Vagal elevation of the st segment is more common. ST segment displacement

The shift of the ST segment relative to the isoelectric line down (depression) is the reason for a more detailed examination of the patient, since the presence of such a change makes it possible to suspect ischemia of the heart muscle.

It should be remembered that the analysis of this segment alone from the overall picture of the electrocardiogram is not informative enough. A correct conclusion is possible only after a comprehensive detailed analysis of the recording in all leads.

What is the ST segment?

A segment on a cardiogram is a section of the curve located between adjacent teeth. The ST segment is located between the negative S wave and the T wave.

The ST segment is a fragment of the electrocardiogram curve, which reflects the period during which both ventricles of the heart are fully involved in the excitation process.

The duration of the ST segment on the ECG depends on the frequency heart rate and changes along with it (the higher the heart rate, the shorter the duration of this section on the cardiogram).

Each of the sections of the electrocardiographic curve has its own diagnostic value:

On the normal cardiogram in the limb leads, the ST segment has a horizontal direction and is located on the isoelectric line. However, its position is also recognized as a variant of the norm and its position is slightly higher than the isoelectric line (one and a half to two cells). This picture on the electrocardiogram is often combined with an increase in the amplitude of the positive T wave.

The greatest attention to this segment in the analysis of the electrocardiogram is given in case of suspected coronary heart disease and in the diagnosis of this disease, since this section of the curve is a reflection of oxygen deficiency in the heart muscle. Thus, this segment reflects the degree of myocardial ischemia.

ST segment depression

The conclusion about depression of the ST segment is made when it is located below the isoelectric line.

The descent of the ST segment below the isoline (its depression) can also be registered on the cardiogram of a healthy person, in this case, the position of the electrocardiogram curve on section S-T does not fall below half a millimeter of the isoelectric line.

The reasons

When analyzing an electrocardiogram, it must be taken into account that the modification of some of its elements can be caused by medications that the patient takes, as well as deviations in the electrolyte composition of the blood.

The shift of the ST segment down relative to the isoelectric line is a non-specific sign. This electrocardiographic phenomenon is observed in various leads in a number of conditions:

• Subendocardial or acute transmural ischemia (with acute myocardial infarction).
• Acute myocardial ischemia of the anterior wall of the left ventricle. It may also be indicative of ST elevation in chest leads.
• Acute ischemia of the lower wall.
• Impact result medicines class of cardiac glycosides.
• Hyperventilation of the lungs (an excess of oxygen in them).
• Reduced potassium content in the peripheral blood (hypokalemia) - in this case, there is a possibility of an additional U wave.
• Hypertrophic changes in the left ventricle, which in some cases can be interpreted as a sign of its overload.
• The horizontal downward displacement of this segment is specific for the chronic course of insufficiency. coronary circulation with myocardial ischemia.
• Vegetovascular dystonia.
• Pregnancy. During this period, a shift of the ST segment below the isoelectric line may be recorded against the background of tachycardia; the degree of depression in these cases does not exceed 0.5 mm.

A change in the ST-T complex in the form of its downward displacement relative to the isoelectric line can also be caused by a complex of reasons. For example, in a patient with myocardial hypertrophy (of any origin) and receiving therapy in the form of cardiac glycosides, there is a possibility of acute subendocardial ischemia.

The detection of ST segment depression is the reason for a thorough analysis of the electrocardiogram recording in all leads for a more accurate diagnosis of the localization of the lesion.

Clinical manifestations

In typical cases, ischemia (hypoxia) of the myocardium is manifested by pressing pains, discomfort, burning sensation in the chest area. Irradiation is characteristic pain in the back and left upper limb. Possible and painless form myocardial ischemia, manifested by discomfort in the retrosternal space, tachycardia, a decrease or increase in blood pressure, heartburn, shortness of breath.

At differential diagnosis of ischemic myocardial damage with VVD, the features are taken into account clinical picture: vegetovascular dystonia is characterized by ST depression in a young patient, more often women, against the background of an increase in heart rate, in the absence of symptoms typical of angina pectoris. In this case, changes in the electrocardiogram are regarded as "non-specific" or as "signs of increased influence of the sympathetic nervous system".

With transient ischemia, Holter monitoring (ECG recording during the day) helps to make a diagnosis. The Holter displays all episodes of oxygen starvation of the heart muscle of patients that took place during the day.

Holter application

Treatment of conditions associated with ST segment depression

In order for the treatment to be effective, it is necessary to act directly on the cause of hypoxia, which is determined using special examination methods. Possible reasons are as follows:

• atherosclerotic vascular lesions;
• unbalanced diet containing excessive amounts of cholesterol;
• emotional overstrain;
• the presence of bad habits;
• sedentary lifestyle;
• excessive physical activity with the unpreparedness of the body;
• metabolic disorders in the body leading to obesity;
• diabetes.

In the treatment of myocardial ischemia, complex therapeutic regimens are used, consisting of the following drugs described in the table:

With insufficient efficiency conservative therapy apply surgical methods treatment:

• stenting of coronary arteries and (or) their branches;
• coronary artery bypass grafting.

In the treatment of vegetovascular dystonia, the main role belongs to the normalization of the excitability of the nervous system. The amino acid Glycine is capable of normalizing the metabolism of nervous tissue. The beneficial effect of this substance on the nervous tissue helps to reduce the astheno-neurotic component.

Appropriate and application nootropic drugs with an additional sedative effect.

If there are tachycardia or tachyarrhythmia in vegetative dystonia, the use of Corvaldin, Corvalol, and potassium preparations is indicated.

For effective treatment vegetovascular dystonia, it is necessary to observe a protective regime: giving up bad habits, a balanced diet, combating physical inactivity, eliminating stress. High efficiency, especially in the composition complex therapy, show massage, physio and acupuncture.

