Voltage is normal. Deciphering a cardiogram in children and adults: general principles, reading the results, an example of decoding

Types of voltage reduction

• emphysema;
• obesity;
• myxedema.

• amyloidosis;
• scleroderma;
• mucopolysaccharidosis.

• malignant tumors;
• diabetes;
• thyrotoxicosis;
• beriberi;
• anemia;
• obesity;
• physical stress;
• myasthenia gravis;
• stress, etc.

Treatment of this pathology

QRS complex wave amplitude

The amplitude of the QRS complex waves varies considerably. She is usually more chest leads than in standard. Normally, in at least one of the standard leads or limb leads, the amplitude of the QRS complex should exceed 5 mm, and in the chest leads - 8 mm.

If the amplitude of the QRS complex in all standard leads and in the limb leads is less than 5 mm or in all chest leads is less than 8 mm, then they speak of a decrease in voltage ECG waves. This decrease is typical for cardiosclerosis, pericarditis, obesity, pulmonary emphysema, myxedema, severe congestive heart failure, etc.

However, it should be borne in mind that the term "decreased voltage of ECG teeth, or" low voltage ", does not differ in the accuracy of the accepted criteria, since there are still no clear standards for the normal amplitude of the teeth in various leads in people of different builds and different thicknesses. chest.

In standard leads and augmented limb leads in adults, the amplitude of the QRS complex in each of these leads should not exceed 22 mm. In any of the chest leads, the amplitude of the ventricular complex should not exceed 25 mm. In cases where the amplitude of the QRS complex in adults exceeds these standards, they speak of an increase in the voltage of the ECG teeth.

The terms “increased ECG wave voltage or “increased QRS complex amplitude” also do not differ in the accuracy of the accepted criteria, since there are still no clear standards for it in people of different builds and with different thicknesses of the chest.

"Guide to electrocardiography", V.N. Orlov

This information is for reference only, consult a doctor for treatment.

Decreased voltage on cardiography - what is it about?

Most of us clearly understand that electrocardiography is a simple, affordable technique for recording, as well as the subsequent analysis of electrical fields that can form during the functioning of the heart muscle.

It's no secret to anyone that ECG procedure is widely used in modern cardiology practice, as it allows to detect many cardiovascular diseases.

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However, not all of us know and understand what specific terms related to this diagnostic procedure can mean. We are talking, first of all, about such a concept as voltage (low, high) on the ECG.

In today's publication, we propose to understand what ECG voltage is, and to understand whether it is good or bad when this indicator is reduced / increased.

What is this indicator?

A classic or standard ECG displays a graph of the work of our heart, which clearly defines:

1. Five teeth (P, Q, R, S and T) - they can have different kind, invest in the concept of norm or be deformed.
2. In some cases, the U wave is normal and should be barely noticeable.
3. QRS complex formed from individual teeth.
4. ST segment, etc.

So, pathological changes in the amplitude of the indicated complex of three QRS teeth are considered to be indicators significantly higher / lower than age norms.

In other words, low voltage, noticeable on a classic ECG, is such a state of a graphical representation of the potential difference (formed during the work of the heart and brought to the surface of the body), in which the amplitude of the QRS complex is below age norms.

Recall that for an average adult, a QRS complex voltage of no more than 0.5 mV in standard limb leads can be considered the norm. If this indicator is noticeably reduced or overestimated, this may indicate the development of a certain cardiological pathology in the patient.

In addition, after classical electrocardiography, physicians must evaluate the distance from the tops of the R waves to the tops of the S waves, analyzing the amplitude of the RS segment.

The amplitude of this indicator in the chest leads, taken as the norm, is 0.7 mV, if this indicator is noticeably reduced or overestimated - this can also indicate the occurrence of cardiological problems in the body.

It is customary to distinguish between peripheral reduced voltage, which is determined exclusively in leads from the limbs, as well as an indicator of general low voltage, when the amplitude of the complexes in question decreases in the chest and peripheral leads.

It cannot be said that a sharp increase in the amplitude of oscillation of the teeth on the electrocardiogram is quite rare, and just like a decrease in the indicators under consideration, it cannot be considered a variant of the norm! The problem can occur with hyperthyroidism, fevers, anemia, heart block, etc.

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Causes

Some decrease in the amplitude of fluctuations of the QRS complexes (low voltage on the ECG) can occur for various reasons and have a radically different value. Most often, such deviations in indicators occur due to cardiac or extracardiac causes.

At the same time, general violations metabolic processes in the heart muscle may not affect the size of the cardiogram waves at all.

Most common causes fixation of a drop in the amplitude of the records on the electrocardiogram can be associated with the following pathologies:

• pathological hypertrophy of the left ventricle;
• severe obesity;
• the development of emphysema;
• the formation of myxedema;
• development of rheumatic myocarditis, pericarditis;
• the formation of diffuse ischemic, toxic, inflammatory or infectious lesions of the heart muscle;
• the progress of sclerotic processes in the myocardium;
• development of dilated cardiomyopathy.

It should be noted that sometimes, the considered deviation on the ECG records may occur due to purely functional reasons. For example, a reduction in the intensity of cardiogram wave oscillations may be associated with an increase in tone. vagus nerve occurring in professional athletes.

In addition, in patients undergoing heart transplantation, the detection of low voltage on the electrocardiogram can be regarded by physicians as one of the symptoms of the development of rejection reactions.

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What diseases can it be?

It must be understood that the list of diseases, one of the signs of which can be considered the changes described above on the electrocardiogram, is incredibly extensive.

Note that such changes in cardiogram records may be inherent not only in cardiological diseases, but also in pulmonary endocrine or other pathologies.

Diseases, the development of which can be suspected after deciphering the ECG records, may be as follows:

• lung lesions - emphysema, primarily, as well as pulmonary edema;
• endocrine pathologies - diabetes, obesity, hypothyroidism and others;
• problems of a purely cardiological nature - ischemic heart disease, infectious lesions of the myocardium, myocarditis, pericarditis, endocarditis, sclerotic tissue lesions; cardiomyopathy of various origins.

What to do?

Primarily, each examined patient must understand that changes in the amplitude of wave oscillations on cardiograms are not a diagnosis at all. Any changes to records this study should only be assessed by an experienced cardiologist.

It is also impossible not to understand that electrocardiography is not the only and final criterion for establishing any diagnosis. To fix a certain pathology in a patient, a comprehensive comprehensive examination is necessary.

Depending on the health problems discovered after such an examination, doctors may prescribe certain medication or other treatment to patients.

