Syndrome of early repolarization of the ventricles

The syndrome of early repolarization of the ventricles does not have specific clinical symptoms - it can be found both in people who have cardiac and vascular pathologies, and in those who are absolutely healthy.

To identify the presence of the syndrome, you need to conduct a comprehensive diagnosis, as well as undergo a regular check-up with a cardiologist. If you have signs of CPHD, you need to exclude psychoemotional stresses, limit your physical activity, and adjust your diet.

Epidemiology

This is a fairly common disorder - this syndrome can occur in 2-8% of healthy people. With age, there is less risk of this syndrome. The syndrome of early repolarization of the ventricles is mainly found in people 30 years old, but in the elderly it is quite a rare phenomenon. In general, this disease is observed in people leading an active lifestyle, as well as athletes. The anomaly bypasses the low-active people. Since the disease has some symptoms similar to the Brugada syndrome, she once again became interested in cardiologists.

[1], [2], [3], [4]

Causes of the syndrome of early repolarization of the ventricles

What is the danger of early ventricular repolarization syndrome? In general, he does not have any characteristic signs, although doctors note that because of changes in the conduction of the cardiac system, the rhythm of the heartbeat may be disturbed. There may be severe complications, such as ventricular fibrillation. In some cases this may even be the cause of the patient's death.

In addition, this disease often manifests itself against the background of severe vascular and cardiac diseases or neuroendocrine problems. In children, such combinations of pathological conditions occur most often.

The appearance of the syndrome of premature repolarization can be triggered by excessive physical exertion. It occurs under the influence of an accelerated electric pulse, which passes through the cardiac conducting system due to the appearance of additional conducting paths. In general, the prognosis is favorable in such cases, although the burden on the heart should be reduced to eliminate the risk of complications.

[5], [6], [7]

Risk factors

What are the exact causes of the syndrome of early repolarization of the ventricles now is not known, although there are some conditions that can become its causative factor of development:

• Medical preparations like a2-adrenomimetics;
• The blood contains a high percentage of fats;
• Dysplasia appears in the connective tissues;
• Cardiomyopathy of a hypertrophic nature.

In addition to the above-described signs, such an anomaly can be observed in those who have heart defects (acquired or congenital) or congenital pathology of the cardiac conduction system.

It is possible that the disease has a genetic factor - there are some genes that can contribute to the emergence of this syndrome.

[8], [9], [10], [11], [12]

Pathogenesis

Scientists suggest that the syndrome of early repolarization of the ventricles is based on the innate characteristics of each person's electrophysiological processes occurring in the myocardium. They lead to premature repolarization of subepicardial layers.

The study of pathogenesis allowed to express the opinion that this disorder appears as a result of an anomaly of carrying out impulses at the atria and ventricles in connection with the presence of additional conducting paths - antegrade, paranodal or atrioventricular. Doctors who studied the problem believe that the QRS complex on the descending knee of the jagged complex is a delayed delta wave.

The processes of ventricular re-and depolarization proceed unevenly. The data of electrophysiological analyzes showed that the basis of the syndrome is the anomalous chronotopography of these processes in separate (or additional) structures of the myocardium. They are located in the basal heart, limited to the space between the anterior wall of the left ventricle and the tip.

Violation of the autonomic nervous system may also cause the development of the syndrome due to the predominance of the sympathetic or parasympathetic divisions. The anteroposterior part may undergo a premature repolarization due to an increase in the activity of the sympathetic nerve on the right. Its branches probably penetrate into the anterior heart wall and the interventricular septum.

[13], [14], [15]

Symptoms of the syndrome of early repolarization of the ventricles

Syndrome of early repolarization of the ventricles is a medical term and means only a change in the patient's electrocardiogram. External symptoms are not a violation. Previously, this syndrome was considered a variant of the norm, and therefore not having a negative effect on life.

To determine the characteristic symptoms of the syndrome of early repolarization of the ventricles, a variety of studies were carried out, but no results were obtained. Violations in the ECG, which correspond to this anomaly, occur even in fully healthy people who do not have complaints. They are also in patients who have cardiac and other pathologies (they complain only about their underlying illness).

