ST segment elevation

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

What is ST segment elevation?

Using a cardiogram, one can evaluate the rhythm and conductivity of the heart based on the position of the segments and teeth of the graph.

ST segment elevation is a deviation above the isoline on an electrocardiogram. Minor elevation is observed in tachycardia, more pronounced - in coronary heart disease and pericarditis. In pericarditis, the S wave is preserved, and its ascending knee is raised. In myocardial infarction, ST segment elevation undergoes reverse development within 2 weeks. During the course of the infarction, the T wave rises and becomes sharper. After 6 months, a past myocardial infarction can be recognized by the disappearance of the R wave.

Causes of ST segment elevation

An electrocardiogram is the main diagnostic method for myocardial ischemia. ST segment and T wave elevation is an early sign of myocardial ischemia. An ECG allows one to determine the extent of ischemia and what part of the heart it has affected. In transmural ischemia, a negative deflection is recorded, which becomes isoelectric only in the ST segment, leading to its elevation. In the case of subendocardial ischemia, the main potential is positive, and the ST segment shifts below the isoline. Determining the leads in which the ST segment elevation is present allows one to localize the site of ischemia. ST segment elevation is noted in the leads that are located above the ischemic epicardium.

Myocardial infarction is the death of cardiomyocytes caused by prolonged ischemia. In this case, the ECG shows changes in the ST segment.

Severe hypotension causes ischemia in patients with coronary artery disease. The myocyte membrane may also be damaged by pancreatic enzymes in acute pancreatitis, resulting in ST elevation on the electrocardiogram. Similar changes are seen in viral myocarditis and myocarditis resulting from staphylococcal or streptococcal sore throat.

ST Elevation Symptoms

The very first cause of ST segment elevation on an electrocardiogram is acute myocardial infarction. ST elevation is only one of its indirect signs.

Acute coronary syndrome is a symptom complex that occurs during myocardial infarction, caused by a pronounced sharp decrease in coronary blood flow. Measures to increase blood flow can save the myocardium from necrosis. Clinical manifestations are always associated with the severity of ischemia. There are painless forms of infarction. It is these latent forms that are the cause of high early mortality in people. Improvement of first aid methods has reduced the number of fatal outcomes. Factors that aggravate the course of myocardial infarction: age, low blood pressure, significant ischemia, manifested by ST segment deviations on the electrocardiogram, female or male gender (women die more often), kidney disease.

Non-specific ST segment elevation

Non-specific ST segment elevation on ECG means that the curve is not quite standard, but within the physiological norm. One method of examination is not a sufficient basis for making a diagnosis, therefore, in controversial cases, the patient is prescribed other diagnostic methods.

The ST segment sometimes has a saddle-shaped configuration in pectus excavatum.

Ischemic ST segment elevation

ST segment elevation in coronary heart disease is a highly probable sign of the pre-scarring stage of the disease. Clinical identification of coronary heart disease begins with an electrocardiogram: in addition to ST elevation, sinus bradycardia, AV block and atrial fibrillation, pathological Q waves can also be detected.

In addition to analyzing the ECG results, it is extremely important for the doctor to get a description of the pain syndrome, indicate its duration and the factors that make the pain disappear, as well as where the pain radiates. If a regular electrocardiogram is not enough to make a diagnosis, daily monitoring and stress tests are performed.

Patients with ST elevation often have myocardial ischemia with coronary artery occlusion. In this case, a large part of the myocardium in the left ventricle is always at risk of damage. Special thrombolytic therapy is prescribed to dissolve the thrombus blocking the lumen of the artery.

ST segment elevation in adults

Modern medicine has identified a number of diseases that can cause sudden death without warning signs. One of the most "mysterious" diseases in this series is Brugada syndrome. They can first be detected at 25-35 years of age. Let's take a closer look at Brugada syndrome, which, like a heart attack or coronary heart disease, is characterized by an ECG pattern of ST segment elevation.

The disease was described quite recently – in 1992. At that time, a case of the disease was described in a 3-year-old girl who died despite all the efforts of doctors and the implantation of a pacemaker.

The disease is interesting because there are no registered cases in African Americans. In Ukraine, the syndrome is extremely rare, but it is assumed that a significant number of people suffer from it. In order not to miss the disease, you need to be attentive if alarming symptoms occur: night attacks of suffocation, atypical ECG, if there are cases of sudden night death in the family. It may also be necessary to undergo genetic testing to confirm or exclude Brugada syndrome. The syndrome has many erased forms, which is why it can be extremely difficult to detect during the patient's lifetime. The average estimated prevalence is 2:100,000.

