Moderate changes in ventricular depolarization. Early ventricular repolarization syndrome in children - what does it mean? Course and stages

Early ventricular repolarization syndrome is a concept that characterizes the results of electrocardiography; it is not a disease and not a pathology at all. A similar feature occurs in almost every tenth patient in the cardiology department. Until now, doctors have not come to a conclusion whether this is a physiological norm or a deviation.

What it is?

It has already been said that this is primarily a term for ECG specialists, but in what cases is it used? The results of electrocardiography look like a curve with several teeth. During early ventricular repolarization, the descending limb of the R wave becomes serrated and the ST segment rises. When comparing the indicators of the usual complex with this syndrome, a noticeable difference can be easily noted.

The phenomenon of early repolarization is characteristic of cases when excitation in the subepicardium is recorded earlier than the normal variant. This usually occurs in athletes and trained people, but it has not been determined whether early repolarization is a way of adaptation of the body or a pathology.

Causes

At the moment, the exact causes of the syndrome have not been found. Some experts associate changes in the electrophysiology of the heart with previous hypothermia, others - with taking a number of medications. It is noted that there are some disorders that are most often accompanied by early ventricular repolarization. These include:

• familial hyperlipidemia - a condition when a person has a tendency to accumulate cholesterol, and this is inherited;
• hypercalcemia;
• connective tissue dysplasia is a systemic pathology in which the development of this tissue is disrupted while the child is in the womb and immediately after his birth;
• pathologies of the autonomic nervous system;
• hypertrophic cardiomyopathy is a genetic disorder in which one of the ventricles (usually the left) has a thickened wall.

Why is the syndrome dangerous?

The main danger of this feature is that it has not been fully studied. Early repolarization can be detected accidentally in completely healthy people during a preventive ECG. Similarly, there are cases of detection of the syndrome in people with certain disorders of cardiovascular activity.

However, does the condition itself somehow affect the activity of the heart? It is believed that disruption of repolarization processes in the myocardium may be the cause of abnormal heart rhythm. There is also information about the effect of the syndrome on the occurrence of systolic and diastolic dysfunction. In children, such changes are more dangerous, as they are accompanied by growth of the heart muscle and the entire body.

Additional diagnostics

Early repolarization syndrome is traditionally considered an electrocardiographic change. There is no way to detect it “on the surface”; there is also no definite clinical picture. In order to identify possible reasons for such results, you can resort to additional diagnostic methods. An ultrasound of the heart will allow you to assess the size of the heart, determine the presence of structural anomalies in the development of the organ and other pathological changes.

A Holter study is the same electrocardiography, only carried out permanently for a day or more (up to three days). This method will reveal the connection between early repolarization of the heart and the time of day when this occurs, the amount of physical activity, stress, etc.

Electrophysiological testing is used to detect arrhythmias and cardiac conduction problems. The examination is carried out on an outpatient basis. The method is quite serious; it is accompanied by electrical stimulation of certain parts of the heart. That is why it is necessary to seriously approach the issue of choosing a clinic in which the patient will undergo an electrophysiological study.

All of these methods are aimed at understanding: the patient really has early ventricular repolarization syndrome or has other cardiovascular pathologies (myocardial infarction, Brugada syndrome - a genetic disease with a high risk of sudden cardiac arrest, pericarditis and others).

Treatment

There is no specific mechanism for treating the syndrome. There are two possible options:

• when early repolarization is a simple phenomenon in the absolute health of the patient;
• when the change is caused by other disorders of cardiovascular activity.

In the first option, treatment is not necessary, since it is not associated with any known disease. You just need to lead a healthy lifestyle, monitor moderation of physical activity, eat right and regularly visit a cardiologist. This will help prevent or promptly detect pathological changes in the heart if they do occur.

The second option involves treating the cause of the syndrome, that is, a concomitant disease. In this case, therapy is selected individually, based on the specific diagnosis, age and individual characteristics of the patient.

Do not self-medicate. Remember that only timely and systematic consultations with a cardiologist can prevent the development of certain cardiovascular diseases associated with early ventricular repolarization.

Early ventricular repolarization syndrome (EVRS) is a medical concept that includes only ECG changes without characteristic external symptoms. It is believed that SRRS is a normal variant and does not pose a threat to the patient’s life.

However, recently this syndrome has become viewed with caution. It is quite widespread and occurs in 2-8% of cases in healthy people. The older a person gets, the less likely he or she is to be diagnosed with CVD; this is due to the occurrence of other cardiac problems as age increases.

Most often, early ventricular repolarization syndrome is diagnosed in young men who are actively involved in sports, in men who lead a sedentary lifestyle, and in people with dark skin (Africans, Asians and Hispanics).

Causes

The exact causes of SRS have not been established to date. However, a number of factors have been identified that contribute to the occurrence of repolarization syndrome:

• taking certain medications, such as α2-agonists (clonidine);
• familial hyperlipidemia (high blood fats);
• connective tissue dysplasia (symptoms are more often found in people with SRGC: joint hypermobility, spider fingers, mitral valve prolapse);
• hypertrophic cardiomyopathies.

In addition, this anomaly is often diagnosed in people with congenital and acquired heart defects and in the presence of congenital pathology of the cardiac conduction system.

The genetic nature of the disease cannot be ruled out either (there are certain genes that are responsible for the occurrence of SRGC).

Kinds

There are two options for SRR:

• without damage to the cardiovascular and other systems;
• involving the cardiovascular and other systems.

From the point of view of the nature of the course, a distinction is made between transient and permanent SRGC.

Based on the localization of ECG signs, doctor A.M. Skorobogaty proposed the following classification:

• Type 1 – with a predominance of signs in leads V1-V2;
• Type 2 – with a predominance in leads V4-V6;
• Type 3 (intermediate) – without a predominance of signs in any leads.

Signs of SRS

There are no characteristic clinical signs of early ventricular repolarization syndrome. There are only specific changes on the ECG:

• ST segment and T wave changes;
• in a number of branches, the ST segment rises above the isoline by 1-2-3 mm;
• often ST segment elevation begins after the notch;
• the ST segment has a rounded shape and directly passes into a tall positive T-wave;
• the convexity of the ST segment is directed downwards;
• The base of the T wave is wide.

Diagnostics

Since this syndrome is an electrocardiographic phenomenon, it can only be established with a certain examination:

• Ultrasound of the heart;
• resting echocardiography;
• Holter monitoring throughout the day;
• electrophysiological study.

In addition, tests are carried out on a bicycle ergometer or treadmill: after physical activity, the heart rate increases, and the ECG signs of SIRS disappear.

A potassium test is used: after taking potassium chloride, panangin or rhythmocor at least 2 grams, the severity of ECG signs of repolarization syndrome increases.

A test with isoproterenol and atropine is not used due to severe side effects.

It is important to distinguish between SRR and myocardial infarction, pericarditis, Brugada syndrome. For this purpose, differential diagnosis is carried out.

Treatment of early ventricular repolarization syndrome

Repolarization syndrome does not require specific treatment. The only thing that is offered to the patient is observation by a cardiologist.

However, a person with SRS should avoid alcohol consumption and intense physical activity to avoid triggering an attack of tachycardia.

In some cases, radiofrequency ablation of an additional beam is performed in an invasive way (a catheter is brought to the site of the beam and destroys it).

Sometimes energotropic therapy (B vitamins, carnitine, phosphorus and magnesium preparations), and antiarrhythmic drugs are used.

