Nonspecific changes in septal repolarization

Current data on the mechanism of contraction of heart fibers, the conduction of a nerve impulse along the pathways are associated with the study of cardiac electrophysiology. Understanding the role of these processes in the development of pathology helps to choose the right treatment for chronic heart failure, myocardial dystrophy, cardiomyopathy.

Violation of the processes of repolarization in the myocardium reveals the “secrets” of metabolic (exchange) changes in the heart muscle, the synthesis and conservation of energy reserves.

We will try to “translate” the scientific language of terms into an accessible interpretation of the biological properties of the cell.

Using electron microscopy, it became possible to study the structure of heart cells. Myofibrils, two types of protein fibers, were identified: thick fibrils turned out to be myosin, and thin fibrils turned out to be actin.

In the process of contraction, thin fibers glide along thick ones, actin and myosin combine to form a new protein complex (actomyosin), muscle tissue is shortened and strained. When relaxing, everything returns to normal. Between them there are bridges on which chemicals are transferred from one cell to another.

The heart is “triggered” by an electrical impulse. It is formed from many electrical currents from the connection of cardiac cells.

Each living cell has its own negative electrical discharge. The difference between the external and internal voltage on both sides of the cell membrane is 80-90 mV. This is the transmembrane potential. It does not change throughout life and is characteristic of each type of cell.

But heart cells are characterized by a change in potential due to movement through the open tubules of ions (charged particles of sodium, potassium, calcium). Thanks to them, an electric current arises. It is also called action potential.

The occurrence of an impulse (electric current or action potential) in the cells of the heart goes through two main periods:

  • Depolarization – sodium and calcium ions enter the cell and the charge changes to positive. With a certain speed, the depolarization wave is transmitted to neighboring cells and covers the entire muscle. Actin combines with myosin and the heart contracts. The wave propagation speed depends on the presence of healthy or altered cells (ischemic or scar tissue) on the path of the pulse.
  • Myocardial repolarization is a longer period, it is necessary to restore the negative intracellular charge, the flow of potassium ions should leave the cells. This phase determines the accumulation of energy in the muscle of the heart and preparation for the next contraction. Visible rest actually includes all the biochemical mechanisms of energy production, enzymes and oxygen from the blood are wasted. Until complete recovery is complete, the heart cannot contract.

The most important mechanism providing sufficient action potential is the sodium-potassium pump.

Scheme of depolarization (right) of the cell membrane

Violation of myocardial repolarization can be detected by electrocardiographic examination to determine the time of repolarization.

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Diagnostics

To diagnose the correct processes of depolarization and repolarization, electrocardiography of the heart (ECG) is used.

The teeth and intervals do not tell the layman anything. Functional diagnostics doctors are familiar with the subtle signs and changes of characteristic teeth, and can calculate the repolarization time.

An increase in the time of depolarization of the ventricles of the heart indicates a mechanical obstacle to the propagation of the impulse. This is possible with blockades of varying degrees.

An acute heart attack most often affects the left ventricle. Here a connective tissue scar is formed, which serves as an obstacle to the impulse.

In conclusion of the ECG, the doctor, in addition to signs of a heart attack, will write about a moderate violation of depolarization.

When decoding, the shape of the complexes, the height and width of the teeth, the level of the main line, the duration of the intervals are taken into account

The impaired repolarization is indicated by a decrease in the T wave. This is characteristic of diffuse dystrophic changes, cardiosclerosis. In this case, the conclusion of the ECG does not make a diagnosis, but helps to understand the mechanism of the formation of symptoms of the disease, stage and form.

Myocardial hypertrophy is impaired by taking certain medications, a lack of trace elements and vitamins in the diet, and dehydration of the body. Such a patient should be examined in a hospital, conduct a stress test with potassium chloride. After the introduction of potassium on the ECG, the normalization of the shape of the ventricular complexes is recorded.

The syndrome of early myocardial repolarization is characterized by the constancy of the ECG picture. In adults, it is necessary to conduct differential diagnosis with acute heart attack.

A typical sign is the elimination of signs after a test with physical activity (20 squats).

When examining children and adolescents, the frequency of detecting metabolic changes in the myocardium increases. The child does not detect any organic diseases of the heart and blood vessels. Significance in such cases is given to energy disorders.

The fetal suffering from cigarette smoke is not visible from the outside.

