Violation of the processes of repolarization of the ventricles on the ecg

An electrocardiogram (ECG) is a common and widely used fairly objective way to diagnose various diseases and pathologies of the cardiovascular system and heart in particular.

The ECG is a kind of record of the heart and looks like a graph of curved lines, automatically printed by the device. According to the interpretation of this graph, you can draw conclusions about the work of the heart, make a diagnosis and make a conclusion about the general condition of the cardiovascular system.

Violation of the processes of repolarization is any change in the stage of relaxation of the heart muscle after contraction. These violations can be detected only by decoding the electrocardiogram graph.

The process of repolarization is a state during which the initial (before contracting) potential of the cell membrane is restored and its electric charge is restored. Nerve impulses (potassium ions) must leave the membrane, the cell accumulates energy, enzymes and oxygen saturation.

The decoding of the electrocardiogram is very individual. The specialist should pay attention to many factors and indicators. It is almost impossible to independently determine the violation of repolarization processes, since with their presence several indicators are changed at once, and these changes can be insignificant or nonspecific.

  • T. VR – the value is negative. Directed up. If the indicator changes, there may be hyper- or hypoglycemia. The relation of this tooth to others is of paramount importance for determining violations of repolarization processes.
  • Q. The norm is 1/4 R at 0,3 s. Increase – possibly the presence of myocardial pathologies.
  • R. Norm – determined on each lead. In the absence, ventricular hypertrophy is possible.
  • S. The normal height is 20mm. The ST segment is important.
  • P. The first or second lead is a positive value. VR is negative. The norm is 0,1 s.
  • Intervals
    • QT – up to 0,4 s.
    • PQ – 0,12 s.
    • RR – 0,62 – 0,66 – 0,6.
    • QRS complex – up to 0,1 s.
  • General information.
    • Heart rate – within beats per minute.
    • Sinus rhythm.
    • The normal location of the electrical axis of the heart (without deviations to the right or left side).

    Repolarization disorders can be caused by various factors. There are three groups of reasons:

    1. Pathology of the neuroendocrine system. It regulates the work of the heart and blood vessels.
    2. Heart diseases: hypertrophy, ischemia and electrolyte imbalance.
    3. Taking medications that negatively affect the work of the heart.

    Violation of the processes of repolarization in the myocardium can also be caused by non-specific reasons. This phenomenon occurs in adolescents and in many cases disappears spontaneously, without the use of drugs. Sometimes treatment is required.

    Non-specific disorders can also occur due to physical overload (from sports or at work), stress, with a change in hormonal levels (pregnancy or menopause).

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    ECG changes

    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.

    1. Atrial depolarization is indicated by the P wave.
    2. 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.
    3. 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.

    Only a qualified doctor can prescribe the intricacies of the result of the ECG, who will prescribe the appropriate treatment.

    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.

    In addition to the listed symptoms, the patient experiences excessive irritability and tearfulness. Pain in the heart is characterized by stitching or cutting sensations with an increase. During repolarization of the lower wall of the left ventricle, a person is dizzy from heavy physical labor, “flies” appear in his eyes, blood pressure rises.

    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:

    1. Complexes of vitamins and minerals. They help to restore the activity of the heart, providing the flow of beneficial substances and trace elements.
    2. Beta-blockers (Anaprilin, Panangin).
    3. Corticotropic hormones. They have a positive effect on the activity of the heart.
    4. 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.

    The human heart is an amazing organ whose conducting system constantly produces impulses that trigger its contraction. The heart works “tirelessly.” But sometimes myocardial repolarization processes may be disturbed – we will talk about this in more detail.

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    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.

    Causes of impaired repolarization processes in childhood

    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.

    IHD as a cause of ventricular myocardial repolarization processes

    In young patients, as well as people of middle, old and senile age, a violation of the processes of ventricular myocardial repolarization can be caused by coronary heart disease, left ventricular myocardial hypertrophy, arterial hypertension, congenital and acquired heart defects, neurocirculatory dystonia, chronic pathology of ENT organs, electrolyte disturbances, taking medications, menopause, etc. The clinical manifestation will depend on the underlying disease.