The patient should retain all previous ECGs, which is required to exclude the diagnosis of myocardial infarction if heart pain occurs.

Complications and prognosis

SRS can cause the following complications:

• sinus bradycardia and tachycardia;
• atrial fibrillation;
• heart block;
• paroxysmal tachycardia;

The prognosis for the development of SRRS is favorable. It is believed that in 28% of cases it increases the risk of death from a cardiac cause, but many researchers suggest that the likelihood of death with SRGC is much lower than with smoking, alcohol abuse and excessive indulgence in “heavy” foods.

One of the most common diagnostic studies of the functioning of the heart muscle is an electrocardiogram. And if we have heard more than once about the rhythm, axis tilt and heart rate from the doctor, then not all of us get to know information about the syndrome of early ventricular repolarization.

For a long time it was believed that this syndrome does not have any effect on the normal functioning of the heart, but is just an electrocardiographic concept and one of the variants of the norm. Numerous observations and ongoing studies prove the opposite - early ventricular repolarization syndrome may indicate malfunctions of the heart muscle, which in severe cases are fatal.

What is SRRJ

An electrocardiogram is a graph recorded on special paper that records the bioelectric potential of the heart. It is expressed in the form of a rise and fall of a curved line vertically and time intervals horizontally.

Vertical peaks are also called waves, they are designated by the letters P, Q, R, S and T. Normally, on the cardiogram, the R wave clearly passes into the S peak, from where the curve begins a smooth rise to the T peak. Whereas in the presence of early ventricular repolarization syndrome (EVRS), ) a pseudo-wave of the descending limb of the R wave and further unevenness in the rise of the ST segment are noted. Such changes are recorded as a result of the fact that the excitation wave in the subepicardial layers of the heart muscle occurs much earlier than it should.

If SRRH is detected, it is necessary to conduct a number of additional studies to identify such cardiovascular diseases as myocardial infarction, pericarditis, left ventricular hypertrophy, pulmonary embolism, digitalis poisoning or left bundle branch block.

Causes and symptoms

As a rule, SRS is detected completely by chance, because this pathology does not have any clinical manifestations. Patients do not report any symptoms; only in rare cases do they notice heart rhythm disturbances in the form of arrhythmia.

It is noteworthy that the causes of this syndrome have not yet been identified.. Over the years of observation, some nonspecific factors have been identified that may have an indirect effect on the appearance of a non-standard curve on the ECG. Among them:

• hypothermia;
• taking certain medications for a long time, in particular, adrenaline, mezaton, ephedrine and other drugs of this group;
• violation ;
• presence of heart disease;
• predisposition to defects in connective tissue structure;
• inflammatory diseases of the heart muscle;
• neurocircular dystonia.

The syndrome can be observed equally in healthy people and in patients suffering from diseases of the cardiovascular system.

Those who are actively involved in sports are most susceptible to SIRD.

According to observations, SRRH is more characteristic of those who are actively involved in various sports. Age does not affect the appearance of pathological changes on the ECG; early ventricular repolarization syndrome can be observed even in children or the elderly.

It is noteworthy that during testing on a bicycle ergometer and other exercise equipment, the electrocardiogram in such people is within normal limits.

Sometimes an incorrect cardiogram is recorded in children with emotional instability

In some cases, an “incorrect cardiogram” is recorded in children with emotional instability, increased anxiety and fatigue, as well as in those who do not follow the principles of the daily routine.

There are two variants of early ventricular repolarization syndrome. In the first option, there are no pathological abnormalities in the functioning of the cardiovascular and other systems; in the second option, there are signs of damage to these systems.

Lifestyle restrictions with SRGC

In the absence of signs of heart and vascular diseases, isolated early ventricular repolarization syndrome is not a contraindication either to military service or to pregnancy and childbirth.

This syndrome is sometimes diagnosed in children who have suffered a cardiac circulatory disorder during embryonic development. For a child with diagnosed SRGC, it is important to be monitored by a cardiologist, conduct additional studies to identify heart disease, and adhere to a work and rest schedule.

Treatment

Early ventricular repolarization syndrome does not require treatment as such. Only in severe cases, when the person’s condition worsens or clinical signs of cardiac dysfunction appear, surgical treatment is performed, in which the patient is implanted with a defibrillator-cardioverter.

But this does not mean that you can forget about the presence of pathology forever. For preventive purposes, it is very important to regularly visit a cardiologist and undergo a cardiac examination once or twice a year. When detecting SRS in athletes, it is recommended to reduce physical activity.

A patient with the syndrome needs to give up bad habits, adhere to an adequate daily routine, avoid stressful situations and regularly take vitamin and mineral complexes.

Early ventricular repolarization syndrome (EVRS) is an electrocardiographic phenomenon that can only be detected by an electrocardiogram. It manifests itself as a rise in the transition of the ventricular complex to the ST segment above the isoline.

The reason for this is the early occurrence of an excitation wave in the subepicardial areas of the myocardium. The main thing that the patient should understand is that this syndrome does not affect the functioning of the heart at all. This disease often occurs in children and adolescents who are actively involved in sports.

There is an opinion that this disease is genetic in nature and is inherited. However, SRS can occur in newborns, children, and adolescents. In the latter, this may be due to hormonal changes in the body.

SRS is also common in athletes, but a direct connection between increased physical activity and the disease has not been identified to date.

In addition, this syndrome can be triggered by an overdose of certain drugs (a2-adrenergic agonists) or hypothermia.

Diagnosis of the disease

It is interesting that the usual method for diagnosing heart rhythm disturbances (physical activity on a special bicycle ergometer) is not suitable for identifying SRHR, since physical activity normalizes the passage of the excitation wave on the cardiogram, so the success rate of this test is only 40%.

In this regard, it is legitimate to interpret the SRR as the result of superimposing a vector of delayed depolarization of individual sections of the myocardium on the initial repolarization phase of the ventricles. Isopotential mapping revealed that the notch on the descending limb of the R wave in the left precordial leads (V3-V6) is a manifestation of early repolarization, while the same changes in the right precordial leads (V1-V2) are caused by the migration of terminal activation currents of the ventricles (Mirwis D.M. 1982 ). Perhaps this is precisely what can explain the data obtained during multipolar electrocardiographic mapping of the heart, when early positive repolarization currents, occurring 5-30 ms before the end of the QRS complex, were recorded with the same frequency in patients with both CRR and those without it.

B. Dysfunction of the autonomic nervous system.

The opinion that SRS owes its occurrence to disorders in the vegetative sphere with a predominance of vagal influence is confirmed by the data of an exercise test, during which the signs of the syndrome disappear (Benyumovich M.S. Salnikov S.N. 1984; Bolshakova T.Yu. 1992; Morace G. et al. 1979; Wasserburger R.D. Alt W.I. 1961). In addition, a drug test with isoproterenol in patients with SRR also helps to normalize the ECG.

According to G.I. Storozhakov et al. (1992), with 24-hour ECG monitoring in people with SRR at night, its signs intensify, which may also indicate the importance of the influence of the vagus in the manifestation of this syndrome.

A. M. Skorobogatiy et al. (1985) believe that dysfunction of the autonomic nervous system only contributes to the manifestation of electrocardiographic signs of SRR, but does not determine their genesis.