ST segment elevation - rise above the isoline on the electrocardiogram. In the article we will tell you what diseases this disorder occurs in and how these diseases can be prevented and treated.

What is ST segment elevation?

With the help of a cardiogram, you can evaluate the rhythm and conduction of the heart by the position of the segments and teeth of the graph.

ST segment elevation - deviation above the isoline on the electrocardiogram. A slight elevation is observed with tachycardia, more pronounced - with coronary artery disease and pericarditis. In pericarditis, the S wave is preserved and his ascending knee is elevated. In myocardial infarction, ST segment elevation reverses within 2 weeks. During the course of a heart attack, the T wave rises and sharpens. After 6 months, myocardial infarction can be recognized by the disappearance of the R wave.

Causes of ST Elevation

ST segment elevation in children

Of greatest concern is the rising number of children with congenital heart anomalies and hypotension. The heart of children is larger than that of adults in relation to the body and has a number of characteristic features. Both ventricles are equal, the openings between the sections of the heart are larger than in adults.

ST-segment elevation treatment

Today, the medical community pays great attention to the issues of the earliest management of a patient with myocardial infarction, in which ST segment elevation is observed on the ECG. If you have had a heart attack before, or if you have diabetes, you are at greater risk of having a heart attack than anyone else.

First of all, it is necessary to provide daily ECG monitoring. Therapy should begin with taking aspirin. Aspirin should be taken at a dosage of 100 mg 1 time per day. Contraindications for admission: age up to 21 years, pathology of the liver and kidneys, a tendency to bleeding. Aspirin is not prescribed for patients with stomach ulcers, gastritis, colitis. Contraindicated in pregnancy, the drug is stopped a few days before the planned surgical intervention. It is rational to use enteric-soluble forms of the drug. They are best taken with meals to reduce the negative impact of aspirin on the gastrointestinal tract. Enteric aspirin is taken without chewing. There is also the usual tableted aspirin and effervescent.

Nitroglycerin is prescribed intravenously. It is used for emergency care with myocardial infarction for more than 100 years. Intravenous infusions of nitroglycerin reduce the area of ​​infarction and prevent left ventricular remodeling. The reduction of complications of myocardial infarction during nitroglycerin therapy has been proven. It reduces the death rate of patients by a third. Intravenous administration of nitroglycerin is indicated for the first 2 days in patients with myocardial ischemia.

ACE inhibitors, such as valsartan, are also prescribed. The drug is rapidly absorbed from the gastrointestinal tract. The maximum concentration in the blood is reached after 2 hours. The half-life is 9 hours. Contraindicated in pregnancy. Side effects: weakness, dizziness and nausea. The recommended dosage is 80 mg once a day.

Another reason why ST segment elevation may occur is coronary heart disease. It cannot be completely cured, but proper treatment it can be slowed down. It is important to change your lifestyle, think about your diet. Attacks of arrhythmia and angina pectoris require hospitalization, you also need to go to the hospital with an increase in cardiac edema.

Treatment for coronary heart disease should be lifelong. Unfortunately, without supportive therapy, coronary artery disease progresses.

Angiotensin receptor blockers stop cardiac hypertrophy. Examples of drugs: losartan, candesartan.

Losartan is an angiotensin receptor blocker. Reduces pressure in the pulmonary circulation and prevents sodium retention. Makes the heart more resilient to physical stress. A stable drop in blood pressure is achieved 2 months after the start of the course. It is rapidly absorbed, and the maximum concentration is reached after 2 hours. Most of the drug is excreted by the intestines. Do not use in pregnant women. Side effects: dizziness, asthenia, headache, impaired memory and sleep. The drug is prescribed at a dose of 50 mg 1 time per day.

Candesartan is a drug to prevent high blood pressure and reduce heart rate. Increases blood flow in the kidneys. The maximum concentration in the blood is reached after 4 hours. The half-life is 9 hours. It is excreted by the kidneys and with bile. Contraindicated in pregnancy. Side effects are manifested in the form of headache, cough, pharyngitis, nausea. Take 8-16 mg 1 time per day.

Prevention of ST segment elevation

500,000 people a year in Ukraine die from coronary heart disease. Most often, coronary artery disease occurs in people over 45 years of age. 50% of patients with ischemia developed the disease on the background arterial hypertension. Reducing alcohol consumption and increasing potassium intake can correct mild forms of arterial hypertension. The best prevention of all CVD is to reduce the intensity of stress.

Unconscious harm to health is the main cause of all human diseases. A city dweller can afford to do exercises in the morning, wake up earlier in the morning to prepare a full breakfast, but does not do this. After 40 years, preventive examinations of the heart should become the norm, but do we often visit the clinic if nothing hurts?

Our heart is a very powerful pump. When we are calm, it contracts 70-85 times per minute. But if we give it physical activity, it is able to pump not 4 liters of blood per minute, as usual, but all 40! Trained people have a lower heart rate, which means that their heart wears out and ages later.

Cardiovascular disease is the leading cause of disability and death in the world. Their cause is atherosclerosis, which develops gradually. Whether you get coronary syndrome, myocardial infarction, coronary heart disease depends on what gender you are, what your blood pressure and blood glucose level are. A total of 40 risk factors for CVD were identified.

In 2009, 18 million people worldwide died of CVD. This year, a "record" was set - every third person ended his life because of a diseased heart or blood vessels.

Improper diet and smoking are the leading causes of CVD. The consequences of an unhealthy diet - high blood sugar and obesity - ultimately cause 85% of heart disease. You must be aware of the pain in chest, elbows, arms, back, breathing difficulties, nausea, dizziness.