    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.

    4 Diagnostics

    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.

    Factors for the development of the disease

    The disease, due to little knowledge, does not have an established list of reasons for its development.

    Based on clinical practice, only a list of the main possible provoking factors has been compiled:

    1. Long-term use of certain medications, such as Clonidine, Adrenaline, Mesatone, Ephedrine, etc.
    2. Increased joint mobility.
    3. Mitral valve prolapse.
    4. High levels of lipids, lipoproteins, blood cholesterol.
    5. Thickening of the walls of the ventricles (hypertrophic cardiomyopathy).
    6. Myocardial inflammation (myocarditis) and its hypertrophy.
    7. Genetic predisposition.
    8. Disorders of the anatomical formations (nodes, bundles and fibers) of the heart.
    9. Electrolyte imbalance.
    10. Defects in the structure of the heart and large vessels, having a congenital or acquired character.
    11. Periodic hypothermia of the body.
    12. Physical activity of high intensity.
    13. Instability of the nervous system, emotional instability.

    The syndrome is more often diagnosed in men than in women. Among them, athletes are at greater risk.

    Statistics by the age criterion show its more frequent manifestations at a young age, in comparison with older people. In some cases, ATS is detected in children and adolescents.

    How to determine deviations from a cardiogram

    • pathologies of the heart muscle itself, such as ischemia, acute heart attack, infiltration;
    • the use of certain drugs (Digoxin, Quinidine, tricyclic antidepressants);
    • electrolyte metabolic disorders (in particular, pronounced changes in the concentration of potassium, magnesium, calcium in the blood);
    • neurogenic causes (for example, hemorrhagic or ischemic stroke, traumatic brain injury, tumor state);
    • metabolic disorders;
    • hypoglycemia (a sharp decrease in blood sugar);
    • disturbances in the conduction of signals in the ventricles;
    • pathology of the rhythm of the ventricles;
    • hyperlipidemia;
    • excessive physical exertion;
    • supercooling.

    In the danger group are people:

    • with heart disease;
    • with diagnosed dysplastic pathologies;
    • black men under the age of 35 years.
    • 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

    Of all the possible violations of the processes of repolarization, the most frequent form, early repolarization, is singled out separately.

    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.

    Symptoms and signs

    This syndrome does not have a characteristic clinical picture. The only reliable symptom of ATS is recorded changes in cardiac activity during an ECG.

    Deviation in the relaxation phase is most often diagnosed by accident, since the syndrome does not affect the well-being of a person until the first complications appear. The disease is most often detected during the diagnosis of other cardiovascular disorders.

    Signs that may indirectly indicate the presence of the syndrome are its consequences: frequent fainting and cardiac arrhythmias.

    Among other complications, against the background of which premature ventricular repolarization can be diagnosed, we can distinguish:

    • a sharp jump in blood pressure (hypertensive crisis);
    • violation of the contractile function of the left ventricle (left ventricular failure, pulmonary edema);
    • violation of the frequency and depth of breathing, a feeling of lack of air;
    • ventricular dysfunction.
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    What diseases are caused

    The causes of violations are very diverse and numerous. Experts do not give a clear answer, which may serve as a reason for their occurrence. These can be non-clinical factors that are not diseases and do not require treatment, and serious pathologies, where timely treatment is vital.

    Most often, the following factors cause a change in normal indicators:

    • Non-specific. Nervous exhaustion, exercise, stress, hormonal imbalance and many other factors that affect the general condition of the body and affect the functioning of the heart indirectly.
    • The sensitivity of heart tissue to the effects of adrenaline and norepinephrine. A general increase in the levels of these hormones.

  • Abuse of drugs that affect the cardiovascular system and increase the load on the heart.
  • Imbalance of electrolytes.
  • Overexertion and ventricular myocardial hypertrophy.
  • Coronary heart disease.
  • Hypertension.
  • Disruption of the neuroendocrine system.
  • Hypersympathicotonia (increased tone of the autonomic nervous system. A diffuse disorder occurs against its background).
  • Change in the normal sequence of depolarization processes.
  • Various inflammatory and dystrophic tissue lesions.
  • Blockade of the branches of the bundle of His (refers to a group of disorders characterized by the expansion of the QRS complex).
  • The decoding of the results of the electrocardiogram is an analysis of its elements: the shape and size of the teeth, segments, intervals between them.