The causes of early repolarization in children, according to scientists, are associated with impaired development at the embryo stage. The culprit is a mother who during pregnancy did not observe the regimen, did not eat well, and suffered from anemia. Children do not require special treatment, but it is recommended that a cardiologist observe, reduce physical and emotional stress, and proper nutrition.

Similar changes are characteristic for athletes, persons who have undergone hypothermia. Some cardiologists prove the hereditary nature of changes in the conduction system of the heart.

Also read: Signs of Heart Arrhythmia

The frequency of detection of early repolarization syndrome ranges from 1 to 9%. In men, it is found 3 times more often. With emergency admission with pain in the heart, the syndrome is detected in 13 to 48% of patients.

It is believed that in this case a faster excitation wave comes from the outer layer of the myocardium inward. A certain role is given to the predominance of the autonomic or sympathetic nervous system, and an increase in the calcium content in the blood.

Existing classifications subdivide early repolarization syndrome due to heart disease:

  • with damage to the heart and blood vessels;
  • without defeat.

According to the degree of severity on the ECG (manifestation in 12 leads) – 3 classes:

  • minimal (available in 2-3 leads);
  • moderate (at 4-5);
  • maximum (6 or more).

No typical clinical symptoms have been identified. There is little connection with rhythm and conduction disturbances. Some cardiologists insist on the increased likelihood of sudden life-threatening heart rhythm disturbances in such patients.

The processes of electrical activity of the myocardium are important in the diagnosis of heart disease. They continue to be studied. Perhaps in the near future there will be new energy drugs or treatments that act through the cellular potential.

Impaired myocardial repolarization

Myocardial repolarization is called the process of restoring the structure of the membrane of a nerve cell.

When a nerve impulse passed through it, under its action the natural state of the membrane was disrupted. It should normalize during the reverse movement of ions.

If there is a violation of the processes of repolarization in the myocardium, this does not happen. Over time, interruptions in the work of the heart begin to manifest.

This condition is quite dangerous for a person, can lead to serious heart ailments that occur against his background.

Causes of the disease

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.

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:

  1. A modified P wave, indicating atrial depolarization.
  2. Violations in the QRS complex. The teeth Q and S in this case are negative, R is positive.
  3. Deviations from the normal values ​​of the T wave. They also indicate a violation of repolarization.

Syndrome of early myocardial 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!

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.

Click on the photo to enlarge

Normal performance

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).

    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).

    With a moderate intensity of pathology, painful symptoms related to the work of the heart may not occur, therefore, the identification of deviations from the norm often occurs at advanced stages.

    A cardiologist, conducting an examination in cases of suspected development of disturbances in the processes of repolarization in the myocardium, studies the nature of the teeth of the cardiogram, interval indicators.

    Normal characteristics of teeth:

    • Tooth T. Direction up (negative VR value).
    • Q wave. The normal rate is 1/4 R (at 300 ms).
    • Tooth R. Present in all leads.
    • Tooth S. Height – 2 cm.
    • Prong P. A positive value in the first two leads, a negative value of VR (100 ms).

    Interval norms: QT – up to 400 ms, QRS complex – up to 100 ms, RR – 0,62 / 0,66 / 0,6 s, PQ – 120 ms.

    In the absence of pathologies, the heart rate is from 60 to 85 beats per minute (sinus rhythm).

    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.

    That is, even at rest, in the membranes of nerve cells, biochemical mechanisms are activated, without which normal work cannot be restored.

    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.

      Cogs.
  • 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. 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 is within 60-85 beats per minute.
    • Sinus rhythm.
    • The normal location of the electrical axis of the heart (without deviations to the right or left side).
  • Causes of ventricular repolarization disorders

    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).

    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.

    Treatment

    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.

    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.

    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.

    5 Treatment

    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.

    Violation of repolarization processes is a medical term that doctors most often use to describe a characteristic picture on an electrocardiogram (ECG). This picture indicates problems with the very last part of the cardiac cycle – ventricular relaxation.

    These disorders can be observed in both adults and children. A distinctive feature is that in children they most often have a benign character and do not pose a danger to their health, while in the elderly they are signs of serious heart diseases such as heart attack, ischemia, and myocarditis.

    Table of Contents:

    • 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).
    • Cardiomyopathy.
    • 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.
    • Stroke.
    • Traumatic brain injuries.
    • Hereditary predisposition to cardiovascular disease.