To confirm a heart attack, in addition to this diagnostic criterion (ST elevation), others must also be present:

1. Anginal attack.
2. The ECG shows signs of left bundle branch block and an enlarged Q wave. A pathological Q wave on the ECG is the most important diagnostic criterion for myocardial infarction. At an early stage, myocardial cells are still viable. Therefore, at first, an enlargement of the pathological Q wave is not observed. In the first days, ST elevation and deepening of the Q wave are observed.
3. Increased levels of troponins in the blood.

Changes in the ECG pattern are associated with damage to myocardial cells. They excite abnormal systolic and diastolic currents.

Other causes of ST elevation on ECG:

1. Acute pericarditis.
2. Left ventricular hypertrophy.

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ST segment elevation in children

The greatest concern is the increasing number of children with congenital heart defects and hypotension. Children's hearts are larger than adults' relative to their body size and have a number of characteristic features. Both ventricles are equal, and the openings between the chambers of the heart are larger than in adults.

Congenital heart defects are anatomical defects in the structure of the heart. Only in 10% of cases are genetic disorders to blame. Environmental factors negatively affect the formation of the heart and blood vessels in the embryonic and postembryonic periods only in 0.5% of cases. Basically, all heart defects are multifactorial in nature (in 90% of cases). When examining a newborn in a maternity hospital, a perinatologist pays attention to some alarming signs that may indicate the presence of cardiovascular pathology: skin color changes, breathing difficulties.

In the United States, 5,000 apparently healthy children die suddenly each year. Only some of these deaths are truly unpredictable. In most cases, clinical symptoms are present that suggest something is wrong. But to prevent sudden infant death, it should be the responsibility of every physician to regularly update their knowledge of how to diagnose heart disease in apparently healthy children. The pediatrician should know whether each child they are seeing is at risk and what treatment and preventive measures should be taken to avoid becoming one of these sad statistics.

The majority of cases of sudden cardiac death in children are registered during physical education classes. Almost always, these cases are caused by congenital heart and vascular pathology that was not diagnosed by a cardiologist in time, such as mitral valve prolapse or vascular aneurysm, Fallot's tetrad, aortic stenosis, etc. Sudden cardiac death has also been observed in children who have suffered myocarditis after complicated tonsillitis.

Tetralogy of Fallot accounts for 15-16% of congenital heart defects. Even in patients who have undergone surgery, the risk of death from ventricular arrhythmia is 7% over 20 years.

Some children with congenital heart defects have only one functioning ventricle. In such patients, after palliative surgery, sinus angle dysfunction sometimes occurs, leading to sudden cardiac death.

Left ventricular hypoplasia is its underdevelopment. Fontan operation, performed at the earliest possible age, reduces the probability of SCD to 5%.

Hypertrophic cardiomyopathy - occurs in 2% of children in the United States. It is more often detected in adolescents. SCD is diagnosed in 7% of children and adolescents with this diagnosis.

All these defects can be diagnosed in time with the help of an electrocardiogram. For such children, it is necessary to organize a strict work and rest regime without overloads. Adults and children need 40 minutes of daily exercise. Every day, you need to walk 4 km in 40 minutes. Obesity has a very bad effect on the socio-psychological adaptation of the child, and later, in adulthood, it leads to cardiovascular disease. Heredity + poor nutrition = obesity! It is important to feed the child correctly, provide him with the right diet with enough meat and fish. Harden the child. Take care of his little vulnerable heart!

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Treatment of ST segment elevation

Today, the medical community pays much attention to the issues of the earliest possible management of a patient with myocardial infarction, in which ST segment elevation is observed on the ECG. If you have already suffered a heart attack, or if you have diabetes, you are at greater risk of developing a heart attack than others.

First of all, it is necessary to ensure daily ECG monitoring. Therapy should be started with aspirin. Aspirin should be taken in a dosage of 100 mg once a day. Contraindications: age under 21, liver and kidney pathology, tendency to bleeding. Aspirin is not prescribed to patients with stomach ulcers, gastritis, colitis. Contraindicated during pregnancy, the drug is stopped a few days before the planned surgical intervention. It is rational to use enteric-coated forms of the drug. They are best taken with meals to reduce the negative impact of aspirin on the gastrointestinal tract. Enteric-coated aspirin is taken without chewing. There is also regular tablet aspirin and effervescent.

Nitroglycerin is administered intravenously. It has been used for emergency care in myocardial infarction for over 100 years. Intravenous nitroglycerin infusions reduce the infarction area and prevent left ventricular remodeling. A reduction in myocardial infarction complications has been proven with nitroglycerin therapy. It reduces patient mortality by a third. Intravenous nitroglycerin is indicated for the first 2 days in patients with myocardial ischemia.

