syndrome early repolarization
syndrome early ventricular repolarization - is the appearance of uncharacteristic for a normal ECG changes in the form of psevdokoronarnogo ST elevation on the contour line in the chest leads and more waves of J in the end part of the complex QRS.
first information about these changes in the ECG recording were seen in the middle of the XX century and for a long time cardiologists around the world did not betray these changes matter.In recent years, the attention of scientific workers in the field of cardiology faces the problem of the phenomenon of early ventricular repolarization, as these changes were more likely to occur in children and young able-bodied people, causing a persistent disorder of the heart.
According to world statistics, the total population of the early ventricular repolarization syndrome occurs in 1-9% of the population at risk include black men under the age of 35 years, patients with dysplastic nature of connective tissue, as well as pat
early repolarization syndrome causes
early repolarization syndrome refers to heart disease of unknown etiology, since this pathology is found equivalent among perfectly healthy individuals and in people with various illnesses.However, there are non-specific factors that trigger ECG changes characteristic of early repolarization syndrome, which include:
- long-term use or overdose of drugs the group agonists;
- family-type hyperlipidemia (innate high content of low density lipoprotein and the insufficient level of high density lipoproteins in the blood), which is a consequence of atherosclerotic heart disease;
- if the patient dysplastic disorders of connective tissue in the form of the emergence of additional chords in the cavity of the heart ventricles;
- obstructive hypertrophic cardiomyopathy in 12% of cases is associated with the manifestations of the syndrome early repolarization;
- the presence of the patient congenital or acquired heart disease.
In recent years began to appear a study aimed at identifying a possible genetic nature of this disease, but yet reliable data on the transfer of early repolarization syndrome is inherited is not revealed.
Underlying etiopathogenetic mechanism of early signs of ventricular repolarization supposed violation of the electric impulse conduction paths for walking away from the atria to the ventricles, and the activation of abnormal pathways.Among researchers there is a belief that the appearance of a burr at the end of the QRS complex is nothing but delayed delta wave.In favor of the data on activation of additional pathways of electrical impulses that are the root cause of the syndrome early repolarization suggests shortening of PQ interval in most patients.
Furthermore, based on the syndrome early repolarization laid imbalance in electrophysiological change mechanism of depolarization and repolarization in certain myocardial structures localized at the apex of the heart and its basal.
In normal cardiac depolarization and repolarization occur on a strict order and in the same direction.Thus, repolarization always starts with the base of the heart epicardium and ends at the apex of the heart endocardium.The syndrome early repolarization repolarization sharply accelerated in the subepicardial layers of the myocardium.
There is a clear relationship of early repolarization syndrome, dysfunction of the autonomic nervous system.Vagal genesis of this phenomenon is proved by carrying out tests with dosed physical activity and drug breakdown with isoproterenol, after which the patient marked the normalization of the ECG parameters and opposite signs of the deterioration of ECG during night sleep.
important factor in the development of early ventricular repolarization syndrome is a condition of the electrolyte balance in the body.For example, under experimental conditions in randomized studies have found a clear relationship progression of symptoms in the early repolarization syndrome gmperkaltsiemii and hyperkalemia.
early repolarization syndrome symptoms
For the definition of specific clinical symptoms characteristic exclusively for the early repolarization syndrome have been many large-scale experimental studies, but they were unsuccessful.Changes in ECG parameters recorded on an equal footing, not only in patients with cardiac pathologies, but also among healthy young adults.
Despite the lack of specific clinical manifestations of bright early repolarization syndrome, changes in cardiac conduction system may be accompanied by the emergence of various forms of arrhythmias (supraventricular tachyarrhythmias, ventricular arrhythmia, ventricular fibrillation and other tachyarrhythmias).
Due to an increased risk of arrhythmogenic complications, early repolarization syndrome is a life-threatening condition and health of patients.The world's statistics there are a large number of registered deaths from asystole ventricular fibrillation, occurred against the backdrop of the early repolarization syndrome.
In addition, 50% of early repolarization syndrome is accompanied by diastolic and / or systolic dysfunction of the heart, which is manifested in various forms of disorders of the central hemodynamics.
early repolarization syndrome is often combined with a syndrome caused by the influence of humoral factors on the hypothalamic-pituitary system (vagotonic, tachycardial, giperamfotonichesky and degenerative syndromes).These pathological disorders are more typical for children suffering neurocirculatory dystonia.
early repolarization syndrome in children
Recently, cardiologists say tends to increase the incidence of the syndrome early ventricular repolarization among childhood.
