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Elevation of ST segment
Last reviewed: 23.04.2024
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Elevation of the ST segment - lifting above the contour on the electrocardiogram. In the article we will tell you, under what diseases this disorder occurs and how these diseases can be prevented and treated.
What is the ST segment elevation?
With the help of a cardiogram, you can evaluate the rhythm and conductivity of the heart according to the position of the segments and teeth of the chart.
Elevation of the ST segment - a deviation above the isoline on the electrocardiogram. A slight elevation is observed with tachycardia, more pronounced - with IHD and pericarditis. When pericardial, the tooth S is retained, and its ascending knee is raised. With myocardial infarction, ST segment elevation undergoes reverse development within 2 weeks. During the course of the infarction, the tooth T rises and sharpens. After 6 months, the transferred myocardial infarction can be recognized by the disappearance of the tooth R.
The causes of ST segment elevation
An electrocardiogram is the main method for diagnosing myocardial ischemia. Elevation of the ST segment and T wave is an early sign of myocardial ischemia. ECG allows you to determine the extent of ischemia prevalence and what part of the heart it touched. With transmural ischemia, a negative deviation 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. The definition of leads in which ST segment elevation is present allows to localize the site of ischemia. Elevation of the ST segment is noted in the leads that are above the ischemic epicardium.
Myocardial infarction is the death of cardiomyocytes caused by prolonged ischemia. On the cardiogram in this case there are changes in the ST segment.
The expressed hypotension causes an ischemia at patients with an ischemic heart disease. The myocyte membrane can also be damaged by pancreatic enzymes in acute pancreatitis, which is expressed by ST elevation on an electrocardiogram. Similar changes are noted in viral myocarditis and resulting from staphylococcal or streptococcal angina.
Symptoms of ST segment elevation
The very first reason for ST segment elevation on an electrocardiogram is acute myocardial infarction. Elevation of ST - only one of its indirect features.
Acute coronary syndrome is a symptom complex that occurs when myocardial infarction is caused by a pronounced sharp decrease in coronary blood flow. Measures to increase blood flow can save myocardium from necrosis. Clinical manifestations are always associated with the severity of ischemia. There are painless forms of myocardial infarction. It is these hidden forms that are the cause of the high early mortality of people. Improving the methods of first aid has reduced the number of deaths. Factors aggravating the course of myocardial infarction: age, low blood pressure, significant ischemia, manifested by abnormalities of the ST segment on the electrocardiogram, female or male gender (women die more often), kidney disease.
Nonspecific elevation of the ST segment
Nonspecific elevation of the ST segment on the ECG means that the curve is not quite standard, but within the physiological norm. One method of investigation is an insufficient basis for diagnosing, therefore in disputable cases the patient is assigned other methods of diagnosis.
The ST segment sometimes has a saddle-shaped configuration with funnel-like deformation of the chest.
Ischemic Elevation of the ST segment
Elevation of the ST segment in IHD is a highly probable sign of the pre-stage stage of the disease. Clinical identification of coronary heart disease begins with a cardiogram: in addition to ST elevation, sinus bradycardia, AV blockade and atrial fibrillation, pathological Q waves can also be detected.
In addition to analyzing the result of the ECG, it is extremely important for the doctor to obtain a description of the pain syndrome, indicate its duration and the factors at which the pain disappears, and also where pain gives. If a normal electrocardiogram is not sufficient for the diagnosis, daily monitoring and stress tests are performed.
In patients with ST elevation, myocardial ischemia with coronary artery occlusion is more common. In this case, the risk of damage is always subject to a large part of the myocardium in the left ventricle. To resolve the thrombus closing the lumen of the artery, a special thrombolytic therapy is prescribed.
Elevation of the ST segment in adults
Modern medicine has identified a number of diseases in which sudden death can occur without precursors. One of the most "mysterious" diseases in this series is the Brugada syndrome. For the first time they can be detected in 25-35 years. Let us dwell in more detail on the Brugada syndrome, in which, just as in the case of an infarction or ischemic heart disease, the ECG pattern is marked by the ST segment elevation.
The disease was described quite recently - in 1992. Then the case of a 3-year-old girl who was lost, despite all the doctors' efforts and implanting a heart stimulant, was described.
The disease is interesting because there are not registered a single case in African Americans. In Ukraine, the syndrome is very rare, but it is estimated that a significant number of people suffer from it. In order not to miss the disease, you need to be careful when there are disturbing symptoms: night attacks of suffocation, atypical ECG, in the presence of cases of sudden nightly death in the family. You may also need to undergo a genetic test to confirm or exclude Brugada syndrome. The syndrome has many erased forms, because of which during the life of the patient it is extremely difficult to identify. The average estimated prevalence is 2: 100,000.
To confirm the infarction, in addition to this diagnostic criterion (ST elevation), there should also be others:
- Anginal infection.
