To understand how a violation of myocardial repolarization develops, its causes should first be studied. There are only a few:
- diseases of the neuroendocrine system that regulates the functioning of the cardiovascular system;
- heart diseases. This may be an electrolyte imbalance. Often the causes are coronary heart disease, hypertrophy;
- prolonged and uncontrolled medication. We are talking about drugs that negatively affect the heart.
Important! Recently, more and more often they began to diagnose a violation of ventricular myocardial repolarization in adolescents. So far, it is not possible to name the exact causal factors of development. But statistics show that in most situations, the pathology goes away on its own, without even requiring medical intervention.
If repolarization of the left ventricle of the myocardium or a violation of the process of cell restoration in any other part of the heart muscle is detected, a person needs to undergo a course of treatment to get rid of this pathological condition, to prevent the development of its complications. Therapy is as follows:
- Vitamin preparations. They must be taken to provide the heart with a good nutrition with useful substances and trace elements important in its work.
- Corticotropic hormones. These are drugs containing cortisone in their composition. This substance favorably affects all processes that occur in the heart.
- Cocarboxylase hydrochloride. Participates in the normalization of carbohydrate metabolism, stabilizes the functioning of the central and peripheral nervous system. It also has beneficial effects on the heart and blood vessels.
- Beta blockers. They are used to eliminate heart diseases that can cause repolarization disorders in the heart muscle.
Considering the fact that any cardiological preparations have a rather strong effect on the body, it is important for the patient to strictly adhere to the dosage determined by the attending physician and the duration of the course of treatment.
There are situations when treatment of impaired repolarization of the heart muscle is not required at all. If the patient’s state of health is assessed well, he is not worried about any symptoms, before prescribing medication, doctors can try to do without it, recommending the person the following:
- restoration of a full, balanced diet, which involves the use of foods rich in vitamins. The exception of fatty and fried foods;
- normalization of the regime of activity and rest, suggesting moderate physical activity, full and high-quality sleep;
- stabilization of the emotional state, minimizing any stressful situations.
After some time following the recommendations, the patient is enough to undergo a re-examination. If the results show the absence of any deviations, then the non-drug treatment of repolarization disorders can be considered successfully completed.
Next, you will only need to periodically visit a cardiologist for the purpose of preventive diagnosis. The time interval between examinations will be determined by the doctor.
Common causes of violations of the repolarization process include:
- the effect of drugs;
- coronary heart disease;
- electrolyte imbalance;
- metabolic disorder (diabetes mellitus);
- hormonal disorders (hyperthyroidism);
- violation of myocardial depolarization;
- overstrain of the heart muscle;
- ventricular hypertrophy of the heart.
Dystrophic and inflammatory lesions of the heart muscle, as well as diseases that cause abnormalities in the neuroendocrine regulation of the cardiovascular system, can lead to impaired repolarization.
A serious pathology leading to disruption of the myocardial repolarization process is hypersympathicotonia. It develops in childhood. In patients with hypersympathicotonia, the level of adrenaline and norepinephrine in the blood is twice the norm.
In some cases, a medical examination does not reveal the causes of the development of myocardial repolarization disorders. In this case, they talk about non-specific causes of the disease. Most often, such disorders occur in adolescents and pass on their own over time.
Violation of myocardial repolarization can occur due to severe stress or physical overstrain. Also, a violation of repolarization can begin during pregnancy or during menopause, when the hormonal background changes dramatically.
When a violation of myocardial repolarization is detected, an ultrasound of the heart and a stress test are performed to exclude or confirm coronary heart disease. If chest pain and other symptoms do not appear during a stress test, then a change in repolarization is associated with hormonal imbalances, the presence of a chronic infection in the body, or other causes.
In some cases, to normalize the cardiogram, it is enough for a certain period of time to have a good rest and start to fully eat, as well as avoid stress and strong physical exertion.
Numerous studies have shown that impaired myocardial repolarization can be triggered by hundreds of reasons. All of them are divided into several main groups, depending on their characteristics:
- diseases associated with impaired neuroendocrine system. It is she who partly regulates the work of all organs of the cardiovascular system;
- heart disease – these include ischemia, hypertrophy, electrolyte imbalance;
- pharmacological effect – uncontrolled intake of drugs that have a negative effect on the heart.
Non-specific reasons are also known that can provoke a change in the processes of myocardial repolarization. In this case, imply its diagnosis in adolescents. The exact list of factors provoking these disorders is not yet known to doctors. But, practice shows that in adolescence, a violation of ventricular myocardial repolarization is quite common, in most cases, goes away on its own, without requiring medical treatment.
Violation of the processes of myocardial repolarization leads to the fact that the cells of the heart muscle are not able to adequately respond to nerve impulses, contractions occur late or occur with insufficient force. This leads to the development of various arrhythmias, hypertrophic and dilatational changes in the myocardium, worsening of blood supply to organs and systems. The most severe consequence is the development of chronic heart failure.
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The speed with which life-threatening complications develop varies greatly depending on the condition of the patient, the characteristics of his lifestyle, and the presence of concomitant diseases. Sometimes heart disease can be detected by a worsening of the general condition in patients with chronic pathologies of other organs and systems – in the conditions of worsening blood supply, the disease is more severe.