    Causes of the disease

    Causes of ventricular repolarization disorders

    One of the forms of these disorders is the syndrome of early repolarization of the ventricles (ATS) – an ECG variant observed in 2–5% of the population, more common in men, young people, adolescents, and athletes. Not so long ago we thought that this syndrome has a completely favorable prognosis, that is, it does not affect the health and life of a person in any way. However, it was later discovered that some of its forms increase the risk of developing dangerous arrhythmias and cardiac arrest. This risk can be assessed by ECG.

    The main causative factors that can provoke a violation of chemical-electrical processes in the myocardium include the following:

    • Myocarditis,
    • Myocardial ischemia,
    • Myocardial infarction with the formation of postinfarction scar, atherosclerotic cardiosclerosis,
    • Arterial hypertension with the formation of hypertrophic cardiomyopathy,
    • Cardiomyopathy of a restrictive, dilated or hypertrophic nature of any origin,
    • The so-called “athlete’s heart”, when professional athletes experience an increase in the left heart with myocardial hypertrophy,
    • Congenital defects of genes encoding the transport of ions into the cell – cause syndromes of lengthening and shortening of the QT interval, as well as syndrome of early repolarization of the ventricles (SRH),
    • Taking some drugs – atropine, cardiac glycosides, adrenaline, etc.
    • Vegetative-vascular dystonia (neurocirculatory).

    Also, disturbances in the processes of repolarization in the myocardium are characteristic of changes in the neuro-regulatory effects on the heart, in particular, from the vagus nerve and the sympathetic nervous system, or from the adrenal glands, when the latter produces an excess of adrenaline and norepinephrine in the blood. Often there are abnormalities in the normal functioning of the heart muscle during pathology of the thyroid gland, because hormones released into the blood by the gland have a direct effect on the heart.

    As a rule, the common processes in the myocardium (ischemia, cardiosclerosis, cardiomyopathy) determine the occurrence of diffuse disturbances in repolarization processes, and limited ones – local disturbances. For example, in case of neurocirculatory dystonia, repolarization disorders occur along the anterior-septal region of the left ventricle, after a heart attack of the lateral and high-lateral departments – along the side wall, and after myocardial infarction along the LV posterior wall – repolarization disorders in the lower or upper LV wall.

    myocardial depolarization and repolarization are normal

    myocardial depolarization and repolarization in ischemia

    In the case when the patient is unable to identify visible causes, and violations of the processes of repolarization are detected, they are called non-specific.

    In addition to pathological causes, moderate disturbances in the processes of repolarization of the left ventricle can occur in a completely healthy person. This is detected when a patient with ECG-diagnosed repolarization disorders after further examination does not reveal any problems from the heart and other organs. In this case, repolarization disorders practically do not pose a threat to the patient’s life.

    Violation of repolarization processes on the ECG is an important indicator of diseases of the cardiovascular system in adults and children

    Repolarization disorders are not an independent disease that has its own symptoms. These are changes on the ECG characteristic of a particular disease. A person can live a long life without even knowing about the existence of an altered ECG, without experiencing any symptoms.

    Therefore, the clinical picture of repolarization disturbance can either be completely absent (for example, with ATS), and can be very bright (for example, with a heart attack). There are no individual symptoms that suggest their existence.

    In the absence of clinical symptoms, this problem is most often detected by chance during electrocardiography. If changes in the ECG have arisen due to any disease, you need to understand that the clinical picture is caused by it, and not by non-specific changes in the ECG.

    In most cases, failure of the processes of repolarization of the heart muscle does not have pronounced symptoms. Often, the pathology is recorded accidentally during routine examinations or during examinations, to confirm another diagnosis – when conducting a graphical recording of the heart (ECG).

    If the violation of repolarization processes occurs in the myocardium as a whole, i.e. diffuse, it provokes a change in blood circulation, which affects the general condition of the body. In this case, symptoms appear that are also characteristic of any other cardiac pathologies:

    • change in heart rate;
    • chest pain;
    • change in emotional state (tearfulness, excessive irritability);
    • fatigue.

    In addition, there are signs that reflect the area of ​​the heart muscle where a violation of repolarization processes is observed. In particular, left ventricular myocardial repolarization is accompanied by a malfunction of the heart rhythm.