Many patients with whom doctors have discovered the syndrome of early repolarization of the ventricles, often have a history of the presence of such types of arrhythmias:

• Ventricular fibrillation;
• Tachyarrhythmia of the supraventricular divisions;
• Ventricular extrasystole;
• Other types of tachyarrhythmias.

Similar arrhythmogenic complications of this syndrome can be considered a serious threat to health, as well as the life of the patient (even death can provoke). World statistics show many deaths due to asystole in ventricular fibrillation, which appeared precisely because of this anomaly.

Half of the subjects with this phenomenon have cardiac dysfunctions (systolic and diastolic), which cause central hemodynamic problems. The patient may develop cardiogenic shock or hypertensive crisis. Also, there may be pulmonary edema and shortness of breath of varying severity.

First signs

The researchers believe that the appeared at the end of the QRS complex is a jagged delta wave. Additional confirmation of the presence of additional electrically conductive pathways (they are the first cause of the phenomenon) is the reduction of the PQ interval in many patients. In addition, the syndrome of early repolarization of the ventricles can arise due to an imbalance in the mechanism of electrophysiology, responsible for the change in the functions of de-and repolarization in different areas of the myocardium, which are located in the basal parts and the cardiac apex.

If the heart is working normally, then these processes occur in the same direction and in a certain order. Repolarization starts from the epicardium of the cardiac base and terminates in the endocardium of the cardiac apex. If there is a violation, the first signs are a sharp acceleration in the subepicardial parts of the myocardium.

The development of pathology depends very much on dysfunction in the autonomic NA. Vagal genesis of anomalies is proved by conducting a sample with moderate physical activity, as well as a drug test with an isoproterenol preparation. After this, the patient stabilizes the ECG, but the ECG signs during sleep at night worsen.

Syndrome of early repolarization of ventricles in pregnant women

This pathology is characteristic only when recording electro-potentials on the ECG and in an isolated form does not affect cardiac activity at all, and therefore does not need treatment. It is usually noticed only if it is combined with fairly rare forms of severe cardiac rhythm disturbances.

Numerous studies have confirmed that this phenomenon, especially accompanied by fainting caused by heart problems, increases the risk of sudden coronary death. In addition, the disease can be combined with the development of supraventricular arrhythmias, as well as a decrease in hemodynamics. All this can result in heart failure. These factors have also become a catalyst for the fact that cardiologists are interested in the syndrome.

The syndrome of early repolarization of the ventricles in pregnant women during the gestation process and the fetus is not reflected in any way.

Syndrome of early repolarization of ventricles in children

If your child is diagnosed with a syndrome of early repolarization of the ventricles, you should undergo such examinations:

• Taking blood for analysis (vein and finger);
• Average portion of urine for analysis;
• Ultrasound examination of the heart.

The above surveys are necessary to exclude the possibility of asymptomatic development of disturbances in work, as well as conduction of heart rhythm.

The syndrome of early repolarization of the ventricles in children is not a sentence, although after its detection it is usually necessary to go through several times the process of examining the heart muscle. The results obtained after ultrasound should be assigned to a cardiologist. He will determine whether the child has any pathologies in the area of the muscles of the heart.

A similar anomaly can be observed in children who had problems with cardiac circulation even during the embryonic period. They will need regular checkups with the cardiologist.

To ensure that the child does not feel attacks of accelerated heartbeat, you should reduce the number of physical exertion, and also make them less intense. It will not prevent him and the observance of the correct diet, and the maintenance of a healthy lifestyle. It will also be useful to protect the child from various stresses.

Forms

The syndrome of early repolarization of the left ventricle is dangerous because in this case, the symptoms of pathology are almost not observed. Usually, this violation is detected only in the course of the electrocardiogram, where the patient was sent for a completely different reason.

The following will be displayed on the cardiogram:

• the tooth P changes, indicating that the atria are depolarized;
• QRS complex indicates depolarization of the ventricular myocardium;
• T wave tells about the features of ventricular repolarization - abnormalities and are a symptom of the disorder.

Of the combination of symptoms, the syndrome of premature myocardial repolarization is isolated. In this case, the process restoring the electric charge is launched ahead of schedule. The cardiogram displays the situation in this way:

• part of ST rises from the pointer J;
• In the declining region of the R wave, special notches can be seen;
• the upwardly directed concavity is observed by the background when ST is rising;
• T wave becomes asymmetrical and narrow.

