Diffuse violation of the process of repolarization what is it

One of the common cardiological diagnoses is a violation of repolarization processes in the myocardium. Although this problem is not always accompanied by any symptoms, its consequences can be very unpleasant. Only a timely visit to a doctor will help to avoid exacerbating problems.

Read more about what are dangerous violations of repolarization processes, and how to treat them – later in the article.

The heart is a complex mechanism, any violation in which leads to malfunctions in the entire circulatory system.

One of the important points of functioning is the consistent reduction and relaxation of the heart, which ensures the correct blood flow.

The contractions occur due to the transmission of nerve impulses – a kind of signal from the brain about the need for such a function.

Phase distribution of electrical impulses

Repolarization is a process during which the membrane potential of a cardiomyocyte is restored. The membrane is preparing to receive a new signal and, accordingly, to reduce. At this moment, the ions return to their original place, which makes it possible to take the next impulse. Speaking of repolarization, cardiologists describe the picture on the ECG at the time of ventricular diastole.

The correct course of myocardial repolarization is very important, since in the absence of treatment there is a risk of developing other diseases of the cardiovascular system:

  • heart rhythm disturbances;
  • left ventricular hypertrophy;
  • coronary artery disease.

If we are talking about the entire muscle (diffuse changes), then the symptoms are often mild. Violation of myocardial repolarization may be accompanied by the following manifestations:

  • violation of blood flow;
  • nervous system disorders;
  • heart rhythm failures;
  • fast fatiguability.

Such symptoms are inherent in many heart diseases, therefore, after receiving alarming ECG results, additional studies are carried out.

Focal disorders of repolarization occur during blockages in different parts of the pathways.

It is interesting to note that even those under the age of 35 who lead a healthy lifestyle and regularly engage in sports suffer from repolarization disorders.

As mentioned above, ventricular repolarization threatens not only older people, but also young and active ones (early ventricular repolarization syndrome stands out separately).

Any diffuse disorders may occur due to:

  • other heart diseases;
  • too intense physical exertion;
  • constant stress;
  • increased levels of adrenaline and norepinephrine;
  • hormonal disorders;
  • electrolyte disturbances in the blood;
  • taking certain drugs.

In general, this condition is rarely the reason for going to the doctor. It is fixed during the examination for specific signs on the cardiogram:

  • irregular T wave;
  • systematically raising the ST by 1-3 mm above the contour;
  • rounded ST view;
  • expansion at the base of tooth T.

In any case, only a specialist can determine the disease.

In women during pregnancy, a violation of the process of proper repolarization in the myocardium is also often observed. This is due to the increased load on the muscle, and, as a rule, passes after the birth of the baby.

ECG will detect abnormalities

Violation of repolarization is not considered a separate diagnosis, it is a symptom. Which indicates the occurrence of pathological processes and heart diseases. In the treatment of a pathological disorder, normal heart function is restored.

To avoid myocardial hypertrophy and mitigate symptoms, the following are used:

  • vitamins for the heart – provides the supply of all necessary elements to the body;
  • corticotropic hormones – cortisone favorably affects the processes inside the secondary muscle;
  • cocarboxylase hydrochloride – restores heart rate;
  • beta blockers to eliminate some heart diseases.

Often, impaired repolarization becomes a sign of emerging coronary disease, which allows you to take measures to eliminate the danger in advance.

Important! Young people need to regularly check the state of the heart muscle in order to provide medical assistance on time.

In the absence of pathological changes or negative trends, people under 35 should not be very worried, but simply undergo a routine examination regularly.

Sometimes repolarization is the result of hormonal disruption. This is characteristic of the adolescent period, when internal restructuring forces the body to work to the limit. Treatment is either not required or is aimed at eliminating the symptoms. Such repolarization occurs after puberty.

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

When doctors talk about repolarization, they do not mean ion current through the membrane of the heart cells, which is impossible to measure in clinical practice, but about the characteristics of the ECG pattern at the time of ventricular relaxation.

The ECG normally has the form of a curve, which consists of several teeth:

  • P – Displays atrial contraction.
  • Q, R, S – represent ventricular contraction.
  • T – Displays ventricular relaxation.

Between these teeth there are segments and intervals. Violations of the processes of repolarization on the ECG in adults and children are displayed by changes in the ST segment and T wave.

