Premature Ventricular Contraction
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thinker
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Premature Ventricular Contraction
Кто-нибудь поделиться опытом лечения PVC? И чем это заболевание грозит в возрасте 57 лет?
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VI
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Уважаемый Мыслитель,
Всё зависит от многих деталей как, например, наличие перенесённых инфарктов, частота PVC's и общий вид кардиограммы. Поэтому ответ стандартный - идите к врачу. В общем, как можно видеть из цитаты, которую я привожу ниже, то скорее всего, ничего страшного, но надо рассматривать конкретный случай и наличие/отсутствие других симптомов и изменений в кардиограмме. Кардиолог тут, скорее всего, не нужен - задача вполне посильная для терапевта (я подразумеваю врачей с американским образованием).
Успехов.
VI
Procedures for Primary Care Physicians, 1st ed., Copyright © 1994 Mosby-Year Book, Inc. :
Prevalence of PVCs in the General Population:
Premature ventricular contractions are common. They are found in up to 50% of otherwise healthy, asymptomatic young adults. Their frequency increases with age; thus, most adults over 60 have some ventricular ectopy during a 24-hour period of monitoring. Less well appreciated is the fact that in the absence of underlying heart disease, complex forms of ventricular ectopy (e.g., multiform PVCs, ventricular couplets, salvos, or longer runs of ventricular tachycardia) are not commonly seen in most individuals. In contrast, both frequent and complex ventricular ectopy are common when underlying heart disease is present.
The term frequent when used to quantify ventricular ectopy is subject to interpretation. In a population of middle-aged individuals with underlying heart disease, frequent ventricular ectopy is most often defined as an average of more than 10 to 30 PVCs per hour over 24 hours of monitoring (i.e., at least 240 PVCs/day). In contrast, among otherwise healthy, asymptomatic young adults, a much lower definition of "frequent" should probably be used. As noted above, although up to half of these individuals have some PVCs during 24 hours of monitoring, it is unusual for them to have as many as 100 PVCs in a day.
A notable exception to these generalities is in the small subset of patients with primary electrical disease. These individuals have extremely frequent and complex ventricular ectopy despite an apparent absence of underlying heart disease. Seventy-three such subjects (with a mean age of 46) have been studied by Kennedy et al., and followed for a period of up to 10 years. Holter monitoring initially demonstrated a mean frequency of 566 PVCs/hour (range 78 to 1994 PVCs/hour) for the group. Multiform PVCs were present in 63%, ventricular couplets in 60%, and ventricular tachycardia in 26%. Extensive noninvasive cardiologic examination failed to reveal underlying heart disease in these asymptomatic individuals, although subsequent cardiac catheterization did disclose coronary artery disease in a small percentage of them. Survival data for the group showed a significantly lower mortality rate than would be expected for age-matched controls. Thus, even individuals with exceedingly frequent and complex ventricular ectopy will often have a relatively benign course when overt evidence of underlying heart disease is absent.
Clinical Significance of PVCs
The significance of ventricular ectopy depends on the clinical setting in which it occurs. Patients with PVCs who do not have underlying heart disease tend to have a benign prognosis. Even among individuals with primary electrical disease who may have alarmingly frequent and complex PVCs (as noted above), treatment is probably not indicated in the absence of symptoms when there is no underlying heart disease. In contrast, in the setting of acute ischemia with angina, any ventricular ectopy at all must be viewed as potentially significant and as a potential trigger of ventricular fibrillation.
Although left ventricular function is the most important predictive factor of mortality during the year following acute myocardial infarction, PVCs are also an
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P390
independent risk factor. Mortality in this year is related to the frequency of ventricular ectopy detected by Holter monitoring prior to discharge from the hospital. Patients with less than one PVC per hour tend to have a low (less than 10%) mortality. The figure rises sharply as a function of PVC frequency. About half of this PVC-associated mortality increase is achieved at frequencies of three PVCs per hour, with a mortality plateau (20% to 30% for the ensuing year) being reached above PVC frequencies of 10 per hour. Thus, a predischarge Holter monitor recording obtained on a myocardial infarction patient needs to be interpreted in a different light from one obtained on a patient with chronic ventricular ectopy, and the definition of "frequent" ventricular ectopy should probably be adjusted downward in such individuals.