But we need to understand that there are many more nuances pointing to the syndrome of early repolarization of the ventricles. Only a qualified doctor can see them in the results of the ECG. Only he can prescribe the necessary treatment.

Syndrome of early repolarization of ventricles in the runner

Constant long-term sports (at least 4 hours per week) on the ECG are demonstrated in the form of signs that indicate an increase in the volume of the cardiac chambers, as well as an increase in the tone of the vagus nerve. Such adaptive processes are considered the norm, so they do not need to be investigated additionally - for health there is no threat.

Sinus bradycardia is observed in more than 80% of trained athletes, i.e. Heart rhythm is less than 60 beats / min. For those in good physical condition. Form of people frequency - 30 beats / min. Is considered normal.

About 55% of young athletes have sinus arrhythmia - the heart rate is accelerated by inhalation, and slows down when exhaled. This phenomenon is quite normal and it must be distinguished from violations in the sinus-atrial node. This can be seen on the electric axis of the P wave, which remains stable if the body is adapted to the sport load. To normalize the rhythm in this case, there will be a small decrease in the load - this will eliminate the arrhythmia.

The syndrome of early repolarization of the ventricles was previously determined only with ST rise, but now it can be detected by the presence of J-wave. This symptom is observed in approximately 35% -91% of people engaged in training, and it is regarded as a syndrome of early repolarization of the ventricles in the runner.

[16], [17], [18], [19], [20]

Complications and consequences

For a long time, the syndrome of early repolarization of the ventricles was considered a normal phenomenon - doctors diagnosed it did not take any kind of treatment. But in fact, there is a risk that this disorder can cause the development of myocardial hypertrophy or arrhythmia.

If you have been diagnosed with this syndrome, you need to undergo a thorough examination, as it can accompany more serious illnesses.

Family hyperlipidemia, in which there is an abnormal increase in lipid levels in the blood. In this disease, the SADM is often diagnosed, although it is not yet possible to understand what the relationship between them is.

Dysplasia in the heart connective tissue often occurs in patients with a more pronounced syndrome.

There is a version that this anomaly is also associated with the appearance of obstructive hypertrophic cardiomyopathy (borderline form), as they have similar ECG-signs.

It can also occur in people with congenital heart disease or in the presence of anomalies in the conduction of cardiac systems.

The disease can cause such consequences and complications as:

• Extrasystole;
• Sinus tachycardia or bradycardia;
• Atrial fibrillation;
• Cardiac blockade;
• Paroxysmal tachycardia;
• Cardiac ischemia.

[21], [22], [23], [24], [25], [26], [27], [28], [29]

Diagnostics of the syndrome of early repolarization of the ventricles

There is only one reliable way to diagnose the syndrome of early repolarization of the ventricles - this is an examination on the ECG. With its help, you can identify the main signs of this pathology. To make the diagnosis more reliable, you need to register the ECG, using exercise, and conduct daily monitoring of the electrocardiogram.

The syndrome of early repolarization of the ventricles on the ECG has the following features:

• segment ST is displaced 3 + mm above the isoline;
• the tooth R is enlarged, and simultaneously with it the tooth S is leveled - this shows that the transitional region in the thoracic leads has disappeared;
• At the end of the particle of the tooth R appears a pseudo-tooth r;
• The QRS complex extends;
• the electric axis moves to the left;
• high T waves with asymmetry are observed.

Basically, in addition to a routine examination on the ECG, a person is made to register the ECG using additional loads (physical or using medication). This allows you to find out what the dynamics of the signs of the disease.

If you are going to visit the cardiologist again, bring the results of past ECG with you, because any changes (if you have this syndrome) can cause an acute attack of coronary insufficiency.

Tests

Often the syndrome of early repolarization of the ventricles in the patient is detected by accident - during the check on the ECG. In addition to the changes recorded by this device, when the cardiovascular system in a person is in order, this syndrome has in most cases no signs. And the examinees themselves have no complaints about their health.