It should also be noted that it is the anterior septal area that is most susceptible to ischemic changes, and this is one of the most frequent localizations of myocardial infarction.
Patients with ECG changes that are characteristic of impaired repolarization processes in the anterior septal area are prescribed a series of additional tests and instrumental methods to determine how much pathology affected the activity of the heart.
In particular, methods such as echocardiography and ultrasound scan are used, allowing you to find out the state of blood flow, determine the presence of blood clots in the vessels and chambers of the heart. Halter ECG detects changes in electrical activity during the day. A biochemical blood test reveals a metabolic disturbance of the microelements necessary for normal heart function, and also allows you to notice an increase in enzyme activity characteristic of damage to the heart muscle.
Determination of neurological status, a blood test for hormones, a history of taking, including medicine, can identify causes that adversely affect myocardial repolarization.
To normalize the electrical activity of the heart, the patient is recommended to reconsider his lifestyle and diet. It is advisable to limit physical and emotional stress, pay attention to physical therapy, walks in the fresh air. In addition, it is advised to normalize weight, if necessary, add more vegetables and fruits, vegetable oil, dietary meat and cereals to the diet.
Of the drugs prescribed drugs containing potassium and magnesium – Cardiomagnyl, Asparkam and others. They are the suppliers of the necessary ions, and at the initial stages of the disease, their regular intake is enough to return the patient to a full life. In more severe cases, drugs from the group of OI-blockers (Bisoprolol, Metaprolol) are used.
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Violation of myocardial repolarization is often asymptomatic, which is extremely dangerous for human life. Pathology can be detected by chance during an ECG examination.
Changes by which a diagnosis can be made are visible on the cardiogram; can distinguish violation of repolarization of the ventricles and atria.
- Atrial depolarization is indicated by the P wave.
- On the cardiogram, the Q and S teeth are down (negative), and R, on the contrary, is up (positive), which indicates the depolarization of the ventricular myocardium. In this case, there can be several positive R waves.
- Deviation of the position of the T wave is a characteristic sign of ventricular repolarization.
The form of the course of the pathology is the syndrome of early repolarization, when the processes of restoration of the electric charge occur earlier than the due date. On the cardiogram, this syndrome is displayed as follows:
- from point J, the ST segment begins to rise up;
- unusual nicks appear in the descending part of the R wave;
- on ST rise in the cardiogram concavity is formed, which is directed upwards;
- the T wave becomes narrow and asymmetric.
Causes of impaired repolarization processes in childhood
IHD as a cause of ventricular myocardial repolarization processes
Appeal to a specialist
- Why do repolarization disorders occur?
- ECG changes
- 4 Diagnostics
- 5 Treatment
- Violation of repolarization in the myocardium: what is it, is treatment necessary
- How to determine deviations from a cardiogram
- Violation of repolarization processes
- Danger state
- Reasons for change
- Medical tactic
- Features of treatment
- Characteristic features of impaired repolarization on the ECG
- Heart cycle description
- Why does this pathology arise?
Why do repolarization disorders occur?
Various reasons can change the ongoing process:
- Diseases of the cardiac and vascular systems – cardiosclerosis, left ventricular hypertrophy, vegetative-vascular dystonia, ischemia.
- Factors not related to cardiovascular pathologies – hormonal disorders, dehydration, impaired renal function, pathology of the nervous system, increased frequency of excitation stage pulses to the heart.
Changes in the functional activity of mediators of adrenergic substances (adrenaline and norepinephrine) can cause some neoplasms. A pathological change in repolarization is observed with an increase in the QT segment, a decrease in the QT interval, and an syndrome of the early end of the excitation phase. Now we will dwell on each of them.
The main reason for the malfunctioning of ion channels is a hereditary predisposition. This phenomenon is quite rare and occurs in one person for 6 thousand. Due to the influence of a genetic factor in the cells of the heart muscle, the ion balance is disturbed, which leads to a lengthening of the excitation process. Such a disorder manifests itself at any age, its clinical signs are sudden and unreasonable tachycardia, which is displayed on the cardiogram as an increase in ventricular contractions with changes in the configuration of the QRS complex. This condition is observed:
- with an emotional outburst;
- taking certain medications;
- sudden loss of consciousness.
This deviation is also quite rare – its appearance is associated with congenital anomalies and gene mutations. Changing the length of the QT segment is caused by improper operation of the potassium channels. It is possible to diagnose a shortening of the repolarization phase if the patient has constant arrhythmia, fainting, frequent attacks of tachycardia, a sudden slowdown in heart rhythm.
A qualified cardiologist may suspect the presence of this pathology even with the appearance of “heartless” signs: an increase in body temperature, an increase in the concentration of calcium or potassium in the blood, a shift in the level of the medium (pH) towards acidity, and the use of cardiac digoxin glycoside. If the ECG records a QT interval of less than 0,33 seconds, this confirms a shortened repolarization process.