    The activity of each of the departments of the heart is indicated on the ECG in Latin letters:

    • P – depolarization of the atria;
    • a combination of QRS characterizes ventricular depolarization;
    • the ST segment shows the time period that the heart needs to restore to its previous state after complete repolarization;
    • upward T wave is responsible for the repolarization of both ventricles.

    On the cardiogram of a healthy person, the ST segment is located on the isoelectric line, then smoothly passes into the region of the T wave.

    Deciphering the results of ECG early ventricular repolarization syndrome can be according to the characteristic graphical signs:

    • the ST segment rises a couple of millimeters above a straight isoelectric line segment (on the ECG print it looks like a sharp rise);
    • on the upward R wave there are specific notches;
    • the T wave is also elevated and has a wide base;
    • the entire QRS complex is getting longer.

    Based on the identified deviations, three types of syndrome are classified:

    1. The first type is the safest in terms of the development of complications. It is characteristic of those who do not have diseases of the cardiovascular system. Graphic signs characteristic of the syndrome are detected in the lateral leads (right and left) of the ECG.
    2. The second type is diagnosed by violations in the lateral and lower lateral leads. The risk of complications will be higher than in the first case.
    3. The third type has symptoms of the syndrome in all ECG leads. This means that the patient has the highest risk of complications.

    Features of the course in children and adolescents

    The syndrome affects not only adults, but also children. The disease is quite rare, but has a wide age range.

    Early repolarization is diagnosed both in infants and in older children. Often adolescents are also affected.

    External symptoms indicative of the syndrome, as well as in adults, are absent. Most parents did not even hear about this pathology before the ECG procedure.

    While maintaining the sinus rhythm, ATS in children is the age norm and should not be a reason for panic. In healthy children, as he grows older, he passes without treatment.

    Sometimes, to eliminate it, it is enough for parents to adjust the lifestyle of the child. It will be to provide the child with a balanced diet, monitoring compliance with the daily routine. Parents should also reduce the physical and emotional stress of the child, as much as possible to reduce the impact of stress factors.

    In the case of newly born babies, a complete comprehensive diagnosis of the heart should be carried out to identify possible abnormalities. If we are talking about adolescents, the reason for the manifestation of this syndrome often lies in active hormonal changes that go without consequences as they grow older.

    An important criterion in choosing a treatment regimen is the fact that the child has other cardiac pathologies. If he has any kind of heart disease or an abnormality of his conducting systems, then the syndrome requires constant medical supervision and treatment. This is associated with a high risk of developing arrhythmic disorders that can result in death.

    The stages of treatment of the disease in children do not differ from the sequence of therapy for adults. Therapy begins with treatment with drugs and dietary supplements. In the absence of its effectiveness, a surgical operation is prescribed.

    As a rule, in the absence of symptoms of early repolarization, the patient does not need therapy and the use of drugs. Self-medication is strictly not allowed: it can provoke severe dysfunctions of the heart muscle.

    A person does not need to panic if he has detected the syndrome in question and if there are no signs of cardiovascular disease.

    The patient can independently choose for himself such therapeutic and preventive measures:

    • categorical abandonment of alcohol and tobacco smoking;
    • limitation of intense physical activity;
    • established mode of work, rest;
    • intake of vitamins and minerals.

    Sometimes these measures are enough to normalize the electrocardiogram. If the cause of the ECG deviation is not found, then the patient is prescribed therapy aimed at normalizing the nutrition of the heart muscle.

    If a child goes in for sports and has developed ventricular repolarization syndrome, then it is quite enough for him to reduce the intensity of physical activity. The doctor will tell you how to limit them and how long to observe a special training regimen.

    With changes in the work of the cardiovascular system, the patient needs to take medications. Often, he is prescribed Mildronate, Preductal, Kudesan, Carniton and other drugs. Radical methods of treatment include surgery.