At the same time, there is evidence that increased tone of the sympathetic component of the nervous system can also initiate SRR (Epstein R.S. et al. 1989). Early repolarization of the anterior apical region may be associated with increased activity of the right sympathetic nerve, which presumably passes through the interventricular septum and anterior wall of the heart (Randal W.C. et al. 1968, 1972; Yanowitz F. et al. 1966). A number of experimental studies (Kralios T.A. et al. 1975; Kuo C.S. et al. 1976) have shown that unilateral stimulation of the right recurrent nerve or the right stellate ganglion causes ST segment elevation in experimental animals, identical to ST segment elevation in SRR.

T. Kralios et al. (1975) suggested that the electrocardiographic manifestations of CRR are caused by local disturbances of the sympathetic innervation of the heart in various disorders of the central nervous system. This theory was further developed in a number of works (Kuo C.S. et al. 1976; Parisi F. et al. 1971; Randal W.C. et al. 1968, 1972; Ueda H. et al. 1964; Yanowitz F. et al. 1966).

The segmental nature of the sympathetic innervation of the heart, revealed by some researchers (Austoni H. et al. 1979), allows us to explain the hypothesis about the role of disturbances in physiological asynchrony of excitation in the genesis of SRR. The authors point out the association of CRR with increased activity of the right sympathetic nerve, which was combined with a shortening of the QT interval in experimental animals.

Controversial data on the influence of the autonomic nervous system on the ECG manifestations of SRR are evident when conducting pharmacological and non-pharmacological tests. Thus, signs of SRR disappear with physical activity and the novodrinum test in 100% of cases, and the atropine test in 8% of cases. Increased signs of SRR are observed in 78% with the obsidan test, 9% of cases with the atropine test (Bolshakova T.Yu. 1992).

D. Electrolyte disturbances.

Attempts have been made to link SPP with (Goldberg E. 1954; Gussak I. Antzelevitch C. 2000). The hypercalcemic J-wave theory was first postulated back in 1920 - 1922. F. Kraus, who drew attention to the appearance of the J point during experimentally induced hypercalcemia.

Similar J-waves associated with elevated calcium levels have been noted in CPP by other authors (Sridharan M.R. Horan L.G. 1984; Douglas P.S. 1984). The most important differences between a hypercalcemic J wave and a J wave in CPP are the absence of a dome-shaped configuration and a shortening of the QT interval.

At the same time, A.M. Skorobogatym et al. (1986) did not find any deviations from the norm in electrolyte levels in patients with SRS.

The experiment showed that with hyperkalemia, the duration of local repolarization decreases in many areas of the myocardium, but in the region of the apex of the heart and at the endocardial level, the shortening of the repolarization time is especially significant. The normal endocardial-epicardial repolarization time gradient was increased at the base and decreased at the apex of the heart, i.e., a situation characteristic of CPP arose. It has been shown that when performing a potassium test, in 100% of cases there is an increase in signs of SRR (Morace G. et al. 1979; Bolshakova T.Yu. Shulman V.A. 1996).

In general, the primary change in the electrolyte balance as the cause of RDD is considered by most authors to be an untenable hypothesis, since no deviations from the norm in electrolyte levels were found in individuals with “pure” RDD. Probably, electrolyte disturbances can explain the electrocardiographic dynamics of some signs of the syndrome, for example, changes in the polarity of the T wave, the duration of ECG intervals in various physiological and pathological conditions (Skorobogaty A.M. et al. 1986).

Clinical significance of the syndrome

SRR was first described in 1936 by R. Shipley and W. Halloran, as a variant of the normal ECG. After the description of the symptoms of the syndrome, the study of SRR did not receive further development for a long time. Only in the late 70s - early 80s did this phenomenon again attract the attention of researchers. The subject of study was the clinical significance of SRR, the mechanisms of its occurrence, as well as clarification of its electrocardiographic signs (Vorobiev L.P. et al. 1985; Skorobogatiy A.M. et al. 1985).

The prevalence of SRR in the population, according to different authors, varies widely - from 1 to 8.2% (Akhmedov N.A. 1986; Vorobyov L.P. et al. 1985; Gritsenko E.T. 1990; Skorobogaty A. M. 1986; Andreichenko T.A. et al. 2005). Noteworthy is the decrease in the frequency of the syndrome with increasing age - from 25.3% in the age group of 15-20 years to 2.1% in people over 60 years old. With age, this phenomenon may disappear or be masked by acquired repolarization disorders (Duplyakov D.V. Emelyanenko V.M. 1998).

In patients with diseases of the cardiovascular system, this syndrome is detected more often than in persons with extracardiac pathology. SRR is recorded in 13% of people with pain in the heart area taken to emergency departments (Lokshin S.L. et al. 1994). In patients with anomalies of the cardiac conduction system, SRR occurs in 35.5% of cases, most often observed in patients with an early age of onset of paroxysmal arrhythmias - in 60.4% (Duplyakov D.V. Emelyanenko V.M. 1998).

SRR is detected in 19.5% of patients in a therapeutic hospital, on average slightly more often in men (19.7%) than in women (15.0%). The syndrome is significantly more often registered in the presence of diseases of the cardiovascular system (Fig. 2). It is noteworthy that patients with SRR are significantly more likely to suffer from cardiovascular diseases (Fig. 3), especially neurocirculatory dystonia (12.1% of patients with SRR versus 6.5% of patients without it) (Bobrov A.L. . 2004).

Early repolarization syndrome is the cause of numerous diagnostic errors. Elevation of the ST segment on the ECG serves as a reason for differential diagnosis with left ventricular hypertrophy, left bundle branch block, pericarditis, pulmonary embolism, digitalis intoxication, acute myocardial infarction (Dashevskaya A.A. et al. 1983; Benyumovich M.S. Salnikov S.N. 1984; Gribkova I.N. et al. 1987; Vacanti L.J. 1996; Hasbak P. Engelmann M.D. 2000; Guo Z. et al. 2002, Mackenzie R. 2004).

Figure 3. Characteristics of heart rhythm disturbances caused by electrophysiological examination of the heart in apparently healthy individuals with SRR.

The course of some cardiovascular diseases, in particular neurocirculatory dystonia, accompanied by severe vegetative attacks with pain in the heart, can cause difficulties in excluding myocardial infarction. Recording an electrocardiogram in such situations makes differential diagnosis difficult. This is explained by similar electrocardiographic manifestations of CRR and the acute phase of myocardial infarction: ST segment elevation and high T waves. The appearance of CRR after a myocardial infarction is not uncommon. The combination of the syndrome with the above pathology forces us to pay more attention to the clinical picture of the disease, changes in laboratory parameters, and data from instrumental diagnostic methods. ECG assessment in dynamics is of great importance (Lokshin S.L. et al. 1994).

An interesting question is the state of the autonomic nervous system in people with SRS. Severe sympathicotonia in some cases leads to the complete disappearance of signs of SRR on the ECG. Vagotonia is a factor in increasing the severity of the syndrome. With 24-hour ECG monitoring in people with SRR, its signs intensify at night, which may also indicate the importance of the influence of the vagus in the manifestation of this syndrome. Increased parasympathicotonia in patients with functional disorders of the cardiovascular system, in particular neurocirculatory dystonia, explains the more frequent detection of CRR in these individuals (Bobrov A.L. Shulenin S.N. 2005).

There is no consensus on the prognostic value of SRR. Most authors consider it a benign electrocardiographic phenomenon (Shipley R.A. 1935, Wasserburger R.D. 1961; Gritsenko E.T. 1990), while the data accumulated to date make us look at CRR as a possible link or manifestation of pathological processes occurring in the myocardium (Skorobogaty A.M. 1986; Storozhakov G.I. et al. 1992; Bobrov A.L. Shulenin S.N. 2005).

