What does early ventricular repolarization syndrome mean? Syndrome of early repolarization of the ventricles of the heart: causes and signs, what is dangerous, treatment and prognosis. Syndrome of early repolarization of the ventricles of the heart - what is it

Early ventricular repolarization syndrome is a medical term for changes in the conduction of cardiac impulses. This feature is found in healthy people and is considered the norm. For a long time, it did not cause concern among doctors, as it did not affect the general state of health.

The syndrome is detected during an ECG and does not have severe symptoms. This ECG phenomenon occurs in individuals with dark skin, in young people involved in sports. And also in men leading an inactive lifestyle. With age, the risk of developing this feature decreases.

Reasons for the deviation

Changes in the electrical charge in the cells of the heart produce a contraction of the organ, which is divided into the contraction itself (depolarization) and relaxation (repolarization) of the heart muscle before the next contraction. Actions alternate.

With an ECG phenomenon, there is a discrepancy in the work of the heart muscle, the consistency between depolarization and repolarization is disturbed. The process of relaxation proceeds in an accelerated mode.

There is still no clear definition of the causes of the syndrome. But the presence of some signs increases the likelihood of developing pathology:

1. Long-term use medicines that act on adrenoreceptors.
2. Destruction of connective tissue in the heart muscle.
3. Increased cholesterol and triglyceride levels.
4. Electrolyte imbalance, which often occurs as a result of dehydration due to excessive alcohol consumption.
5. Thickening of the wall of the left ventricle.
6. Heart defects obtained in utero or after birth.
7. Impact of low temperatures.

Do not exclude the occurrence of the syndrome at the genetic level.

Characteristic features

An ECG phenomenon can occur for a long time without any symptoms. Under equal research conditions, it occurs both in healthy people and in patients with abnormalities in the work of the heart.

In adults

If a person is prone to sudden fainting, or in the genus there are cases of cardiac arrest due to cardiac arrhythmias, then ventricular repolarization can provoke the development of arrhythmias of a different nature:

• the work of the heart becomes inefficient due to inconsistent contraction of muscle fibers - ventricular fibrillation;
• violation of the heart rhythm, expressed by a strong push, fading of the heart, anxiety, lack of air - extrasystole;
• accelerated painful heartbeat - tachycardia.

Dysfunctions of the heart in the conduction of an electrical impulse lead to the appearance of hemodynamic disorders. The patient suffers from shortness of breath, pulmonary edema. Often, blood pressure increases and a hypertensive crisis develops, as well as cardiogenic shock. The patient may experience sudden cardiac arrest, and failure to provide timely assistance will lead to death.

During pregnancy

The syndrome of early repolarization of the ventricles in pregnant women is determined during an ECG study. If the changes do not depend on heart disease, then this condition does not threaten the life of either the mother or the newborn. Pregnancy occurs with complications in the presence of the above symptoms.

ECG phenomenon in children and adolescents

Changes in the work of the heart in a child, characterized as a syndrome of premature repolarization of the ventricles, are rare. Parents often do not notice problems, because the disease does not manifest itself. But if they are detected, they are prescribed additional methods diagnostics:

• ultrasound examination of the heart;
• laboratory analysis of urine;
• blood test from a vein and a finger.

If no cardiac pathology is detected, drug treatment are not assigned. But the following guidelines must be observed:

1. Systematic follow-up with a cardiologist.
2. Stabilization of the emotional state of the child, protection from stressful situations.
3. Reducing physical activity.
4. Inclusion in the menu of products containing potassium, magnesium, B vitamins.
5. IN adolescence make sure that the child does not drink alcoholic beverages and does not smoke.

This phenomenon occurs in sports people. The training process leads to the fact that the walls of the left ventricle become denser. The body gets used to the stress. The heart of athletes works more slowly, 60 beats per minute. This is considered normal and does not affect athletic performance.

Diagnostics

Early repolarization of the ventricles of the heart is detected during a cardiogram, where the following changes are visible:

• the ST segment rises above the isoline by 3 mm;
• a downward bulge appears on the ST segment;
• the R wave changes the amplitude upwards in the chest leads, while the S wave decreases or is not visible at all;
• point J is located above the isoline on the descending knee of the R$ wave;
• wave J resembles a notch;
• the QRS complex expands.

