LOWN Classification

Simple VES Grade I: Monomorphic VES under 30 times per hourGrade II: Monomorphic VES over 30 times per hour
Grade I: Monomorphic VES under 30 times per hour
Grade II: Monomorphic VES over 30 times per hour
Complex VES Degree III: Polymorphic VES Degree IVa: Trigeminus/Couplets Degree IVb: Salvos Degree V: “R-on-T Phenomenon
Grade III: Polymorphic VES
Grade IVa: Trigeminus/Couplets
Grade IVb: Salvos
Grade V: “R-on-T phenomenon
Grade I: Monomorphic VES under 30 times per hour
Grade II: Monomorphic VES over 30 times per hour
Grade III: Polymorphic VES
Grade IVa: Trigeminus/Couplets
Grade IVb: Salvos
Grade V: “R-on-T phenomenon

The symptoms of ventricular extrasystoles are similar to those of supraventricular extrasystoles, so sufferers often have no symptoms. Depending on the severity of the ventricular extrasystoles, patients often experience a cardiac stutter or cardiac arrest, especially when the extrasystole causes a compensatory pause. In the case of more pronounced ventricular extrasystoles, there may be an increase in the number of cases, since the irregular beating action of the heart can no longer guarantee an adequate supply of blood to the organism.

In very rare cases, ventricular extrasystoles can also lead to ventricular fibrillation and sudden cardiac death, but more often this is associated with previous heart attacks or other heart diseases.

Disturbances of consciousness
Swindle
Weakness or fainting (syncope)

As already mentioned, extrasystoles often occur in healthy people, so that a precise explanation of the causes is often difficult. In heart-healthy people, for example, increased extrasystoles can occur.

Increased activity of the vagus nerve, which innervates the heart, can also lead to extrasystoles. This can occur particularly in people who are very active in sports. In addition to these factors, extrasystoles can also have organic causes in the heart itself.

Extrasystoles are often caused by diseases of the coronary arteries (coronary heart disease), such as heart attacks. A previous heart attack has often caused scar tissue on the heart, which blocks the normal electrical excitation conduction of the heart and can thus lead to extrasystoles. Diseases of the heart muscle (cardiomyopathies) and inflammation of the heart muscle (myocarditis) can also be causes of extrasystoles.

However, causes outside the heart can also be responsible for extrasystoles. Hyperthyroidism, for example, can cause increased extrasystoles due to an increased amount of thyroid hormones in the bloodstream, as this status is comparable to a permanent excitation of the organism. Another cause of extrasystoles can be an electrolyte disorder, especially the potassium and magnesium balance should be checked.

In case of potassium deficiency, especially a therapy with dehydrating drugs (diuretics) should be checked, since this therapy can often lead to a loss of potassium and thus can also cause the development of extrasystoles. Other drugs that can trigger extrasystoles include digitalis, sympathomimetics, antiarrhythmics and tricyclic antidepressants. If extrasystoles are suspected, the drugs used should always be checked for possible side effects on the heart and, if necessary, different doses should be administered or discontinued after consultation with the treating physician.

Emotional excitement or instability
Severe fatigue
Stimulants like alcohol, nicotine or caffeine
Drug use (cocaine, amphetamines)

The diagnosis of extrasystoles is almost exclusively done by ECG and long-term (24h) ECG. The possible organic cause of extrasystoles can only be clarified by an ECG. Exercise ECGs are also frequently used to verify whether the extrasystoles occur only under stress or are independent of it.

Similar observations can be made in a 24h long-term ECG. Here, the heart activity is recorded over 24 hours and patients are also asked to write down exactly what they did at what time and when and whether they noticed extrasystoles, for example as a heart stumbling or racing heart. In this way, statements can be made as to whether extrasystoles and certain behavioral patterns, such as drinking coffee in the morning, are causally related.

Based on the long-term ECG, the ventricular extrasystoles can be classified according to the LOWN classification. Furthermore, the diagnosis can be further confirmed by ergometry or an ultrasound examination of the heart (echocardiography). However, the exact diagnosis of extrasystoles is only sought under certain criteria.

If extrasystoles occur particularly frequently (more than 30 times per hour), are the result of heart disease or cause symptoms, it is advisable to examine the extrasystoles more closely.In the ECG, extrasystoles may appear differently depending on the time at which they occur relative to normal heart excitation. Normally, one can recognize extrasystoles in the ECG by the fact that another QRS complex, i.e. another heartbeat, is clearly outside the normal heart rhythm. Depending on whether these are monomorphic or polymorphic ventricular extrasystoles, the additional QRS complexes may be differently altered and distorted.

If an extrasystole follows shortly after the actual heartbeat, a compensatory pause often occurs afterwards, which means that a normal heartbeat cannot take place because the heart is still excited by the extrasystole. In the ECG, this can be recognized by a larger gap between two normal excitations and an extrasystole in between, compared to the actual rhythm. Sporting activity is healthy, keeps the body and mind fit and prevents many diseases of civilization.

Nevertheless, these additional beats of the heart can occur during sporting activity. Many people experience extrasystole only while doing sports because the extra beats are favored by the sport. There are two reasons for this: Firstly, there is a relative lack of oxygen in the tissue during exercise, since more oxygen is consumed during physical exertion than at rest.

This oxygen deficiency can cause increased extrasystoles because it can trigger potential fluctuations in the heart muscle cells. The second reason for the increased occurrence of extrasystoles during physical exertion is the release of adrenaline, which is needed by the body to adapt to sporting activity. By activating the sympathetic nervous system of the heart, adrenaline causes an increase in the heart rate and contractility of the heart muscle as well as an acceleration of the transmission of stimuli and a lowering of the excitation threshold. The lower excitation threshold makes the occurrence of extrasystoles more probable, since possible potential fluctuations at the end of a cardiac action can now more easily exceed the necessary threshold potential. Extrasystoles are therefore favored by sporting activity, but are completely harmless in heart-healthy people.