Stable rhythm and conduction disturbances in patients with cardiovascular diseases in the presence of SRR occur 2-4 times more often and can be combined with paroxysms of supraventricular tachycardias. During electrophysiological studies, paroxysmal supraventricular rhythm disturbances are induced in 37.9% of practically healthy individuals with SRR. The structure of rhythm disturbances is dominated by atrial fibrillation - 71% of all arrhythmias (Fig. 4). Both congenital anomalies in the structure of the conduction system of the heart and increased tone of the parasympathetic part of the autonomic nervous system, which has a direct impact on the occurrence of supraventricular arrhythmias, are assumed to be the reasons for the arrhythmogenicity of SRR (Duplyakov D.V. Emelianenko V.M. 1998).

Figure 4. Structure of diseases of internal organs in patients with SRR and without SRR.

It should also be noted that not all studies (Gritsenko E.T. 1990; Lokshin S.L. et al. 1994) revealed a difference in the frequency and structure of cardiac arrhythmias occurring in individuals with SRR, compared with a similar group of individuals without this syndrome. G.V. Gusarov et al. (1998) in their study showed that the arrhythmogenicity of the syndrome decreases against the background of physical activity in people with SRR. According to the authors, catecholamines produced during physical activity help eliminate or reduce the difference in the duration of the action potential of different areas of the myocardium.

Recently, there has been an opinion that rhythm and conduction disturbances that occur in people with SRR are caused not so much by the syndrome itself, but by its “provoking” arrhythmogenic activity in the pathology of the cardiovascular system, and this must be taken into account when planning antiarrhythmic therapy (Duplyakov D. V. Emelyanenko V.M. 1998).

A number of authors consider CRR as a cardiac marker of connective tissue dysplasia (Lokshin S.L. et al. 1994). According to our data, some isolated signs of undifferentiated connective tissue dysplasia (dolichomorphy, joint hypermobility, arachnodactyly) are identified in subjects with SRR significantly more often (51%) than in persons without this phenomenon (41%). As the severity of the syndrome increases, the number of recorded signs of undifferentiated connective tissue dysplasia increases (Bobrov A.L. Shulenin S.N. 2005).

When considering CRR as a manifestation of cardiac connective tissue dysplasia syndrome, the prognostic significance of the combination of CRR and accessory chords of the left ventricle occupies a special position. It is believed that the most clinically significant are transverse basal and multiple chords, which lead to disturbances in intracardiac hemodynamics and diastolic function of the heart, and contribute to the occurrence of cardiac arrhythmias (Domnitskaya T.M. 1988; Peretolchina T.F. et al. 1995; Nranyan N. V. 1991). Abnormal stretching of the papillary muscles and the development of mitral regurgitation are considered as the cause of the development of extrasystole. According to our data, signs of connective tissue dysplasia of the heart are detected significantly more often in patients with SRS than in persons without the syndrome: 57.1% and 33.3%, respectively. In more than a third of people with SRR, oblique accessory chords of the left ventricle are recorded (35% in the group with SRR and 9% in those examined without SRR) (Boitsov S. Bobrov A. 2003). Accessory chordae can cause hemodynamic disturbances. Such disorders most often manifest as deterioration in left ventricular diastolic function, which occurs due to resistance to relaxation when the oblique chordae are located high. An increase in myocardial stiffness can also occur due to a deterioration in intramural blood flow that occurs during chordal tension. It has been shown that accessory chordae, when located basally, can lead to a decrease in tolerance to physical exercise (Yurenev A.P. et al. 1995). According to our data, in individuals with SRR with oblique basal-median chordae, the greatest changes in the relaxation function of the left ventricle are detected (Bobrov A.L. et al. 2002).

We assessed the state of central hemodynamics in practically healthy young people (24.9 ± 0.6 years) with SRR in comparison with subjects without this phenomenon. Persons with SRR, compared to those examined without the syndrome, are characterized by a deterioration in the relaxation function of the left ventricle, a weakening of the contractile function of the left chambers of the heart, and an increase in the mass of the left ventricular myocardium (Bobrov A.L. Shulenin S.N. 2005).

When comparing the studied echocardiographic parameters in groups of different severity of SRR, it turned out that as the electrocardiographic manifestations of this syndrome increase, the identified deviations in the parameters of central hemodynamics intensify. At the same time, the absolute values ​​of these indicators in groups of people with the syndrome under study remain, as a rule, within the age norm. Extreme degrees of SRR are characterized by the appearance in some individuals of signs of asymptomatic diastolic dysfunction of the left ventricle of the heart. Their share was 3.5% of all subjects with SRR (Bobrov A.L. et al. 2002).

The effect of SRR on central hemodynamic parameters in people of the older age group has still not been studied. Our studies have shown that in practically healthy older individuals (50.9 ± 1.9 years) with SRS, significantly worse indicators of contractility and relaxation of the myocardium of the left chambers of the heart and an increase in myocardial mass are recorded compared with individuals without the syndrome. As the severity of the syndrome increased, the differences between the control group (persons without SRR) and those examined with SRR increased. In the group with the maximum severity of the syndrome, the proportion of people with asymptomatic dysfunction of the left ventricle of the heart was half of all subjects with SRR. In the control group, cases of asymptomatic left ventricular dysfunction were recorded in 10% of cases (Bobrov A.L. Shulenin S.N. 2005).

Stress echocardiography performed on all subjects in the older age group showed that in people with SRR, in response to physical activity, there was a slight increase in left ventricular ejection fraction (2%), while in the control group its increase was 20%. The absence of an increase in the ejection fraction and even its fall was observed in subjects with extreme degrees of severity of the syndrome (Bobrov A.L. Shulenin S.N. 2005). The deterioration of the characteristics of central hemodynamics as the severity of CRR increases, the appearance of pathological changes in diastolic and systolic functions in a number of cases of extreme severity of the syndrome under study, and the increase in the proportion of detected hemodynamic abnormalities in older age suggest a pathogenetic connection between CRR and heart failure (Shulenin S.N. Bobrov A L. 2006). Apparently, SRR, if sufficiently expressed, can be an independent factor in its formation (Bobrov A.L. Shulenin S.N. 2005).

The presented data dictate, in our opinion, the need for a significant change in the attitude of general practitioners to the fact of diagnosing early ventricular repolarization syndrome in an examined person (examined for fitness to work in extreme conditions) or a patient.

Detection of CRR during electrocardiographic examination requires the following algorithm:

1. Conducting questioning and physical examination to identify signs of chronic heart failure and heart rhythm disturbances.

2. Phenotypic examination of the patient to identify external stigmata of undifferentiated connective tissue dysplasia, assessment of the severity of dysplasia.

3. Assessment of the severity of early repolarization syndrome.

4. Conducting daily ECG monitoring to exclude paroxysmal heart rhythm disturbances.

5. Conducting resting echocardiography to exclude hidden systolic and diastolic myocardial dysfunction and the presence of left ventricular remodeling.

6. In persons with moderate and maximum severity of SRR with normal echograms at rest, stress echocardiography is performed to identify signs of systolic dysfunction against the background of physical activity.