To confirm the diagnosis, patients are assigned a number of examinations:

• Electrocardiogram during additional load - determine the heart rate;
• ECG after the introduction of a potassium preparation - the symptoms of repolarization are aggravated;
• the drug "Novocainamide" is administered intravenously - there is an increase in symptoms;
• results of blood biochemistry and lipid composition;
• monitoring the work of the heart for a day according to Holter - they find out that with early repolarization, the heartbeat is disturbed, the patient experiences pain.

Examinations are necessary to differentiate the ECG phenomenon from other diseases. Brugada syndrome, increased potassium content in the heart cells, disorders in the tissues of the heart muscle such as pericarditis, arrhythmogenic dysplasia during the study give the same changes in the ECG as the syndrome of early ventricular repolarization.

Treatment

Patients with the identified syndrome need to reconsider the usual rhythm of life:

• reduce physical activity - when playing sports, avoid weight lifting exercises, practice interval training;
• review nutrition by adding foods with potassium and magnesium;
• eat fresh vegetables and fruits, add nuts to cereals;
• eat cottage cheese, sea fish dishes, soy products;
• save your nerves, avoid conflict situations.

Preparations

If serious illnesses are diagnosed against the background of the syndrome, then the use of drugs cannot be avoided:

1. "Novocainamide", "Quinidine", "Etmozin" - are aimed at eliminating arrhythmias, slowing down the process of repolarization.
2. "Kudesan", "Carnitine" - energy-tropic means to cope with the symptoms.

vitamins

In the treatment of these disorders, vitamin therapy is of great importance. Lack of B vitamins in the body negatively affects nervous system and in the work of the heart. A person receives them with food or as tablets (for example, "Maxi-Chel", "Direct"):

• B1 - found in legumes, meat, cereals, rose hips, milk, eggs.
• B3 - any cabbage, cereals, green pea, potato.
• B5 - present in green vegetables, sprouted wheat, dark rice. Additional use of pantothenic acid is recommended.
• B6 - kidneys, liver, eggs, cereals, nuts, fish.

Surgery

In case of ineffectiveness of drug therapy, apply:

1. Invasive catheter ablation method - helps to eliminate a bundle of abnormal pathways using a catheter through which a radio wave of the desired frequency is passed. This technique is indicated only in cases where all the risks of complications are excluded - pulmonary embolism, cardiac tamponade.
2. In violation of the heart rate, in the case of frequent loss of consciousness, the patient is shown implantation of a pacemaker.
3. With an increase in attacks of ventricular fibrillation by surgical intervention, the patient is implanted with a defibrillator-cardioverter. Modern techniques allow to reduce the operation to an invasive method. This procedure does not cause complications, without consequences is tolerated by patients.

Must be used with caution surgical intervention. When diagnosing SRPG on the ECG, a closed form of the syndrome can be detected. In this case, the operation of the patient is contraindicated.

Prevention and prognosis

When a person is young and full of energy, he does not think about serious illnesses. To avoid cardiovascular pathologies, including SRHR, certain recommendations should be followed and children should be taught to do this.

For modern cardiologists, such a diagnosis as the syndrome of early repolarization of the ventricles of the heart, in most cases, is of no interest. That is, from the point of view of physicians, the phenomenon does not pose a serious danger to the patient and does not require any specific treatment, except for general recommendations for a healthy lifestyle. Is this really so, we understand below.

What is early ventricular repolarization syndrome?

Doctors speak of early ventricular repolarization syndrome (ERRS) when a patient has obvious changes in the results of an electrocardiogram, but at the same time he does not have obvious signs of a pathological condition. That is why SRW is more of a medical cardiological term than an independent disease. But, despite this, according to the ICD, the pathology has its own code - I45–I45.9.

To date, the phenomenon of early ventricular repolarization is detected in approximately 3–8% of cases in perfectly healthy patients with a third-party ECG. At the same time, it is much more difficult to detect the syndrome in older patients, since they already have age-related changes in the work of the heart. Remarkably, the syndrome is more common in black men, male athletes or men leading a sedentary and sedentary lifestyle.