The process of repolarization can be influenced by many factors, including:

  • Diseases of the myocardium itself (for example, myocarditis, ischemia, heart attack, infiltrative process).
  • Medicines (e.g. digoxin, quinidine, tricyclic antidepressants and many other drugs).
  • Electrolyte disturbances in the concentration of potassium, magnesium and calcium.
  • Neurogenic factors (for example, ischemic or hemorrhagic stroke, traumatic brain injury, brain tumor).
  • Metabolic factors (e.g., hypoglycemia, hyperventilation).
  • Violations of the conductivity of electrical signals in the ventricles.
  • A pathological rhythm whose source is in the ventricles.

Secondary disturbances in repolarization in the myocardium are normal changes in the ST segment and T wave, which develop solely due to changes in the sequence of excitation of the ventricles. Such changes are most often focal in nature, that is, they are observed only in part of the ECG leads. They include:

  • Changes characteristic of the bundle of His.
  • Changes in Wolf-Parkinson-White syndrome.
  • Changes characteristic of premature contractions of the ventricles, ventricular arrhythmias, and ventricular rhythm.

Primary disturbances of repolarization processes are ECG changes that are not dependent on uncoordinated ventricular activation, but may be the result of a diffuse or focal pathological process that affects ventricular relaxation. They include:

  • The effects of drugs (e.g., digoxin or quinidine).
  • Electrolyte disturbances (e.g. hypokalemia).
  • Ischemia, heart attack, inflammation (myocarditis).
  • Neurogenic factors (for example, subarachnoid hemorrhage can cause an extension of the QT interval).

One of the forms of these disorders is Early Ventricular Repolarization Syndrome (AED) – 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.

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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.


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.

Violation of repolarization is not a disease, but its symptom detected by doctors on an ECG. It is necessary to treat the disease itself, and not its manifestations on the cardiogram. After eliminating the causes of these disturbances, the ECG normalizes on its own. The effectiveness of the therapy depends on the type of disease.


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.

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.

Appeal to a specialist

Violation of the processes of repolarization in the myocardium

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. .

Firstdisturbances in the work of the heart, which include ischemic disease, and abnormalities in the balance of electrolytes, and overstrain of the heart muscles
The secondit is necessary to name an unbalanced amount of hormones (adrenaline / norepinephrine), to which tissues have an increased sensitivity
The thirdis 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.

The following classification of early repolarization syndrome exists:

  • with damage to the heart muscle and blood vessels;
  • no lesion.

The syndrome is also classified according to the severity on the electrocardiogram into 3 classes:

  1. Minimal (observed in a small number of leads, from 2 to 3).
  2. Moderate (the number of leads increases from 4 to 5).
  3. Maximum (6 or more leads).

According to statistics, deviations in the work of the heart are detected 3 times more often in males.

However, most often the disease appears during pregnancy or menopause in women, since at this time the sensitivity of the body increases significantly and the general hormonal background changes. The disease is detected, as a rule, during routine examinations, in case of any complaints about well-being.

At risk are both professional athletes who are experiencing constant physical activity, and people who have experienced hypothermia. And some doctors even claim that the disease is hereditary.

There is no generally accepted classification of the syndrome of premature myocardial repolarization. It is important to distinguish 2 variants of the syndrome:

  1. SRG, proceeding without damage to the cardiovascular and other systems;
  2. Anemia accompanied by damage to the cardiovascular and other systems.

Most often, disturbances in the cell repolarization phase are caused by changes in the following factors:

  • insufficient oxygen supply to the heart muscle (hypoxia);
  • a decrease in pressure in the bed of the coronary arteries;
  • a change in systolic pressure in the cavity of the ventricles of the heart.

The causes of such violations of ventricular repolarization in adults, there are quite a lot. For convenience, they were combined into several groups:

  • diseases of the cardiovascular system (ischemic, inflammatory, dystrophic origin, myocardial hypertrophy, diffuse change in the structure of the ventricles);
  • the presence of pathology from the nervous system (neurocirculatory dystonia, sympathoadrenal dysfunction);
  • dysregulation of the neuroendocrine system (increased production of hormones);
  • menopause and pregnancy;
  • exposure to certain drugs;
  • non-specific causes of development (the phenomenon of early repolarization).

Many studies by scientists indicate that dozens of different stimuli can precede disturbances in repolarization processes.

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.

