Removing an electrocardiogram is a mandatory and necessary examination to make a complete picture of a person’s health status within any medical commission. A referral from the attending physician is also issued on the ECG if he suspects any cardiac abnormalities in the patient. But the issued conclusion is not always clear to the layman.
For example, what is a violation of the process of repolarization on the ECG? What are its reasons? Is this 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, specialists use it to describe characteristic patterns on electrocardiograms. In this case, a problem was found with the final part of the cardiac cycle. This is a relaxation of the ventricles.
Difference for children and adults
Violation of the process of repolarization on the ECG is noted in both children and adults. The differences are important: in children, such a violation is for the most part benign. That is, it does not pose a danger to the child.
But the violation of the process of repolarization 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 processes of repolarization 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, a diffuse (general) violation is observed, in the second - focal.
Diffuse disturbances of the processes of repolarization 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 of a limited nature. In this case, only a specific area of the heart is affected. For example, a blockage of the bundle of His or a case of myocardial infarction.
What does violation of repolarization processes mean? The full answer specifically for you can give only the attending cardiologist.
Cardiac cycle progression
How does a focal or diffuse violation of repolarization processes occur? To answer the question, remember the course of the heart cycle.
The contraction of our heart is caused by electrical impulses that are conducted to each of the myocardial cells (we are talking about the heart muscle). After such an electrical pulse, cardiomyocytes go through the stages of contraction-relaxation. The latter constitute the cardiac cycle.
It must be understood that behind each of these stages are the complex mechanisms of the flow of potassium, calcium, and chlorine ions in the cells. Those electrical changes in the membranes of cardiomyocytes (heart muscle cells) that underlie the stage of contraction are called polarization. Accordingly, the electrical change underlying muscle relaxation is referred to as repolarization.
ECG display
What does violation of the process of repolarization of the lower wall of the left ventricle mean? Here, of course, this does not mean ion current through the membrane of myocardial cells. It is so far impossible to change this under clinical conditions. This is a characteristic of the electrocardiogram pattern at the time of relaxation of the patient's ventricles.
The ECG is normal - this is a curve that consists of a series of teeth:
- P - this tooth indicates atrial contraction.
- Q, R, S - contraction of the ventricles of the heart.
- T - tooth displays the contraction of the heart ventricles.
Between these teeth, intervals and segments can be seen. What is the interpretation on the ECG of a violation of repolarization processes? In both adults and children, this will be reflected by characteristic pathological changes in two elements: the ST segment and T wave.
Causes
Why is the violation of repolarization processes on the ECG displayed in a teenager, adult, infant or elderly person? There are many reasons for this.
We list the main factors of such changes:
- Pathologies, diseases affecting the myocardium itself: ischemia, myocarditis, heart attack, infiltrative processes.
- Taking certain medications: quinidine, digoxin, tricyclic antidepressants and many other drugs.
- The presence of electrolyte disturbances in concentrations in the body of potassium, calcium, magnesium.
- A number of neurogenic factors: hemorrhagic or ischemic strokes, brain tumor, traumatic brain injury.
- Metabolic causes: hypokalemia, hyperventilation, etc.
- Violation of the conductivity of electrical signals in the heart ventricles.
- Pathological rhythms, the causes of which are specifically the ventricles.
As for children, such violations can be provoked additionally by genetic defects. Therefore, when they are detected, the specialist additionally draws attention to clinical fainting (both in case of stress and for no apparent reason), congenital deafness and information from a family history (medical history). If there is a suspicion of congenital symptoms, then genetic studies are appointed to identify mutant genes.
Other common causes of the disorder in children are acquired and congenital heart defects, cardiomyopathy.
Primary violations
The primary disturbances of repolarization are changes in the ECG, independent of the uncoordinated work of the ventricles. May be the result of both focal and diffuse pathological process, which causes relaxation of the ventricles.
Their reasons are the following:
- The effect of certain medications indicated above.
- Electrolyte disturbances.
- Heart attack, ischemia, inflammation of the heart muscle.
- The complex of neurogenic factors.
Secondary disorders
A moderate violation of the processes of repolarization is not dangerous for the health of children. But for adults, especially the elderly, this is a rather alarming factor that cannot be ignored.
Secondary disturbances in repolarization may also be noted. These are already normal changes in the T wave and ST segment. They can develop only due to specific changes in the sequence of excitation of the ventricles. For the most part, they differ in focal nature - they will be observed only in part of the branches of the electrocardiogram.
Secondary violations here will include the following:
- Changes characteristic of the bundle of His.
- Changes in Wolf-Parkinson-White disease.
- The changes that accompany premature contractions of the ventricles, ventricular rhythms, and ventricular arrhythmias.
SRGR
One of the forms of the above disorders is called the syndrome of early repolarization of the ventricles - SRG. This option on the ECG is observed in 3-5% of the population, mainly in adolescents, athletes, men. Until recently, it was believed that with this syndrome the most favorable prognoses are possible. That is, the violation does not adversely affect either life or human health.
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 by the same electrocardiogram.
Signs of Violation
First of all, we recall that this violation is inherently not 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 healthy life with such violations, since they will not report about themselves with some unpleasant, disturbing manifestations.
Therefore, there are no clear, concrete signs of impaired repolarization processes on the ECG. The clinical picture may not manifest itself at all. Or be very bright, as it happens with a heart attack. Therefore, there are no individual symptoms by which, without making a cardiogram, it is possible to detect 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 accident. Say, during a routine physical examination. If you find 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.
Diagnostics
How is it possible to identify disturbed repolarization processes? Of course, using the same ECG. The specialist will note the characteristic changes of 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 doctor appoints such additional examinations:
- Laboratory tests of blood composition. 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 violations in the contractility of the myocardium.
- Coronarography This is a diagnostic study of the coronary arteries that supply the heart with blood.
Directions of treatment
Since the disturbed repolarization processes are not an independent disease, but a sign of a disease, disorder, pathology, it cannot be said 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 a disease.
After the cause of the violation of repolarization of the heart 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 with such a violation, the following therapy is prescribed:
- Reception of vitamin complexes. They support full-fledged cardiac activity, ensure the entry into the body of 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.
- Taking cocarboxylase hydrochloride. It helps to restore carbohydrate metabolism, as well as improve trophism of the peripheral and central nervous system. The drug also has a beneficial effect on the entire cardiovascular system as a whole.
- Prescribing drugs such as panangin or anaprilin, or other beta-blockers.
Forecasts
In the same way, it is impossible to express any universal forecasts. It all depends on the reasons that caused the display of changes on the ECG.
For example, with benign SRH, there are no threats to the life and health of the patient. And already in the case of myocardial infarction it is difficult to say. There is already a great risk that the patient may remain disabled. A fatal outcome with a similar pathology cannot be ruled out.
Finally
Summing up, we can conclude that the disturbed repolarization processes on the ECG are not a disease in themselves. These are signs of a particular pathology. They can also be a benign syndrome that does not pose a danger to the patient.