Changes caused in the heart by the syndrome

The identified syndrome does not pose a danger to most patients. Until recently, it was generally considered the norm. But there is a group of patients in whom the syndrome can provoke serious disturbances in the work of the heart and the same serious consequences. This group includes persons with a history of such conditions and pathologies:

• frequent fainting of unknown etiology;
• sudden death from in family history;
• early repolarization of the heart ventricles only in the lower leads of the ECG (II, III, aVF).

These patients may develop serious cardiac complications:

• (slow heart rate);
• sinus tachycardia;
• heart block;
• arrhythmia is atrial;
• ischemia of the heart;
• fibrillation of the heart ventricles.

Also, in this group of patients, sudden and sudden death can occur with untimely medical care.

Cause of the syndrome

As such, the immediate causes of early repolarization of the ventricles of the heart in children and adults have not been identified. However, doctors cite a number of provoking factors that can have a significant impact on changes in the work of the heart. They are:

1. Frequent and prolonged hypothermia. They are a kind of stress for of cardio-vascular system.
2. Failures in the electrolyte balance. Often occurs with dehydration. It, in turn, in most cases occurs against the background of frequent use of alcohol.
3. Congenital heart defects in children.
4. Long-term medication (Mezaton, Adrenaline, Ephedrine, etc.).
5. Inflammation of the myocardium and its hypertrophy.
6. The presence of defects in the structures of the connective tissues of the body.
7. Dystonia of a neurocircular nature.

Often SRW is diagnosed in athletes, so sport can also become one of the factors provoking the syndrome. In addition, the phenomenon of early repolarization is also detected in children who are emotionally unstable or do not comply with the regime of work and rest. The connection between the syndrome and the emotional component in this case should not be ruled out.

Syndrome symptoms

As a rule, outwardly, the symptoms and signs of the syndrome of early repolarization of the ventricles in the patient are not observed. Many studies have been carried out to identify them, but medicine has not been successful in this regard. The main signs of SRRS are only visible changes in the results of the electrocardiogram. On it, doctors determine such changes:

• The presence of the ST segment and its rise above the existing isoline by 1–3 mm (most often the segment begins to rise after a notch).
• The T wave changes in a positive direction, and the ST segment passes into it.

Diagnosis of pathology

In order to diagnose the pathological condition of a patient with SRCC, it is enough to pay attention to ECG result. However, this applies only to patients who do not have concomitant cardiac pathologies. If we are talking about patients with other heart pathologies, then the cardiologist may prescribe other hardware diagnostic methods, such as ultrasound of the heart.

In general, to identify SRW in a healthy-looking person, the following diagnostic methods are used:

• potassium test. The drug is administered intravenously. And if the patient has cardiac pathologies, their symptoms will increase somewhat.

Important: for children, this method of diagnosis is not used.

• Testing for short-term intense load. The patient is tested on special simulators with a gradual increase in load, while simultaneously monitoring the work of the heart through ECG sensors.
• Biochemistry of blood with the addition of lipidogram data.

If the diagnosis is carried out on a child, then it is very important to find out possible cause phenomenon formed on the ECG. For this, a small patient undergoes a number of the following studies:

• electrocardiographic study;
• Ultrasound of the heart (sometimes Doppler);
• general urine analysis;
• general and biochemical analysis blood.

Important: the child should be observed by a cardiologist even in the absence of obvious cardiac pathologies. To do this, it is advisable to do an ultrasound of the heart and a cardiogram every six months.

Treatment

If the patient did not have any additional cardiac pathologies, then the entire treatment of the syndrome is reduced to general recommendations. That is, the cardiologist recommends that the patient refuse all bad habits and optimize physical exercise. In particular, it is desirable for a patient with SRPG to avoid static physical exertion or sudden exorbitant efforts with weight lifting. Interval training is also prohibited.

Rarely, a cardiologist may order radiofrequency ablation of the Kent's bundle. An apparatus is brought through the catheter and an additional beam is destroyed.

Also, as maintenance therapy, a patient with early repolarization syndrome is prescribed vitamins and minerals. In particular, preparations of magnesium, phosphorus and potassium, as well as B vitamins are used.

Children with the detection of SRRS can be prescribed drugs from the following groups:

• magnesium;
• energy-tropic;

It is advisable to include in the diet foods rich in potassium (dried apricots, raisins, bananas). It also shows the elimination and avoidance of any stressful situations.