Всё зависит от многих деталей как, например, наличие перенесённых инфарктов, частота PVC's и общий вид кардиограммы. Поэтому ответ стандартный - идите к врачу. В общем, как можно видеть из цитаты, которую я привожу ниже, то скорее всего, ничего страшного, но надо рассматривать конкретный случай и наличие/отсутствие других симптомов и изменений в кардиограмме. Кардиолог тут, скорее всего, не нужен - задача вполне посильная для терапевта (я подразумеваю врачей с американским образованием).
Успехов.
VI
Procedures for Primary Care Physicians, 1st ed., Copyright © 1994 Mosby-Year Book, Inc. :
Prevalence of PVCs in the General Population:
Premature ventricular contractions are common. They are found in up to 50% of otherwise healthy, asymptomatic young adults. Their frequency increases with age; thus, most adults over 60 have some ventricular ectopy during a 24-hour period of monitoring. Less well appreciated is the fact that in the absence of underlying heart disease, complex forms of ventricular ectopy (e.g., multiform PVCs, ventricular couplets, salvos, or longer runs of ventricular tachycardia) are not commonly seen in most individuals. In contrast, both frequent and complex ventricular ectopy are common when underlying heart disease is present.
The term frequent when used to quantify ventricular ectopy is subject to interpretation. In a population of middle-aged individuals with underlying heart disease, frequent ventricular ectopy is most often defined as an average of more than 10 to 30 PVCs per hour over 24 hours of monitoring (i.e., at least 240 PVCs/day). In contrast, among otherwise healthy, asymptomatic young adults, a much lower definition of "frequent" should probably be used. As noted above, although up to half of these individuals have some PVCs during 24 hours of monitoring, it is unusual for them to have as many as 100 PVCs in a day.
A notable exception to these generalities is in the small subset of patients with primary electrical disease. These individuals have extremely frequent and complex ventricular ectopy despite an apparent absence of underlying heart disease. Seventy-three such subjects (with a mean age of 46) have been studied by Kennedy et al., and followed for a period of up to 10 years. Holter monitoring initially demonstrated a mean frequency of 566 PVCs/hour (range 78 to 1994 PVCs/hour) for the group. Multiform PVCs were present in 63%, ventricular couplets in 60%, and ventricular tachycardia in 26%. Extensive noninvasive cardiologic examination failed to reveal underlying heart disease in these asymptomatic individuals, although subsequent cardiac catheterization did disclose coronary artery disease in a small percentage of them. Survival data for the group showed a significantly lower mortality rate than would be expected for age-matched controls. Thus, even individuals with exceedingly frequent and complex ventricular ectopy will often have a relatively benign course when overt evidence of underlying heart disease is absent.
Clinical Significance of PVCs
The significance of ventricular ectopy depends on the clinical setting in which it occurs. Patients with PVCs who do not have underlying heart disease tend to have a benign prognosis. Even among individuals with primary electrical disease who may have alarmingly frequent and complex PVCs (as noted above), treatment is probably not indicated in the absence of symptoms when there is no underlying heart disease. In contrast, in the setting of acute ischemia with angina, any ventricular ectopy at all must be viewed as potentially significant and as a potential trigger of ventricular fibrillation.
Although left ventricular function is the most important predictive factor of mortality during the year following acute myocardial infarction, PVCs are also an
--------------------------------------------------------------------------------
P390
independent risk factor. Mortality in this year is related to the frequency of ventricular ectopy detected by Holter monitoring prior to discharge from the hospital. Patients with less than one PVC per hour tend to have a low (less than 10%) mortality. The figure rises sharply as a function of PVC frequency. About half of this PVC-associated mortality increase is achieved at frequencies of three PVCs per hour, with a mortality plateau (20% to 30% for the ensuing year) being reached above PVC frequencies of 10 per hour. Thus, a predischarge Holter monitor recording obtained on a myocardial infarction patient needs to be interpreted in a different light from one obtained on a patient with chronic ventricular ectopy, and the definition of "frequent" ventricular ectopy should probably be adjusted downward in such individuals.
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Encephalon
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thinker
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