Various cardiological problems can be eliminated with the help of cardioprotectors, antiarrhythmic drugs, sedatives and other medical procedures. In any case, self-treatment, with any changes in the cardiogram, is categorically unacceptable!

In conclusion, we note that any changes in the electrocardiogram should not lead to the patient's panic.

It is categorically unacceptable to independently evaluate the primary diagnostic findings obtained with the help of this study, because the data obtained are always additionally checked by physicians.

Establishing a correct diagnosis is possible only after taking an anamnesis, examining the patient, evaluating his complaints and analyzing the data obtained from certain instrumental examinations.

At the same time, only a doctor and no one else can judge the state of health of a particular patient with a cardiogram, which shows a decrease in the amplitude of indicators.

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What are the nuances of the ECG voltage you need to know? Reasons for the appearance in the diagnosis

What is voltage?

• 5 teeth (P, Q, R, S and T);
• ST segment;
• group of QRS waves.

Reasons for the appearance

• pulmonary edema;
• diabetes;
• hypothyroidism;
• cardiac ischemia;
• left ventricular hypertrophy;
• obesity;
• rheumatic myocarditis;
• pericarditis;
• myxedema;
• myocardial damage;
• dilated cardiomyopathy.

What to do?

• avitaminosis;
• unhealthy diet;
• chronic infections;
• anemia;
• myasthenia gravis;
• thyrotoxicosis;
• frequent stress;
• chronic fatigue, etc.

How is the treatment going?

• anabolic steroids;
• vitamin complexes;
• cardiac glycosides;

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Low voltage ECG - what is it?

Low voltage on ECG is a sign of myocardial dystrophy

The value of the QRS parameters can vary widely. At the same time, they, as a rule, have greater values ​​in chest leads than in standard ones. The norm is the value of the amplitude of the QRS teeth more than 0.5 cm (in the lead from the limbs or standard), as well as the value of 0.8 cm in the chest leads. If smaller values ​​are recorded, then they speak of a decrease in the parameters of the complex on the ECG.

Do not forget that clear normal values ​​\u200b\u200bof the amplitude of the teeth, depending on the thickness of the chest, as well as the type of physique, have not yet been determined. Since these parameters affect the electrocardiographic voltage. It is also important to consider the age norm.

Types of voltage reduction

There are two types: peripheral and general decline. If the ECG shows a decrease in the teeth only in the leads from the limbs, then they talk about peripheral change, if the amplitude is also reduced in the chest leads, then this is a general low voltage.

Decreased ECG voltage can have many causes

Reasons for low peripheral voltage:

• heart failure (congestive);
• emphysema;
• obesity;
• myxedema.

Total voltage may be reduced as a result of pericardial and cardiac causes. Pericardial causes include:

• pericardial effusion;
• pericarditis;
• adhesions of the pericardium.

• myocardial damage of an ischemic, toxic, infectious or inflammatory nature;
• amyloidosis;
• scleroderma;
• mucopolysaccharidosis.

Dilated cardiomyopathy leads to chronic heart failure

The amplitude of the teeth may be less than normal if the heart muscle is affected (dilated cardiomyopathy). Another reason for abnormal ECG parameters is treatment with cardiotoxic antimetabolites. As a rule, in this case, pathological changes on the electrocardiogram occur acutely and are accompanied by severe violations of the functional capabilities of the myocardium. If, after heart transplantation, the amplitude of the teeth is reduced, then this can be regarded as its rejection.

ECG changes in myocardial dystrophy

It should be noted that pathological changes on the cardiogram, manifested by a decrease in the parameters of the amplitude of the teeth, are often noted with dystrophic changes myocardium. The reasons leading to this are the following:

• acute and chronic infections;
• renal and hepatic intoxication;
• malignant tumors;
• exogenous intoxications caused by drugs, nicotine, lead, alcohol, etc.;
• diabetes;
• thyrotoxicosis;
• beriberi;
• anemia;
• obesity;
• physical stress;
• myasthenia gravis;
• stress, etc.

Dystrophic damage to the heart muscle is observed in many heart diseases, such as, inflammatory processes, ischemic disease, heart disease. On the ECG, the voltage of the teeth is reduced primarily by T. Some diseases may have certain features on the cardiogram. For example, with myxedema, the QRS wave parameters are below normal.

Treatment of this pathology

The goal of therapy for this electrocardiographic manifestation is to treat the disease that caused the pathological changes on the ECG. Also application medicines that improve nutritional processes in the myocardium and help eliminate electrolyte disturbances.

The main thing is that patients with such a pathology are prescribed anabolic steroids (nerobolil, retabolil) and nonsteroidal drugs(inosine, riboxin). Treatment is carried out with the help of vitamins (groups B, E), ATP, cocarboxylase. Assign funds containing: calcium, potassium and magnesium (for example, asparkam, panangin), oral cardiac glycosides in small doses.

According to the result of the ECG, the specialist will identify the problem and prescribe the necessary treatment.

For the preventive purpose of cardiac muscle dystrophy, it is recommended to timely treat the pathological processes leading to this. It is also necessary to prevent the development of beriberi, anemia, obesity, stressful situations etc.

Summing up, it should be noted that such a pathological change on the electrocardiogram as a decrease in voltage is a manifestation of many cardiac, as well as extracardiac diseases. This pathology is emergency treatment in order to improve the nutrition of the myocardium, as well as preventive measures that contribute to its prevention.

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ECG voltage

The ECG voltage is one of the main indicators that allows you to diagnose heart disease still on early stage. If the voltage is too high or too low, then there is a high risk of cardiopathy, pathological changes in the heart. To determine how this indicator affects further events, you first need to understand its essence.

What is voltage?

The voltage of an electrocardiogram is called changes in the amplitude of three teeth - QRS. To make a diagnosis, doctors pay attention to the following elements of the ECG:

• 5 teeth (P, Q, R, S and T);
• wave U (may appear, but not for everyone);
• ST segment;
• group of QRS waves.

The above indicators are considered basic. Any deviations from the norm change the voltage of the cardiogram. Pathology can be called changes in just three QRS teeth, which are evaluated in combination.

In other words, a low-voltage potential can be seen on the ECG during the work of the heart at the moment when the three QRS teeth are located below the accepted norms. For an adult, the QRS is considered to be no more than 0.5 mV. If the voltage diagnostic time exceeds the norm, cardiac pathology is unambiguously diagnosed.

An obligatory step in the analysis of the electrocardiogram is the assessment of the distance from the top of the R and S waves. The amplitude of this section should be normal at 0.7 mV.