The cause of myocardial infarction with ST segment elevation and acute coronary syndrome is often atherosclerosis. Prevention of atherosclerosis is a healthy diet, physical activity and control of blood glucose levels. To prevent obesity, we recommend that you limit your calorie intake in your diet. Reduce the amount of carbohydrates and fats consumed and eat fractionally. Do not eat foods rich in cholesterol. Especially a lot of it in the yolks, so 4 yolks per week is enough. Limit the liver, caviar, sausage, milk. Cook and bake food in the oven. Food should be varied with plenty of fruits, cereal grains and meat, wholemeal bread. Avoid animal fat. It is recommended to limit fatty meat, butter and yolks. Useful fish of the northern seas: herring, mackerel, salmon. Drink good quality raw water. Avoid stress and keep your blood pressure under control. Salt your food less. Do prevention and remember that the heart is a very delicate organ. If you have high blood pressure, you need courses of antihypertensive therapy, anti-ischemic therapy, if you have coronary artery disease. It also helps to prevent heart disease by completely quitting smoking. Only about 30% of adults are not at risk for CVD. Half of the population has several risk factors that, when combined, cause heart and vascular disease.

Arterial hypertension and lipid metabolism disorders almost always lead to the development of coronary heart disease. Nicotine is the cause of vasospasm. Smokers most often die from myocardial infarction and oncological diseases. If you can not cope with the addiction yourself, it may be worth contacting a narcologist for qualified help - today there are many ways to get rid of addiction: nicotine chewing gums, reflexology. Let the best motivator for you be that each cigarette “steals” 20 minutes of your life from you.

Useful jogging, swimming and skiing, hiking, gymnastics. All this not only tones the heart, but also develops muscle strength, joint mobility, and the ability to breathe properly. The most familiar physical activity for everyone is ordinary walking. Only by combining all methods of CVD prevention, you can be sure that the threat will pass you by. Paradoxically, the problem of heart disease is more common in developed countries with large cities and good infrastructure. This is because the automation of production and everyday life has freed a person from physical exertion. As a result, the elasticity of blood vessels decreases. And lifestyle modification can significantly slow down the development of many diseases. Of course, medicine should be thanked for such rapid growth, for the development modern methods treatment, but without understanding that everyone creates his own life, the fight against diseases cannot be successful. Only a change in behavior can help humanity in this struggle. Changing behavior and increasing awareness, awareness of responsibility for one's health. This is for everyone.

ST segment elevation on an ECG is just one of the signs of serious heart problems.

What is it, ST segment depression? These are cascade changes at the biochemical level that appear during oxygen starvation in the myocardium, which can be seen on the electrocardiogram.

In about one case out of five, after the end of an attack of tachycardia, a certain period of time (several weeks) can be observed that it has lengthened Q-T interval, the ST segment decreased and unmotivated T waves appeared, which express myocardial ischemia. If the changes are prolonged, the electrocardiogram can be used to conclude that a small-focal infarction has occurred.

Symptoms that indicate the diagnosis of ST segment depression (what it is, we will understand in this article): pupils are dilated, the appearance of tachycardia, chest pain, fear of death, suffocation.

Signs of ischemia on the ECG

Highly likely signs of “pre-scar” ischemia of the heart are ST-segment shifts: this is characterized by rise (elevation) and decrease (depression). Holter monitoring fixes these changes as follows: the ST trend deviates from the zero level of the "beard" and "peaks".

All layers of the myocardium die off and this fact is reflected on the ECG by the Q wave (it will be wide, with an amplitude of more than a quarter of the height of the R wave in the same direction).

ST elevation and the presence of Q are referred to as diagnoses: acute myocardial ischemia with ST segment elevation, as well as Q-forming infarction. There may be other causes of ST segment depression on the ECG.

It happens in other conditions such ST elevation.

The early repolarization syndrome is characterized by the appearance of a notch on the descending knee of the R wave. This condition is fixed on the Holter for a rather long time.

Also do not exclude pericarditis with changes in almost all leads.

ST depression on the ECG (what is it, we analyze) may be associated with an overdose of glycosides, but it will differ in a different shape of the segment, in which case it resembles a "trough".

All other changes in the QRS complex are considered possible. This means that they are not diagnosed. Most often this is manifested by a negative T wave.

If the patient has acute chest pain and any ECG changes, you need to remember a simple rule - he should be hospitalized without fail. Even if he doesn't have a heart attack. It is worse not to do this, and the person will die.

Symptoms of Ischemia Segment Depression

ST segment depression (what it is, they often ask) entails the appearance of coronary disease. It is difficult to recognize based on clinical symptoms. The detection of pathology is rarely observed during the passage of the medical examination. The main symptom is the pain that has arisen behind the sternum, where the pain source is located.

Additional visual characteristics of the diagnosis include: the release of cold sweat, blue skin, rapid breathing, muscle fatigue is observed.

To assess the ability of the heart muscles to respond to an increase in heart rate, it is necessary to do tests with physical activity.

When a person is healthy, he does not have pathologies, since the heart responds adequately to a possible increase in load. During physical activity arterial hypertension decreases, sometimes there is an increase in systolic pressure.

After the patient has suffered a myocardial infarction, the cause of reduced pressure is myocardial ischemia. When the contraction of the heart is repeated pathologically often, reduced cardiac functionality is evidence of ventricular dysfunction. This situation is observed when using cardiotropic drugs.

ST segment depression (ECG and Holter)

The ST segment in ischemic depression is characterized by "beards" during episodes of ischemia.

On the Holter ECG recording: a clear depression of the ST segment (what it is, many are interested in) is visible in the leads that characterize the lower wall of the LV myocardium. There is a fixation of horizontal red lines that pass through the Q wave.

ST segment elevation (ECG and Holter)

The ST segment with ischemic elevation is characterized by "peaks" at the time of an ischemic attack.