- On ECG - signs of left bundle branch blockade and enlargement of Q wave. Pathological Q-wave on ECG is the most important diagnostic criterion of myocardial infarction. At an early stage, myocardial cells are still viable. Therefore, first, an increase in the pathological Q wave is not observed. In the early days, ST elevation and a Q-tooth depression are observed.
- Increased level of troponins in the blood.
The change in ECG pattern is associated with damage to myocardial cells. They excite abnormal systolic and diastolic currents.
Other causes of ST elevation on the ECG:
- Acute pericarditis.
- Left ventricular hypertrophy.
[Elevation of the ST segment in children
The greatest concern is the increase in the number of children with congenital heart anomalies and hypotension. The heart of children is larger than that of adults with respect to the body and has a number of characteristic features. Both ventricles are equal, the openings between the divisions of the heart are greater than those of adults.
Congenital heart defects are anatomical defects in the structure of the heart. Only in 10% of this is caused by genetic disorders. Environmental factors negatively affect the formation of the heart and blood vessels in the embryonic and postembryonic periods in only 0.5% of cases. Basically, all heart defects have a multifactorial nature (in 90% of cases). When examining a newborn in a maternity hospital, the perinatologist pays attention to some alarming signs that may indicate the presence of a cardiovascular pathology: skin discoloration, difficulty breathing.
In the US, 5,000 apparently healthy children suddenly die every year. Only some of these deaths can not really be predicted. In most cases, there are clinical symptoms that allow you to suspect that something is wrong. But in order to prevent sudden child death, it is the duty of every doctor to regularly update knowledge on the diagnosis of heart disease in outwardly healthy children. The pediatrician should know whether each particular child he is watching belongs to the risk group and what preventive measures should be taken to avoid falling into this sad statistics.
The main percentage of cases of child sudden cardiac death is recorded in physical education classes. Almost always behind these cases is the congenital pathology of the heart and blood vessels, which was not diagnosed at the time by the cardiologist, for example, mitral valve prolapse or vascular aneurysm, Fallot tetrad, aortic stenosis, etc. Also, sudden cardiac death was observed in children who underwent myocarditis after a complicated angina.
The tetralogy of Fallot in the structure of congenital heart defects is 15-16%. Even in operated patients for 20 years, the risk of death from ventricular arrhythmia is 7%.
Some children with congenital heart defects function only one ventricle. In such patients, after palliative surgery, dysfunction of the sinus angle sometimes occurs, leading to sudden cardiac death.
Hypoplasia of the left ventricle is its underdevelopment. Operation Fontena, performed at the earliest possible age, reduces the likelihood of SCD to 5%.
Hypertrophic cardiomyopathy - in the US it occurs in 2% of children. It is more often found in young men. ARV 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 mode of work and rest without overload. Adults and children need 40 minutes of daily exercise. Every day you need to go 4 km in 40 minutes. Very bad effect on the socio-psychological adaptation of the child obesity, and later, in adulthood, it leads to CVD. Heredity + irrational nutrition = obesity! It is important to properly feed the child, provide him with the right diet with enough meat and fish. Temper the child. Take care of his small vulnerable heart!
How to examine?
Who to contact?
Treatment of ST segment elevation
Today, the medical community pays much attention to the issues of the earliest management of a patient with myocardial infarction, in which the ST segment is elevated on the ECG. If the heart attack has already been transferred by you earlier, or if you are sick with diabetes, you risk getting a heart attack more than others.
First of all, you need to provide 24-hour ECG monitoring. Therapy should be started with aspirin. Aspirin should be taken at a dosage of 100 mg once a day. Contraindications to admission: age to 21 years, liver and kidney pathology, tendency to bleeding. Aspirin is not prescribed to patients with a stomach ulcer, gastritis, colitis. Contraindicated in pregnancy, the drug is stopped several days before the planned surgery. It is rational to use enteric-soluble forms of the drug. It is better to take them during meals to reduce the negative impact of aspirin on the digestive tract. Intestinal aspirin is taken without chewing. Also, there is regular tableted aspirin and effervescent.
Intravenous appoint nitroglycerin. It is used for emergency care for myocardial infarction for more than 100 years. Intravenous nitroglycerin infusions reduce the area of infarction, prevent remodeling of the left ventricle. The decrease in complications of myocardial infarction with nitroglycerin therapy was proved. It reduces the death rate of patients by a third. Intravenous introduction of nitroglycerin is shown in the first 2 days of patients with myocardial ischemia.
Also, ACE inhibitors, for example, valsartan, are prescribed. The drug is rapidly absorbed from the gastrointestinal tract. The maximum concentration in the blood is reached after 2 hours. Elimination time is 9 hours. Contraindicated in pregnancy. Side effects: weakness, dizziness and nausea. The recommended dosage is 80 mg once a day.