If diastolic and systolic dysfunction of the left ventricle and signs of its remodeling are detected, patients with RVR should be recommended a set of modern non-drug measures aimed at the prevention and treatment of chronic heart failure - optimization of nutrition, salt and water intake; individualization of the volume of physical activity and organization of lifestyle; regular medical monitoring of functional indicators of the cardiovascular system.

Thus. Early repolarization syndrome is not a harmless electrocardiographic phenomenon, as was believed in the middle of the last century. Early repolarization syndrome is detected in 20% of patients in a therapeutic hospital, prevailing in the group of patients with cardiovascular pathology. The syndrome is combined with a more frequent occurrence of supraventricular heart rhythm disturbances. CPP is a cardiac marker of connective tissue dysplasia. An increase in the severity of the syndrome is combined with more frequent detection of phenotypic signs of connective tissue dysplasia. SRR is accompanied by deterioration of central hemodynamics. As the severity of the syndrome increases, these changes increase, in some cases leading to the appearance of signs of chronic heart failure and the development of hypertrophic myocardial remodeling.

You can get acquainted with the original source and the list of references on the website of the journal Bulletin of Arrhythmology

Below we will consider the features of the use of this drug to lower blood pressure caused by hypertension and associated pathologies, analyze the indications and contraindications for its use, paying special attention to the risk of overdose and side effects.

Description

Composition and release form

Lisinopril is a drug prescribed for hypertension and other diseases to lower blood pressure:

• Available in tablet form;
• the most common dosages of the active substance are from 2.5 mg to 20 mg;
• the package contains 20, 30 or 50 tablets.

The main active ingredient is lisinopril dihydrate. In addition to it, the tablets contain excipients:

• corn starch;
• microcrystalline cellulose;
• magnesium stearate;
• calcium hydrogen phosphate, etc.

pharmachologic effect

This medicine belongs to a group of drugs that inhibit the action of ACE. The main effect is to reduce the transformation of angiotensin-1 into angiotensin-2.

In addition, this medicine:

• reduces the level of aldosterone secretion;
• helps reduce the degradation of bradycardin;
• stimulates the formation of prostaglandins.

Due to this, the following effects are achieved:

1. The patient's blood pressure (BP) decreases to acceptable values.
2. There is a decrease in pressure in the capillaries of the lungs.
3. The strength of peripheral vascular resistance decreases.
4. The volume of blood pumped by the heart per minute increases noticeably.
5. The resistance of the myocardium (heart muscle) to functional loads increases (the effect is especially pronounced in people with severe heart failure).
6. Hypertrophy of the heart muscle and arterial walls is reduced (with long-term systematic use).

In addition, taking this medicine promotes the excretion of sodium salts in the urine, i.e. it is also characterized by a natriuretic effect.

When taking the medicine, the absorption of the active substance in the gastrointestinal tract is 25–29% (the presence or absence of food in the gastrointestinal tract does not affect this process). The active substance does not undergo transformation in the body and is excreted by the kidneys without changes in composition. When taking it, you should also consider how these blood pressure pills work. Lisinopril demonstrates its effect approximately 45–60 minutes after administration, and reaches its greatest effectiveness after approximately 5–7 hours (the interval may vary depending on the dosage of the drug and the initial condition of the patient). The total duration of action is about a day.

Indications and contraindications for use

Before taking these pills, you need to carefully study what Lisinopril is intended for, what kind of blood pressure it helps with, how it is used in combination therapy, and what contraindications exist.

The main purpose of this drug is to reduce blood pressure, which increases with various forms of arterial hypertension. It can be used as a separate drug, or together with other drugs as part of a therapeutic complex.

In addition, Lisinopril is prescribed for:

• heart failure (most often chronic) - as part of therapy.
• heart attack (early treatment, on the first day) - to prevent heart failure, improve ventricular function and maintain a stable level of hemodynamics.
• nephropathy in patients with diabetes mellitus types 1 and 2

Before taking Lisinopril for blood pressure, it is important to familiarize yourself with the most important contraindications. This medicine is not prescribed if the patient has:

• hypersensitivity to substances that inhibit the action of ACE;
• edema (hereditary Quincke, angioedema, etc.);
• severe hypertension;
• mitral valve stenosis.

This also includes:

• pregnancy (in the first trimester - undesirable, in the second and third - impossible due to the risk of fetal intoxication);
• lactation (if it is necessary to take the drug, the child is transferred to artificial feeding).

The presence of coronary heart disease, coronary or renal failure, diabetes mellitus and some other diseases in a patient may also be a reason for refusing to prescribe the medicine. In any of these situations, it is recommended to consult a doctor before starting treatment.

Patients on a diet with a limited salt content and elderly people should also consult with a specialist about how to use Lisinopril - at what pressure it should be taken and whether it can be taken at all.

Instructions for use

If you have been prescribed Lisinopril, the instructions for use included in the kit fairly fully describe the main aspects of its use. So only the most important nuances will be listed here:

• The drug is taken orally no more than once a day, regardless of the time of day. Eating is also unimportant, since it does not affect the process of absorption of the active substance;
• The standard daily dosage of the drug, which is used to lower blood pressure, is 10 mg. For persistent hypertension, the dosage can be maintained for several months until sustainable improvement occurs;
• with further treatment, an increased dose is prescribed - 20 mg per day;
• the maximum daily dose used to lower blood pressure in arterial hypertension is 40 mg/day. It is prescribed by a doctor in exceptional cases.

When Lisinopril is taken for blood pressure according to this regimen, reviews indicate that the maximum effect of the medicine appears 3-4 weeks after the start of treatment. If you interrupt treatment or reduce the dosage without consulting a specialist, it is very likely that the dynamics will worsen or blood pressure will increase again.

Note! If the patient is being treated with diuretics, it is necessary to stop taking diuretics at least 48 hours before taking the drug. If this is not done, there is a risk that the pressure will drop sharply, causing a general deterioration of the condition. In a situation where giving up diuretics is impossible, it is necessary to reduce the dosage of Lisinopril (up to 5 mg/day):

• if the patient has heart failure, then the starting dose is 2.5 mg. On days 3–5 of treatment (depending on dynamics), the dose is usually doubled;
• in the treatment of nephropathy (diabetic), the drug is prescribed in a dosage of 10 to 20 mg per day;
• renal failure is also one of the indications for taking the drug: with creatine clearance up to 10 ml/min – 2.5 mg, up to 30 ml/min – 5 mg, up to 80 ml/min – 10 mg per day;
• if the drug is used for myocardial infarction, then it should be taken according to the following algorithm: on the first and second days - 5 mg, and starting from the third day - 10 mg every two days, and at the final stage - 10 mg / day. If a patient develops acute myocardial infarction, the duration of taking the medicine is at least one and a half months.

Note! If you have been prescribed Lisinopril, the instructions for use for blood pressure can only be used in the treatment of hypertension. For other diseases, the drug should be used according to the regimen prescribed by the doctor!

Possible side effects

Side effects when taking Lisinopril are similar to side effects caused by taking other ACE inhibitors. The frequency of these effects may vary:

• often: allergic rashes, decreased blood pressure, cough, gastrointestinal upset, headache, etc.;
• uncommon: emotional lability, loss of balance, sleep disturbances, nasal congestion, erectile dysfunction, hallucinations, general weakness;
• extremely rare: a sharp decrease in blood sugar levels, abdominal pain (may be accompanied by nausea or vomiting), shortness of breath, fainting.

If side effects from this list occur, as well as swelling of parts of the body, skin lesions (rash, peeling), severe dizziness, rapid heartbeat, or yellowness of the skin around the eyes, you should immediately stop taking the drug and consult a doctor!