Until recently, this change was not considered a pathology. However, recent scientific research suggests that this disorder is considered sinus arrhythmia. Today it is most common among young people who are actively involved in sports. A clear clinical symptomatology of the disease is not observed, but there are a number of reasons that can cause it:
- excessive physical stress;
- a change in blood balance of electrolytes;
- ischemic disease;
- prolonged hypothermia of the body;
- diffuse change in the myocardium of one of the main chambers of the heart – the left ventricle;
- increased blood lip >
ECG of the heart. Impaired myocardial repolarization
Violation of ventricular myocardial repolarization is not a diagnosis, but just a conclusion that the doctor of functional diagnostics leaves on an electrocardiogram. The ECG conclusion only supplements the complex of diagnostic measures. ECG signs of impaired repolarization processes is a change in the ST segment and T wave.
The main signs of impaired myocardial repolarization processes are flattening or negative T wave, as well as a decrease in the ST segment in the chest leads. These changes can be diffuse or local in nature, affecting the anterior, posterior, lower, lateral wall or a specific area of the heart. During pregnancy, a decrease in the ST segment to 0,5 mm below and 1-3 mm above the contour is acceptable. The T wave in most patients becomes negative, smoothed, or biphasic.
In the chest leads, a gradual decrease in the amplitude of the T wave by the end of pregnancy can be observed, which is not a pathological sign. In middle-aged and older patients with impaired myocardial repolarization, a diagnostic search, as a rule, is aimed at identifying possible cardiovascular pathology.
It is dangerous that the change in the processes of repolarization does not manifest itself in any way. A person learns about him only after passing an ECG, to which he was sent for a completely different reason. The electrocardiogram will show such violations:
- A modified P wave, indicating atrial depolarization.
- Violations in the QRS complex. The teeth Q and S in this case are negative, R is positive.
- Deviations from the normal values of the T wave. They also indicate a violation of repolarization.
Among all cases, doctors often diagnose early myocardial repolarization syndrome. It is notable for the early appearance of arousal in the subepicardial parts of the heart muscle. This condition is not manifested by symptoms that the patient himself might have noticed, is noted only during the examination. In addition, it is diagnosed even in healthy people, and was previously considered the norm, today it begins to cause concern among doctors, because it is quite common – in about 8% of patients undergoing examination. On the electrocardiogram, the syndrome of early repolarization of the ventricles of the myocardium is manifested as follows:
- violation in the characteristics of the ST segment, wrong T wave;
- systematic rise of ST over the isoline by 1,2,3 mm;
- the presence of a notch before an increase in ST;
- rounded ST shape;
- ST convex, which is directed downward;
- base extension T.
Regardless of what type of pathology is diagnosed, doctors will refer the patient to an additional examination, which allows to obtain complete information about his state of health, to select effective treatment. So a person has yet to undergo daily monitoring of ECG, ultrasound of the heart, electrophysiological examination.
Important! It should be noted that after physical exertion that a person suffered, the symptoms of SRGR on the electrocardiogram no longer appear. They disappear after an increase in heart rate.
Samples with potassium may also be used. After a person takes potassium chloride or panangin, an increase in signs of repolarization is observed on the ECG.
Diagnosis of myocardial repolarization disorders is made using an ECG. When diagnosing the syndrome of early myocardial repolarization on a bicycle ergometer, the excitation wave is normalized by increasing the number of heart contractions, which leads to the disappearance of signs of repolarization disturbance on the ECG. Also, normalization can be observed with a sample with potassium (the patient should take at least 2 g of this substance).
Early repolarization syndrome needs to be differentiated from acute myocardial infarction, left ventricular hypertrophy, pericarditis and intoxication with certain drugs.
The presence of repolarization disorders is determined by the ECG according to characteristic changes in the ST segment and T wave. These changes can be observed in all or part of the ECG leads. Sometimes they can be used to judge the causes of these violations, and sometimes not. For additional verification of the diagnosis, doctors prescribe examinations:
- Laboratory blood tests to detect inflammatory diseases, metabolic and electrolyte problems.
- Echocardiography is an ultrasound examination of the heart, allowing to reveal its structural changes and impaired myocardial contractility.
- Coronarography is a study of patency of the coronary arteries supplying the heart.
In addition to the electrocardiogram and to diagnose a violation of the processes of repolarization, the cardiologist may prescribe other studies:
- Functional pharmacological tests (most often, potassium chloride and anaprilin).
- Ultrasound examinations.
- Samples with physical activity.
- Hormonal status research
Since diffuse repolarization disorders do not differ in the specific clinical picture, a thorough diagnosis is necessary to clarify the diagnosis. First of all, a cardiologist:
- ascertains the nature of the current clinical picture – what symptoms appear, their duration, frequency;
- collects personal and family history;
- examines the patient’s medical history;
- ascertains whether the patient is taking any medications without a doctor’s prescription.
In addition, they carry out such diagnostic measures as:
- general and biochemical blood test;
- coronary angiography;
- chest x-ray;
- blood test for hormones.
Based on the diagnostic results, the doctor determines the cause of the onset of symptoms, the nature of the pathological process and treatment tactics that will help eliminate the violation of repolarization in the ventricular myocardium. The course of basic therapy will be aimed primarily at eliminating the root cause factor. If cardiac pathology is established, then a pacemaker is set for the patient.
- to stabilize blood pressure.
The appointment of drugs is carried out strictly on an individual basis. It is strongly not recommended to take them on your own or make adjustments to the scheme prescribed by a doctor. In addition to directly directed against the pathology of medical measures, you should adhere to the general recommendations:
- limit yourself to physical activity;
- quit smoking and excessive drinking;
- Healthy food;
- avoid stress and nervous experiences;
- control your blood pressure;
- take daily walks in the fresh air.