Important: it is desirable to save all previous transcripts of the electrocardiogram (ECG) in order to compare changes in the dynamics of the heart during the next examinations.

Prevention

To prevent various cardiac pathologies, including SRHR, cardiologists around the world recommend taking care of the cardiovascular system. In general, this is maintaining a healthy lifestyle and maintaining a normal psycho-emotional background. A balanced diet will not be superfluous. Hiking in the fresh air and optimal regular exercise will help maintain heart health.

With the phenomenon of early repolarization of the heart ventricles, the prognosis for patients is favorable. But if the patient has other cardiac pathologies in the form of palpitations, arrhythmia or tachycardia, valve insufficiency, etc., then you should be on the lookout. Dispensary observation a cardiologist in this case is mandatory.

Specific cardiac syndrome found not only in patients with heart disease, but also in absolutely healthy people. Early ventricular repolarization this is the syndrome of premature repolarization. Very often mistakenly confused with premature repolarization, despite the fact that these are completely different pathologies.

Pathological changes on the ECG for a long time were considered a variant of the norm, until a clear relationship with cardiac arrhythmias was revealed. The disease is asymptomatic, which greatly complicates timely diagnosis.

The syndrome of early (premature, accelerated) repolarization of the ventricles of the heart is characterized by specific changes on the electrocardiogram in the absence of obvious causes. ICD-10 code: I45.6

Pathogenesis

The contraction of the chambers of the heart occurs as a result of changes in the electrical charge in the cells of the myocardium - cardiomyocytes. As a result, sodium, calcium and potassium ions pass into the intercellular space and back. The process is carried out by successive main phases:

• depolarization- reduction;
• repolarization the ventricles are relaxing before a new contraction.

Early repolarization of the ventricles is formed as a result of improper impulse conduction along the conduction system of the heart from the atria to the ventricles. To transmit an electrical impulse, they are activated abnormal pathways. The development of the phenomenon is due to an imbalance between repolarization and depolarization in the basal regions, the apex of the heart. A significant reduction in the period of relaxation of the myocardium is characteristic. On the ECG, often along with SRRG, a violation of the repolarization processes in the myocardium is recorded, in particular, a violation of the repolarization of the lower wall of the left ventricle.

Classification

In children and adults, the syndrome of early repolarization of the ventricles can have 2 variants of development:

• without damage to the cardiovascular system;
• with defeat.

According to the nature of the flow, there are:

• transitory form;
• permanent form.

Depending on the localization of the ECG signs of RRW, they are divided into 3 types.

• I characteristics observed in a healthy person. ECG signs are recorded only in chest leads V1, V2. The likelihood of complications is extremely low.
• II ECG signs are recorded in the lower lateral and lower sections, leads V4-V6. The risk of complications is increased.
• III ECG changes are recorded in all leads. The risk of complications is the highest.

Causes

Reliable reasons are not fully understood. There are only hypotheses for the occurrence of early repolarization:

• genetic predisposition. Mutation of genes that are responsible for balancing the processes of entry of certain ions into the cell and their exit outside.
• Violation of the processes of contraction and relaxation of individual sections of the myocardium, which is typical for Brugada syndrome type I.
• Changes in action potentials of cardiomyocytes. The process is associated with the mechanism of release of potassium ions from the cells. This also includes increased susceptibility to a heart attack with.

According to statistics, accelerated repolarization syndrome is typical for 3-10% of healthy people most different ages. Most often, changes are recorded in young people aged 30 years, in people leading healthy lifestyle life of athletes.

Nonspecific factors affecting the development of early ventricular repolarization syndrome:

• congenital form hyperlipidemia, which provokes the development;
• prolonged use of certain medications, or an overdose of them (for example, beta-agonists);
• , which is characterized by additional chords in the cavity of the ventricles;
• high blood levels;
• electrolyte imbalance;
• neuroendocrine changes;
• : congenital, acquired;
• disturbances in the work of the autonomic nervous system;
• hypothermia of the body;
• excessive physical activity.

Symptoms

Clinical symptoms are observed only in the form of the disease, which is accompanied by disturbances in the work of the cardiovascular system:

• loss of consciousness, ;
• rhythm disorders ( tachyarrhythmia, ventricular fibrillation);
• vagotonic, hyperamphotonic, tachycardial, dystrophic are formed under the influence of humoral factors on the hypothalamic-pituitary system;
• systolic and diastolic dysfunction of the heart caused by its hemodynamic disorders (, hypertensive crisis, ).