What is typical for the onset of an ischemic episode: ST elevation begins in leads, which are characteristic of the anterolateral sections of the LV myocardium. This means the beginning of reciprocal (reverse) horizontal depression of the ST segment by 1 mm or more in the AVR leads.

What is typical for the development of an episode of ischemia: an increase in ST segment elevation is noted, changes are recorded in previously "calm" leads. The middle chest leads take on the shape of a "cat's back", which is the difference between myocardial infarction in acute form.

Sign of myocardial death

Deep and wide Q is noted in leads. This indicates a myocardial infarction with extensive localization.

Fix the complete blockade of the right leg of the bundle of His, as well as rhythm disturbance with supraventricular tachycardia.

Now it became clear what it is - depression of the ST segment.

Treatment will depend on the cause of its occurrence. But in case of any suspicion, a person should be immediately hospitalized.

Treatment Methods

For patients diagnosed with acute non-ST elevation coronary syndrome, the choice of therapy depends on the possible risks of myocardial infarction and death.

What will be the risk factors?

All of these risks increase with age. Coronary complications occur more frequently in males with severe and long-term angina pectoris or a previous myocardial infarction. An increased risk occurs with violations of the function of the left ventricle, congestive heart failure, as well as with arterial hypertension and diabetes. These well-known risk factors lead to a poor prognosis in coronary syndrome in acute form.

What matters is the time that has passed since the last fact of ischemia, whether there is rest angina pectoris and whether there is a response to drug treatment.

More often it is advisable to appoint:

• anti-ischemic drugs - they reduce myocardial oxygen consumption (heart rate decreases, blood pressure decreases, left ventricular contractility is suppressed) or lead to vasodilation;
• beta blockers;
• nitrates;
• calcium antagonists;
• antithrombotic drugs;
• antiplatelet agents.

In addition, fibrinolytic (thrombolytic) treatment is used.

Some non-ST elevation studies done with streptokinase, tissue plasminogen activators, or urokinase have shown that this intervention is even associated with some increased risk of mortality and infarction. Thus, thrombolytic therapy is not recommended for patients with acute non-ST elevation coronary syndrome.

W. Brady et al. analyzed the results of evaluation by emergency physicians of 448 ECGs with ST segment elevation. An erroneous assessment of the ECG in the form of overdiagnosis of acute myocardial infarction (MI) with subsequent thrombolytic therapy in patients was detected in 28% of cases with heart aneurysm (AS), in 23% - with early ventricular repolarization syndrome (ERVR), in 21% - with pericarditis and in 5% - with blockade of the left leg of the His bundle (LBBB) without signs of MI.
The assessment of the ECG phenomenon, which consists in ST segment elevation, is complex and includes an analysis of not only the features of ST changes and other ECG components, but also the clinical picture of the disease. In most cases, a detailed analysis of the ECG is sufficient to differentiate the underlying syndromes leading to ST-segment elevation. ST changes can be a variant of a normal ECG, reflect non-coronary changes in the myocardium and cause acute coronary pathology requiring emergency thrombolytic therapy. Thus, the therapeutic tactics in relation to patients with ST segment elevation is different.
1. Norma
Concave ST segment elevation is acceptable in limb leads up to 1 mm, in chest leads V1-V2, sometimes V3 up to 2-3 mm, in leads V5-V6 up to 1 mm (Fig. 1).
2. Myocardial infarction
with ST segment elevation (MI)
MI is necrosis of a section of the heart muscle, resulting from absolute or relative insufficiency of the coronary circulation. Electrocardiographic manifestations of ischemia, damage and necrosis of the myocardium depend on the location, depth of these processes, their duration, and the size of the lesion. It is believed that acute myocardial ischemia manifests itself mainly by changes in the T wave, and damage - by displacement of the ST segment, necrosis - by the formation of an abnormal Q wave and a decrease in the R wave (Fig. 2, 4).
The ECG of a patient with MI undergoes changes depending on the stage of the disease. At the stage of ischemia, which usually lasts from several minutes to 1-2 hours, a high T wave is recorded above the lesion. Then, when ischemia and damage spread to subepicardial regions, ST segment elevation and T wave inversion are detected (from several hours to 1-3 days .). The processes occurring at this time can be reversible, and the ECG changes described above may disappear, but more often they pass to the next stage, with the formation of necrosis in the myocardium. Electro-cardiographically, this is manifested by the appearance of a pathological Q wave and a decrease in the amplitude of the R wave.
3. Prinzmetal's Angina (SP)
With the development of spasm of the epicardial artery and subsequent transmural damage to the myocardium, there is an increase in the ST segment in the leads, reflecting the affected area. In SP, the spasm is usually short-lived, and the ST segment returns to baseline without subsequent myocardial necrosis. In SP, the characteristic features are the cyclicity of pain attacks, the monophasic type of the curve on the ECG, and cardiac arrhythmias. If the spasm continues long enough, MI develops. The cause of angiospasm of the coronary arteries is endothelial dysfunction.
Elevation of the ST segment in SP and developing MI does not have significant differences, since it is a reflection of one pathophysiological process: transmural ischemia due to occlusion of the epicardial artery caused by transient spasm in the first state and persistent thrombosis in the second (Fig. 3, 4).
Patients with SP are predominantly young women who do not have classic risk factors for coronary heart disease (CHD), except for smoking. SP is associated with such manifestations of angiospastic conditions as Raynaud's syndrome and migratory headaches. Combines these syndromes with the possibility of developing arrhythmias.
For the diagnosis of SP samples with physical activity uninformative. The most sensitive and specific provocative test is intravenous administration 50 mcg of ergonovine with a 5-minute interval until a positive result is obtained, while the total dosage of the drug should not exceed 400 mcg. The test with ergonovine is considered positive when an attack of angina pectoris and a rise in the ST segment on the ECG occur. For the rapid relief of symptoms of angiospasm caused by ergonovine, nitroglycerin is used. The dynamics of changes in the ST segment in SP can be traced by long-term ECG recording using the Holter method. In the treatment of SP, vasodilators are used - nitrates and calcium antagonists, b-blockers and high doses of acetylsalicylic acid are contraindicated.
4. Aneurysm of the heart (AS)
AS usually develops after transmural MI. The bulging of the ventricular wall causes stretching of neighboring areas of the myocardium, which leads to the appearance of a zone of transmural damage in the surrounding areas of the myocardium. On the ECG for AS, a picture of transmural MI is characteristic, and therefore QS is observed in most ECG leads, occasionally Qr. For AS, a “frozen” ECG is specific, which does not undergo dynamic changes in stages, but remains stable for many years. This frozen ECG has features observed in II, III stages of MI with ST segment elevation (Fig. 5).
5. Syndrome of early repolarization of the ventricles (ERVR)
SRW is an ECG phenomenon consisting in the registration of ST-segment elevation up to 2-3 mm with a downward bulge, as a rule, in many leads, most significantly in the chest. The transition point of the descending part of the R wave into the T wave is located above the isoline, often at the place of this transition a notch or wave is determined (“camel hump”, “Osborne wave”, “hat hook”, “hypothermic hump”, “J wave”) , the T wave is positive. Sometimes, within the framework of this syndrome, there is a sharp increase in the amplitude of the R wave in the chest leads, in combination with a decrease and subsequent disappearance of the S wave in the left chest leads. ECG changes may decrease during exercise testing and regress with age (Fig. 6).
6. Acute pericarditis(OP)
A characteristic ECG sign of pericarditis is a concordant (unidirectional with a maximum QRS wave) shift of the ST segment in most leads. These changes are a reflection of damage to the subepicardial myocardium adjacent to the pericardium.
In the ECG picture of OP, a number of stages are distinguished:
1. Concordant ST shift (ST elevation in leads where the maximum wave of the ventricular complex is directed upward - I, II, aVL, aVF, V3-V6, and ST depression in leads where the maximum wave in the QRS is directed downward - aVR, V1, V2, sometimes aVL), turning into a positive T wave (Fig. 7).