Doctors divide the voltage into two groups: peripheral and general. Peripheral voltage makes it possible to evaluate parameters only from the limbs. The total voltage takes into account the results of both thoracic and peripheral leads.

Reasons for the appearance

The voltage can change in different directions, but more often it decreases. This is due to the action of cardiac or extracardiac causes. In addition, the metabolic processes that take place in the myocardium may in no way affect the amplitude of the teeth.

A decrease in voltage may indicate the course of heart disease, but sometimes this indicator indicates a pathology of the pulmonary or endocrine sphere. In such cases, the doctor prescribes an additional examination of the patient. The list of diseases associated with low voltage is long.

The most common pathologies:

• pulmonary edema;
• diabetes;
• hypothyroidism;
• cardiac ischemia;
• left ventricular hypertrophy;
• obesity;
• rheumatic myocarditis;
• pericarditis;
• development of sclerotic processes in the heart;
• myxedema;
• myocardial damage;
• dilated cardiomyopathy.

Changes in voltage can occur due to functional disorders in the work of the heart, for example, increased tone of the vagus nerve. Often this condition is diagnosed in professional athletes. The intensity of fluctuations of the teeth on the cardiogram is reduced.

Important! People who have undergone a heart transplant sometimes have low voltage on their ECGs. This indicator speaks of possible development rejection.

What to do?

Everyone who undergoes an ECG should understand that low or high voltage is not a diagnosis, but only an indicator. To establish an accurate diagnosis, cardiologists refer their patients to additional heart examinations.

If pathological processes are detected, the doctor will prescribe the appropriate treatment. It may be based on medications, switch to patient mode diet food, physical therapy.

Important! In this case, it is impossible to self-medicate, since you can only aggravate the situation of the disease. Only a doctor prescribes and cancels drugs or procedures.

What factors affect the voltage drop?

If the indicators on the cardiogram are higher or lower than normal, then the doctor must determine the cause of the changes. Often the amplitude decreases due to dystrophic pathologies of the heart muscle.

There are a number of reasons that affect this indicator:

• avitaminosis;
• unhealthy diet;
• chronic infections;
• liver and kidney failure;
• orgasmic intoxications, such as those caused by lead or nicotine;
• excessive consumption of alcoholic beverages;
• anemia;
• myasthenia gravis;
• prolonged physical activity;
• malignant neoplasms;
• thyrotoxicosis;
• frequent stress;
• chronic fatigue, etc.

Many chronic diseases can affect the performance of the heart, therefore, at the appointment with a cardiologist, all existing diseases should be taken into account.

How is the treatment going?

First of all, the doctor treats the disease that provokes low voltage on the ECG.

In parallel, a cardiologist may prescribe drugs that strengthen myocardial tissues and improve their metabolic processes. Often such patients are prescribed a reception:

• non-steroidal anti-inflammatory drugs;
• anabolic steroids;
• vitamin complexes;
• cardiac glycosides;
• preparations of calcium, magnesium and potassium.

The main aspect in solving this problem is to improve the nutrition of the heart muscle. Besides drug treatment, the patient must monitor his daily routine, nutrition and the absence of stressful situations. To consolidate the results of therapy, it is recommended to return to a healthy diet, normal sleep and moderate physical activity, if necessary, for example, in case of obesity.

Low voltage on the ECG means a decrease in the amplitude of the teeth, which can be noted in various leads (standard, chest, from the extremities). Such a pathological change on the electrocardiogram is characteristic of myocardial dystrophy, which is a manifestation of many diseases.

The value of the QRS parameters can vary widely. At the same time, they, as a rule, have greater values ​​in chest leads than in standard ones. The norm is the value of the amplitude of the QRS teeth more than 0.5 cm (in the lead from the limbs or standard), as well as the value of 0.8 cm in the chest leads. If smaller values ​​are recorded, then they speak of a decrease in the parameters of the complex on the ECG.

Do not forget that clear normal values ​​\u200b\u200bof the amplitude of the teeth, depending on the thickness of the chest, as well as the type of physique, have not yet been determined. Since these parameters affect the electrocardiographic voltage. It is also important to consider the age norm.

There are two types: peripheral and general decline. If the ECG shows a decrease in the teeth only in the leads from the extremities, then they speak of a peripheral change, if the amplitude is also reduced in the chest leads, then this is a general low voltage.

Reasons for low peripheral voltage:

• heart failure (congestive);
• emphysema;
• obesity;
• myxedema.

Total voltage may be reduced as a result of pericardial and cardiac causes. Pericardial causes include:

• myocardial damage of an ischemic, toxic, infectious or inflammatory nature;
• amyloidosis;
• scleroderma;
• mucopolysaccharidosis.

The amplitude of the teeth may be less than normal if the heart muscle is affected (dilated cardiomyopathy). Another reason for abnormal ECG parameters is treatment with cardiotoxic antimetabolites. As a rule, in this case, pathological changes on the electrocardiogram occur acutely and are accompanied by severe violations of the functional capabilities of the myocardium. If, after heart transplantation, the amplitude of the teeth is reduced, then this can be regarded as its rejection.

It should be noted that pathological changes on the cardiogram, manifested by a decrease in the parameters of the amplitude of the teeth, are often observed with dystrophic changes in the myocardium. The reasons leading to this are the following:

• acute and chronic infections;
• renal and hepatic intoxication;
• malignant tumors;
• exogenous intoxications caused by drugs, nicotine, lead, alcohol, etc.;
• diabetes;
• thyrotoxicosis;
• beriberi;
• anemia;
• obesity;
• physical stress;
• myasthenia gravis;
• stress, etc.

Dystrophic damage to the heart muscle is observed in many heart diseases, such as inflammatory processes, coronary disease, heart defects. On the ECG, the voltage of the teeth is reduced primarily by T. Some diseases may have certain features on the cardiogram. For example, with myxedema, the QRS wave parameters are below normal.

The goal of therapy for this electrocardiographic manifestation is to treat the disease that caused the pathological changes on the ECG. Also, the use of drugs that improve the nutritional processes in the myocardium and help eliminate electrolyte disorders.

The main thing is that patients with this pathology are prescribed anabolic steroids (nerobolil, retabolil) and nonsteroidal drugs (inosine, riboxin). Treatment is carried out with the help of vitamins (groups B, E), ATP, cocarboxylase. Assign funds containing: calcium, potassium and magnesium (for example, asparkam, panangin), oral cardiac glycosides in small doses.