Analyzes and diagnostics

The main changes are recorded on the electrocardiogram. Some patients have concomitant clinical symptoms diseases of the cardiovascular system, but most often patients feel completely healthy and do not notice any changes.

Syndrome of early reoplarization of the ventricles on the ECG:

• elevation of the ST segment above the isoline;
• the bulge during the rise of the ST segment is directed downward;
• an increase in the R wave with a parallel decrease in the S wave or with its complete disappearance;
• point J is above the isoline, at the level of the descending knee of the R wave;
• extension QRS complex on the ECG;
• on the descending knee of the R wave, a "notch" is recorded.

Treatment

The phenomenon of early ventricular repolarization requires the patient to change their lifestyle:

• avoid stress, get enough sleep;
• complete rejection of excessive physical activity;
• change in diet: eating foods rich in magnesium, potassium,.

If necessary, drug therapy is carried out.

The doctors

Medications

• when rhythm disturbances are detected, antiarrhythmics that slow down repolarization;
• specific agents are used in the detection of cardiac pathology (beta-blockers, antihypertensives, coronary lytics, etc.);
• a good effect is given by drugs with a metabolic effect (,), however, this group of drugs does not have a convincing evidence base;
• B vitamins improve neuromuscular conduction and help restore the balance of the electrical activity of the heart.

Procedures and operations

TO surgical treatment premature repolarization is resorted to only when severe forms of arrhythmia are detected, which negatively affect the functioning of the cardiovascular system. By introducing a catheter into the right atrium, it is possible to “kill” additional pathways for conducting impulses by means of radiofrequency ablation.

If a patient has frequent attacks of atrial fibrillation, it is recommended to install cardioverter-defibrillator, which allows timely elimination of life-threatening attacks of arrhythmia.

Syndrome of early repolarization of the ventricles in children

The reasons for the development of early repolarization syndrome in children can be very different:

• lack of sleep and irregular daily routine;
• physical overload;
• constant anxiety, stress or nervous fatigue;
• isolation, lack of healthy emotional contact with parents;
• hypothermia;
• poor quality and unbalanced nutrition.

A similar syndrome can be recorded on the ECG in any child who reacts too emotionally to the assessment of his knowledge at school, takes the events close to his heart, and is overloaded in extracurricular activities. Lack of proper rest, increased exercise in sports sections can adversely affect the well-being of the child.

Forecast. What is dangerous syndrome of early repolarization of the ventricles of the heart

Modern cardiologists work to prevent and prevent the development of pathology, which can lead to death. That is why patients with early ventricular repolarization syndrome should be regularly observed by a cardiologist to monitor ECG dynamics and to identify hidden symptoms of another pathology. It is not the syndrome itself that is dangerous, but the consequences to which it can lead in the absence of proper treatment of the causative disease.

Persons who go in for sports are recommended to undergo an examination in specialized physical education dispensaries, assessing the condition before and after intensive training, as well as before competitions.

There are no clear data on the transition of SRHR into a serious pathology. The risk of death increases significantly with the abuse of fatty foods and smoking. Timely and complete competent examination will help to identify or exclude true reason and avoid problems in the future.

List of sources

• Lysenko L.M., Kuznetsova O.A., Shilina L.V. "Pathological changes in the cardiovascular system in athletes against the background of physical overstrain syndrome", an article in the journal BC "Medical Review" No. 4 dated 10.03.2015
• Inaccessible A.V., Blagova O.V. "Principles of combined antiarrhythmic therapy" article in the journal BC No. 11 dated 11.06.2005
• Doshchitsin V.L. "Treatment of patients with ventricular arrhythmias", Regular issues of "BC" No. 18 of 09/14/2001

Early ventricular repolarization syndrome (ERPS), demonstrated as an increase in the J-point on the electrocardiograph, was previously considered benign education. Recent studies have shown that it may be associated with a higher risk of ventricular arrhythmias and death from sudden heart failure.

People with SRHR have a higher risk of recurrent heart complications. Cardioverter-defibrillator implantation and isoproterenol are the recommended therapy. Asymptomatic cases are common and have a better prognosis.

