Symptomatic arterial hypertension in extrasystolic arrythmia

Type of funding sources: None.

Within the main causes of the secondary arterial hypertensions the main roles play renal, endocrine and hemodynamic. In the list of reasons of the secondary hemodynamic arterial hypertension there’re no extrasystoles.

Purpose. To determine the relationship between different types of  extrasystoles and the the secondary hemodynamic arterial hypertension.

Materials and methods.  We observed 132 patients with supraventricular and ventricular extrasystoles. Extrasystoles were divided into groups due to the moment of their appearance in cardiocycle:

1. Extrasystoles before the mitral valve opening.

2,3.  Exstrasystoles in phase of fast ventricules filling before and after the peak of transmitral blood flow.

4. Extrasystoles in slow ventricules filling phase. 

5. Other extrasystoles (allorrhythmias and group extrasystoles). 

The reason for that dividing was the different contribution of each type into the hemodynamics and heart output. We analyzed the regular, extraordinary and first post-extrasystolic contractions. Intra-arterial blood flow was estimated by ultrasound-doppler. The moment of extrasystoles appearance was determined by echocardiography, electrocardiography and 24-hours ECG monitoring. The kinetics of vessel wall was calculated by sphygmograms and included speed, acceleration, power and work parameters.

The BP measuring was made by Korotkov method that the moment of measuring was in the first post-extrasystolic wave on sphygmogram. We duplicated it after the normalization and calibration of carotid arteries sphygmograms.

Results. The main importance to the hemodynamic changes has the moment of extrasystole appearance in cardio cycle and the ability of the first post-extrasystolic contraction to reestablish an adequate resulting blood flow. It is characterized by: stroke volume rising from 5 to 40%; systolic BP increase up to 30% (with formation of the secondary hemodynamic AH) compared with the systolic BP with normal heart rate; rising of arterial walls kinetic parameters (speed, acceleration, power, work); blood flow velocity rising; grown arterial wall deformation.  The maximum of these parameters was in first post-extrasystolic contraction with extrasystoles before the mitral valve opening and extrasystoles before the transmitral peak blood outflow.

The special hemodynamic situation appears when there’re allorrhythmias when, for example, in case of constant bigeminia, BP is increased in 50% of time, and in case of trigimenia – in 1/3 of time.

Conclusion. We believe it’s necessary to include extrasystoles into the list of the reasons of  the  secondary hemodynamic arterial hypertension. The main features of this type of AH are: unstable BP rising, prevalence growth of systolic BP, direct relationship with extrasystoles’ appearance moment. The risen blood flow of first post-extrasystolic contraction can be the reason of additional arterial walls deformation and complications that may cause the any AH.