Subject to all doctor’s recommendations, serious complications can be avoided and cardiac performance can be stabilized. If isolated, that is, without cardiac pathology, impaired repolarization processes is diagnosed, the prognosis is favorable. In other cases, everything will depend on what caused the development of the pathology.
Action potential of the heart cell
In fact, it’s not worth going to the very back of the heart electrophysiology. It is important to understand the basic principles of the electrical work of the heart.
The muscle membrane of the heart or myocardium can be in an excited state and at rest.
Having reached the muscle cell, the impulse transfers the cells of the heart muscle from the resting state to the state of excitation (depolarization) through a chain of biochemical reactions.
Due to this, the chambers of the heart contract, expelling oxygen-enriched blood to the great vessels and providing tissues and organs with it.
After a pulse run, the excited membrane acquires its former charge, passing into the resting phase. Such a phase change allows not only the conductive system, but also the entire myocardium to prepare for the next reduction without loss.
However, sometimes for certain reasons, there may be a violation of myocardial repolarization.
Similar changes in the cardiogram can be not only in an adult, but also in a child. Not always the presence of such changes indicates a pathology of the cardiovascular system.
What could be the reason for the violation of repolarization processes in childhood? Two main groups of causes can be distinguished. The first group is functional in nature.
Very often, the intensive growth of the child’s body and an increase in physical exertion, emotional upheaval and other factors lead to an inadequate response of the cardiovascular system.
A number of diseases that affect the electrophysiological state of the myocardium can be the cause of ventricular repolarization disorders. Not always these diseases affect the cardiovascular system, other organs and systems may be involved.
Possible causes may include thyrotoxicosis, decreased thyroid function, anemia, chronic tonsillitis, inflammation of the heart muscle, neurocirculatory dystonia, cytostatic drugs, glucorticosteroids, non-steroidal anti-inflammatory drugs, pneumonia, bronchial asthma, etc.
Quite often, patients may not complain. During pregnancy, such changes in the cardiogram may be recorded. As a rule, these changes are not diffuse, but local.
Clinically, a violation of the repolarization processes in pregnant women may not manifest itself in any way.
An increase in the volume of the vascular bed and the volume of circulating blood during pregnancy are characterized by certain changes in the ECG, which should not be forgotten before rushing into a panic.
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Violation of ventricular myocardial repolarization is not a diagnosis, but just a conclusion that the doctor of functional diagnostics leaves on an electrocardiogram. The ECG conclusion only supplements the complex of diagnostic measures.
ECG signs of impaired repolarization processes is a change in the ST segment and T wave.
Unlike the syndrome of early repolarization, they are nonspecific in nature and can be observed in a number of diseases not only of the cardiovascular, but also of other systems.
These changes can be diffuse or local in nature, affecting the anterior, posterior, lower, lateral wall or a specific area of the heart. During pregnancy, a decrease in the ST segment to 0,5 mm below and 1-3 mm above the contour is acceptable.
The T wave in most patients becomes negative, smoothed, or biphasic.
In the chest leads, a gradual decrease in the amplitude of the T wave by the end of pregnancy can be observed, which is not a pathological sign.
In middle-aged and older patients with impaired myocardial repolarization, a diagnostic search, as a rule, is aimed at identifying possible cardiovascular pathology.
Therefore, an electrocardiographic study can be supplemented by a number of instrumental and laboratory methods necessary for a specialist to make a diagnosis.
Seeing such a conclusion on the ECG, do not rush into a panic and think up all kinds of scary stories. This still does not mean anything. It’s worth starting with your doctor and starting to dot all the “and”.
Identification and elimination of the cause can lead to the fact that the ECG of both a child and an adult returns to normal. It is not the ECG that needs to be treated, but the patient. First of all, you need to find the root cause and try to eliminate it.
In a child, it is necessary to correctly select the regime of physical exertion, minimize emotional stress, deal with the treatment of pathology of ENT organs, etc.
The course without symptoms is not observed in all cases of violation of the repolarization process. Sometimes pathology can occur with vigorous physical activity. In this case, the patient experiences a change in heart rate.
The disease may also be accompanied by:
After some time, pains in the heart come, the rhythm of the heartbeats becomes more frequent, sweating increases. These symptoms are not specific, and when they occur, you need to differentiate the disease from other heart diseases.
If you do not start therapy in time, then the symptoms become more pronounced and longer in time. The patient begins to experience shortness of breath, and swelling occurs on his legs.
The treatment of repolarization disorders depends on the cause of the pathology. If such a cause is not identified, the following is used in the treatment:
- Complexes of vitamins and minerals. They help to restore the activity of the heart, providing the flow of beneficial substances and trace elements.
- Beta-blockers (Anaprilin, Panangin).
- Corticotropic hormones. They have a positive effect on the activity of the heart.
- Cocarboxylase hydrochloride. Helps to restore carbohydrate metabolism and has a positive effect on the cardiovascular system.
The patient is taken to the dispensary, periodically monitoring the results of treatment by repeated ECG.