For the preventive purpose of cardiac muscle dystrophy, it is recommended to timely treat the pathological processes leading to this. It is also necessary to prevent the development of beriberi, anemia, obesity, stressful situations, etc.

Summing up, it should be noted that such a pathological change on the electrocardiogram as a decrease in voltage is a manifestation of many cardiac, as well as extracardiac diseases. This pathology is subject to urgent treatment in order to improve the nutrition of the myocardium, as well as preventive measures that contribute to its prevention.

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In my conclusion, sinus arrhythmia is written, although the therapist said that the rhythm is correct, and visually the teeth are located at the same distance. How can this be?

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Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Electrocardiogram is a widely used method of objective diagnostics various pathologies of the human heart, which is used today almost everywhere. An electrocardiogram (ECG) is taken in a clinic, in an ambulance, or in a hospital department. An ECG is a very important recording that reflects the condition of the heart. That is why the reflection of the most different options Cardiac pathology on the ECG is described by a separate science - electrocardiography. Electrocardiography also deals with the problems of correct ECG recording, decoding issues, interpretation of controversial and unclear points, etc.

Definition and essence of the method

An electrocardiogram is a record of the work of the heart, which is represented as a curved line on paper. The cardiogram line itself is not chaotic, it has certain intervals, teeth and segments that correspond to certain stages of the heart.

To understand the essence of the electrocardiogram, you need to know what exactly the device called the electrocardiograph records. The ECG records the electrical activity of the heart, which changes cyclically, in accordance with the onset of diastole and systole. The electrical activity of the human heart may seem like a fantasy, but this unique biological phenomenon exists in reality. In reality, there are so-called cells of the conduction system in the heart, which generate electrical impulses that are transmitted to the muscles of the organ. It is these electrical impulses that cause the myocardium to contract and relax with a certain rhythm and frequency.

An electrical impulse propagates through the cells of the conduction system of the heart in a strictly sequential manner, causing contraction and relaxation of the corresponding departments - the ventricles and atria. The electrocardiogram reflects exactly the total electrical potential difference in the heart.

decoding?

An electrocardiogram can be taken at any clinic or general hospital. You can contact a private medical center where there is a specialist cardiologist or therapist. After recording the cardiogram, the tape with curves is examined by the doctor. It is he who analyzes the recording, deciphers it and writes the final conclusion, which reflects all visible pathologies and functional deviations from the norm.

An electrocardiogram is recorded using a special device - an electrocardiograph, which can be multi-channel or single-channel. The ECG recording speed depends on the modification and modernity of the device. Modern devices can be connected to a computer, which, if there is a special program, will analyze the recording and issue a ready-made conclusion immediately after the procedure is completed.

Any cardiograph has special electrodes that are applied in a strictly defined order. There are four clothespins in red, yellow, green and black, which are placed on both hands and both legs. If you go in a circle, then the clothespins are applied according to the "red-yellow-green-black" rule, from the right hand. Remembering this sequence is easy thanks to the student saying: "Every-Woman-Worst-Hell." In addition to these electrodes, there are also chest electrodes, which are installed in the intercostal spaces.

As a result, the electrocardiogram consists of twelve curves, six of which are recorded from chest electrodes, and are called chest leads. The remaining six leads are recorded from electrodes attached to the arms and legs, with three of them called standard and three more reinforced. The chest leads are designated V1, V2, V3, V4, V5, V6, the standard ones are simply Roman numerals - I, II, III, and the reinforced leg leads - the letters aVL, aVR, aVF. Different leads of the cardiogram are necessary to create the most complete picture of the activity of the heart, since some pathologies are visible on the chest leads, others on the standard leads, and still others on the enhanced ones.

The person lies down on the couch, the doctor fixes the electrodes and turns on the device. While the ECG is being written, the person should be absolutely calm. We must not allow the appearance of any stimuli that can distort the true picture of the work of the heart.

How to make an electrocardiogram with the subsequent
decoding - video

The principle of decoding the ECG

Since the electrocardiogram reflects the processes of contraction and relaxation of the myocardium, it is possible to trace how these processes proceed and to identify the existing pathological processes. The elements of the electrocardiogram are closely related, and reflect the duration of the phases of the cardiac cycle - systole and diastole, that is, contraction and subsequent relaxation. The interpretation of the electrocardiogram is based on the study of the teeth, from the position relative to each other, duration, and other parameters. For analysis, the following elements of the electrocardiogram are studied:
1. teeth.
2. intervals.
3. Segments.

All sharp and smooth bulges and concavities on the ECG line are called teeth. Each tooth is designated by a letter of the Latin alphabet. The P wave reflects the contraction of the atria, the QRS complex - the contraction of the ventricles of the heart, the T wave - the relaxation of the ventricles. Sometimes after the T wave on the electrocardiogram there is another U wave, but it does not have a clinical and diagnostic role.

An ECG segment is a segment enclosed between adjacent teeth. For diagnosing heart disease great importance play segments P - Q and S - T. The interval on the electrocardiogram is a complex that includes a tooth and an interval. The P-Q and Q-T intervals are of great importance for diagnosis.

Often in the conclusion of a doctor you can see small letters, which also represent teeth, intervals, and segments. Small letters are used if the prong is less than 5 mm long. In addition, several R-waves may appear in the QRS complex, which are commonly referred to as R ’, R ”, etc. Sometimes the R wave is simply missing. Then the whole complex is denoted by only two letters - QS. All this is of great diagnostic value.

ECG interpretation plan - a general scheme for reading the results

When deciphering the electrocardiogram, the following parameters are required to reflect the work of the heart:

• the position of the electrical axis of the heart;
• determination of the correctness of the heart rhythm and the conductivity of the electrical impulse (blockades, arrhythmias are detected);
• determination of the regularity of contractions of the heart muscle;
• determination of heart rate;
• identification of the source of the electrical impulse (determine whether the rhythm is sinus or not);
• analysis of the duration, depth and width of the atrial P wave and the P-Q interval;
• analysis of the duration, depth, width of the complex of teeth of the ventricles of the heart QRST;
• analysis of the parameters of the RS-T segment and the T wave;
• analysis of the parameters of the interval Q - T.

Based on all the studied parameters, the doctor writes a final conclusion on the electrocardiogram. The conclusion may look something like this: "Sinus rhythm with a heart rate of 65. Normal position of the electrical axis of the heart. Pathology was not detected." Or like this: "Sinus tachycardia with a heart rate of 100. Single supraventricular extrasystole. Incomplete blockade of the right leg of the His bundle. Moderate metabolic changes in the myocardium."

