Extrasystoles are heart problems in which the ventricle of the heart compresses prematurely, i.e. before it is filled with blood.

The heartbeat is triggered by an electrical signal coming from some specialized cells of the right atrium.
The electrical signal propagates downwards to the atrioventricular node (AV), which is a part of the heart with specialized cells.
From the AV node, the signal runs along special fiber bundles in the heart wall to the ventricles, the lower chambers of the heart.
The electrical impulse causes a contraction of the ventricles that pump the oxygen-rich blood into the body.

Premature ventricular contraction (PVC) is a premature heartbeat that originates in the ventricles and disrupts normal heart rhythm.
Extrasystole occurs in this order:

  1. a normal heartbeat,
  2. an additional blow (PVC),
  3. a short break,
  4. a stronger heartbeat than usual.

The heart fills with a larger amount of blood in the break after PVC, the subsequent contraction is therefore stronger.
This model can be random or at specific intervals.
Premature ventricular heartbeat is also possible in a healthy heart and is common in well-trained athletes.
Extrasystole can also be seen in fetuses, but if the heart is healthy, this is nothing to worry about.
Atrial extrasystoles are not dangerous.

Types of extrasystoles

  1. In the bigeminal nerve, every normal contraction is followed by a premature ventricular contraction.
  2. In the trigeminal nerve, two normal beats are coupled with a ventricular extrasystole.
  3. In the quadrigeminus, three ventricular contractions and one premature contraction occur.


Symptoms of cardiac extrasystoles

Often, premature ventricular contractions do not cause symptoms, but you may have a strange sensation in the chest, for example:

  1. Palpitation
  2. a stumbling heart sensation
  3. a heart that stops
  4. Heartbeat loss
  5. Lump in your throat
  6. increased awareness of the heartbeat

Patients with premature ventricular contractions have no symptoms, but in rare cases may occur:

  1. Fatigue
  2. dizziness or drowsiness,
  3. Nausea
  4. Faint.

The reason for this is that premature ventricular contractions can reduce cardiac ejection to the organs.
The result is low blood pressure.

Patients with three or more consecutive premature ventricular contractions have ventricular tachycardia.
Prolonged ventricular tachycardia can lead to decreased cardiac output, low blood pressure and fainting (syncope).
Ventricular tachycardia can lead to ventricular fibrillation, which is an abnormal heart rhythm that can be fatal.

What are the causes of ventricular extrasystoles?

Even though ventricular extrasystoles (VES) occur more frequently, doctors are not always able to figure out the reason for this.

Risk factors include:

  • some types of medicines, such as stimulants and asthma medications
  • hormonal imbalance
  • Lesions of the heart muscle due to coronary disease, congenital heart disease or infections (myocarditis)
  • Alcohol and drugs
  • Caffeine
  • Fear;
  • Stomach problems such as reflux esophagitis, gastritis and hiatal hernia, in this case, extrasystoly occurs during digestion (after eating). The gastroesophageal reflux can also cause coughing and bitter taste in the mouth, but these symptoms are not caused by extrasystoles.
  • Postprandial extrasystoles (occurring after eating) may be the cause of compression of the vagus nerve, which can alter the heartbeat. The pressure on the vagus nerve can provoke extrasystoles, which occur with deep inhalation or when the individual bends forward.
  • Pregnancy, due to physical change and especially because of the increase in size of the uterus
  • high blood pressure or hypertension


With frequent premature ventricular contractions, there is an increased risk of developing changes in the heartbeat (arrhythmia).

If extrasystoles occur in patients with heart disease, dangerous arrhythmia can develop and sudden death can occur, but these are rare events.

Diagnosis and diagnostic examinations

If the doctor suspects extrasystoly, he can order an electrocardiogram (ECG). This investigation can reveal extra shocks, the type of electrical wave, and the origin.

If premature ventricular contractions occur rarely, they may not be revealed during this examination.
It may be necessary to wear an event recorder or a Holter ECG for at least 24 hours.

Standard ECG
In a standard ECG, sensors (electrodes) are placed on the chest and extremities to record a graphical picture of the electrical signals passing through the heart.
The duration of the examination is a few minutes.

Stress ECG
This diagnostic examination is used to record the electrical activity of the heart while walking on a treadmill or riding on a bicycle ergometer.
This can help determine the importance of extrasystoles. If premature heartbeats disappear or decrease during the test, then they are considered harmless.

Dynamic Holter electrocardiogram
This portable device is carried in your pocket or on a shoulder strap.
It automatically registers cardiac activity over a period of 24 hours and shows the doctor the heart rhythm.

Event Recorder
This portable ECG is worn like a Holter ECG.
If the patient feels symptoms, he presses a button and the device records the electrical heart activity for a short time.
This allows the doctor to see the heart rhythm when symptoms appear.

Diagnostic blood tests for disorders causing the extrasystoles include:

  1. electrolyte levels in the blood to control low levels of potassium or magnesium (hypokalemia or hypomagnesaemia);
  2. drug levels in the blood, the toxicity of digoxin and aminophylline or the enzyme levels of the thyroid gland are checked, for example, hyperthyroidism can provoke extrasystoles;
  3. The oxygen content of the blood (oximetry) can be measured to detect hypoxia;
  4. The blood tests may be done to detect the use of drugs or amphetamines;
  5. Blood levels of heart enzymes such as creatine kinase (CK) and troponin are examined to detect myocardial damage as a result of a heart attack.

Antiarrhythmic drugs

Arrhythmias drugs are used to control premature ventricular contractions with the aim of preventing ventricular tachycardia, ventricular fibrillation and sudden cardiac death.

Antiarrhythmic drugs include beta-blockers such as amiodarone (Cornaron). Unfortunately, there is little scientific evidence to confirm that antiarrhythmic drugs prevent tachycardia and ventricular fibrillation.
Beta-blockers are prescribed to many heart patients for various reasons, not only for arrhythmias.

For anxiety, the doctor may prescribe antidepressants such as bromazepam (Lexotanil).

Natural remedies for ventricular extrasystoles

The following remedies can control extrasystoles and improve heart health.
If the examinations reveal no existing heart disease or risks to the heart (isolated or benign extrasystoles), the patient does not need any medication.

  • Triggering substances or events. In the case of frequently occurring symptoms, the symptoms and activities can be written down. This helps identify substances or activities that can trigger extrasystoles.
  • Avoid certain substances. Caffeine, alcohol, tobacco and drugs can trigger premature ventricular contractions. Decreasing or discontinuing these substances may reduce symptoms. Extrasystoles in the evening or during the night are often caused by drinks or vices.
  • Reduce stress. Anxiety can lead to abnormal palpitations, especially at night or early in the morning. If anxiety causes extrasystoles, one should try relaxing techniques such as meditation or physical exercises.
  • Herbal remedies. Hawthorn extract contains proanthocyanidins and flavonoids that normalize heart rhythm and reduce anxiety.
  • Osteopathy. This therapy can be effective in removing obstacles that compress the vagus nerve and relaxing the diaphragmatic muscles.

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