Another reason why the ST segment can be elevated is ischemic heart disease. It can not be cured completely, but with proper treatment it can be braked. It is important to change the way of life, to think about your diet. Attacks of arrhythmia and stenocardia require hospitalization, and also need to go to hospital with an increase in cardiac edema.
Treatment of coronary heart disease should be lifelong. Unfortunately, without maintenance therapy, IHD progresses.
Blockers of angiotensin receptors stop cardiac hypertrophy. Examples of drugs: losartan, candesartan.
Losartan - blocker of angiotensin receptors. Reduces pressure in a small circle of circulation and prevents sodium retention. Makes the heart more hardy to exercise. A stable drop in blood pressure is achieved 2 months after the start of the course. Quickly absorbed, and the maximum concentration is achieved after 2 hours. Most of the drug is excreted by the intestine. Do not use in pregnant women. Side effects: dizziness, asthenia, headache, memory impairment and sleep. The drug is given in a dose of 50 mg once a day.
Candesartan - a drug to prevent increased 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 period is 9 hours. It is excreted by the kidneys and with bile. Contraindicated in pregnancy. Side effect manifests itself in the form of headache, cough, pharyngitis, nausea. Take 8-16 mg once a day.
Prevention of ST elevation
500 000 people a year in Ukraine die from coronary heart disease. Most often, IHD occurs in people older than 45 years. 50% of patients with ischemia have a disease on the background of hypertension. Reducing alcohol consumption and increasing potassium intake makes it possible to correct mild forms of hypertension. The best prevention of all CVD is a decrease in 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 it. After 40 years, preventive examinations of the heart should become the norm, but do we often visit the polyclinic if nothing hurts?
Our heart is a very powerful pump. When we are calm, it is reduced 70-85 times per minute. But if we give him physical exertion, it can pump in a minute not 4 liters of blood, as usual, but all 40! The trained people have a lower heart rate, which means that their heart wears out and ages later.
Cardiovascular diseases are the main cause of disability and death in the world. Their cause is atherosclerosis, which develops gradually. Will you get coronary syndrome, myocardial infarction, coronary heart disease, depends on what sex you are, what your blood pressure and glucose level are. A total of 40 risk factors for CVD were found.
According to the 2009 data, 18 million people worldwide died from CVD around the globe. This year, a "record" was set - every third person ended his life path because of a sick heart or blood vessels.
Malnutrition and smoking are the leading causes of CVD. The consequences of unhealthy eating - increased blood sugar and obesity - eventually cause 85% of heart damage. You must be pricked by pain in the chest, elbows, hands, back, difficulty breathing, nausea, dizziness.
The cause of myocardial infarction with ST segment elevation and acute coronary syndrome often becomes atherosclerosis. Prevention of atherosclerosis is a healthy diet, physical activity and control of blood glucose. To avoid obesity, we recommend that you limit the intake of calories in the diet. Reduce the amount of carbohydrates and fats consumed and eat fractional. Do not eat foods that are 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 the dishes in the oven. Food should be varied with lots of fruits, cereals and meat, and coarse bread. Give up animal fat. It is recommended to limit fatty meat, butter and yolks. Useful fish of the northern seas: herring, mackerel, salmon. Drink high-quality raw water. Avoid stress and keep under control the pressure. Less salt food. Do preventive maintenance and remember that the heart is a very delicate organ. If you have high blood pressure, you need antihypertensive therapy, anti-ischemic therapy if you have CHD. Helps to prevent heart disease is also a complete cessation of 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. Smoking people most often die from myocardial infarction and oncological diseases. If you can not cope with the addiction yourself, you might want to turn to the expert in narcology for qualified help - today there are many ways to get rid of addiction: nicotine chewing gums, reflexology. Let the best motivator for you is that each cigarette "steals" you 20 minutes of life.
Useful lessons for jogging, swimming and skiing, tourism, gymnastics. All this not only tones the heart, but also develops strength in muscles, joint mobility, the ability to breathe properly. The most common physical activity for everyone is ordinary walking. Only by combining all the methods of CVD prevention, you can be sure that the threat will pass you by. Paradoxically, but with the problem of heart disease, developed countries with large cities and good infrastructure are more likely to face. All because the automation of production and life freed the person from physical exertion. As a result, the elasticity of the vessels decreases. A modification of the way of life can significantly slow down the development of many diseases. Of course, medicine needs to be thanked so much for such a rapid growth, for the development of modern methods of treatment, but without understanding that everyone creates their own life, the fight against disease can not be successful. Only changing behavior can help humanity in this struggle. Change of behavior and increase of awareness, awareness of responsibility for one's health. This is something everyone can do.
Elevation of the ST segment on the ECG is only one sign of serious heart problems.