Disorder of repolarization in the myocardium is an electrocardiographic phenomenon found in many people. To understand what the concept of "repolarization" means in general, you need to turn to basic physiology.
What it is
The human heart consists of 2 types of cells - typical cardiomyocytes (muscle cells that provide contraction) and atypical cardiomyocytes (generating and conducting nerve impulses). Thanks to the activity of the latter, the heart is capable of constant and rhythmic contraction. This is called automatism.
At the moment when the heart is at rest (not contracting), positively charged particles (cations) are located outside the cardiomyocyte membrane, and negatively charged particles (anions) are inside.
When ions begin to move through special channels, the membrane charge changes (inside to "+", outside to "-"). As soon as the difference in charges reaches a certain value, an excitation wave is generated (depolarization occurs), which is transmitted to the muscle cells, and the heart contracts. Then the ions return to their original place (the myocardium relaxes), and the cycle repeats again. This moment of reverse movement of ions is called repolarization.
Violation of repolarization is a very common phenomenon among both adults and children (more often in males). Moreover, it can be observed in absolutely healthy people, and in those who suffer from severe cardiac diseases.
A special type of this pathology stands out separately - syndrome of early repolarization of the myocardium, or ventricles (VAD), mainly found in adolescents, and even newborns who do not have any heart disease. SRDS can also be found in adults.
Causes of occurrence
The exact cause of the disturbances in the repolarization processes is unknown. Pathology can develop under the following conditions:
- Autonomic dysregulation syndrome - better known as vegetative-vascular dystonia;
- organic heart disease - ischemic disease, myocarditis, heart failure, cardiosclerosis, cardiomyopathy, thickening of the interventricular septum;
- the use of drugs that affect the excitability or metabolism of myocardial cells - antidepressants, adrenomimetics, psychostimulants, cardiac glycosides;
- connective tissue dysplasia is a hereditary pathology characterized by insufficient production of collagen protein and manifested by hypermobility of the joints, increased skin elasticity, impaired metabolic processes in the myocardium;
- changes in the content of electrolytes in the blood - sodium, potassium, calcium, magnesium;
- excessive physical exertion - SRDS is common among athletes.
Possible manifestations and consequences for the body
As a rule, when repolarization is violated, a person does not bother. Therefore, in almost everyone, this syndrome is found either during a preventive medical examination, or during examination for another disease.
If symptoms appear, then only in the event of a violation of repolarization against the background of some kind of cardiac pathology. Then the patient may complain of heart pain, dizziness, rapid pulse, etc.
I am often asked about whether a violation of myocardial repolarization is dangerous, especially during pregnancy. No, but it may indicate the presence of a heart disease.
As for the SRRZH, for a long time it was considered absolutely harmless, it was mistaken for an "accidental find." However, many years of clinical studies have made this questionable.
It turned out that those people who showed signs of SRPC on the ECG have a very high risk of developing paroxysmal supraventricular tachycardia, atrial fibrillation and Wolff-Parkinson-White syndrome in the future (after a few years).
How deviations are determined
The main and only method for diagnosing violations of ventricular repolarization is electrocardiography. On the film, nonspecific changes in the T wave are visible (mainly in the chest leads) - it becomes high, pointed, or, conversely, its amplitude decreases, it can be negative.
Of much greater interest is ECG diagnostics of SRPC, in which the following main symptoms are noted:
- elevation of the ST segment;
- point j, “camel hump”, “Osborne wave” - a notch on the descending part of the ST segment;
Shortening of PQ and QT intervals may also be observed.
Decoding the cardiogram requires special care from the doctor, since the ST segment elevation occurs in other, more serious pathologies - angina pectoris, myocardial infarction, pericarditis, etc. Most often, the clinical picture does not help in differential diagnosis, because SRDS is not accompanied by any symptoms.
However, if I find the above changes on the film in an adult (especially after 40 years), then I additionally prescribe stress tests, i.e. taking an ECG while the patient is doing moderate physical activity - on a bicycle ergometer or treadmill (treadmill). With SRDS, the cardiogram returns to normal. This helps me to make a differential diagnosis with a painless form of angina pectoris and heart attack.
In the case of an undefined ECG picture, I use special tests with drugs. The patient is injected with potassium chloride or Novocainamide. After 30 minutes, an ECG is taken. With SRDS, the symptoms become more distinct.
To detect possible arrhythmias, I conduct daily (Holter) ECG monitoring to my patients.
Since SRPC can develop against the background of organic heart disease, I prescribe echocardiography to assess the morphological structure of the myocardium.
Treatment and proper observation
There is evidence of the use of so-called "energotropic" drugs (Carnitine, Kudesan), which normalize metabolic processes in the myocardium. However, the repolarization disorders themselves, as a rule, do not require treatment.
I prefer to pay more attention to the conditions and pathologies that caused the occurrence of violations, and if they are detected, direct therapeutic measures (medication and non-medication) to eliminate them.
In the absence of any illnesses, it is necessary to be regularly monitored by a doctor in the future. At least once a year, undergo a minimal cardiological examination - full-time examination, ECG recording, Holter monitoring.
With a prolonged course of SRR, I use magnesium preparations to prevent the occurrence of arrhythmias, less often antiarrhythmic drugs (Amiodarone).
If life-threatening arrhythmias develop, radiofrequency ablation may be needed.
Expert advice
The phrase "violation of repolarization" should not frighten the patient. But you shouldn't ignore it either. In the presence of this pathology, you should be examined to find out the cause.
In view of the potential danger of SRDS (the appearance of arrhythmias), as a preventive measure, I recommend that my patients give up smoking, intense physical activity and the use of drugs that slow down the pulse.
Clinical case
Recently I saw a patient who came to me with complaints of shortness of breath, aggravated by walking, climbing stairs, and at night. For several years he has been suffering from arterial hypertension. Received no treatment.During a general examination, an increase in pulse rate up to 126 per minute is noted, high blood pressure is up to 150/95 mm Hg. Art., swelling of the feet and lower thirds of the legs, enlargement and soreness of the liver on palpation.
An ECG was performed. decoding - sinus tachycardia, diffuse disturbances in the processes of repolarization of the left ventricular myocardium, signs of left ventricular hypertrophy. The patient is referred for echocardiography. Holter monitoring did not reveal other pathological abnormalities. The result is hypertrophy and dilatation (expansion) of the left heart, a decrease in the left ventricular ejection fraction - 55%. Clinical diagnosis: “Chronic heart failure stage IIB, NYHA functional class II. Background disease: Hypertension stage III, arterial hypertension 2 degrees. " Prescribed treatment: limiting salt intake to 3 g per day, Bisoprolol 5 mg 1 time per day, Perindopril 10 mg 1 time per day, Amlodipine 5 mg 1 time per day.
Should you be afraid of the diagnosis
Repolarization disorders are not in themselves dangerous or life-threatening. When there is such an inscription on your cardiogram, do not be alarmed. This is a reason to look for a possible cause. If this is not found, you need to periodically visit a cardiologist for regular examination.