Overdose

In case of an overdose of the drug, blood pressure may sharply decrease, as well as tachycardia and relaxation of the smooth muscles of peripheral blood vessels. To eliminate the consequences of an overdose, the following actions must be taken:

• Rinse the stomach (the product is effective due to its slow absorption).
• Take activated carbon.

• Place the person on their back so that their legs are higher than their head.
• Monitor blood pressure levels and, if necessary, adjust them (if there is a sharp decrease, Dopamil is used).

Note! In the described situation, hemodialysis is ineffective. In any case, in case of overdose (even in the absence of pronounced negative effects), it is necessary to consult a doctor as soon as possible.

Interaction with other drugs and substances

Concomitant use of Lisinopril with other medications can lead to undesirable consequences:

• antacids – slowing down the absorption of the active substance;
• "Indomethacin", adrenergic stimulants and sympathomimetics - decreased therapeutic effect;
• neuroleptics and quinine – increased hypotensive effect;
• potassium-sparing diuretics (Triamterene, Amiloride and analogues) – hyperkalemia.

During treatment with the use of Lisinopril (or its analogues), experts recommend completely abstaining from drinking alcohol. This is due to the fact that simultaneous use of the drug and alcohol unpredictably enhances the hypotensive effect. The consequences may be tachycardia, bradycardia, acute heart failure, and in some cases, orthostatic collapse, accompanied by fainting.

"Lisinopril" in pharmacies

In pharmacies in the Russian Federation, this medicine is dispensed with a doctor's prescription.

If you are planning to buy Lisinopril for blood pressure, its price will depend on the dosage, the number of tablets in the package and the manufacturer:

• 5 mg No. 30 – from 20 to 70 rubles.
• 10 mg No. 20 – from 22 to 120 rubles.
• 20 mg No. 30 – from 80 to 200 rubles.

There are several analogue drugs. The most popular are:

• "Diroton" (Hungary, "Gedeon Richter").
• "Lysinoton" (Iceland, "ACTAVIS Ltd").
• "Lizoril" (India, "Ipca Laboratories").
• "Irumed" (Croatia, "Belupo").

Some other drugs also have an effect similar to that of Lisinopril.

Conclusion

Lisinopril is a drug that, when used correctly and selected the optimal dosage, provides effective regulation of blood pressure and has a good effect in the treatment of hypertension. At the same time, given the possibility of side effects and the risk of overdose, it should be taken only as prescribed by a doctor according to the regimen established by him.

Low blood pressure causes no less health problems than high blood pressure. Therefore, all patients with problematic blood vessels should know how to react to pressure of 60 to 40. And such information will not hurt a healthy person who suddenly has a drop in blood pressure.

1. Description
2. Causes
3. Symptoms
4. Blood pressure 60 over 40 in bedridden patients
5. What could be the consequences?
6. Diagnostics
7. Treatment
8. Prevention
9. Forecast
10. Finally

Description

What is low blood pressure? Normal blood pressure is considered to be 100 to 60 mmHg. pillar Anything below is not the norm. But low blood pressure can be explained by objective reasons, as well as by individual characteristics of a person. It is considered a critical indicator for health when blood pressure is 60 to 40 mmHg. pillar

Most often, hypotension occurs in children, pregnant women, and people with certain disorders of the parasympathetic nervous system. There are many such patients among people who are professionally involved in sports. Also, older people do not always suffer from high blood pressure; it may be quite the opposite.

Causes

There are several reasons why this condition may occur:

1. Heredity.
2. Sedentary work and sedentary lifestyle.
3. Work in hazardous production.
4. Pregnancy, especially with toxicosis.
5. Elderly age.

Hypotension is also common in adolescents. If it does not cause you to feel unwell and does not interfere, then you can completely ignore this condition. This does not apply to elderly patients, as well as those who suffer from low blood pressure. Therefore, it is worth knowing what to do if the pressure is 60 to 40.

Symptoms

Symptoms of low blood pressure are difficult to confuse with something else. A specific condition can be recognized by the following characteristics:

1. Goosebumps in the eyes. Often observed when changing body position.
2. Shortness of breath and palpitations during high physical exertion.
3. Constant fatigue and increased fatigue.
4. Harsh light and loud sounds may interfere. Excessive irritability appears.
5. The temperature is reduced, coldness is felt in the legs and arms.
6. Muscle weakness.
7. Decreased sexual desire.

If a person has several of these signs at once, then it is worth consulting a doctor so that a specialist can conduct a full diagnosis and identify disturbances in the functioning of the body.

Blood pressure 60 over 40 in bedridden patients

The danger of low blood pressure in bedridden patients is that it is practically invisible. An active person may feel dizzy and nauseous, but a patient with a sedentary lifestyle will not notice such changes. This can trigger cardiogenic shock, which in turn can be fatal. Therefore, others need to be careful and respond to the following signs of cardiogenic shock:

1. Pale skin.
2. Marble pattern on the face.
3. The patient complains of an anxious state and speaks of a fear of death.
4. Blueness of lips and skin.
5. Loss of consciousness.

In bedridden people, due to reduced activity, hypotension is more common than in others. Therefore, whenever possible, it is worth giving all systems a small but daily load. There are special exercises for this.

What could be the consequences?

Interestingly, quite a large number of people live with low blood pressure for a long time and do not even notice it. They have the advantage of no restrictions on food and drinks such as coffee, chocolate, and strong tea.

But it is worth understanding that a sharp one-time drop in pressure to a critical level of 60 to 40 may indicate serious violations. For example, this is possible with open gastrointestinal bleeding, as well as problems with the adrenal glands and endocrine disease.

Cardiogenic shock has 4 types, each of which complicates the functioning of the entire body and can ultimately lead to death. Arrhythmic shock can result from tachycardia of the cardiac ventricles. True cardiogenic shock occurs when the heart's ability to pump is reduced. Reflex occurs due to sharp pain. Areactive does not respond to active resuscitation efforts.

Cardiogenic shock can develop due to myocardial infarction, when more than 40% of the heart muscle is affected, or due to diabetes mellitus.

Diagnostics

First of all, if your blood pressure readings are 60 to 40, you should immediately call an ambulance. Doctors will be able to help and diagnose cardiogenic shock. In addition, in the future, specialists will prescribe adequate treatment.

First of all, doctors must normalize blood pressure. In order for it to stabilize and not fall in the future, you should find out the cause of the problem. This is done through a range of diagnostic procedures such as cardiac cardiogram, echocardiogram and angiography. In addition, cardiogenic shock is diagnosed by measuring pulse pressure, monitoring impaired consciousness, and measuring the rate of urine output.

Treatment

It is important to provide first aid to the victim if blood pressure is low. It can save a person's life. Immediately after calling the ambulance, the patient is placed on a flat surface in a position so that his legs are elevated. They provide a supply of fresh air and also give an anesthetic if the condition is due to pain.

Then unbutton your shirt and breathe freely. Provide the patient with complete rest.

In this case, doctors must hospitalize the patient and perform a cardiogram and other diagnostic measures in the hospital. After this, treatment is prescribed. First of all, measures are taken to restore and normalize blood pressure. For this purpose, both drug treatment and (in severe cases) surgical intervention are used.

Drugs are administered intravenously that improve renal pressure, have a positive effect on the functioning of the heart muscle and increase blood pressure. In order for the heart muscle to function normally, the patient is prescribed solutions of glucose, calcium and magnesium.