This review gives short description the latest data related to early repolarization and the risk of arrhythmias, life threatening.

Sudden cardiac death (SCD) is defined as natural in a person who may or may not have previously diagnosed heart disease, but whose time and manner of death are unexpected. "Sudden" is defined as 1 hour or less between a change in clinical status heralding the onset of a terminal clinical event and cardiac arrest itself.

The vast majority of SCD cases are associated with cardiac arrhythmias. The most common electrophysiological mechanisms are ventricular arrhythmias. About 10% of cases are associated with primary electrophysiological disorders, known (Brugada syndrome) or unknown (idiopathic HF) anomalies.

Early ventricular repolarization, referred to as "J-waves" or "J-point elevation", is an electrocardiographic abnormality consistent with elevation of the junction between the end of the QRS complex and the beginning of the ST segment in 2 adjacent areas.

Early repolarization syndrome (ARS) is considered "normal", benign.

RRFS is an electrocardiographic (ECG) object characterized by an increase in the J-point, manifested either as blurring of the QRS (during the transition from the QRS segment to the ST segment) or as a notch (positive deviation inscribed in the end of the S-wave), ST segment elevation with superior concavity and known T-waves, two adjacent findings.

Prevalence

Commonly seen in athletes, cocaine users, hypertrophic obstructive cardiomyopathy, interventricular septum. The prevalence varies from 3% to 24% of the general population.

Young adults, especially those at risk for vagotonia, men, African Americans, and athletes are subpopulations with a higher prevalence.

J-point elevations >0.2 mV are associated with significant cardiac arrhythmia mortality.

Pathophysiology, theories

The pathophysiological basis of early ventricular repolarization is not fully understood. The most discussed hypothesis points to an increased susceptibility to cardiac arrest in critical ischemic conditions. For example, acute coronary syndromes.

Another hypothesis about the mechanism suggests the association of localized depolarization disorders with abnormalities, as in type 1 Brugada syndrome.

The genetic basis of ER syndrome continues to be elucidated. Suspected gene mutations have been reported involving the gene KCNJ8(responsible for the ATP-sensitive potassium channel), genes CACNA1C, CACNB2, CACNA2D1(responsible for L-type cardiac calcium channel), SCN5A(responsible for the sodium channel - I Na). Mutations accelerate epicardial repolarization.

Clinical signs

clinical picture divided into two main groups. The first includes those that show recognized symptoms. For example, people at high risk of fainting, survivors of cardiac arrest. This group very rarely has recurrent cardiac events. The Haissaguerre study showed a 41% recurrence of arrhythmias at 51 months.

The second most common group are asymptomatic people. They have an ER pattern on the ECG. This group is less likely to have adverse cardiac events. The challenge is to distinguish people at risk of sudden cardiac death from those who may have a benign course of the disease.

ECG diagnostics

The electrocardiographic sign of RRGC is an elevation (>1 mm above baseline) of the QRS–ST junction. Presents as either QRS blur or notching, ST-segment elevation with superior concavity, prominent T-waves in two or more adjacent inferior, lateral leads in those resuscitated from unexplained ventricular arrhythmia.

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Recent studies have omitted ST elevation in the definition of early repolarization syndrome. The term "J-Wave Syndrome" has been proposed to describe RRGC and Brugada Syndrome as spectrums of a clinical condition.

1. type 1: shows ER in the lateral precordial leads. It is observed in healthy male athletes. Has the lowest risk of developing malignant arrhythmias (Figure 3);
2. Type 2: Shows derangement in the inferior, inferolateral leads. Associated with higher risk of malignant arrhythmias;
3. type 3: (Figure 4) has the highest risk of malignant arrhythmias.

The European Heart Rhythm Association, Asia Pacific (HRS / EHRA / APHRS) heart rate criteria are recommended for diagnosis. Shown in Table 1.

Table 1

General opinion on the diagnosis, treatment of syndromes of primary hereditary arrhythmia;

ER: early repolarization; ECG: electrocardiogram; SCD: sudden cardiac death.

Watch the video - srrzh on ecg, signs

Differential Diagnosis

Early ventricular repolarization syndrome has a wide differential, including short and long QT, other conditions that cause ST-segment elevation (acute pericarditis, idiopathic VF). Brugada Syndrome (BS) is the closest clinical entity to SRCC.