    During the operation, a radiofrequency ablation procedure is performed. It eliminates the process of pathological disorders in the myocardium and normalizes heart rate.

    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.

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    Violation of the processes of repolarization can be observed during puberty of adolescents. Deviations in the physiological development of the heart muscle may be pathological. Improper development of chambers and blood vessels of the heart, stenosis (narrowing) of the valves. 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.

    Additional diagnostic tests

    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).
    • Echocardiography.
    • Ultrasound examinations.
    • Samples with physical activity.
    • Hormonal status research

    But of course, the electrocardiogram, along with the observations and questioning of the patient, is of paramount importance. It is also necessary to remember that focusing on the dynamics of research, rather than one-time indicators.

    Early ventricular repolarization is sometimes detected by chance at a physical examination. This is because the disease does not have symptoms of pathology, other than those that are detected on the electrocardiogram.

    Along with impaired repolarization in patients, the following can be detected:

    • heart rhythm failures;
    • hyperkalemia, that is, an increase in the amount of potassium in the blood;
    • disturbances in the processes of exchange of electrolytes in the blood;
    • Brugada syndrome;
    • phenomena of pericarditis.

    In all these cases, the patient needs additional clinical research. During the diagnosis, the results of activities such as:

    1. Test with physical activity (signs of violation on the electrocardiogram in this case may be absent).
    2. Potassium test (the patient consumes only 2 g of the potassium preparation causes a noticeable aggravation of the problem and some disturbances in the conduction of nerve impulses).
    3. The introduction of Novocainamide into the vein enhances the manifestation of myocardial repolarization syndrome on an electrocardiogram.
    4. The patient is assigned holter monitoring (that is, he is given an electrocardiogram in a daily regimen).
    5. The results of a biochemical blood test and a lipid profile supplement the data of a clinical examination.

    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.

    What is dangerous pathology?

    The characteristic features of repolarization include:

    • horizontal or descending rise S – T (convexity is turned down);
    • the presence of a notch in the fragment R.

    Such changes indicate that the heart muscle does not relax sufficiently, which is fraught with the development of dangerous pathologies.

    This syndrome can cause the development of arrhythmic disorders, such as:

    1. Ventricular extrasystole – premature contraction of the myocardium.
    2. Tachyarrhythmia is a pathologically rapid irregular heartbeat.
    3. Tachycardia – excessive rhythmic acceleration of the heart rhythm at fixed intervals.
    4. Bradycardia is a slowdown in heart rate.
    5. Atrial fibrillation – frequent chaotic atrial contractions.

    A prolonged course of SRGR in combination with arrhythmic disorders is dangerous because there remains a high risk of developing severe ventricular pathology, such as fibrillation.

    During fibrillation, the muscle fibers of the ventricles perform random arrhythmic contractions of an irregular nature. In the absence of emergency assistance, this condition ends with cardiac arrest and actually leads to death.

    The syndrome is also dangerous because it can provoke a heart block, slowing down or completely stopping the transmission of electrical impulses in the heart muscle. In patients with this syndrome, coronary artery disease may develop.

    In patients with impaired repolarization on the ECG, you can see changes in the T wave, U, ST segment. In a healthy person, the ST segment is located on the isoline. The T wave in standard leads is positive, not very high. It is normally directed in the same direction as the main ventricular complex (QRS). It can be negative in a healthy patient in enhanced avL lead.

    The causes of changes in repolarization mechanisms are as follows:

    • ischemic damage to the heart muscle;
    • hypertrophy and overstrain of the muscle tissue of the ventricles;
    • violations of the contractile mechanisms of various parts of the heart;
    • electrolyte imbalance in the body (in adolescents and pregnant women);
    • the effect of drugs on the work of the heart muscle.

    Often deviations of the ST segment from its normal position occur with ischemic damage to heart tissue. With a heart attack, the ST segment rises and is slightly distorted in the form of a curved back of a cat. Damage can be detected in various walls of the body. In addition to the ST segment, you can see a deep Q wave on the ECG. The deeper it is, the greater the thickness of the wall damage.

    ECG myocardial infarction

    The following types of heart attack are distinguished by localization:

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    Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.