In the case of a diffuse disorder, that is, changes that affect the entire heart muscle, symptoms appear associated with the general well-being of the person and with the heart rhythm.

Deviations in the work of the heart affect the functioning of the whole organism. .

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. .

So, the external manifestations of violations of the repolarization process are almost invisible, and therefore this deviation can only be detected by a doctor after an appropriate examination, for example, an ECG.

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. .

Numerous factors can intervene in this process. These can be diseases of the cardiovascular system, and non-heart related causes:

  • Left ventricular hypertrophy;
  • Coronary artery disease;
  • Cardiosclerosis;
  • Hormonal imbalance, malfunction of the kidneys or dehydration;
  • Diseases of the nervous system, rapid flow of “exciting” impulses to the heart;
  • The malfunctioning of adrenaline receptors may be due to some tumors.

Violation of the process of repolarization of the heart muscle is associated with one of three conditions:

  • QT interval increase;
  • QT interval reduction;
  • Syndrome of early repolarization of the heart ventricles.

Let us consider each of them in more detail.

  • change in the frequency of contractions of the heart muscle (tachycardia, bradycardia);
  • chest pains;
  • arrhythmia;
  • frequent and abrupt mood swings;
  • feeling tired, depressed.

Such symptoms make it possible to suspect an early ventricular repolarization syndrome. Many experts consider this condition a variant of the norm.


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 manifests itself on the cardiogram by reducing the duration of the QT interval to less than 0. 33-0.

35 s, and QT lengthening syndrome – an increase in the interval duration of more than 0. 47-0.

When considering pathology, the treatment prescribed by cardiologists directly depends on the root cause, which became the factor that provoked the violation. If it was possible to identify it, the main task becomes its elimination with subsequent re-diagnosis of disorders after the course of treatment.

In cases where the cause as such cannot be identified, therapy is carried out in the following areas:

  • the use of vitamins that will support the normal functioning of the heart;
  • hormones based on cortisone, which beneficially affect all processes in the body, including the work of the heart;
  • Panangin and Anaprilin are used to treat many heart diseases, medicines belong to the group of beta-blockers.

Before choosing a dosage, and indeed the drug itself, a cardiologist must carefully analyze all the results of the studies and evaluate the general state of health.

Medication is usually prescribed only in case of a real threat to life or irreversible heart changes. In the early stages of adults, the disease is treated with vitamins to maintain and normalize the functioning of the heart muscle.

Beta blockers are used in extreme cases. .

The question of the need for treatment of disorders of repolarization processes should be resolved as soon as possible after detecting them on the cardiogram and further examination of the patient.

In the absence of a causal cardiac pathology, the patient is prescribed drugs or a pacemaker is established based on the presence or absence of clinical manifestations of tachyarrhythmias (fainting, tachycardia, heart failure).

For the smooth functioning of body systems, a number of conditions are necessary. One of them is the lack of cardiological disorders. When exposed to a number of unfavorable factors, a cardiac pathology, called a violation of myocardial repolarization, can develop.

Repolarization is one of the cyclic phases of the functioning of the heart muscle (myocardium), accompanied by the restoration of the electric membrane charge.

Causes of impaired repolarization processes in childhood

IHD as a cause of ventricular myocardial repolarization processes

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.

Normal performance

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).

What is a violation of myocardial repolarization

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.

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.

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.

Pathological repolarization disorders provoke changes in the ECG curve of the height of the T wave. However, it is impossible to make a precise diagnosis – this phenomenon is observed not only with heart diseases, but also with any metabolic disorders. If the shift of the ST segment is also traced, this indicates a violation of the electrolyte balance in the cells. The process of repolarization can be disrupted by a serious pathology – hypersympathicotonia, accompanied by an increase in the level of adrenaline in the blood.

This condition is caused by an increase in the tone of the sympathetic part of the autonomic system and causes:

  • decrease in sweating, secretion of saliva and mucus;
  • dry skin;
  • tachycardia;
  • pain in the heart;
  • noticeable change in mood;
  • increase in blood pressure.

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What exactly caused the violation of myocardial repolarization is not precisely determined today. Numerous studies have identified several reasons that can cause a change in the processes of myocardial repolarization:

  • 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.

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 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.

