Extrasystoles: Causes

Pathogenesis (development of disease)

Extrasystoles are premature contractions of the heart muscle between normal contractions due to autonomic excitation. Extrasystoles do not originate in the sinus node (which is the normal pacemaker center) but in ectopic (outside the normal pacemaker structures) excitation centers. Depending on the place of origin in the heart, a distinction is made between ventricular extrasystoles (VES, which originate in the ventricles) and supraventricular extrasystoles (SVES, which originate in one of the atria). Supraventricular extrasystole is divided into:

  • Atrial SVES (ectopic focus is in the atrial myocardium/muscle of the atria).
  • Nodal SVES (ectopic focus is at the AV node; synonym: AV junctional SVES).

Ventricular extrasystole (VES) occurs in one of the ventricles (heart chambers). In this case, excitation from a ventricular ectopic (located outside the normal pacemaker structures) focus spreads across the ventricles.

  • A distinction is made between right ventricular and left ventricular extrasystoles.
  • VES often occur in the context of increased sympathetic tone (state of excitation of the sympathetic nervous system) or also in the context of relevant structural heart disease – most commonly myocardial ischemia (reduced blood flow to the heart muscle).
  • Polymorphic VES (arise at multiple sites of origin in the ventricle/cardiac chamber) usually indicate non-ischemic cardiomyopathy (myocardial disease not associated with inferior blood flow).

Most often, however, extrasystoles are without disease value.

Etiology (causes)

Behavioral causes

  • Diet
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
  • Consumption of stimulants
    • Alcohol – 6 drinks (70 g alcohol) daily: 200% increased risk of supraventricular arrhythmias.
    • Coffee
    • Tobacco (smoking)
  • Psycho-social situation
    • Stress

Causes related to disease

  • Cor pulmonale – right heart strain due to lung disease.
  • Hypertensive heart disease – heart disease due to hypertension (high blood pressure).
  • Coronary heart disease – atherosclerosis (arteriosclerosis, hardening of the arteries) of the coronary arteries.
  • Meteorism (flatulence) → due toRoemheld syndrome (reflex cardiac symptoms caused by gas accumulation in the intestine and stomach; eg. after lavish, high-fat meal; symptomatology: extrasystoles (heartbeat occurring outside the physiological heart rhythm), sinus bradycardia (< 60 heartbeats/min), sinus tachycardia (> 100 heartbeats/min), angina pectoris (chest tightness; sudden pain in the cardiac region), dysphagia (dysphagia), syncope (brief loss of consciousness), vertigo (dizziness)).
  • Mitral valve stenosis – narrowing of a heart valve.
  • Myocardial infarction (heart attack)
  • Myocarditis (inflammation of the heart muscle)

Laboratory diagnoses – laboratory parameters that are considered independent risk factors/causes.