    The form of this disease, which is often fixed in young people, is the syndrome of early repolarization of the myocardial ventricles. Today it is considered only as an electrocardiographic concept that does not affect the functioning of the heart.

    Interesting! Such a phenomenon, according to statistics, is registered in 8% of people, most of whom have excellent health and exercise regularly.

    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 reasons are divided into 3 main groups:

    1. Diseases of the neuroendocrine system of the body.
    2. Ischemia, hypertrophy, or electrolyte imbalance.
    3. The impact of medications, the uncontrolled use of drugs can lead to the development of heart disease.

    Doctors also identify a group of non-specific causes of the development of disorders. Nevertheless, a clear list of factors provoking a violation of repolarization processes has not yet been formulated. For example, adolescents are quite often diagnosed with such a deviation, which soon passes without any medical treatment.

    So, the symptoms include:

    • pulse rate change;
    • pain in the heart;
    • changes in the rhythm of the heart;
    • prostration;
    • tearfulness and irritability.

    The above symptoms may appear even at the start of the development process. However, patients rarely take such changes in their general well-being seriously, which means that they rarely turn to cardiologists in such cases. However, it is at this stage of the development of the disease that you can quickly cope with it and normalize the work of the heart.

    On the electrocardiogram of patients, changes in the P wave are observed; in the QRS complex, Q and S have negative indicators, and R – positive. Features of the deviation of the process from the norm are revealed thanks to the tooth T.

    Diagnosis often distinguishes its early form, or early repolarization syndrome, from the overall picture of the disease. In this case, recovery begins earlier than expected. Of course, there are much more subtleties, and all of them can be seen by a professional in the results of the ECG, on the basis of which therapy is prescribed.

    The pathological processes accompanying violations of myocardial repolarization are manifested:

    • 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, a violation of the repolarization processes in a child is manifested by an increased tone of the vagus nerve.

    A disease affecting the myocardium is often detected by chance, during medical examinations, which is explained by the asymptomatic course of the disease.

    • 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).
  • Violation of the processes of repolarization – the main symptoms:

    • Headache
    • Weakness
    • Dizziness
    • Increased temperature
    • Cardiopalmus
    • Dyspnea
    • Memory impairment
    • Heart rhythm disturbance
    • Rapid pulse
    • High blood pressure
    • Malaise
    • 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.

    The main causes of pathology

    • the presence of diseases of the heart muscle, in particular, overstrain of the tissues of the ventricles, ischemia, electrolyte imbalance, hypertrophy;
    • the negative effect of medications when they are uncontrolled;
    • increased levels of hormones (adrenaline and norepinephrine) and sensitivity to heart tissue;
    • non-specific reasons. Stress, strong physical exertion, a general change in hormonal levels.

    Important! This pathology is increasingly being diagnosed in children and adolescents, especially during phases of active growth. In addition, it is often found in pregnant women.

    The syndrome of early myocardial repolarization during an ECG is usually displayed as follows:

    • the appearance of additional small teeth in the descending knee of the R wave;
    • the formation of concavity (upward) in the segment of the ST segment, which goes up from point J;
    • narrowness and asymmetry of tooth T.

    Interesting! A number of studies have confirmed the hypothesis that patients with confirmed pathology have a higher chance of developing sudden death of the heart muscle, especially if one of the symptoms of the disease is loss of consciousness of cardiac origin.

    The cardiogram shows changes in the T waves (shape distortion, base expansion, asymmetry), P, R (positive), Q, S (negative). The ST line rises above the contour by 1-3 mm, a notch appears before the ST increases. The ST shape becomes rounded or convex downward.

    Failures regarding the processes of left ventricular myocardial repolarization are identified by a complex of QRS teeth: Q, S – negative, R – positive. The ST-segment rises from point J, notches are noticeable in the descending segment of the R wave.

    For a more detailed study of violations and monitoring of the patient’s condition, diagnostic procedures are periodically repeated, supplemented by supporting measures.

    Diagnostics

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

    Due to the fact that the patient does not have any strictly specific complaints specific to repolarization disorders, the diagnosis is established on the basis of an electrocardiogram. Therefore, the main diagnostic method is ECG and its variations – daily monitoring of the ECG, ECG after exercise, sometimes – transesophageal ECG.