In the conclusion on the electrocardiogram, the doctor must necessarily reflect the following parameters:

• sinus rhythm or not;
• rhythm regularity;
• heart rate (HR);
• position of the electrical axis of the heart.

If any of the 4 pathological syndromes are identified, then indicate which ones - rhythm disturbance, conduction, overload of the ventricles or atria, and damage to the structure of the heart muscle (infarction, scar, dystrophy).

An example of decoding an electrocardiogram

At the very beginning of the electrocardiogram tape there should be a calibration signal, which looks like a capital letter "P" 10 mm high. If this calibration signal is absent, then the electrocardiogram is uninformative. If the height of the calibration signal is below 5 mm in standard and enhanced leads, and below 8 mm in the chest leads, then the electrocardiogram voltage is low, which is a sign of a number of heart pathologies. For the subsequent decoding and calculation of some parameters, it is necessary to know how much time fits into one cell of graph paper. At a tape speed of 25 mm / s, one cell 1 mm long is 0.04 seconds, and at a speed of 50 mm / s - 0.02 seconds.

Checking the regularity of heart beats

It is estimated by intervals R - R. If the teeth are located at the same distance from each other throughout the entire recording, then the rhythm is regular. Otherwise, it is called correct. Estimating the distance between the R-R waves is very simple: the electrocardiogram is recorded on graph paper, which makes it easy to measure any gaps in millimeters.

Calculation of heart rate (HR)

It is carried out by a simple arithmetic method: they count the number of large squares on graph paper that fit between two R teeth. Then the heart rate is calculated by the formula, which is determined by the speed of the tape in the cardiograph:
1. The belt speed is 50 mm/s - then the heart rate is 600 divided by the number of squares.
2. The belt speed is 25 mm/s - then the heart rate is 300 divided by the number of squares.

For example, if 4.8 large squares fit between two R teeth, then the heart rate, at a tape speed of 50 mm / s, will be 600 / 4.8 = 125 beats per minute.

If the rhythm of heart contractions is incorrect, then the maximum and minimum heart rates are determined, taking as a basis also the maximum and minimum distances between the R waves.

Finding the Source of the Rhythm

The doctor studies the rhythm of heart contractions and finds out which node of nerve cells causes cyclic processes of contractions and relaxations of the heart muscle. This is very important for determining blockades.

ECG interpretation - rhythms

Normally, the sinus ganglion is the pacemaker. And such a normal rhythm itself is called sinus - all other options are pathological. In various pathologies, any other node of the nerve cells of the conduction system of the heart can act as a pacemaker. In this case, cyclic electrical impulses are confused, and the rhythm of heart contractions is disturbed - an arrhythmia occurs.

In sinus rhythm on the electrocardiogram in lead II, there is a P wave in front of each QRS complex, and it is always positive. On one lead, all P waves should have the same shape, length and width.

With atrial rhythm the P wave in the II and III leads is negative, but is present in front of each QRS complex.

Atrioventricular rhythms characterized by the absence of P waves on cardiograms, or the appearance of this wave after the QRS complex, and not before it, as is normal. With this type of rhythm, the heart rate is low, ranging from 40 to 60 beats per minute.

Ventricular rhythm characterized by an increase in the width of the QRS complex, which becomes large and rather intimidating. The P waves and the QRS complex are completely unrelated to each other. That is, there is no strict correct normal sequence - the P wave, followed by the QRS complex. The ventricular rhythm is characterized by a decrease in heart rate - less than 40 beats per minute.

Identification of the pathology of the conduction of an electrical impulse in the structures of the heart

To do this, measure the duration of the P wave, the P-Q interval and the QRS complex. The duration of these parameters is calculated from the millimetric tape on which the cardiogram is recorded. First, consider how many millimeters each tooth or interval occupies, after which the resulting value is multiplied by 0.02 at a writing speed of 50 mm / s, or by 0.04 at a writing speed of 25 mm / s.

The normal duration of the P wave is up to 0.1 seconds, the P-Q interval is 0.12-0.2 seconds, the QRS complex is 0.06-0.1 seconds.

Electrical axis of the heart

Referred to as angle alpha. It can have a normal position, horizontal or vertical. Moreover, in a thin person, the axis of the heart is more vertical relative to the average values, and in full people it is more horizontal. The normal position of the electrical axis of the heart is 30-69 o , vertical - 70-90 o , horizontal - 0-29 o . Angle alpha, equal to from 91 to ±180 o reflects a sharp deviation of the electrical axis of the heart to the right. Angle alpha, equal to from 0 to -90 o , reflects a sharp deviation of the electrical axis of the heart to the left.

The electrical axis of the heart can deviate with various pathological conditions. For instance, hypertonic disease leads to a deviation to the right, a violation of conduction (blockade) can shift it to the right or left.

Atrial P wave

The atrial P wave should be:

• positive in I, II, aVF and chest leads (2, 3, 4, 5, 6);
• negative in aVR;
• biphasic (part of the tooth lies in the positive region, and part - in the negative) in III, aVL, V1.

The normal duration of P is no more than 0.1 seconds, and the amplitude is 1.5 - 2.5 mm.

Pathological forms of the P wave may indicate the following pathologies:
1. High and sharp teeth in II, III, aVF leads appear with hypertrophy of the right atrium ("cor pulmonale");
2. The P wave with two peaks with a large width in I, aVL, V5 and V6 leads indicates left atrial hypertrophy (for example, mitral valve disease).

P–Q interval

The P–Q interval has a normal duration of 0.12 to 0.2 seconds. An increase in the duration of the P-Q interval is a reflection of atrioventricular block. On the electrocardiogram, three degrees of atrioventricular (AV) blockade can be distinguished:

• I degree: simple prolongation of the P-Q interval with the preservation of all other complexes and teeth.
• II degree: prolongation of the P-Q interval with partial loss of some QRS complexes.
• III degree: lack of communication between the P wave and QRS complexes. In this case, the atria work in their own rhythm, and the ventricles in their own.

Ventricular QRST complex

The ventricular QRST-complex consists of the QRS-complex itself and the S-T segment. The normal duration of the QRST-complex does not exceed 0.1 seconds, and its increase is detected with blockade of the Hiss bundle legs.

QRS complex consists of three teeth, respectively Q, R and S. The Q wave is visible on the cardiogram in all leads except 1, 2 and 3 chest. A normal Q wave has an amplitude up to 25% of that of an R wave. The duration of the Q wave is 0.03 seconds. The R wave is recorded in absolutely all leads. The S wave is also visible in all leads, but its amplitude decreases from the 1st chest to the 4th, and in the 5th and 6th it may be completely absent. The maximum amplitude of this tooth is 20 mm.