- decrease in sweating, secretion of saliva and mucus;
- dry skin;
- pain in the heart;
- noticeable change in mood;
- increase in blood pressure.
Usually, in conclusion, a specialist writes a transcript for precisely these indicators. But if the patient already has some kind of diagnosis or is suspected of having, more detailed data are indicated, where attention is paid to specific violations of certain indicators (for example, the length of specific teeth or intervals, the distance from certain points).
- Coronary heart disease.
- Thickening (hypertrophy) of the heart.
- Overexertion of the heart ventricles.
- The presence of additional ventricular chords.
- Electrolyte (calcium, potassium, magnesium) imbalance.
- Hypersympathicotonia (disorders related to the processes of repolarization in the myocardium are explained by an increased concentration of norepinephrine, adrenaline, tissue hypersensitivity to hormones).
- Abuse of medications (taking medications not prescribed by a doctor, exceeding the prescribed dosage).
- Regular drinking.
- Complications of diseases of the neuroendocrine system involved in the regulation of vital functions of the heart and blood vessels.
- Hormonal disruptions.
- Impaired thyroid function, diabetes, and other diseases affecting the endocrine system.
- Severe menopause, pregnancy. During pregnancy, the cardiovascular (as well as others) body system is susceptible to the effects of negative factors, therefore, with the first symptoms of impaired repolarization processes in the myocardium, you should consult your doctor.
- Staying in a state of chronic stress.
- Intense physical exertion, professional sports activities.
- Negative effects of exposure to low temperatures.
- Age factors.
- Heart defects (congenital, acquired).
- Tumor diseases.
- Traumatic brain injuries.
- Hereditary predisposition to cardiovascular disease.
Violation of repolarization in the myocardium: what is it, is treatment necessary
- Increased temperature
- Memory impairment
- Heart rhythm disturbance
- Rapid pulse
- High blood pressure
- Pallor of the skin
- Tingling in the heart
- Blood pressure fluctuations
- General worsening
- Slow heartbeat
Violation of the processes of repolarization is a disease during which the phase of repolarization shortens or becomes longer in time. Such a violation can be symptomatic, but this can only be determined by conducting the necessary diagnostic measures.
If the reasons that could cause such changes in the myocardium cannot be established, then the main treatment is aimed at nourishing and supporting the heart muscle. With such changes, vitamin complexes, cocarboxylase hydrochloride, hormonal preparations, potassium, magnesium preparations can be recommended. In any case, it is necessary to consult a specialist in order to timely engage in the treatment or prevention of cardiovascular diseases. Be healthy!
- Beta-blockers (anaprilin, panangin). They are prescribed only in case of a significant threat to the health or even the life of the patient.
- Drugs that stimulate the synthesis of carbohydrates from proteins (corticotropic hormones – cortisone).
- Drugs that improve heart function, control carbohydrate metabolism in the body and normalize processes in the central and peripheral nervous system (specifically trophic) – cocarboxylase hydrochloride
- Complexes of vitamins and minerals that make up the missing components.
Violation of the processes of repolarization can be due to many factors. But all of them can be diagnosed and compensated in a timely manner. An already existing disease speaks of missed diagnoses. In case of problems with the cardiovascular system, neglect of the simple rules of prevention can cause serious harm to health.
- Mineral and vitamin complexes (contribute to meeting the needs of cells of a vital organ in essential substances).
- Cocarboxylase hydrochloride (provides normalization of carbohydrate metabolism, prevents neurological disorders, improves the condition of the heart and blood vessels).
- Corticotropic hormonal drugs (due to the content of cortisone, cardiac pathologies are eliminated).
- Beta-blockers (eliminate concomitant diseases that affect the heart).
To increase the effectiveness of the treatment of diffuse disorders of the processes of repolarization in the myocardium, it is advisable:
- Minimize consumption of fried, fat-rich foods, give up alcohol.
- Vitaminize the diet.
- Optimize the day (exclude physical overload, eliminate sleep disturbances).
- Avo >
In the absence of severe symptoms, as prescribed by the doctor, the treatment course is limited to organizational measures, potent drugs are not used. If the prerequisites for the development of unsafe ventricular tachyarrhythmias are created, the syndrome of shortening of the QT interval progresses, and conservative methods do not lead to an improvement in dynamics, there is a need to install an electrical pacemaker.
How to determine deviations from a cardiogram
Not a single doctor makes a diagnosis or prescribes treatment only by the results of electrocardiography! For this purpose, anamnesis data and a complete clinical picture of the patient’s pathological condition are collected, additional studies are performed: echocardiography, ultrasound scanning of the heart, functional stress tests.
It is difficult to unambiguously interpret the final data of the ECG curve – this is due to the heterogeneous nature of bioelectric processes. After conducting a comprehensive examination and establishing an accurate diagnosis, a qualified cardiologist prescribes a course of therapeutic measures aimed at eliminating the etiological causes of pathological changes.
- regularly monitor the ECG;
- eat rationally;
- to carry out activities aimed at strengthening the state of health of the body and preventing the formation of pathological processes;
- comply with the recommendations of the attending physician about the possibility of physical activity;
- constantly take vitamins and prescribed medications.
The prognosis of the course of heart diseases when the patient fulfills all the instructions of an experienced specialist is completely favorable. The presence of deaths of close relatives from sudden cardiac arrest is very important – this phenomenon significantly complicates the prognosis. The absence of a burdened family history has a more favorable meaning.