    The main criteria on the cardiogram are the following signs:

    • The presence of a small R wave in the ventricular complex QRST,
    • The presence of oblique elevation (ST segment elevation),
    • Change in the T wave – it becomes narrow, asymmetric and even negative, as with ischemic changes.

    Such changes are most characteristic of the syndrome of early repolarization of the ventricles (ATS), which is often found in children, adolescents, young people and athletes. This syndrome is one of the variants of violation of repolarization processes.

    classic version of changes in SRGR

    Other options for impaired repolarization processes are QT shortening syndrome and QT lengthening syndrome. The last two syndromes should not be confused with shortened PQ syndrome, since these are completely different types of heart rhythm disturbances. The shortened QT syndrome is manifested on the cardiogram by a decrease in the duration of the QT interval of less than 0.33-0.35 s, and QT lengthening syndrome – by an increase in the duration of the interval of more than 0.47-0.48 s.

    In the case of the presence of the main pathology in the patient, which could serve as a causative factor in the repolarization disorder, an additional examination is prescribed to the patient. Of the standard methods, echocardioscopy, a blood test for the content of thyroid hormones or adrenal glands, chest x-ray, and coronary angiography for heart attacks or ischemic changes are usually indicated.

    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.

    Additional examinations

    • Ultrasound examinations (heart, other internal organs).
    • Daily ECG monitoring.
    • Electrophysiological examination.
    • Coronarography.
    • Load tests.
    • General, biochemical analyzes of urine, blood (allow identifying metabolic failures, inflammatory diseases).
    • Endocrinological consultation.

    Before carrying out diagnostic measures, it is necessary to exclude physical activity in order to avoid distortion of the results.

    Forecast

    The prognosis for repolarization disorders depends on the causes of the changes on the ECG. For example, with benign SRH there is no threat to the life or health of the patient. And with myocardial infarction, which on the ECG is also manifested by repolarization disorders, there is a high risk of death, and in the future, patient disability.

    The prognosis for isolated ventricular early repolarization syndrome is completely favorable. The prognosis in the presence of any of the repolarization disorders caused by other diseases is determined by the nature and severity of this disease. For example, the prognosis for heart disease, which was not promptly corrected by surgery, is unfavorable, while after surgery, the duration and quality of life increase significantly.

    The prognosis for impaired repolarization processes in the myocardium is determined by the list of negative factors, accompanying symptoms.

    With heart disease, heart attack, ventricular ailments, unfavorable history, the probability of irreversible consequences reaches a maximum. The benign course of the pathology detected at an early stage is characterized by insignificant risks of irreversible pathologies. There is no serious threat to the life of the body.

    In order to avoid complications, it is necessary to optimize (improve) the nutrition system, the mode of work and rest, and abandon addictions. With a clear implementation of the doctor’s recommendations, the normal functioning of the myocardium is restored, favorable dynamics are observed, confirmed by periodic examinations.

    What does violation of repolarization processes mean?

    Everyone knows: his health and life expectancy largely depend on how well the heart works. Therefore, if in the decoding of the ECG in an adult, instead of the word “norm”, the entry “violation of the processes of repolarization” appears, then he begins to feel anxiety. What does such a verdict mean and how dangerous is it?

    What is the violation of repolarization processes on the ECG? In adults, this can be either a variant of the norm that does not require medical attention, or a warning about a serious pathology. Let’s try to describe the essence of the phenomenon in simple language.

    The heart is based on the alternation of excitation (depolarization) and relaxation (repolarization). The work of this body is controlled by the brain. He sends him electrical pulses. They are captured by nerve cells and transferred to the appropriate receptors.

    With the passage of such a signal, the structure of the cell membrane at the molecular level changes – without this, sodium ions simply cannot move freely through it. Repolarization is the process of restoring the electric charge of a cardiomyocyte (muscle cell of the heart) after a nerve impulse passes through it, causing it to be excited.

    It occurs in those short moments when the heart rests before the next contraction.

    Violation of repolarization can be triggered by a number of factors. This phenomenon is often lead to increased physical exertion – intense training or just a quick climb up the stairs. Deviation on the ECG may also occur because a person drank cold water or was worried before it.

    Signs of repolarization are often found in women during pregnancy and during menopause. But cardiac pathologies (coronary heart disease, cardiosclerosis), disorder of the activity of NS, kidney disease, hormonal imbalance are also capable of causing such a violation. Similar deviations sometimes occur while taking adrenomimetics.