The S–T segment is very important from a diagnostic point of view. It is by this tooth that one can detect myocardial ischemia, that is, a lack of oxygen in the heart muscle. Usually this segment runs along the isoline, in 1, 2 and 3 chest leads, it can rise up to a maximum of 2 mm. And in the 4th, 5th and 6th chest leads, the S-T segment can shift below the isoline by a maximum of half a millimeter. It is the deviation of the segment from the isoline that reflects the presence of myocardial ischemia.

T wave

The T wave is a reflection of the process of eventual relaxation in the cardiac muscle of the ventricles of the heart. Usually with a large amplitude of the R wave, the T wave will also be positive. Negative T wave is recorded normally only in lead aVR.

Q-T interval

The Q - T interval reflects the process of ultimately contracting in the myocardium of the ventricles of the heart.

ECG interpretation - norm indicators

The transcript of the electrocardiogram is usually recorded by the doctor in the conclusion. A typical example of a normal heart ECG looks like this:
1. PQ - 0.12 s.
2. QRS - 0.06 s.
3. QT - 0.31 s.
4. RR - 0.62 - 0.66 - 0.6.
5. Heart rate is 70 - 75 beats per minute.
6. sinus rhythm.
7. the electrical axis of the heart is located normally.

Normally, the rhythm should be only sinus, the heart rate of an adult is 60-90 beats per minute. The P wave is normally no more than 0.1 s, the P-Q interval is 0.12-0.2 seconds, the QRS complex is 0.06-0.1 seconds, Q-T is up to 0.4 s.

If the cardiogram is pathological, then specific syndromes and abnormalities are indicated in it (for example, partial blockade of the left leg of the Hiss bundle, myocardial ischemia, etc.). Also, the doctor can reflect specific violations and changes in the normal parameters of the teeth, intervals and segments (for example, shortening of the P wave or Q-T interval, etc.).

Deciphering the ECG in children and pregnant women

Generally in children and pregnant women normal performance cardiac electrocardiograms are the same as in healthy adults. However, there are certain physiological features. For example, the heart rate in children is higher than in adults. The normal heart rate of a child under 3 years of age is 100 - 110 beats per minute, 3-5 years - 90 - 100 beats per minute. Then gradually the heart rate decreases, and in adolescence it is compared with that of an adult - 60 - 90 beats per minute.

Pregnant women may have a slight deviation of the electrical axis of the heart by later dates gestation due to compression by the growing uterus. In addition, sinus tachycardia often develops, that is, an increase in heart rate up to 110 - 120 beats per minute, which is functional state and passes on its own. An increase in heart rate is associated with a large volume of circulating blood and increased workload. Due to the increased load on the heart in pregnant women, an overload of various parts of the organ can be detected. These phenomena are not a pathology - they are associated with pregnancy, and will pass on their own after childbirth.

Deciphering an electrocardiogram in a heart attack

Myocardial infarction is a sharp cessation of oxygen supply to the cells of the heart muscles, as a result of which necrosis of a tissue site that has been in a state of hypoxia develops. The reason for the violation of oxygen supply can be different - most often it is a blockage of a blood vessel, or its rupture. The infarction captures only part of the muscle tissue of the heart, and the extent of the lesion depends on the size blood vessel that is clogged or torn. On the electrocardiogram, myocardial infarction has certain signs by which it can be diagnosed.

In the process of development of myocardial infarction, four stages are distinguished, which have different manifestations on the ECG:

• acute;
• acute;
• subacute;
• cicatricial.

Acute stage myocardial infarction can last for 3 hours - 3 days from the moment of circulatory disorders. At this stage, the Q wave may be absent on the electrocardiogram. If it is present, then the R wave has a low amplitude, or is completely absent. In this case, there is a characteristic QS wave reflecting a transmural infarct. Second sign acute heart attack- this is an increase in the S-T segment by at least 4 mm above the isoline, with the formation of one large T wave.

Sometimes it is possible to catch the phase of myocardial ischemia preceding the most acute one, which is characterized by high T waves.

Acute stage myocardial infarction lasts 2-3 weeks. During this period, a wide and high-amplitude Q wave and a negative T wave are recorded on the ECG.

Subacute stage lasts up to 3 months. A very large negative T wave with a huge amplitude is recorded on the ECG, which gradually normalizes. Sometimes the rise of the S-T segment is revealed, which should have leveled off by this period. This is an alarming symptom, as it may indicate the formation of an aneurysm of the heart.

Cicatricial stage a heart attack is the final one, since a connective tissue is formed at the damaged site, incapable of contraction. This scar is recorded on the ECG in the form of a Q wave, which will remain for life. Often the T wave is flattened, has a low amplitude, or is completely negative.

Deciphering the most common ECGs

In conclusion, doctors write the result ECG decoding, which is often incomprehensible, since it consists of terms, syndromes, and simply a statement of pathophysiological processes. Consider the most common ECG findings that are incomprehensible to a person without a medical education.

Ectopic rhythm means not sinus - which can be both a pathology and a norm. The ectopic rhythm is the norm when there is a congenital abnormal formation of the conduction system of the heart, but the person does not make any complaints and does not suffer from other cardiac pathologies. In other cases, an ectopic rhythm indicates the presence of blockades.

Change in repolarization processes on the ECG reflects a violation of the process of relaxation of the heart muscle after contraction.

Sinus rhythm is the normal heart rate of a healthy person.

Sinus or sinusoidal tachycardia means that a person has a regular and regular rhythm, but an increased heart rate - more than 90 beats per minute. In young people under 30 years of age, it is a variant of the norm.

Sinus bradycardia- This is a low number of heartbeats - less than 60 beats per minute against the background of a normal, regular rhythm.

Nonspecific ST-T wave changes mean that there are minor deviations from the norm, but their cause may be completely unrelated to the pathology of the heart. Must pass full examination. Such non-specific ST-T changes can develop with an imbalance of potassium, sodium, chloride, magnesium ions, or various endocrine disorders, often during menopause in women.

Biphasic R wave in conjunction with other signs of a heart attack indicates damage to the anterior wall of the myocardium. If no other signs of a heart attack are detected, then a biphasic R wave is not a sign of pathology.

QT prolongation may indicate hypoxia (lack of oxygen), rickets, or overexcitation nervous system in a child, which is a consequence of birth trauma.

