Taking an electrocardiogram is a mandatory and necessary examination for a complete picture of a person's he alth status within any medical commission. An ECG is also given a referral from the attending physician if he suspects any cardiac abnormalities in the patient. But the issued conclusion is not always clear to a non-specialist.
For example, what is a violation of the process of repolarization on the ECG? What are its reasons? Is it an independent disease? How to plan further diagnostics? How does this violation manifest itself? What treatment can be prescribed? We will answer these and other important questions on the topic in the article.
Definition
Violation of the repolarization process on the ECG is a purely medical term. Most often, it is used by specialists to describe characteristic patterns on electrocardiograms. In this case, a problem was found with the final part of the cardiac cycle. This is relaxation of the ventricles.
The difference between children and adults
Violationthe process of repolarization on the ECG is noted in both children and adults. The differences here are important: in children, such a violation is mostly benign. That is, it does not pose a danger to the child.
But a violation of the repolarization process on the ECG in the elderly is most often a sign of serious heart disease: ischemia, heart attack, myocarditis.
Focal and diffuse
Violation of the repolarization processes on the ECG in adults can be recorded both on all branches of the ECG, and on some part of them. In the first case, there is a diffuse (general) violation, in the second - focal.
Diffuse disorders of repolarization processes on the ECG in adults indicate that the pathology has spread to the entire heart muscle (as happens, for example, with myocarditis). Focal disorders - a pathology that is limited. In this case, only a specific area of \u200b\u200bthe heart is affected. For example, a His bundle block or a case of myocardial infarction.
What does the violation of repolarization processes mean? Only the attending cardiologist can give a complete answer specifically for you.
The flow of cardiac cycles
How does focal or diffuse disturbance of repolarization processes occur? To answer the question, let's recall the course of the cardiac cycle.
The contraction of our heart is caused by electrical impulses that are conducted to each of the cells of the myocardium (we are talking about the heart muscle). After such an electrical impulse, cardiomyocytes go through the stages of contraction -relaxation. The latter constitute the cardiac cycle.
One must understand that behind each of these stages there are complex mechanisms of the current of potassium, calcium, chlorine ions in cells. Those electrical changes in the membranes of cardiomyocytes (cardiac muscle cells), which underlie the stage of contraction, are called polarization. Accordingly, the electrical change underlying muscle relaxation is already called repolarization.
Display on ECG
What does a violation of the process of repolarization of the lower wall of the left ventricle mean? Here, of course, we do not mean the current of ions through the membranes of myocardial cells. It is not yet possible to change this in a clinical setting. We are talking about the characteristics of the picture of the electrocardiogram at the time of relaxation of the ventricles of the patient's heart.
A normal ECG is a curve that consists of a series of teeth:
- P - this wave indicates atrial contraction.
- Q, R, S - contraction of the ventricles of the heart.
- T wave represents the contraction of the heart ventricles.
Intervals and segments can be seen between these teeth. What does the decoding on the ECG of violations of repolarization processes look like? In both adults and children, this will be displayed by characteristic pathological changes in two elements: the ST segment and the T wave.
Reasons
Why does the repolarization process appear on the ECG in a teenager, adult, infant or elderly person? There are many reasons for this.
Let's list the main factors of such changes:
- Pathologies, diseases affecting the myocardium itself: ischemia, myocarditis, heart attack, infiltrative processes.
- Using certain drugs: quinidine, digoxin, tricyclic antidepressants, and many more.
- The presence of electrolyte disturbances in the concentrations in the body of potassium, calcium, magnesium.
- A number of neurogenic factors: hemorrhagic or ischemic strokes, brain tumors, traumatic brain injuries.
- Metabolic causes: hypokalemia, hyperventilation, etc.
- Impaired conduction of electrical signals in the heart ventricles.
- Pathological rhythms, the causes of which are located specifically in the ventricles.
As for children, such disorders can be provoked additionally by genetic defects. Therefore, when they are detected, the specialist additionally pays attention to clinical syncope (both in case of stress and for no apparent reason), congenital deafness and information from the family history (medical history). If congenital symptoms are suspected, then genetic tests are ordered to identify mutant genes.
Other common causes of heart failure in children are acquired and congenital heart defects, cardiomyopathy.
Primary Violations
Primary repolarization disorders are considered to be ECG changes that do not depend on the uncoordinated work of the ventricles. May bethe result of both focal and diffuse pathological processes that generate relaxation of the ventricles.