ACE inhibitors, such as valsartan, are also prescribed. The drug is quickly 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 appear is coronary heart disease. It cannot be cured completely, but with proper treatment it can be slowed down. It is important to change your lifestyle, think about your diet. Attacks of arrhythmia and angina require hospitalization, and you also need to go to the hospital if cardiac edema increases.

Treatment of ischemic heart disease should be lifelong. Unfortunately, without maintenance therapy, ischemic heart 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 exertion. A stable drop in blood pressure is achieved 2 months after the start of the course. It is quickly absorbed, and the maximum concentration is achieved after 2 hours. Most of the drug is excreted by the intestines. Do not use in pregnant women. Side effects: dizziness, asthenia, headache, memory and sleep disorders. The drug is prescribed at a dose of 50 mg once a day.

Candesartan is a drug used 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 bile. Contraindicated in pregnancy. Side effects include headache, cough, pharyngitis, and nausea. Take 8-16 mg once a day.

Prevention of ST segment elevation

500,000 people die from ischemic heart disease in Ukraine every year. Most often, ischemic heart disease occurs in people over 45 years old. 50% of patients with ischemia developed the disease against the background of arterial hypertension. Reducing alcohol consumption and increasing potassium intake allows you to correct mild forms of arterial hypertension. The best prevention of all CVD is reducing the intensity of stress.

Unconscious harm to health is the main cause of all human diseases. A city dweller can afford to do morning exercises, wake up earlier in the morning to prepare a full breakfast, but does not do this. After 40 years, preventive heart examinations 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 beats 70-85 times per minute. But if we give it physical exercise, it is capable of pumping 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 diseases are the leading cause of disability and death in the world. They are caused by atherosclerosis, which develops gradually. Whether you will get coronary syndrome, myocardial infarction, or ischemic heart disease depends on your gender, blood pressure, and blood glucose levels. A total of 40 risk factors for CVD have been identified.

According to 2009 data, 18 million people died from CVD all over the world. This year a "record" was set - every third person ended their life due to a diseased heart or blood vessels.

Poor nutrition and smoking are the leading causes of CVD. The consequences of unhealthy eating – high blood sugar and obesity – ultimately cause 85% of heart failures. You should definitely be alerted by pain in the chest, elbows, arms, back, difficulty breathing, nausea, dizziness.

Atherosclerosis is often the cause of myocardial infarction with ST segment elevation and acute coronary syndrome. Prevention of atherosclerosis is a healthy diet, physical activity and control of blood glucose levels. To avoid obesity, we recommend that you limit your calorie intake. Reduce the amount of carbohydrates and fats you consume and eat frequently. Avoid foods rich in cholesterol. Yolks are especially high in cholesterol, so 4 yolks a week is enough. Limit liver, caviar, sausage and milk. Boil and bake dishes in the oven. Food should be varied with plenty of fruit, cereals and meat, whole grain bread. Avoid animal fat. It is recommended to limit fatty meat, butter and yolks. Fish from the northern seas is useful: herring, mackerel and salmon. Drink high-quality raw water. Avoid stress and keep your blood pressure under control. Add less salt to your food. Practice prevention and remember that the heart is a very delicate organ. If you have high blood pressure, you need courses of hypotensive therapy, anti-ischemic therapy, if you have coronary heart disease. Complete cessation of smoking also helps prevent heart disease. 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 vascular spasm. Smokers most often die from myocardial infarction and cancer. If you cannot cope with the bad habit on your own, perhaps you should contact a narcologist for qualified help - today there are many ways to get rid of addiction: nicotine chewing gum, reflexology. Let the best motivator for you be the fact that each cigarette "steals" 20 minutes of your life.

Running, swimming, skiing, hiking, and gymnastics are useful. All this not only tones the heart, but also develops muscle strength, joint mobility, and the ability to breathe correctly. The most common physical activity for everyone is ordinary walking. Only by combining all methods of preventing CVD, you can be sure that the threat will pass you by. Paradoxically, developed countries with large cities and good infrastructure are more likely to face the problem of heart disease. This is because the automation of production and everyday life has freed people from physical activity. As a result, the elasticity of blood vessels decreases. And lifestyle modification can significantly slow down the development of many diseases. Of course, we should say a huge thank you to medicine for such rapid growth, for the development of modern treatment methods, but without understanding that everyone creates their own life, the fight against diseases cannot be successful. Only a change in behavior can help humanity in this fight. A change in behavior and increased awareness, awareness of responsibility for your health. Everyone can do this.

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