Get a treatment program

Violation of myocardial repolarization, the treatment of which completely depends on the root cause of the disease and is aimed at eliminating it, is not rarely considered as normal options, especially in young people. For people over the age of 50, this pathology, combined with complaints about the work of the heart muscle and the corresponding history, can be a manifestation of hypertension or coronary artery disease.

If the exact causes of the appearance of violations of repolarization processes in the heart are not established, then complex therapy with the following drugs is carried out:

  • vitamin complexes that will provide the cardiovascular system with the necessary trace elements and vitamins, thereby supporting its full-fledged work;
  • cocarboxylase hydrochloride, which helps restore carbohydrate metabolism and heart function, as well as normalizes trophic processes in the peripheral and central nervous system;
  • hormones of the corticotropic series, the active substance of which is cortisone. Its main function is to stimulate the synthesis of carbohydrates from proteins, which is necessary for the normal functioning of the body as a whole;
  • panangin or anaprilin, which belong to the group of drugs of β-blockers. They are used to treat this disease extremely rarely, only in cases where there is a real threat to the patient’s health.

The selection of drugs and their dosage for each patient is carried out individually, after a detailed study of the results of analyzes and examinations.

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.
  • 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.
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    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.

    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!

    Impaired repolarization processes – symptoms and treatment

    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.

    • Headache
    • Weakness
    • Dizziness
    • Increased temperature
    • Cardiopalmus
    • Dyspnea
    • Memory impairment
    • Heart rhythm disturbance
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    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.

    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. In the case of severe disorders – to decide on the formulation of a two-chamber pacemaker, which sequentially provides atrial and ventricular contraction.

    How is the disease identified on the ECG

    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.

    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.

    The timely establishment of deviations in the repolarization process in children is very important – this syndrome can cause sudden death

    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, the results of recent scientific studies indicate 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 lipid levels;
    • use of adrenostimulants;
    • disturbances in the complex of anatomical formations of the heart muscle.

    It is difficult to detect early repolarization, but practicing cardiologists believe that people with this pathology often have cases of tachycardia and sudden cardiac arrest.

    • 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.

    Additional examinations

    The purpose of the additional examination is to clarify the cause of the diffuse changes in the myocardium. After all, if the cause is removable – the heart can be restored completely, diffuse disorders are reversible. And if the cause is not removable, you can try to reduce its effect on the heart, by prescribing supporting metabolic drugs, or by transferring a chronic heart-traumatic disease to the remission stage.

    If non-specific signs of impaired myocardial repolarization are detected on the ECG, the doctor will prescribe the patient:

    • General clinical tests (OAC, OAM),
    • Biochemical blood test with indicators of the kidneys, liver, pancreas, rheumatic complex,
    • Ultrasound of the heart,
    • Ultrasound of internal organs,
    • consultation of an endocrinologist, gynecologist for women,
    • Holter ECG monitoring, stress tests.
    • 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.

    How to determine deviations

    The main and only method for the diagnosis of ventricular repolarization disorders is electrocardiography. On the film, nonspecific changes of the T wave (mainly in the chest leads) are visible – it becomes high, pointed, or, conversely, its amplitude decreases, it can be negative.

    Of much greater interest is the ECG diagnosis of SRGR, in which the following main signs are noted:

    • ST segment lift;
    • point j, “camel hump”, “Osborne wave” – notch on the descending part of the ST segment;

    Shortening of the PQ and QT intervals may also be observed.

    Decoding a cardiogram requires special care from a doctor, since an ST segment elevation occurs in other, more serious pathologies, such as angina pectoris, myocardial infarction, pericarditis, etc. Most often, the clinical picture does not help in differential diagnosis, because Anemia is not accompanied by any symptoms.

    However, if I find the above changes on the film in an adult (especially after 40 years), then I additionally prescribe stress tests, i.e. ECG removal at a time when the patient performs moderate physical activity – on a bicycle ergometer or treadmill (treadmill). With ATS, the cardiogram returns to normal. This helps me make a differential diagnosis with a painless form of angina pectoris and heart attack.

    In the case of an uncertain ECG picture, I use special tests with drugs. The patient is injected with potassium chloride or Novocainamide. After 30 minutes, the ECG is removed. With ATS, the symptoms become more distinct.

    To detect possible arrhythmias, I conduct my patients daily (Holter) ECG monitoring.

    Since ATS can develop amid organic heart diseases, I prescribe echocardiography to assess the morphological structure of the myocardium.