    During repolarization, the heart muscle is at rest. On the cardiogram, this is reflected in the QT segment. Its duration, if everything is normal in a person, is 0,3-0,4 s.

    A decrease or increase in the duration of this period indicates that the repolarization process is impaired.

    However, the diagnostic doctor takes into account not only this indicator – it also evaluates the shape and size of the teeth, the presence of additional waves.

    An increase in QT often accompanies congenital pathologies that are associated with gene disorders. An extended QT interval appears on the cardiogram, the T wave changes. Such a deviation can manifest itself with the following symptoms:

    • sudden rapid heartbeat of intense emotions or physical overload;
    • fainting.

    If QT is shortened, it is usually associated with impaired functioning of potassium channels. In this case, you can notice on the graph that the interval is less than or equal to 0,33-0,35 s. What can the patient feel? Sometimes this is not manifested by external signs, but such warning signs may be noted:

    • slow heart rate at any time of the day;
    • pulse acceleration in the form of an attack of atrial fibrillation or tachycardia;
    • loss of consciousness.

    In the blood there is an increased content of calcium and potassium. In addition, an increase in the acidity of the pH of the internal environment of the body is detected.

    Another violation is early repolarization.

    The main signs of such a deviation, which are visible on the graph, are additional notches and waves on the descending part of the R wave (it is called “pseudo-tooth R”), a change in the ST segment, which is expressed in its oblique or horizontal rise above the contour (this forms a bend, downward).

    If repolarization has affected the entire myocardium, then this negatively affects the general state of health, which is manifested as follows:

    • change in heart rate up or down;
    • stitching, aching, or cutting pain in the heart;
    • decrease in working capacity;
    • dizziness;
    • fainting;
    • “Quick tears”, irritability.

    If a certain area of ​​the heart muscle is affected, then any one symptom prevails. So, if the patient often jumps in the pulse, then it can be assumed that this is a violation of the processes of repolarization in the myocardium of the left ventricle.

    If there is a violation of the processes of repolarization in the lower wall of the left ventricle, this is manifested by the fact that when performing work that requires physical effort, a person begins to feel dizzy, flies float before his eyes, blood pressure rises. Then shortness of breath develops and swelling on the legs appears.

    Violation of the processes of repolarization in the anterior septal region, due to hyperactivity of nerve fibers passing in the anterior wall of the myocardium and interventricular septum, is often recorded during VVD.

    Treatment will depend on how serious the cause of the pathology is. If it could not be found, then the following treatment regimen is used:

    • multivitamin and mineral complexes;
    • corticotropic hormones;
    • cocarboxylase hydrochloride (restores carbohydrate metabolism, normalizes the functioning of CCC);
    • in the most severe cases – beta-blockers Anaprilin, Panangin.

    No one will argue that it is best to have a perfect cardiogram. But if you have found violations of the processes of repolarization, then do not make hasty conclusions.

    Undergo an ultrasound of the heart to make sure there is no coronary heart disease, do a stress test. If, according to the results of such a diagnosis, everything is normal, then the worst can be ruled out.

    Most often, to normalize the condition, it is enough to revise your regimen and drink vitamins.

    Causes of the disease

    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.

    Danger state

    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:

    1. Myocarditis of any etiology.
    2. Cardiomyopathies – hypertrophic, dilated, restrictive.
    3. Coronary heart disease.
    4. Electrolyte imbalance associated with a change in the concentration of potassium, calcium, sodium, chlorine in the body.
    5. The development of metabolic acidosis, or alkalosis.
    6. Respiratory failure with the formation of alkalosis or acidosis.
    7. Severe pulmonary hypertension.
    8. 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.

    1. Complete blood count – the identification of markers of the infectious process.
    2. A blood test to determine the electrolyte composition.
    3. Echocardiography for assessing the state of the heart chambers.
    4. Dopplerography of the vessels of the heart. If necessary – angiography.
    5. 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!

    Medical tactic

    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.

    The primary diagnostic method is an electrocardiogram.

    Therapeutic procedures include the use of:

    • 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).
    • Clinical data – fainting (with or without stress), congenital deafness,
    • Family history data (established diagnosis JUDGE QT or FEMALINE QT, sudden cardiac death in close relatives under 30 years of age).
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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.

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