Myocardial hypertrophy means that muscular wall the heart is thickened, and works with a huge load. This may result in:

• heart failure;
• arrhythmias.

Also, myocardial hypertrophy can be a consequence of myocardial infarction.

Moderate diffuse changes in the myocardium mean that the nutrition of tissues is disturbed, dystrophy of the heart muscle has developed. This is a reparable condition: you need to see a doctor and undergo an adequate course of treatment, including the normalization of nutrition.

Deviation of the electrical axis of the heart (EOS) left or right is possible with hypertrophy of the left or right ventricle, respectively. EOS can deviate to the left in obese people, and to the right in thin people, but in this case this is a variant of the norm.

Left type ECG- EOS deviation to the left.

NBPNPG- an abbreviation for "incomplete blockade of the right leg of the bundle of His". This condition can occur in newborns, and is a variant of the norm. In rare cases, NBBBB can cause arrhythmia, but generally does not lead to the development of negative consequences. The blockade of the bundle of Hiss is quite common in people, but if there are no complaints about the heart, then this is absolutely not dangerous.

BPVLNPG- an abbreviation meaning "blockade of the anterior branch of the left leg of the bundle of His". It reflects a violation of the conduction of an electrical impulse in the heart, and leads to the development of arrhythmias.

Small R wave growth in V1-V3 may be a sign of ventricular septal infarction. To accurately determine if this is the case, another ECG study needs to be done.

CLC syndrome(Klein-Levy-Kritesko syndrome) is a congenital feature of the conduction system of the heart. May cause arrhythmias. This syndrome does not require treatment, but it is necessary to be regularly examined by a cardiologist.

Low voltage ECG often recorded with pericarditis (large volume connective tissue in the heart, replacing the muscle). Moreover, this feature may be a reflection of exhaustion or myxedema.

Metabolic changes are a reflection of malnutrition of the heart muscle. It is necessary to be examined by a cardiologist and undergo a course of treatment.

Conduction retardation means that the nerve impulse passes through the tissues of the heart more slowly than normal. By itself, this condition does not require special treatment- this may be a congenital feature of the conduction system of the heart. Regular follow-up with a cardiologist is recommended.

Blockade 2 and 3 degrees reflects a serious violation of the conduction of the heart, which is manifested by arrhythmia. In this case, treatment is necessary.

Rotation of the heart with the right ventricle forward may be an indirect sign of the development of hypertrophy. In this case, it is necessary to find out its cause, and undergo a course of treatment, or adjust the diet and lifestyle.

The price of an electrocardiogram with a transcript

The cost of an electrocardiogram with decoding varies significantly, depending on the specific medical institution. So, in public hospitals and clinics, the minimum price for the procedure for taking an ECG and decoding it by a doctor is from 300 rubles. In this case, you will receive films with recorded curves and a doctor's conclusion on them, which he will make himself, or with the help of a computer program.

If you want to get a thorough and detailed conclusion on the electrocardiogram, an explanation by the doctor of all parameters and changes, it is better to contact a private clinic that provides such services. Here the doctor will be able not only to write a conclusion by deciphering the cardiogram, but also to calmly talk to you, slowly explaining all the points of interest. However, the cost of such a cardiogram with decoding in private medical center ranges from 800 rubles to 3600 rubles. You should not assume that bad specialists work in an ordinary clinic or hospital - just a doctor in public institution, as a rule, a very large amount of work, so he simply does not have time to talk with each patient in great detail.

Types of voltage reduction

• emphysema;
• obesity;
• myxedema.

• amyloidosis;
• scleroderma;
• mucopolysaccharidosis.

• malignant tumors;
• diabetes;
• thyrotoxicosis;
• beriberi;
• anemia;
• obesity;
• physical stress;
• myasthenia gravis;
• stress, etc.

Treatment of this pathology

In my conclusion, sinus arrhythmia is written, although the therapist said that the rhythm is correct, and visually the teeth are located at the same distance. How can this be?

Low voltage ECG - what is it?

Low voltage on the ECG means a decrease in the amplitude of the teeth, which can be noted in various leads (standard, chest, from the extremities). Such a pathological change on the electrocardiogram is characteristic of myocardial dystrophy, which is a manifestation of many diseases.

Low voltage on ECG is a sign of myocardial dystrophy

The value of the QRS parameters can vary widely. At the same time, they, as a rule, have greater values ​​in chest leads than in standard ones. The norm is the value of the amplitude of the QRS teeth more than 0.5 cm (in the lead from the limbs or standard), as well as the value of 0.8 cm in the chest leads. If smaller values ​​are recorded, then they speak of a decrease in the parameters of the complex on the ECG.

Do not forget that clear normal values ​​\u200b\u200bof the amplitude of the teeth, depending on the thickness of the chest, as well as the type of physique, have not yet been determined. Since these parameters affect the electrocardiographic voltage. It is also important to consider the age norm.

Types of voltage reduction

There are two types: peripheral and general decline. If the ECG shows a decrease in the teeth only in the leads from the extremities, then they speak of a peripheral change, if the amplitude is also reduced in the chest leads, then this is a general low voltage.

Decreased ECG voltage can have many causes

Reasons for low peripheral voltage:

• heart failure (congestive);
• emphysema;
• obesity;
• myxedema.

Total voltage may be reduced as a result of pericardial and cardiac causes. Pericardial causes include:

• pericardial effusion;
• pericarditis;
• adhesions of the pericardium.

• myocardial damage of an ischemic, toxic, infectious or inflammatory nature;
• amyloidosis;
• scleroderma;
• mucopolysaccharidosis.

Dilated cardiomyopathy leads to chronic heart failure

The amplitude of the teeth may be less than normal if the heart muscle is affected (dilated cardiomyopathy). Another reason for abnormal ECG parameters is treatment with cardiotoxic antimetabolites. As a rule, in this case, pathological changes on the electrocardiogram occur acutely and are accompanied by severe violations of the functional capabilities of the myocardium. If, after heart transplantation, the amplitude of the teeth is reduced, then this can be regarded as its rejection.

ECG changes in myocardial dystrophy

It should be noted that pathological changes on the cardiogram, manifested by a decrease in the parameters of the amplitude of the teeth, are often observed with dystrophic changes in the myocardium. The reasons leading to this are the following:

• acute and chronic infections;
• renal and hepatic intoxication;
• malignant tumors;
• exogenous intoxications caused by drugs, nicotine, lead, alcohol, etc.;
• diabetes;
• thyrotoxicosis;
• beriberi;
• anemia;
• obesity;
• physical stress;
• myasthenia gravis;
• stress, etc.