Their reasons are as follows:
- The effect of certain drugs listed above.
- Electrolyte disturbances.
- Heart attack, ischemia, inflammation of the heart muscle.
- Complex of neurogenic factors.
Secondary violations
Moderate disturbance of repolarization processes is not dangerous for children's he alth. But for adults, especially the elderly, this is quite a worrying factor that should not be ignored.
Secondary disturbances in repolarization may also be noted. These are already normal changes in the T wave and the ST segment. They can develop only because of specific changes in the sequence of excitation of the ventricles. For the most part, they are focal in nature - they will be observed only in part of the branches of the electrocardiogram.
Secondary offenses here would include the following:
- Changes characteristic of bundle branch blockades.
- Changes in Wolff-Parkinson-White disease.
- Changes that accompany premature ventricular contractions, ventricular rhythms and ventricular arrhythmias.
SRRJ
One of the forms of the above disorders is called the syndrome of early repolarization of the ventricles - ERP. This variant on the ECG is noted in 3-5% of the population, mainly in adolescents, athletes, and men. Until recently, it was believed that with such a syndromethe most favorable forecasts are possible. That is, the violation does not negatively affect either the life or the he alth of people.
But today the situation is different. Scientific studies have confirmed that the syndrome increases the risk of developing both dangerous arrhythmias and cardiac arrest in general. This risk can be assessed on the same electrocardiogram.
Signs of violation
First of all, we recall that this disorder is not inherently an independent pathology or disease. These are ECG changes that may be characteristic of certain diseases and disorders. Moreover, a person can live a long he althy life with such disorders, as they will not report themselves with any unpleasant, disturbing manifestations.
Therefore, there are no clear, specific signs of a violation of repolarization processes on the ECG. The clinical picture may not manifest itself at all. Or be very bright, as happens with a heart attack. Therefore, there are no separate symptoms by which, without making a cardiogram, it is possible to identify such a heart disorder.
Therefore, if the clinical symptoms of diseases, pathologies of the heart do not manifest themselves in any way, violations are detected purely by chance. Say, during a routine medical examination. If you found a violation of repolarization due to the fact that you turned to a cardiologist with certain symptoms, then you need to understand that their cause was the development of a specific disease.
Diagnosis
How is it possible to determine the disturbed processes of repolarization? Of course,using the same ECG. The specialist will note the characteristic changes in the T wave and ST segment. As we have already said, they can be found both on all ECG leads, and in some specific part of them.
In certain cases, by the type of tooth and segments, specialists can judge the causes of the violation, the pathology or disease that caused it. If this is not possible, then the following additional examinations are prescribed by the doctor:
- Laboratory blood tests. This allows you to determine the presence of inflammatory diseases that can cause electrolyte and metabolic problems.
- Echocardiography. This is an ultrasound examination of the heart. It reveals structural changes, as well as disturbances in myocardial contractility.
- Coronary angiography. This is a diagnostic study of the coronary arteries, which supply the heart with blood.
Treatment directions
Since disturbed repolarization processes are not an independent disease, but a sign of some disease, disorder, pathology, one cannot say about a single therapy in this case. To get rid of such a violation, you need to deal with its cause. In this case, with illness.
After the cause of the violation of repolarization of the cardiac ventricles is eliminated, the process will return to normal and will not be displayed on the ECG.
If there is no root cause in the form of any disease, then the following therapy is prescribed for such a violation:
- Taking vitamin complexes. They support the full functioning of the heart,provide the body with all the necessary trace elements and vitamins.
- Prescribing corticotropic hormonal drugs. The main active compound here is cortisone. It has a beneficial effect on many vital processes in the body.
- Intake of cocarboxylase hydrochloride. It helps to restore carbohydrate metabolism, as well as improve the trophism of the peripheral and central nervous system. The drug has a beneficial effect on the entire cardiovascular system as a whole.
- Prescribing drugs such as panangin or anaprilin, or other beta-blockers.
Forecasts
Similarly, no universal predictions can be made. It all depends on the reasons that caused the changes to be displayed on the ECG.
For example, there are no threats to the patient's life and he alth in benign SRCC. And already in the case of myocardial infarction it is difficult to say. There is already a high risk that the patient may remain disabled. It is impossible to exclude a lethal outcome with a similar pathology.
In conclusion
Summing up, we can conclude that impaired repolarization processes on the ECG are not a disease in and of themselves. These are signs of a particular pathology. They can also be a benign syndrome that does not pose a danger to the patient.