- Pathological changes in the T wave;
- ST segment deviation from the contour;
- Violation of the indicators of the QRS complex (normal Q and S teeth are negative, and R wave is positive);
- P wave change
The ECG syndrome of early repolarization of the ventricles of the heart is characterized by some specific abnormalities:
- the ST segment begins to rise from point J;
- T wave narrow, significant violation of symmetry;
- nicks or other changes occur in the lower part of the R wave;
- an upward concavity is formed in the interval of the ST segment.
Violation of repolarization processes
Under the influence of a changed hormonal background, nonspecific disturbances of repolarization processes occur. In many cases, they do not appear and do not bother a woman. However, they should still be remembered, because in some situations they can lead to the development of arrhythmias and severe hemodynamic disorders. In order to prevent the development of conditions dangerous to health and life, the following rules must be observed:
- daily pressure measurement;
- a visit to the therapist immediately after confirmation of pregnancy, subsequently every 4 weeks;
- ECG recording on the recommendation of a doctor, or every three months and immediately before birth;
- for women with a cardiac pathology identified before pregnancy – observation by a cardiologist
- if you experience any discomfort in the heart area – an immediate consultation with a cardiologist.
Compliance with such recommendations will save the health of not only the expectant mother, but also the baby.
Diffuse disorders of repolarization of the heart are changes that are clearly visible on the cardiogram. They can occur in the elderly as a marker of cell involution or in people of all ages as a marker of external effects on the heart.
Diffuse disorders of the processes of repolarization in the myocardium are dangerous because there is a high probability of an additional reduction before the end of the process of repolarization.
Clinically, this is manifested by the appearance of extrasystoles (in the best case, supraventricular, in the worst – ventricular).
In severe cases, polymorphic polytopic ventricular tachycardia can develop, which goes into ventricular fibrillation and causes a person to die.
Not always a diffuse violation of the process of repolarization of the heart leads to such complications. Sometimes the condition simply remains an ECG phenomenon that does not affect hemodynamics and does not cause other rhythm disturbances.
Unfortunately, when a doctor sees a person and his electrocardiogram with impaired repolarization, he cannot predict whether this person will have complications or not.
Therefore, it is necessary to constantly be under the supervision of a cardiologist and periodically make new cardiograms.
Reasons for change
Diffuse changes in repolarization processes can occur during the development of the following conditions:
- Myocarditis of any etiology.
- Cardiomyopathies – hypertrophic, dilated, restrictive.
- Coronary heart disease.
- Electrolyte imbalance associated with a change in the concentration of potassium, calcium, sodium, chlorine in the body.
- The development of metabolic acidosis, or alkalosis.
- Respiratory failure with the formation of alkalosis or acidosis.
- Severe pulmonary hypertension.
- Shock of various etiologies.
Particular attention should be paid to coronary heart disease. It is generally accepted that this disease leads to a heart attack of a local area of the left ventricle. Such a complication is really characteristic of this pathology. However, at the same time, all parts of the heart, and not just separate areas of the left ventricle, suffer from constant ischemia (lack of blood flow and oxygen).
Of course, the degree of tissue ischemia is different – it depends on the degree of narrowing of the coronary arteries and ensuring collateral blood flow. But all cardiomyocytes to one degree or another will suffer from coronary heart disease and in them diffuse repolarization disorders can develop in all of them. Moreover, the severity of such changes will also depend on the degree of ischemia.
To identify changes, you need to record a cardiogram or a series of them. To identify possible complications, it is necessary to conduct Holter monitoring. But to identify the causes of this condition, other diagnostic methods are needed.
- Complete blood count – the identification of markers of the infectious process.
- A blood test to determine the electrolyte composition.
- Echocardiography for assessing the state of the heart chambers.
- Dopplerography of the vessels of the heart. If necessary – angiography.
- Treadmill test in the department where there is a resuscitation kit.
The latter technique allows you to identify hidden cardiac ischemia and diagnose coronary disease. This method should never be used first, especially if there is at least minimal suspicion of the presence of myocarditis in humans. Incorrect load diagnosis can result in death!
Before proceeding with the treatment of pathology, it is necessary to find out the cause of the condition and, as soon as possible, eliminate it. Otherwise, all therapeutic measures will be ineffective.
If you identify the cause at the initial stage and quickly eliminate it – there is a chance that the diffuse violation of the repolarization process will disappear.
If the cause is eliminated, and the changes remain, it is necessary to use special cardioprotective drugs.
- Pallor of the skin
- Slow heartbeat
- Blood pressure fluctuations
- Memory impairment
- Heart rhythm disturbance
- Increased temperature
- Tingling in the heart
- General worsening
- Rapid pulse
Violation of the processes of repolarization is a disease during which the phase of repolarization shortens or becomes longer in time. Such a violation can be symptomatic, but this can only be determined by carrying out the necessary diagnostic measures. In order to understand the essence of the problem, let us consider in more detail what repolarization is. The work of the heart involves three phases:
- muscle contraction;
Violation of the processes of repolarization in the myocardium can occur just at the stage of excitation. This stage is divided into two stages:
- depolarization is the beginning when the muscle is actively “working”;
- repolarization – the end of the phase – the cell “rests”.