It is a primary disorder of repolarization, characterized by a pronounced J-wave, causing a pattern of incomplete right bundle branch block, ST segment elevation in the right precordial leads (V1-V3) (Figure 5).

Represents a significant risk of sudden cardiac death in individuals without known structural heart disease. Autosomal dominant condition, more common in males. Symptoms are fainting with or without any warning signs, convulsions, nocturnal agonal breathing.

The ECG remains the cornerstone of diagnosis. The feature of Brugada provocation on the ECG with a sodium channel blocker is not observed in the ER.

In fact, sodium channel blockers weaken the J-spot in most people with ventricular repolarization. The J-point is increased with sodium channel blockers in the right precordial leads in individuals with the Brugada ECG.

Acute pericarditis

In acute pericarditis, there is an increase in the J-point with a resultant elevation of the ST segment, as in early repolarization. The presentation symptom is markedly different in the two conditions.

In most individuals with acute pericarditis, the increase is diffuse in all limbs and precordial leads. In addition, in acute pericarditis, there is often a deviation of the PR segment, which is not present in the ER.

Myocardial damage

Patients with acute myocardial injury caused by ST-elevation myocardial infarction (STEMI) initially have J-point elevation with concave elevation. It becomes more prominent, bulging (rounded up) as the infarction persists.

The main distinguishing feature is the presence of clinical symptoms such as chest pain, shortness of breath. ER and terminal QRS notch should be considered when stratifying the risk of arrhythmias in people with coronary artery disease and after coronary artery bypass surgery.

Diseases with a J-wave on the electrocardiogram

• Hypothermia;
• hyperkalemia;
• Hyperkalemia;
• Vasospastic angina;
• early repolarization;
• Short QT syndrome;
• hypoxia;
• Acidosis;
• pulmonary embolism;
• Arrhythmogenic right ventricular cardiomyopathy;
• Subarachnoid hemorrhage.

signs

The identification of high-risk patients remains challenging. Surface ECG is the only tool available to distinguish between benign and malignant forms of RRCC.

Horizontal or downward ST elevation is associated with poorer outcomes (versus rapid ST elevation) after J-point elevation. The degree of J-point elevation is predictive: fuzzy, jagged ≥ 2 mm (0.2 mV) is associated with higher risk.

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Other abnormalities, such as localization of the pattern in the inferior or inferolateral (vs. lateral) leads, extension into a BrS pattern, also represent a worse prognosis.

The benign type is associated with a young age group, left ventricular hypertrophy on the ECG, low blood pressure, and heart rate, which are hallmarks of healthy, physically active individuals.

On the other hand, the malignant form is characterized by a horizontal, downward variation (Figure 6). Associated with the elderly, ECG indicating coronary artery disease.

The morphology of the segment helps to distinguish the "benign" from the "malignant" form. However, there is no way to know who is at significant risk for QRS lubrication or notching unless cardiac arrest has occurred.

Treatment

The ER pattern is a benign incidental finding without any specific signs or symptoms. There is no risk stratification strategy for asymptomatic patients with an ER pattern. It is generally accepted that these people do not require special studies or therapeutic interventions.

Among survivors of SCD, the recurrence rate is 22-37% within two to four years. Since there are no structural heart diseases, they have an excellent prognosis for long-term survival with treatment. The best treatment strategy is an implantable pacemaker (ICD). Recommendations for therapeutic interventions are given in Table 3.

Table 3 Therapy

ER: early repolarization; ICD: implantable cardioverter defibrillator.

People with VF repolarizing had a higher relapse rate over five years of follow-up than people with VF without ER (43 against 23%,). In terms of long-term therapy, it has been shown that relapses are effectively suppressed by quinidine therapy.

Encouraging results have been reported by Gurabi et al, who demonstrated that, in addition to the quinidine cilostazol, milrinone suppresses hypothermia-induced VT/VF.

Between the two ends of the spectrum, there is a "gray zone" where there are no clear guidelines. Examples include patients with syncope who may have a "malignant" ER pattern or a significant family history of sudden cardiac death.

Current guidelines suggest that ICD implantation is considered for individuals at high risk for unexplained syncope.