4. Normalization of the ECG (smoothed or slightly negative T waves can persist for a long time). Sometimes, with pericarditis, there is involvement in the inflammatory process of the atrial myocardium, which is reflected on the ECG in the form of a shift in the PQ segment (in most leads, PQ depression), the appearance of supraventricular arrhythmias. In exudative pericarditis with a large amount of effusion on the ECG, as a rule, there is a decrease in the voltage of all teeth in most leads.
7. Spicy cor pulmonale(OLS)
With ALS, ECG signs of overload of the right heart are recorded for a short time (occurs with status asthmaticus, pulmonary edema, pneumothorax, the most common cause is thromboembolism in the pulmonary artery basin). The most characteristic ECG signs are:
1. SI-QIII - the formation of a deep S wave in lead I and a deep (pathological in amplitude, but, as a rule, not widened) Q wave in lead III.
2. Elevation of the ST segment, turning into a positive T wave (monophasic curve), in the "right" leads - III, aVF, V1, V2, in combination with depression of the ST segment in leads I, aVL, V5, V6. In the future, the formation of negative T waves in leads III, aVF, V1, V2 is possible. The first two ECG signs are sometimes combined into one - the so-called sign of McGene-White - QIII-TIII-SI.
3. Deviation of the electrical axis of the heart (EOS) to the right, sometimes the formation of an EOS of the SI-SII-SIII type.
4. Formation of a high pointed P wave (“P-pulmonale”) in leads II, III, aVF.
5. Blockade of the right leg of the bundle of His.
6. Blockade of the posterior branch of the left leg of the bundle of His.
7. Increased R wave amplitude in leads II, III, aVF.
8. Acute signs of right ventricular hypertrophy: RV1>SV1, R in lead V1 more than 7 mm, ratio RV6/SV6 ≤ 2, S wave from V1 to V6, displacement of the transition zone to the left.
9. Sudden onset of supraventricular arrhythmias (Fig. 8).
8. Brugada Syndrome (SB)
SB is characterized by syncope and episodes sudden death in patients without organic damage heart, accompanied by changes in the ECG, in the form of a permanent or transient blockade of the right leg of the His bundle with the rise of the ST segment in the right chest leads (V1-V3).
Currently, the following conditions and diseases that cause SB are described: fever, hyperkalemia, hypercalcemia, thiamine deficiency, cocaine poisoning, hyperparathyroidism, hypertestosteroneemia, mediastinal tumors, arrhythmogenic right ventricular dysplasia (ARVC), pericarditis, MI, SP, mechanical obstruction of the outflow tract of the right ventricle ventricular tumors or hemopericardium, pulmonary embolism, dissecting aortic aneurysm, various anomalies of the central and autonomic nervous system, Duchenne muscular dystrophy, Frederick's ataxia. Drug-induced SB has been described in the treatment of sodium channel blockers, mesalazine, vagotonic drugs, α-adrenergic agonists, β-blockers, 1st generation antihistamines, antimalarials, sedatives, anticonvulsants, antipsychotics, tri- and tetracyclic antidepressants, lithium preparations.
The ECG of patients with SB is characterized by a number of specific changes that can be observed in full or incomplete combination:
1. Complete (in the classic version) or incomplete blockade of the right leg of the bundle of His.
2. Specific form of ST segment elevation in the right chest leads (V1-V3). Two types of ST segment elevation have been described: "saddle-back type" ("saddle") and "coved type" ("arch") (Fig. 9). The “coved type” rise significantly prevails in symptomatic forms of SB, while the “saddle-back type” is more common in asymptomatic forms.
3. Inverted T wave in leads V1-V3.
4. Increase in the duration of the PQ (PR) interval.
5. The occurrence of paroxysms of polymorphic ventricular tachycardia with spontaneous termination or transition to ventricular fibrillation.
The last ECG sign mainly determines the clinical symptoms of this syndrome. The development of ventricular tachyarrhythmias in patients with SB occurs more often at night or early morning hours, which makes it possible to associate their occurrence with the activation of the parasympathetic link of the autonomic nervous system. ECG signs such as ST segment elevation and PQ prolongation may be transient. H. Atarashi proposed to take into account the so-called "S-terminal delay" in lead V1 - the interval from the top of the R wave to the top of the R wave. The lengthening of this interval to 0.08 s or more in combination with ST elevation in V2 is more 0.18 mV is a sign of an increased risk of ventricular fibrillation (Fig. 10).
9. Stress cardiomyopathy
(tako-tsubo syndrome, SKMP)
SKMP is a type of non-ischemic cardiomyopathy that occurs under the influence of severe emotional stress, more often in older women without significant atherosclerotic lesions of the coronary arteries. Damage to the myocardium is manifested in a decrease in its contractility, most pronounced in the apical regions, where it becomes "stunned". Echocardiography reveals hypokinesis of the apical segments and hyperkinesis basal segments left ventricle (Fig. 11).