Normally, the repolarization process lasts 0,3-0,4 seconds. If there is a steady deviation from this norm, then there is a violation of the process of repolarization in the myocardium of the ventricles. This problem is not always independent, since it is preceded by certain etiological factors. In children, a violation of myocardial repolarization can be caused by congenital diseases and not only with respect to the cardiovascular system.
- myocardial ischemia;
- a history of myocardial infarction;
- arterial hypertension, hypertension;
- congenital disease – SRH (early ventricular repolarization syndrome);
- left ventricular hypertrophy;
- malfunctioning of adrenaline receptors;
- disturbances in the hormonal background;
- diseases of the central nervous system;
- taking some “heavy” drugs – hormones, antibiotics, steroids, sedatives.
In addition, there are a number of predisposing factors that, in the presence of the above pathologies, can provoke a violation of repolarization processes:
- electrolyte imbalance;
- debilitating physical activity;
- frequent stresses, nervous experiences, being in a negative psycho-emotional environment;
- reception of adrenostimulants.
It should be noted that people with SRH of ventricular repolarization are at risk, as they develop cardiovascular diseases much more often and there is a greater likelihood of sudden cardiac arrest.
In order to understand what a pathology is, it is worth finding out the definition and explanation of the system itself in normal mode. Myocardial repolarization serves as a stabilizer of the habitual state of a nerve cell after an impulse has passed through it. It is after this that the structure of the cell changes and becomes irregular. Thanks to repolarization, everything is back to normal.
Given the above definition of this process, its importance becomes clear. Failures in the operation of such a system can cause a number of complications and malfunctions in the operation of our motor, which is fraught with very serious consequences. One of these problems is a deviation in the rhythm of the heartbeat. As a result, this is a lack of blood supply to organs and a general deterioration in well-being. However, it is worth clarifying that often such a pathological process takes place without visible and tangible consequences.
Very often, a violation of myocardial repolarization is not manifested by any symptoms. In this case, this pathology can be detected only with a routine examination during an ECG.
In some cases, a violation of the repolarization process can manifest itself as a change in heart rate, especially during physical exertion. Also, a violation of myocardial repolarization can manifest itself as fatigue, headaches and dizziness, irritability and tearfulness. Over time, heart pain, palpitations, and excessive sweating may join.
What is dangerous in this situation is the almost complete absence of symptoms of the disease. Often, repolarization of the left ventricle is detected only during an ECG, for which a person received a referral for a completely different reason.
What can the doctor see on the electrocardiogram, getting the opportunity to make such a diagnosis as a violation of the repolarization processes occurring in the myocardium:
- changes in the P wave, indicating the presence of atrial depolarization;
- QRS complex will show ventricular myocardial depolarization. On the cardiogram, you can see that Q and S are negative, R is positive. In this case, the last teeth can be several;
- the T wave gives information about the features of ventricular repolarization, according to its deviations from the norm, and violations are diagnosed.
From the general picture of the disease, its form is very often distinguished – the syndrome of early myocardial repolarization. This means that all processes of electric charge recovery start earlier than it should be. On the cardiogram, such a change will be displayed as follows:
- the ST segment begins to rise from point J;
- in the descending section of the R wave, peculiar notches can be detected;
- against the rise of ST, concavity is observed. It is directed upwards;
- T wave is characterized by narrowness and asymmetry.
Of course, there are an order of magnitude more nuances, and only a qualified specialist can read them on the results of an ECG, as well as prescribe an effective treatment.
Features of treatment
If we consider a violation of repolarization, treatment will depend primarily on the cause of these disorders. If it is identified, then the main goal will be its elimination with re-diagnosis after the patient undergoes a course of treatment. If there is no root cause as such, therapy is carried out in the following areas:
- vitamin preparations – they will support the full-fledged work of the heart, will be able to ensure the intake of all the vitamins and minerals he needs;
- corticotropic hormones – the main active ingredient is cortisone, which has a beneficial effect on the processes occurring in the body, including the heart;
- cocarboxylase hydrochloride – helps restore carbohydrate metabolism, improve trophism of the central and peripheral NS, has a beneficial effect on the cardiovascular system;
- Anaprilin or panangin are drugs from the beta-blocker group. They are used to treat many heart ailments.
Before choosing a drug and its dosage, the doctor will carefully examine the test results, getting a full assessment of the patient’s health status. Only if the violation does pose a threat to health, for example, if the syndrome of early repolarization of the ventricles of the myocardium is diagnosed, the doctor will select the most effective therapy.
Violations of the electrical activity of the heart can not manifest themselves for a long time. The patient can consider himself completely healthy until he makes an ECG. However, there may be some deterioration in well-being that the attentive patient will notice. But the trouble is that often such phenomena develop in patients about 50 years and older, and they consider heart problems at this age to be the norm.
The most striking symptoms occur during physical exertion – discomfort in the heart, fatigue quickly occurs, and health deteriorates. At rest, and especially in the fresh air, discomfort quickly passes. These same symptoms can occur in a stuffy room and with emotional experiences. If the patient takes any drugs that affect the metabolism of potassium, sodium or magnesium, then discomfort may occur some time after taking the medicine.