The survey includes the following tests:

• A test under physical exertion, in which there are no signs of a disease on the ECG;
• A sample with potassium: a patient with a syndrome takes potassium (2g) to make the symptoms more pronounced;
• The use of novocainamide - it is administered intravenously, so that the signs of anomaly are clearly manifested on the ECG;
• Daily monitoring of ECG;
• Taking a biochemical blood test, as well as the results of a lipidogram.

[30], [31], [32], [33]

Instrumental diagnostics

The syndrome of early repolarization of the ventricles can be detected only when tested on an ECG and in no other way. This disease has no special clinical symptoms, so it can be found even in a perfectly healthy person. Although in some cases, the syndrome may accompany certain diseases, for example, neurocircular dystonia. For the first time this phenomenon was identified and described in 1974.

When carrying out instrumental diagnostics, an electrocardiogram is used, as mentioned above. In this case, the main sign of the presence of a given syndrome in a person is a change in the RS-T segment-an upward rise from the isoelectric line is observed.

The next symptom is the appearance of a specific notch, which is referred to as the "transition wave" on the R-wave descending knee. This notch may also appear at the top of the rising S-tooth (similar to r '). This is a rather important feature for differentiation, because an isolated upward elevation of the RS-T particle can also be observed in serious serious diseases. Among them - the acute stage of myocardial infarction, acute pericarditis and the so-called stenocardia of Prinzmetal. Therefore, when making a diagnosis, you need to be very careful, and if necessary, prescribe a more in-depth examination.

ECG signs

The syndrome of early repolarization of the ventricles does not have specific clinical symptoms. It can be seen only as some changes in the indications on the electrocardiogram. These are the signs:

• The tine T and the particle ST change shape;
• In some branches, the ST segment rises above the isoline by 1-3 mm;
• Often, the ST segment starts to rise after a notch;
• The particle ST has a rounded shape, which then passes directly into the high T-tooth with a positive value;
• The convexity of the particle ST is directed downwards;
• T wave T has a broad base.

Most of the ECG signs of anomaly are noticeable in the areas of the thoracic leads. The segment ST rises above the isoline, with a downwardly-directed convexity. The acute T-tooth has a high amplitude and in some cases can be inverted. The junction point J is located high on the descending R-tooth bend or on the last part of the S-tooth. The appearance of a change in the S-wave on the descending particle ST of the notch may cause the formation of the tooth r'.

If the S-wave decreased or even disappeared from the left thoracic leads (V5 and V6 marks), this demonstrates a cardiac rotation counter-clockwise along the longitudinal axis. In this case, in the V5 and V6 regions, a QRS complex is formed, which is of the qR type.

[34], [35]

Differential diagnosis

This syndrome is able to accompany a variety of diseases and be provoked by various causes. When performing a survey, it can be confused with diseases such as hyperkalemia and arrhythmogenic dysplasia in the right ventricle, pericarditis, Brugada's syndrome, and electrolyte imbalance. All these factors make us pay attention to this anomaly - consult a cardiologist and undergo a comprehensive examination.

Differential diagnosis is carried out in order to:

• Eliminate the possibility of acute disturbance in the lower wall of the left ventricle;
• Exclude the possibility of acute disturbance in the anterior lateral wall of the left ventricle.

This phenomenon can lead to the appearance on the electrocardiogram of signs of coronary syndrome (acute form). In this case, differential diagnosis can be carried out on the following grounds:

• The clinical picture inherent in IHD is absent;
• In the final part of the QRS complex with the presence of a notch there is a characteristic shape;
• The ST segment takes on a peculiar form;
• When a functional ECG sample is taken using physical exertion, the ST segment is often located near the isoline.

The syndrome of early repolarization of the ventricles must be differentiated with Brugada syndrome, myocardial infarction (or coronary syndrome, when the ST segment rises), pericarditis and arrhythmogenic dysplasia in the right ventricle.

In case of myocardial infarction, in addition to the clinical picture, it is very important to conduct a dynamic ECG examination, as well as to reveal the level of markers (troponin and myoglobin) of myocardial destruction. There are cases when, in order to clarify the diagnosis, you need to perform coronarography.

[36], [37], [38]

Treatment of the syndrome of early repolarization of the ventricles

People who have discovered a syndrome of early repolarization of the ventricles should give up intensive sports and overall physical activity. You also need to adjust your diet - add foods that contain magnesium and potassium, as well as vitamin B (these are raw fruits with vegetables, greens, nuts, soy products, sea fish).