    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.

    A patient with a violation of the repolarization process needs follow-up, as well as:

    • 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.

    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.


    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.

    6 Non-Heart Problems

    Diffuse violation of repolarization processes on the ecg

    Violation of repolarization processes means that for some reason the heart cells cannot fully relax or remain at rest for the required amount of time, or the processes of excitation-relaxation are out of sync with time. This condition can not manifest itself clinically and can be registered only when recording an ECG, and may be one of the manifestations of cardiac pathology or diseases of internal organs.

    If the doctor fixes the changes characteristic of repolarization disorders only in some leads of the cardiogram, then these changes are focal in nature – the changes affected some kind of private department, the heart area. If changes in the cardiogram are observed in all leads, then in the conclusion of the cardiogram the doctor will indicate that violations of the repolarization processes are diffuse.

    Violation of repolarization processes is not uncommon in conditions that are not at all connected with the heart. Such changes may occur with:

    1. Anemia The connection between diffuse changes in the heart and anemia is that a low amount of hemoglobin during anemia cannot transfer as much oxygen as a healthy heart needs to work. Oxygen “hunger” of cardiomyocytes in case of anemia also causes these nonspecific ecg changes.
    2. Infectious diseases, both acute and chronic. These conditions contribute to metabolic disorders in the body, as well as in the heart. After treatment of acute infection and recovery, diffuse disorders in the heart are also eliminated. Chronic pathology contributes to the progression of repolarization disorders, exacerbation of diffuse changes, which in consequence can even lead to ischemia.
    3. Intoxication with alcohol, nicotine, drug use. Long-term systematic abuse threatens cardiovascular disasters: heart attack, severe arrhythmias. And the first “bell” in such patients is precisely diffuse changes in the myocardium.

    3 ECG signs

    How does a doctor determine that diffuse disturbances in the processes of repolarization of the heart muscle occur? The following changes are recorded in all leads of the cardiogram:

    • Reducing the height of the T wave, its inversion (reverse location), flattening, narrowing. Normally, the T waves should be 0,5 mm or more in amplitude in leads I and II.
    • Depression or reduction of the ST segment below the isoelectric line by no more than 1 mm. If the downward displacement of this segment is more than 1 mm – we are talking about ischemia, a serious cardiac pathology.

    It should be remembered that the above ECG changes can also be observed due to improper electrode application, or be the result of poor contact with the skin, occur when drinking cold water.

    Normal performance

    These changes can be recorded in newborns

    Not always a violation of the processes of repolarization of the heart should be considered as a deviation from the norm. This condition is a natural sign of aging of the body, including the heart muscle. With age, metabolic processes in the body, including the heart, worsen, the myocardium becomes more flabby, the conductivity and excitability of the heart cells are impaired, the processes of repolarization worsen, diffuse changes in the myocardium develop.

    These changes can be recorded in newborn children, children of the first year of life due to the immaturity of the autonomic regulation of heart activity, in adolescents during puberty due to excessive activity of hormones, intensive growth. Diffuse changes in the myocardium at the cellular level can develop with prolonged exposure to stress, increased physical exertion, overwork, and a violation of the psycho-emotional sphere.

    These changes can be recorded in people who are fond of various diets, with systematic malnutrition, exhaustion. In the case when diffuse changes in the cardiogram are associated with age-related aging of the body, the process is irreversible. It can only be slowed down, but it is not possible to restore the structure of the myocardium. In all other cases described above, the process is reversible provided that the factors causing these changes are timely eliminated.

    5 Cases of the heart

    Diffuse changes in the myocardium can occur (quite often) in the pathology of the cardiovascular system. These violations may indicate:

    1. Myocarditis is an inflammation of the heart muscle. When the entire muscle is affected by inflammation, it is diffuse changes that develop. The nature of the inflammatory process can be completely different: infectious, bacterial, allergic.
    2. Cardiosclerosis is a stage of cicatricial changes, it can occur after myocarditis, an extensive heart attack. In myocarditis, these are more often diffuse changes, in case of a heart attack – focal (for example, focal disorders of left ventricular repolarization).
    3. Long-term coronary heart disease, hypertension, expressed atherosclerotic processes in coronaries. In people who have these diseases, the presence of diffuse changes in the myocardium on the ECG in a large percentage of cases is guaranteed.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.