Prevention

To prevent cardiogenic shock from occurring, you need to take maximum care of your health. There are several rules that will help you avoid the unpleasant consequences of hypertension:

1. Be outdoors more often.
2. Take walks.
3. Choose a balanced diet that excludes large amounts of fatty foods.
4. Quit alcohol and smoking.
5. Ensure sleep (8 hours a day) in a ventilated area.

Also, if an elderly person has heart problems, you should not delay going to the doctor, and you should also strictly follow all his recommendations.

Forecast

If you start the process too much and do not monitor your health, the prognosis can be very unfavorable. This is especially true for older people. The mortality rate from cardiogenic shock is 85 out of 100. But it is important to understand that it does not happen just like that.

If the first symptoms of hypotension appear and low blood pressure interferes with a normal lifestyle, go to the doctor immediately. Then the prognosis is favorable, and the person need not fear for his health. Constant blood pressure monitoring, a healthy lifestyle and moderate physical activity will make the situation completely controllable and manageable.

Finally

Everyone knows the dangers of high blood pressure. But few people realize that hypotension is just as serious as hypertension. Therefore, it is worth paying attention to the fact that you regularly have tinnitus or constantly feel tired. Any decrease in pressure, especially if this phenomenon is constant, must be agreed with a specialist. Don't risk your health.

If someone in your presence experiences cardiogenic shock, which you can recognize by the color of their skin, you must call an ambulance as quickly as possible and provide first aid to the victim.

Early ventricular repolarization syndrome in children is a pathology that does not have any clinical manifestations and is often discovered only during a complete cardiac examination.

This pathology was first discovered in the mid-20th century, and for several decades it was considered only as an ECG - a phenomenon that does not have any effect on the functioning of the organ itself.

However, recently there has been an increase in the number of people who have this phenomenon, and this is not only the adult population, but also school-age children. According to statistics, the disease occurs in 3-8% of people.

Despite the fact that the syndrome itself does not manifest itself in any way, but in combination with others it can lead to a very unfavorable outcome, for example, coronary death, heart failure.

That is why, if this problem is detected in a child, it is necessary to provide him with regular medical monitoring.

What is the diagnosis of MARS in cardiology in a child? find out right now.

Characteristics and features

What does it mean? The heart is the organ that is entrusted with a range of vital functions.

The work of the heart is carried out thanks to an electrical impulse that occurs inside the heart muscle.

This impulse is provided periodic change in the state of the organ, alternating periods of depolarization and repolarization (the period of relaxation of the heart muscle before its next contraction).

Normally, these periods alternate with each other, their duration is approximately the same. Violation of the duration of the repolarization period leads to disruption of heart contractions and malfunctions of the organ itself.

Early repolarization syndrome may be different:

• early repolarization, accompanied by damage to the heart and other internal organs, or without such damage;
• syndrome of minimal, moderate or maximum severity;
• permanent or transient early repolarization.

Causes

To date, the exact reason that can trigger the occurrence of this disorder is not installed However, there are a number of unfavorable factors that, according to doctors, increase risk of developing the syndrome.

Symptoms and signs

The clinical picture of early ventricular repolarization syndrome is hidden; this pathology does not manifest itself in any way.

Often parents even are unaware of the existence of this problem at their child.

However, the long course of this disease may provoke development of various types, such as:

• ventricular fibrillation;
• ventricular extrasystole;
• supraventricular tachyarrhythmia;
• tachyarrhythmia of other types.

Complications and consequences

How dangerous is the disease? It is believed that early repolarization syndrome is a normal variant; in the presence of other abnormalities in the functioning of the heart, this condition can provoke the development serious complications dangerous to the health and life of the child. Such complications may include:

• heart block;
• tachycardia of paroxysmal type;
• atrial fibrillation;
• extrasystole;
• ischemic heart diseases.

Many of these complications can lead to serious consequences, and if the child is not treated promptly, death is quite possible.

Diagnostics

It is quite difficult to establish the presence of the disease, since its clinical manifestations are erased character.

To obtain a detailed picture, the child must undergo a comprehensive examination, which includes the following: diagnostic measures:

1. Tests that determine the child’s body’s response to potassium.
2. Holter monitoring.
3. ECG (the study is carried out directly after the child performs physical exercises, as well as after intravenous administration of Novocainamide).
4. Tests to determine the level of lipid metabolism in the body.
5. Blood test for the content of biochemical components.

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Treatment

The choice of treatment regimen is made by a doctor and depends on the severity of the pathology, its manifestations and the risk of complications. In most cases, early repolarization is asymptomatic, the sinus rhythm of the heart is maintained.

In this case, this phenomenon is considered as a variant of the norm, however, the child needs medical supervision.

In addition, it is necessary adjust your lifestyle and diet. The child must be protected from stress and excessive physical activity; during adolescence, smoking and drinking alcohol are unacceptable.

If early repolarization was a consequence of a dysfunction of the nervous system, then it is necessary to eliminate the root cause of the problem.

In this case, heart function will be restored immediately after successful treatment of the underlying disease.

The child is also prescribed taking medications, such as:

1. Means that normalize metabolic processes in the body.
2. Drugs to normalize the functioning of the heart muscle.
3. Mineral complexes containing potassium and magnesium.

In case of significant disturbances in the functioning of the heart, or the occurrence of arrhythmic complications, the doctor resorts to more radical methods of treatment. Today, the radiofrequency ablation method is popular, helping to eliminate arrhythmic disorders.

Indications for the use of this method of treatment are the presence additional pathways in the myocardium. In all other cases, using this method is not recommended.

In case of a complex course of the disease, a surgical operation is indicated for the child (except for cases when the child develops a closed form of early repolarization).

Also, in severe cases of the disease, the use of pacemaker, for example, if the disease is accompanied by frequent loss of consciousness, heart attacks, which can lead to the death of the child.

Doctor Komarovsky's opinion

Early repolarization syndrome occurs in children quite rare.

Although, many parents simply do not know that their child has this problem, because in most cases the disease does not manifest itself in any way.

However, it can trigger the development serious complications, especially if the child has any other heart disease.

If the disease was nevertheless identified, the child needs systematic monitoring from a cardiologist, even if, in addition to early repolarization, no other heart problems were detected.

Forecast

Regular observation of the child by a cardiologist, compliance with all instructions of the attending physician, proper nutrition, daily routine and lifestyle - prerequisites for a favorable course illness.

Otherwise, this disease can lead to very unpleasant and dangerous consequences, and even death.

Prevention measures

Any ways to prevent the development of early repolarization syndrome today does not exist, since the cause of this problem has not been identified. In addition, the disease occurs both in people suffering from heart defects and in those whose hearts work normally.

Early repolarization syndrome occurs relatively rarely in children, and in most cases this phenomenon considered a variant of the norm. However, if the child has any other heart disease, early repolarization can lead to disastrous consequences.

That is why a child who has this disease should see a cardiologist regularly, periodically undergo an ECG procedure to observe changes in the state of the heart over time.

In addition, it is necessary to adjust your lifestyle and diet.

If necessary, the doctor prescribes medications, and in more severe cases- surgery and use of a pacemaker.

You will find first aid specialists for pulmonary stenosis in newborns on our website.

We kindly ask you not to self-medicate. Make an appointment with a doctor!