Screening

There are no recommendations for ECG screening of families of asymptomatic individuals or a family history of ER with VF. There are no recognized provocative tests that would aid in the diagnosis of an underlying disorder in family members of patients with SRPC. However, with preliminary observation, latent cases are recognized.

Scientific editor: Strokina O.A., therapist, doctor of functional diagnostics.
November, 2018.

Early ventricular repolarization syndrome (ERRS) is a medical term that includes only ECG changes without characteristic external symptoms. It is believed that SRRG is a variant of the norm and does not pose a threat to the life of the patient.

Recently, however, this syndrome has been treated with caution. It is quite widespread and occurs in 2-8% of cases in healthy people. The older a person becomes, the less likely it is to detect SRW in him, this is due to the occurrence of other cardiac problems with increasing age, similar in electrocardiographic signs.

Most often, early ventricular repolarization syndrome is diagnosed in young men who are actively involved in sports, in men who lead a sedentary lifestyle, and in individuals with dark skin (Africans, Asians, and Hispanics).

Causes

The exact causes of RRS have not been established to date. However, a number of factors have been identified that contribute to the occurrence of repolarization syndrome:

• taking certain medications, such as a2-agonists (clonidine);
• familial hyperlipidemia (high blood fat);
• connective tissue dysplasia (in persons with SRRG, its symptoms are more often detected: joint hypermobility, "spider" fingers, mitral valve prolapse);
• hypertrophic cardiomyopathies.

In addition, this anomaly is often diagnosed in people with congenital and acquired heart defects and in the presence of a congenital pathology of the conduction system of the heart.

Also, the genetic nature of the disease is not ruled out (there are certain genes that are responsible for the occurrence of RRW).

Kinds

There are two options for the RRR:

• without damage to the cardiovascular and other systems;
• involving the cardiovascular and other systems.

From the point of view of the nature of the flow, SRRG is distinguished as transient and permanent.

According to the localization of ECG signs, doctor A.M. Skorobogaty proposed the following classification:

• type 1 - with a predominance of signs in leads V1-V2;
• type 2 - with a predominance in leads V4-V6;
• 3rd type (intermediate) - without a predominance of signs in any leads.

Signs of SRRS

There are no characteristic clinical signs of early ventricular repolarization syndrome. There are only specific changes on the ECG:

• ST segment and T wave changes;
• in a number of branches, the rise of the ST segment is 1-2-3 mm higher than the isoline;
• quite often the rise of the ST segment begins after a notch;
• the ST segment is rounded and goes directly into a high positive T-wave;
• the convexity of the ST segment is turned downward;
• the base of the T wave is wide.

Diagnostics

Since this syndrome is an electrocardiographic phenomenon, it can only be established with a certain examination:

• Ultrasound of the heart (echocardiography):
  • stress echocardiography (for impaired ventricular contractility)
  • echocardiography at rest;
• Holter monitoring during the day;
• electrophysiological study.

In addition, tests are carried out on a bicycle ergometer or treadmill: after exercise, the heart rate rises, and the ECG signs of RRW disappear.

A potassium test is used: after taking potassium chloride, panangin or rhythmocor at least 2 grams, the severity of ECG signs of repolarization syndrome increases.

A test with isoproterenol and atropine is not used due to severe side effects.

It is important to distinguish between SRCC and myocardial infarction, pericarditis, Brugada syndrome. For this purpose, differential diagnosis is carried out.

Treatment of early ventricular repolarization syndrome

Repolarization syndrome does not require specific treatment. The only thing that is offered to the patient is observation by a cardiologist.

However, a person with HRH should avoid alcohol and strenuous exercise to avoid triggering a tachycardia attack.

In some cases, radiofrequency ablation of an additional beam is performed in an invasive way(the catheter is brought to the site of the beam and destroys it).

Sometimes energy-tropic therapy is used (vitamins of group B, carnitine, phosphorus and magnesium preparations, mexidol, kudesan), antiarrhythmic drugs(amiodarone).

Important! The patient should keep all the previous ECG, which is required to exclude the diagnosis of myocardial infarction in the event of pain in the heart.

Complications and prognosis

SRRZh can provoke the occurrence of the following complications: - Abstract of the doctor No. 61, 2011.