The phenomenon is not expressed disorders of cardiac activity, children with the syndrome early repolarization necessarily need to pass the standard blood and urine tests, ECG registration in the dynamics, as well as echocardiography in order to determine the possible causes of the disease and related diseases.
If a child has been "isolated syndrome early repolarization," that is not accompanied by other cardiac pathologies, then such patients is not appropriate to apply the medication, and need only to normalize eating behavior (balanced diet and enrich the menu baby products containinguseful for the organism micronutrients), to limit the excessive physical activity and the effects of stress.
is mandatory preventive passage of ultrasound of the heart and ECG 2 p.a year and, if necessary, correction of medical treatment a cardiologist.
antiarrhythmic agents only when it is expedient to appoint attested violations of cardiac rhythm when the ECG study.As a preventive measure to children it recommended the use of drugs, which include magnesium.
syndrome early repolarization on ECG
The only reliable method of diagnosis of the phenomenon of early ventricular repolarization is ECG study.When handling the patient into the study of functional diagnostics, ECG study reveals signs of early repolarization syndrome.For details of the diagnosis is necessary to resort to the ECG with stress, as well as the daily monitoring of ECG.
the main group ECG character of the phenomenon of early repolarization are:
- shift of the ST segment by more than 3 mm above the contour;
- chest leads to a simultaneous increase in tooth R, leveling wave S, as a sign of the disappearance of the transition zone;
- appearance psevdozubtsa r at the end of the wave R;
- elongation complex QRS;
- displacement of the electrical axis to the left;
- the emergence of asymmetric high waves T.
As a rule, in addition to the standard ECG study, patients must be performed ECG under additional stress (physical or drug load) in order to determine the dynamics of ECG signs of the phenomenon of early repolarization.
when you visit the sick cardiologist necessarily need to provide historical records of ECG, as changes in the phenomenon of early repolarization can simulate an attack of acute coronary insufficiency.The main difference between early repolarization syndrome of acute myocardial infarction is the constancy of changes in the ECG and the absence of chest pain with typical irradiation.
early repolarization syndrome treatment
all persons suffering from the syndrome early repolarization is contraindicated in severe physical activity.Correction of eating behavior intended to include in the diet of foods containing potassium, magnesium and vitamin B (herbs, fruits and vegetables raw, saltwater fish, soy and nuts).
In most cases, the syndrome early ventricular repolarization does not require medical correction, but if the patient has significant symptoms concomitant cardiac disease (coronary syndrome, various forms of arrhythmia), it recommended the appointment of a specific drug therapy.
numerous randomized studies have proven the efficacy energotropic therapy in relieving symptoms early repolarization syndrome in both children and adults.Of course, this group of drugs are not relevant to the drugs of choice for this disease, but their application improves trophic heart muscle and prevents possible complications of the heart activity.Among energotropic agents most effective in this situation are: Qudesan a daily dose of 2 mg per 1 kg of weight, Carnitine 500 mg of 2 p.per day, vitamin B complex, Neurovitan 1 tablet per day.
include antiarrhythmics advisability of appointing a group of drugs that slow the process of repolarization - novokainamid at a dose of 0.25 mg every 6 hours, quinidine sulfate, 200 mg 3 times a day, Etmozin 100 mg 3 times a day.
Among the invasive methods of treatment most effective in the early repolarization syndrome is catheter radiofrequency ablation, which can be used locally to eliminate beam pathological pathways provoking rhythm disturbance.This methodology is applied at the expressed disturbances of cardiac rhythm occurring against the backdrop of the early repolarization syndrome.
Despite its effectiveness, catheter ablation, as any surgical procedure can cause complications that threaten the life of the patient (cardiac tamponade, pulmonary embolism, damage to the coronary vessels), and therefore, must be a differentiated approach to the question of the appointment of this method of treatment.
In a situation where a patient with established early repolarization syndrome, observed repeated episodes of ventricular fibrillation, the patient should be prepared for implantation of cardioverter defibrillator,.Modern microsurgical approaches in cardiology allow installing defibrillators minimally invasive manner without thoracotomy.Cardioverter defibrillator third generation does not cause adverse reactions and their operation is well tolerated by patients.Currently, this method is the best in the treatment of arrhythmogenic pathologies.