In the ECG picture of SKMP, a number of stages are distinguished:
1. ST segment elevation in most ECG leads, no reciprocal ST segment depression.
2. The ST segment is approaching the isoline, the T wave is smoothing out.
3. The T wave becomes negative in most leads (except aVR where it becomes positive).
4. Normalization of the ECG (smoothed or slightly negative T waves can persist for a long time).
10. Arrhythmogenic dysplasia/
right ventricular cardiomyopathy (ARVC)
ARVH - pathology, which is an isolated lesion of the right ventricle (RV); often familial, characterized by fatty or fibrous-fatty infiltration of the ventricular myocardium, accompanied by ventricular arrhythmias of varying severity, including ventricular fibrillation.
Currently, two morphological variants of ARVD are known: adipose and fibro-fatty. The fatty form is characterized by almost complete replacement of cardiomyocytes without thinning of the ventricular wall; these changes are observed exclusively in the pancreas. The fibro-fatty variant is associated with a significant thinning of the pancreatic wall; the left ventricular myocardium may be involved in the process. Also, with ARVD, moderate or severe dilatation of the pancreas, aneurysms, or segmental hypokinesia can be observed.
ECG signs:
1. Negative T waves in chest leads.
2. Epsilon (ε) wave behind the QRS complex in leads V1 or V2, which sometimes resembles incomplete RBBB.
3. Paroxysmal right ventricular tachycardia.
4. The duration of the QRS interval in lead V1 exceeds 110 ms, and the duration of the QRS complexes in the right chest leads may exceed the duration of the ventricular complexes in the left chest leads. Of great diagnostic value is the ratio of the sum of QRS durations in leads V1 and V3 to the sum of QRS durations in V4 and V6 (Fig. 12).
11. Hyperkalemia (HK)
ECG signs of increased potassium in the blood are:
1. Sinus bradycardia.
2. Shortening of the QT interval.
3. The formation of high, spiked positive T waves, which, in combination with a shortening of the QT interval, gives the impression of ST elevation.
4. Expansion of the QRS complex.
5. Shortening, with increasing hyperkalemia - prolongation of the PQ interval, progressive impairment of atrioventricular conduction up to complete transverse blockade.
6. Decrease in amplitude, smoothing of the P wave. With an increase in the level of potassium, the complete disappearance of the P wave.
7. Possible depression of the ST segment in many leads.
8. Ventricular arrhythmias (Fig. 13).
12. Left ventricular hypertrophy (LVH)
LVH occurs in arterial hypertension, aortic heart disease, insufficiency mitral valve, cardiosclerosis, congenital heart defects (Fig. 14).
ECG signs:
1. RV5, V6>RV4.
2. SV1+RV5 (or RV6) >28 mm in persons over 30 years of age or SV1+RV5 (or RV6) >30 mm in persons under 30 years of age.
13. Overload right
and left ventricle
The ECG during LV and RV overload looks identical to the ECG during hypertrophy, however, hypertrophy is a consequence of prolonged overstrain of the myocardium by excess blood volume or pressure, and changes on the ECG are permanent. An overload should be considered in the event of an acute situation, changes in the ECG gradually disappear with the subsequent normalization of the patient's condition (Fig. 8, 14).
14. Left bundle branch block (LBBB)
LBBB is a violation of conduction in the main trunk of the left branch of the His bundle before it splits into two branches, or the simultaneous defeat of two branches of the left leg of the His bundle. Excitation in the usual way spreads to the pancreas and roundabout, with a delay - to the left ventricle (Fig. 15).
On the ECG, a widened, deformed QRS complex (more than 0.1 s) is recorded, which in leads V5-V6, I, aVL has the form rsR ', RSR ', RsR ', rR ' (the R wave predominates in the QRS complex). Depending on the width of the QRS complex, left bundle branch block is either complete or incomplete (incomplete LBBB: 0.1 s 15. Transthoracic cardioversion (TIT)
Cardioversion may be accompanied by transient ST elevation. J. van Gelder et al. reported that 23 of 146 patients with atrial fibrillation or flutter after transthoracic cardioversion had ST-segment elevation greater than 5 mm and no clinical or laboratory evidence of myocardial necrosis. Normalization of the ST segment was observed on average within 1.5 minutes. (from 10 s to 3 min.). However, patients with ST elevation after cardioversion have a lower ejection fraction than patients without ST elevation (27% and 35%, respectively). The mechanism of ST segment elevation is not fully understood (Fig. 16).
16. Wolff-Parkinson-White Syndrome (SVPU)
SVPU - conducting an impulse from the atria to the ventricles along the additional Kent-Paladino bundle, bypassing the normal conduction system of the heart.
ECG criteria for SVPU:
1. Shortened PQ interval to 0.08-0.11 s.
