ventricular ES
Classification (reference criteria):
The form
A source
Time of appearance
Amount
Allorhythmy
Prognostic value (clinical)

The form (morphology)

Time of appearance

Amount:
-single
paired

Allorhythmias
Bigeminy
trigeminy

Heart block
3 курс

Heart blocks
Classification:
By localization:
Sinoatrial block
Intra and inter atrial
Atrioventricular block:
proximal (AVN)
distal (His Bundle)
Bundle branch block
By duration: transitory and permanent
By origin: Structural and autonomic

Sinus node exit block occurs when the action potential initiated by the sinoatrial node is suppressed or completely blocked before it leaves the SN and reaches the atrium - therefore, the SN block is an exit block
SN exit block

SN exit blocks (SNEB)

Замещающий АВ комплекс

AV blockade
Proximal, nodular (benign).
Distal, bundle (irreversible).
1. Transient (usually nodular): lower AMI, myocarditis, drugs, hyper K+.
2. Persistent (often bundle): anterior AMI, idiopathic fibrosis.
Functional (usually nodal and up to II degree type 1) - vagotonic, in athletes.
Structural (AMI, myocarditis, cardiomyopathy).

AV block I degree

AV block II degree 1 type

200 мс
AV block II degree 2 type

AV block II degree 2:1
1
2

AB block III degree (complete)

His bundle branch block
RHBBB
Sign of block: deformity of QRS
Completeness attribute: QRS width >120 ms

Causes of RBBB
Congenital heart disease
Coronary arteryt disease
PE
COPD
Pulmonary hypertension
Cardiomyopathies
Degenerative damage to the cardiac conduction system (with aging)

LBBB