Treatment of the syndrome of early repolarization of the ventricles is carried out by an invasive method - an additional bundle is subjected to radiofrequency ablation. Here the catheter is brought to the location of this beam and liquidated.

This syndrome can cause an acute form of coronary syndrome, so it is important to find the cause of problems with cardiac activity and heart valves work in a timely manner. The acute form of the coronary syndrome can cause sudden death.

If the patient has associated life-threatening arrhythmias or pathologies, he may be prescribed a course of drug therapy - it will prevent the development of health-threatening complications. There are also cases when a patient is prescribed surgical treatment.

Medications

Often, if there is a syndrome of early repolarization of the ventricles, no medication is prescribed, but if the patient also has the symptoms of any cardiac pathology (this may be one of the forms of arrhythmia or coronary syndrome), he will need to undergo a course of specific treatment with medications.

Numerous random studies have shown that for the elimination of the signs of this pathology, the medicament means of energy therapy are very suitable - they are suitable for both adults and children. Of course, this group of drugs does not apply to the syndrome directly, but they help to improve the trophism of the heart muscle, and also to get rid of possible complications in its work. The best syndrome is treated with such energotropic drugs: Qudesan, whose dose is 2 mg / 1 kg per day, Carnitine 500 mg twice daily, Neurovitan 1 tablet per day and vitamin complex (group B).

Drugs from the antiarrhythmic group may also be prescribed. They are able to slow the repolarization process. Among such drugs, Novokainamide is given (dosage of 0.25 mg for every 6 hours), quinidine sulfate (three times a day for 200 mg), Etmozin (three times a day for 100 mg).

Vitamins

If a patient has a syndrome of early repolarization of the ventricles, he may be prescribed the intake of vitamins from group B, medicines including magnesium and phosphorus, as well as carnitine.

To your heart was healthy, you need to maintain a full diet, as well as satisfy the body's need for obtaining useful micronutrients and vitamins.

Physiotherapy, as well as homeopathy, herbal treatments and alternative means for the treatment of the syndrome of early repolarization of the ventricles, are not applied.

Operative treatment

The syndrome of early repolarization of the ventricles can be treated in a radical way - through surgical intervention. But it should be understood that this method is not used if the patient has an isolated form of the disease. It can be used only if there are clinical symptoms of moderate or severe intensity or there is a deterioration in health.

If additional pathways are found in the myocardium or the CPH has some clinical signs, the patient is prescribed a radiofrequency ablation procedure that destroys the focus of the arrhythmia that has arisen. If a patient experiences life-threatening heart rhythm disturbances or he loses consciousness, doctors can implant him with a pacemaker.

Operative treatment can be used if a patient with a syndrome has frequent attacks of ventricular fibrillation - he is implanted with a so-called defibrillator-cardioverter. Thanks to modern microsurgical techniques, it is possible to install such a device without thoracotomy, with a minimally invasive method. Cardioverter-defibrillators of the 3rd generation are well tolerated by patients, without causing rejection. Now this method is considered the best way to treat arrhythmogenic pathologies.

Prevention

The syndrome of early repolarization of the ventricles can not be prevented, since until now it has not been possible to identify the clear cause of its appearance. Prevention is also impossible, because anomaly can manifest itself not only in people suffering from cardiac pathologies, but also in those who do not have health problems.

[39], [40], [41], [42]

Forecast

Multiple studies have shown that this phenomenon has an optimistic outlook, although there are some nuances.

Completely benign this syndrome is still not possible, because sometimes it can become a substratum for sudden cardiac deaths, arrhythmias of the ventricles, athletes may have hypertrophic cardiomyopathy.

Having syncopated conditions athletes after physical exertion must undergo thorough examinations. If arrhythmias have life-threatening symptoms, patients need to implant an ICD.

Syndrome of early repolarization of the ventricles and the army

This pathology is not a basis for the ban on military service, draftees with such a diagnosis undergo a medical examination and get a verdict "goen".

By itself, the syndrome can become one of the factors of the rise of the segment (non-ischemic nature).

[43], [44], [45], [46]