2. D-wave - an additional wave at the beginning of the QRS complex, due to the excitation of the "non-specialized" ventricular myocardium. The delta wave is directed upward if the R wave predominates in the QRS complex, and downward if the initial part of the QRS complex is negative (Q or S wave predominates), except for WPW syndrome, type C.
3. Blockade of the bundle branch of His (widening of the QRS complex for more than 0.1 s). In WPW syndrome, type A, the conduction of the impulse from the atria to the ventricles is carried out along the left Kent-Paladino bundle, for this reason, the excitation of the left ventricle begins earlier than the right one, and the blockade of the right branch of the His bundle is recorded on the ECG. In WPW syndrome, type B, the impulse from the atria to the ventricles is conducted along the right Kent-Paladino bundle. For this reason, the excitation of the right ventricle begins earlier than the left, and the blockade of the left leg of the His bundle is fixed on the ECG.
In WPW syndrome, type C, the impulse from the atria to the lateral wall of the left ventricle goes along the left Kent-Paladino bundle, which leads to excitation of the left ventricle before the right one, and the ECG shows right bundle branch block and a negative D-wave in leads in V5- V6.
4. P wave of normal shape and duration.
5. Tendency to attacks of supraventricular tachyarrhythmia (Fig. 17).
17. Atrial flutter (AF)
TP is accelerated, superficial, but the correct rhythm of atrial contraction with a frequency of 220-350 per minute. as a result of the presence of a pathological focus of excitation in the atrial muscles. Due to the appearance of a functional atrioventricular block, most often 2:1 or 4:1, the frequency of ventricular contractions is much less than the atrial rate.
ECG criteria for atrial flutter:
1. F-waves, spaced at equal intervals, with a frequency of 220-350 per minute, of the same height, width and shape. F waves are well defined in leads II, III, aVF, often superimposed on the ST segment and imitate its elevation.
2. There are no isoelectric intervals - flutter waves form a continuous wave-like curve.
3. The typical F waveform is "sawtooth". The ascending leg is steep, and the descending leg descends gradually gently downward and passes without an isoelectric interval into the steep ascending leg of the next wave F.
4. Almost always there is a partial AV block of varying degrees (usually 2:1).
5. QRS complex of the usual form. Due to the layering of the F waves, the ST interval and the T wave are deformed.
6. The R-R interval is the same with a constant degree of atrioventricular blockade (correct form of atrial flutter) and different - with a changing degree of AV blockade (irregular form of atrial flutter) (Fig. 18).
18. Hypothermia (Osborne syndrome, GT)
Characteristic ECG criteria for GT are the appearance of teeth in the J-point region, called Osborne waves, ST-segment elevation in leads II, III, aVF and left chest V3-V6. Osborn's waves are directed in the same direction as the QRS complexes, while their height is directly proportional to the degree of GT. As the body temperature decreases, along with the described changes in ST-T, slowing of the heart rate, lengthening of the PR and QT intervals (the latter - mainly due to the ST segment) are detected. As the body temperature decreases, the amplitude of the Osborn wave increases. At a body temperature below 32 ° C, atrial fibrillation is possible, ventricular arrhythmias often occur. At a body temperature of 28-30°C, the risk of developing ventricular fibrillation increases (the maximum risk is at a temperature of 22°C). At a body temperature of 18 ° C and below, asystole occurs. HT is defined as a decrease in body temperature to 35°C (95°F) or below. It is customary to classify GT as mild (at a body temperature of 34-35°C), moderate (30-34°C) and severe (below 30°C) (Fig. 19).
Thus, the Osborn wave (hypothermic wave) can be considered as a diagnostic criterion for severe central disorders. The amplitude of the Osborn wave was inversely correlated with a decrease in body temperature. According to our data, the severity of Osborn's wave and the value of the QT interval determine the prognosis. Prolongation of the QT interval c >500 ms and severe deformation of the QRST complex with the formation of Osborn's tooth significantly worsen the life prognosis.
19. Positional changes
Positional changes in the ventricular complex sometimes mimic signs of MI on the ECG. Positional changes differ from MI by the absence of the ST segment and TT wave dynamics characteristic of a heart attack, as well as by a decrease in the depth of the Q wave during ECG registration at the height of inhalation or exhalation.
Conclusion
Based on the analysis of domestic and foreign literature, as well as our own data, I would like to emphasize that ST segment elevation does not always reflect coronary pathology, and the practitioner often has to make a differential diagnosis of many diseases, including rare ones.