The direction of depolarization is shown by the arrow. Depolarization and repolarization of individual muscle cells (fibers) occurs in one direction. However, throughout the myocardium, depolarization proceeds from the inner layer (endocardial) to the outermost layer (epicardial), and repolarization occurs in the opposite direction. The mechanism for this difference is not completely clear..

The depolarizing electric current is recorded on the electrocardiogram in the form (excitation and depolarization of the atria) and (excitation and depolarization of the ventricles).

After some time, the depolarized cell, completely engulfed in excitation, begins to return to a resting state. This process is called repolarization. A small area on the outside of the cell again acquires a positive charge, then the process spreads along the cell until it is completely repolarized. Ventricular repolarization on the electrocardiogram corresponds to , waves and (atrial repolarization is usually hidden by ventricular potentials).

The electrocardiogram shows all the cells of the atria and ventricles, not individual cells. In the heart, depolarization and repolarization are usually synchronized, so the electrocardiogram can record these electrical flows in the form of certain waves (teeth P, T, U, QRS complex, ST segment).

From this article you will learn: what is early ventricular repolarization syndrome of the heart (abbreviated as EVRS), why it is dangerous for the patient. How it manifests itself, and when it is necessary to treat patients.

Article publication date: 04/05/2017

Article updated date: 05/29/2019

Early ventricular repolarization syndrome is a term doctors use to describe certain ECG changes that have no obvious cause.

Contractions of the heart are caused by changes in the electrical charge in its cells (cardiomyocytes). These changes have two phases - depolarization (responsible for the contraction itself) and repolarization (responsible for the relaxation of the heart muscle before the next contraction) - which replace each other. They are based on the transition of sodium, potassium and calcium ions from the intercellular space into the cells and vice versa.

Click on photo to enlarge

This syndrome was recently considered completely harmless, but scientific research has demonstrated that it may be associated with an increased risk of ventricular arrhythmias and sudden cardiac death.

SRR is more common in athletes, cocaine addicts, patients with hypertrophic cardiomyopathy, young people, and men. Its incidence ranges from 3% to 24% of the general population, depending on the methods used to interpret the ECG.

Cardiologists deal with the problem of SRR.

Reasons for the development of SRRD

The process of early repolarization is not yet fully understood. The most popular hypothesis of its origin states that the development of the syndrome is associated either with increased susceptibility to ischemic diseases, or with minor changes in the action potential of cardiomyocytes (heart cells). According to this hypothesis, the development of early repolarization is associated with the process of potassium leaving the cell.

Another hypothesis about the mechanism of development of SRR indicates a connection between disturbances in the processes of depolarization and repolarization of cells in certain areas of the heart muscle. An example of this mechanism is Brugada syndrome type 1.

Brugada syndrome on ECG. Click on photo to enlarge

The genetic causes of the development of SRGC continue to be studied by scientists. They are based on mutations of certain genes that affect the balance between the flow of some ions into the heart cells and the release of others outside.

Manifestations of SRR on ECG

The diagnosis of SRGC is made on the basis of electrocardiography. The main ECG signs of this syndrome are:

• Elevation (rise) of the ST segment above the isoline.
• The presence of a downward-facing convexity on the ST segment.
• An increase in the amplitude of the R wave in the precordial leads with the simultaneous disappearance or decrease of the S wave.
• Placement of the J point (the point at which the QRS complex enters the ST segment) above the isoline, on the descending limb of the R wave.
• Sometimes a J wave is observed on the descending limb of the R wave, resembling a notch in appearance.
• Expansion of the QRS complex.

The classic definition of SRR on the ECG (ST segment elevation). Click on photo to enlarge
New definition of SRRS syndrome on ECG. Click on photo to enlarge

These signs of early ventricular repolarization syndrome on the ECG are better visible at a lower heart rate.

Based on the ECG, three subtypes of the syndrome are distinguished, each of which is accompanied by its own risk of complications.

Table 1. Types of SRR:

Symptoms in patients

Clinical manifestations of pathology can be divided into two groups.

First group

The first group includes those patients in whom this syndrome leads to complications - fainting and. Fainting is a short-term loss of consciousness and muscle tone, which is characterized by a sudden onset and spontaneous recovery. It develops due to deterioration of blood supply to the brain. In case of SRGC, the most common cause of fainting is a violation of the rhythm of contractions of the ventricles of the heart.

Cardiac arrest is the sudden cessation of blood circulation due to ineffective or absent heartbeats. With SRRH, cardiac arrest is caused. Ventricular fibrillation is the most dangerous heart rhythm disorder, which is characterized by rapid, irregular and uncoordinated contractions of ventricular cardiomyocytes. Within a few seconds of the onset of ventricular fibrillation, the patient usually loses consciousness, then his pulse and breathing disappear. Without the necessary assistance, a person most often dies.

Second group

The second (and largest) group of patients with SRBC have no symptoms . Early repolarization of the ventricles is detected accidentally on the ECG. This group is less prone to developing complications and is characterized by a benign course of this syndrome.

Until complications develop, pathology does not limit a person’s activities and activities in any way.

Determining the risk of SIRS

For most people, SRHR does not pose any threat to their health and life, but it is very important to identify among all patients with this syndrome those who are at risk of developing severe heart rhythm disturbances. For this, the following are of great importance:

1. Medical history (anamnesis). Scientists say that 39% of patients who experienced cardiac arrest associated with early ventricular repolarization had experienced fainting beforehand. Therefore, the presence of syncope in people with ECG signs of CVD is an important factor indicating an increased risk of sudden cardiac death. Up to 43% of patients with ESRD who survive cardiac arrest will develop dangerous heart rhythm disturbances again. 14% of patients with ventricular fibrillation causing ventricular fibrillation have a family history of sudden death in close relatives. These data confirm that medical history has the potential to help predict the risk of complications of SRBC.
2. The nature of changes on the ECG. Scientists and doctors have found that certain ECG characteristics of the syndrome may indicate an increased risk of complications. For example, an increased risk of sudden death is observed in people with signs of early ventricular repolarization in the inferior ECG leads (II, III, aVF).

Knowing the dangers of SIRS can help you seek medical help early and prevent life-threatening complications.

Treatment

SRR occurs quite often. In most patients, it does not pose any danger to the health and life of patients.

People with ECG changes who do not have any clinical symptoms of RBC do not require any specific treatment. A small number of patients at risk of developing complications may require implantation of a cardioverter-defibrillator or conservative therapy.

An implantable cardioverter defibrillator is a small device placed under the skin of the chest that treats dangerous heart rhythm problems. From it, electrodes are inserted into the cavity of the heart, through which, at the moment of arrhythmia, the device delivers an electrical discharge that restores normal heart rhythm.

Patients with early ventricular repolarization are implanted with a cardioverter defibrillator in cases where they have already had dangerous heart rhythm disturbances in the past. Also, this operation may be indicated for people with SRGC who have close relatives who died at a young age from sudden cardiac arrest.

Conservative therapy is carried out for patients in whom this syndrome has led to the development of a life-threatening heart rhythm disorder. In such cases, isoproterenol (to suppress acute ventricular fibrillation) and quinidine (for maintenance therapy and to prevent the development of arrhythmias) are used.

Forecast

The vast majority of people with signs of impaired ventricular repolarization on the ECG have a favorable prognosis. However, in a small number of patients, these changes in the electrophysiological characteristics of the heart can have catastrophic consequences. The main task of doctors in this situation is to identify these patients before the first episode of a dangerous heart rhythm disorder occurs.