Dizziness episodes, headaches, and a sudden feeling of tiredness or weakness can also occur periodically. Patients suffering from impaired myocardial repolarization processes get tired faster. Since the anterior-septal region takes on the greatest load, then if the pathology develops in it, then the symptoms will be most pronounced, and will lead to complications much faster.
Pain in the heart, a feeling of palpitations, or, conversely, interruptions in the work of the heart, rhythm disturbances are much later symptoms that indicate that there is a serious and persistent pathology that requires long-term treatment.
- Decreased disability, fatigue, weakness.
- Painful sensations in the heart.
- Arrhythmias (ventricular, supraventricular, tachyarrhythmias).
- The instability of the pulse frequency.
- Shortness of breath observed with increased physical exertion.
- Irritability, mood instability.
- Cardiogenic shock, hypertensive crisis, pulmonary edema (with heart dysfunction).
Symptoms of pathology in children and adolescents are supplemented by tachycardia, neurocirculatory dystonia. Also, violation of repolarization processes in a child is manifested by an increased tone of the vagus nerve. A disease that affects the myocardium is often detected by chance during medical examinations, which is explained by the asymptomatic course of the disease.
Mild abnormalities in the duration of the repolarization phase can be asymptomatic. In some cases, there are non-specific and short-term symptoms: shortness of breath, tingling in the heart after physical exertion. In general, a violation of the repolarization processes is characterized by the following clinical picture:
- at any time of the day for no apparent reason, a slowdown in heart rhythm may occur;
- sinus arrhythmia;
- shortness of breath, rapid pulse, even with slight physical exertion;
- unstable blood pressure, most often high.
In addition, the symptomatic complex may include symptoms atypical for heart disease:
- initial stage of acidosis;
- weakness, malaise;
- headaches, dizziness;
- deterioration in cognitive functions, memory problems;
- general deterioration of health, pallor of the skin.
Due to the fact that the clinical picture is non-specific, in no case should you take any drugs to eliminate symptoms without a doctor’s prescription. This can lead to a sharp deterioration in well-being.
Characteristic features of impaired repolarization on the ECG
Early myocardial repolarization is characterized by the following features:
- in the descending part of the tooth R there may be serrations;
- ST segment rise starts from point J;
- asymmetric narrow tooth T.
A change in myocardial repolarization can be manifested by the presence of a right angle between the beginning of the T wave and the end of the ST segment. Such a picture may appear on the cardiogram of a patient with left ventricular hypertrophy or coronary artery disease. The same picture may appear in older people or middle-aged women, but already being a variant of the norm.
Syndrome of early myocardial repolarization is manifested in ECG by elevation above the contour of the site of transition of the interventricular complex to the ST segment. This syndrome occurs in professional athletes and accompanies myocardial hypertrophy. The presence of early repolarization syndrome is not a normal option and may contribute to sudden cardiac arrest.
Heart cycle description
The contraction of the heart is due to electrical impulses that are conducted to each cell of the myocardium (heart muscle). After receiving such an impulse, each cardiomyocyte passes through the stage of contraction and relaxation, which make up the cardiac cycle. However, behind each of these stages there is a complex mechanism of the flow of calcium, potassium and chlorine ions from and to the cell. The electrical changes in the membranes of cardiomyocytes that underlie contraction are called depolarization, while the underlying changes in relaxation are called repolarization.
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Why does this pathology arise?
Any disease or pathology is caused by various deviations and incorrect changes in the work of various systems of our body. Such irregular processes can be caused by both external and internal factors. Such a pathological process can occur in a child during the period of active growth, and in an adult from an excess of physical activity. Strong stress can also affect changes. All of these options are non-specific violations.
|First||disturbances in the work of the heart, which include ischemic disease, and abnormalities in the balance of electrolytes, and overstrain of the heart muscles|
|The second||it is necessary to name an unbalanced amount of hormones (adrenaline / norepinephrine), to which tissues have an increased sensitivity|
|The third||is the incorrect effect of pharmacological preparations on the body, due to improper use or dosing of substances|
Important! Sometimes the appearance of pathology can be caused by some changes in the body. Often they are associated with a restructuring of the hormonal background and an increase in susceptibility. The main examples of such changes are pregnancy and menopause.
Violation of ventricular myocardial repolarization may also be non-specific. This primarily applies to adolescents, but so far, unfortunately, the causes of the pathological process are not exactly known.
For the normal course of depolarization and repolarization processes, it is necessary that the body receives a sufficient amount of sodium, potassium and magnesium ions. Their lack causes repolarization disturbances. In addition, these processes can be triggered by some pathologies of the myocardium – hypertrophy, ischemia, pathologies of regulatory influences, most often with endocrine diseases. Drugs that alter the intake, absorption, or excretion of trace elements (e.g. diuretics) can also have a similar effect.
On the ECG, the pathological process is manifested by a change in the shape of the QRS complex – negative Q and S waves become more pronounced, and the height of the positive R wave decreases. The whole complex becomes more extended in time. The T wave, which normally has small dimensions, becomes pronounced, the interval between it and the previous complex increases, due to which the T wave and P wave can already be layered on top of each other. Other changes on the ECG are possible, which will tell the experienced cardiologist that there are disturbances in the electrical activity of the heart.
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