Literature
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Its main goal is to help the practitioner to quickly determine and, if necessary, flexibly change the optimal treatment strategy in patients with chronic heart failure, depending on the clinical situation, taking into account current Russian and international recommendations.

2 360 R




The features of performing cardiac MRI in children of different age groups are considered in detail. MRI scans of the normal anatomy of the heart and mediastinum in infants are presented. Atlas on the clinical use of magnetic resonance imaging for diagnosing the anatomy of congenital heart defects in children.

1 484 R




Modern diagnostic methods for assessing pulmonary hypertension, such as right heart catheterization, echocardiography, image diagnostic methods, and others, are described in detail. Separate chapters are devoted to various forms of pulmonary hypertension - idiopathic, chronic thromboembolic

2 190 R




The book is devoted to CT diagnostics of diseases of the cardiovascular system. Ischemic heart disease and anomalies of the coronary arteries. Arrhythmias of the heart. valve pathology. Diseases of the aorta. Diseases of the peripheral arteries.

1 700 R




The age-related features of the physiology and pathophysiology of the cardiovascular system are considered. Modern views on the diagnosis of diseases, anesthetic and perfusion safety of surgery, and intensive care after surgery are outlined. The conditions and results of the use of extracorporeal support systems for the cardiovascular system and heart transplantation in children are presented.

6 100 R




The manual is devoted to the study of urgent problems of extracorporeal blood purification in intensive care units and intensive care units. The issues of epidemiology and pathogenesis, diagnosis and choice of methods of hemocorrection in acute kidney injury occupy a central place in the publication. A large section is devoted to modern principles of extracorporeal treatment of sepsis, based on pathogenetic ideas about the mechanisms of progression of this serious disease.

4 990 R




Early diagnostic signs of emergency cardiac conditions and assessment of risk factors for their occurrence, step-by-step recommendations for providing affordable minimally sufficient emergency medical care, features of the use of drugs, typical medical errors.

1 570 R




The origin of the normal ECG teeth and its changes are interpreted from the standpoint of vector analysis. ECG changes in various diseases are presented: ischemic heart disease, cardiopathy, myo- and pericarditis, pulmonary embolism, heart defects, hypertension, pathology of the kidneys, lungs, endocrine glands, electrolyte metabolism disorders

1 890 R




You will not find such a complete differential diagnostic echocardiographic series as in this publication, supported by video materials and illustrations. The book helps to systematize, classify and conduct differential echocardiographic diagnosis in a patient based on the totality of signs identified during the study.

2 750 R




The criteria for a normal electrocardiogram, indicators of heart rate variability, assessment of late ventricular potentials, and features of the daily dynamics of the QT interval in HM are presented. The section of private pathology shows the diagnostic value of HM when examining patients with brady and tachyarrhythmias, syncope and other diseases.

The ECG ruler is designed to decipher an electrocardiogram taken at a speed of 50 or 25 mm/s




The heart rate scale is synchronous with the Q-T interval scale at a speed of 50 mm/s. The number of heartbeats corresponds to two R-R intervals. Millivolt scale to determine the voltage of the R wave. Table of P-Q and Q-T intervals per second at different heart rates. Scale for calculating the duration of the P wave, QRS complex, P-Q and Q-T intervals per second. ST segment displacement scale, P and T wave values ​​in mV in relation to the isoline. Einthoven's triangle to determine the angle α (alpha) of the deviation of the electrical axis of the heart.

479 R




The basics of ECG are given, which allow one to independently master this research method in a short time. For students, trainees, internists, cardiologists, and other physicians who want to quickly acquire or refresh their knowledge of ECG.




It contains all the information necessary for a student of a medical university and a practical doctor about modern methods of ultrasound examination of the heart, including in one-dimensional and Doppler modes.

559 R




MRI semiotics of coronary heart disease with a focus on assessing myocardial viability. The role and place of the technique in the structure of methods in the examination of patients with coronary artery disease are determined. The teaching aid has been compiled to assist the practicing radiologist in conducting the study, interpreting the results and writing conclusions.

490 R




Preventive cardiology. Biological bases of vascular atherosclerosis. Mechanisms and diagnosis of systemic hypertension. Cardiovascular diseases of atherosclerotic origin. Coronary blood flow and myocardial ischemia.




Methods for assessing the patient's health status and evaluating the results of various examination methods are discussed. Several chapters discuss the pathophysiological mechanisms of the development of various cardiovascular diseases, the diagnosis and treatment of acute and chronic forms of diseases.

3 590 R




It is a practical guide that includes the main aspects of conducting functional stress tests. The book is well illustrated: it contains clinical examples, diagrams, tables. Recommendations for the interpretation of tests are given.

1 390 R




In the textbook, from a modern standpoint, changes in the electrocardiogram are considered in violation of the functions of automatism, excitability and conduction, in atrial and ventricular hypertrophy, as well as in myocardial damage of various etiologies.

1 550 R




Criteria for early diagnosis of cardio-cerebrovascular pathology are proposed, a classification of isolated and combined forms of heart and brain damage in the latent and manifest periods of arterial hypertension is developed. Based on the proposed method of automatic dynamic manometry, the features of blood pressure variability and its regulation in children and adults were studied.

1 300 R




Recommendations for perfusion scintigraphy. The applied radiopharmaceuticals, activity and administered doses, stress tests, principles of obtaining and methods of image reconstruction, variants of normal and pathological accumulation of radiopharmaceuticals, the sequence of drawing up conclusions are considered.

520 R




The normal and radiation anatomy of the heart is described according to the data of computed tomography and magnetic resonance imaging. The second chapter is devoted to the description of radiation semiotics of the most common types of myocardial diseases, which presents the data of CT, MRI, radioisotope diagnostic techniques.

956 R




The method of studying the bioelectrical activity of the heart is indispensable in the diagnosis of rhythm and conduction disorders, ventricular and atrial myocardial hypertrophy, coronary heart disease, myocardial infarction and other heart diseases.

680 R




The publication contains test questions and clinical tasks with answers and explanations for self-control. The book is addressed to both physicians who are starting to conduct stress testing, and experienced professionals who want to be able to exchange practical experience.

1 560 R




An innovative approach to ECG interpretation and a new system for step-by-step, fast and accurate ECG interpretation are proposed. The author has developed a standard sequential interpretation of the main ECG parameters (waves, intervals, position of the electrical axis of the heart, assessment of LV hypertrophy). The key positions of the ECG are clearly presented in the form of algorithms and schemes with the final output in clinical practice.

4 590 R