Dystrophic damage to the heart muscle is observed in many heart diseases, such as inflammatory processes, coronary disease, heart defects. On the ECG, the voltage of the teeth is reduced primarily by T. Some diseases may have certain features on the cardiogram. For example, with myxedema, the QRS wave parameters are below normal.

Treatment of this pathology

The goal of therapy for this electrocardiographic manifestation is to treat the disease that caused the pathological changes on the ECG. Also, the use of drugs that improve the nutritional processes in the myocardium and help eliminate electrolyte disorders.

The main thing is that patients with this pathology are prescribed anabolic steroids (nerobolil, retabolil) and nonsteroidal drugs (inosine, riboxin). Treatment is carried out with the help of vitamins (groups B, E), ATP, cocarboxylase. Assign funds containing: calcium, potassium and magnesium (for example, asparkam, panangin), oral cardiac glycosides in small doses.

According to the result of the ECG, the specialist will identify the problem and prescribe the necessary treatment.

For the preventive purpose of cardiac muscle dystrophy, it is recommended to timely treat the pathological processes leading to this. It is also necessary to prevent the development of beriberi, anemia, obesity, stressful situations, etc.

Summing up, it should be noted that such a pathological change on the electrocardiogram as a decrease in voltage is a manifestation of many cardiac, as well as extracardiac diseases. This pathology is subject to urgent treatment in order to improve the nutrition of the myocardium, as well as preventive measures that contribute to its prevention.

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Electrocardiogram (ECG) in diseases and heart syndromes

Acute cor pulmonale:

Acute cor pulmonale develops with a sharp increase in pressure in the pulmonary circulation, which leads to overload and dilatation of the right ventricle and atrium. Most often, the development of acute cor pulmonale due to thromboembolism pulmonary artery, severe asthmatic condition, pulmonary edema, pneumothorax, massive pneumonia and other lung lesions.

In some cases, atrial fibrillation occurs.

Myocarditis:

In patients with myocarditis of various etiologies, the ECG has no specific changes. More often in a number of leads, changes in the T wave are detected, which can be smoothed or not deeply inverted. Less commonly, there is a slight depression of the ST segment, sometimes the rise of this segment, which may indicate a concomitant lesion of the pericardium.

With small focal lesions, the electrocardiographic picture may be normal.

Pericarditis:

In patients with various types of pericarditis, as a rule, characteristic ECG changes. In dry fibrinous pericarditis in the acute period, ECG changes are associated with concomitant damage to the subepicardial layers of the myocardium. At the same time, there is an upward shift of the ST segment in many leads. The ST segment remains elevated for several days to several weeks, then it approaches the isoelectric line, and the T wave may invert. Unlike myocardial infarction, these changes develop more slowly, are detected in many leads, there is usually no discordant downward displacement of the ST segment, and there is no pathological Q wave.

The voltage of the QRS complex decreases especially sharply in the limb leads. There may be shift of the ST segment above or below the isoline, as well as inversion of the T wave in various leads.

Cardiomyopathy:

This is a group of diffuse myocardial lesions of unknown etiology. There are hypertrophic, dilated and restrictive cardiomyopathy.

Electrolyte imbalance:

Electrocardiogram with an overdose of cardiac glycosides:

With an overdose of cardiac glycosides, potassium ions are released from the cell and, conversely, an increase in the content of intracellular calcium. This leads to changes in the final part of the ventricular complex, which are very characteristic of saturation and intoxication with cardiac glycosides - segment S-T and the T wave.

Electrocardiogram for alcoholic myocardial dystrophy:

Damage to the heart muscle in chronic alcoholism is caused by the direct toxic effect of ethanol on the myocardium, as well as a deficiency of B vitamins associated with malnutrition.

Electrocardiogram for thyrotoxic myocardial dystrophy:

Mild degrees of thyrotoxicosis are usually accompanied by electrocardiographic signs of increased activity of the sympathetic nervous system: sinus tachycardia, an increase in the amplitude of the P and T waves in II and III leads, and an increase in the T wave in the chest leads.

Electrocardiogram for menopausal and dyshormonal myocardial dystrophy:

Often in women with severe dyshormonal disorders, in menopause ECG reveals changes in the terminal part of the ventricular complex, similar to those in coronary heart disease: the formation of a high positive, biphasic or negative T wave and, less often, a decrease in the ST segment. These changes are observed more often in chest assignments. In contrast to coronary heart disease in menopausal and dyshormonal myocardial dystrophy, the shift of the ST segment and especially the change in the T wave quickly normalize during a functional stress test with potassium or obzidan. A clear positive test is therefore an important differential diagnostic criterion, indicating a greater likelihood of dyshormonal myocardial dystrophy and making the diagnosis of coronary heart disease doubtful. However, it should be remembered that the results of the test are not an absolute differential diagnostic sign.

Electrocardiogram with lesions of the central nervous system:

Various lesions of the central nervous system may be accompanied by electrocardiographic changes, most pronounced in patients with craniocerebral injuries, especially subarachnoid hemorrhages. The described changes are observed in patients with brain tumors, its infectious lesions, as well as during neurosurgical operations. For damage to the central nervous system, changes in the final part of the ventricular ECG complex, in particular, an increase in the amplitude of the T wave or, conversely, its smoothness and inversion.

Long QT syndromes - syndromes of delayed ventricular repolarization:

Main clinical manifestation long QT syndromes - attacks of loss of consciousness - usually associated with the development of fibrillation or ventricular flutter; less often during attacks, asystole of the heart is recorded. With these syndromes, attacks of paroxysmal ventricular tachycardia or ventricular flutter of the "pirouette" type. These seizures are characterized by a bidirectional fusiform form on the ECG due to the changing direction of the leading teeth of the ventricular complexes, the absence of strict rhythm. These attacks are short, stop spontaneously, but can transform into ventricular fibrillation.

Dextrocardia:

Dextrocardia due to a mirror-like change in the topography of the heart relative to the sagittal plane and its displacement to the right determines the orientation of the vector P, QRS and T to the right, i.e. to the minus of lead I and to the positive pole of lead III.

What are the nuances of the ECG voltage you need to know? Reasons for the appearance in the diagnosis

The ECG voltage is one of the main indicators that allows you to diagnose heart disease at an early stage. If the voltage is too high or too low, then there is a high risk of cardiopathy, pathological changes in the heart. To determine how this indicator affects further events, you first need to understand its essence.

What is voltage?

The voltage of an electrocardiogram is called changes in the amplitude of three teeth - QRS. To make a diagnosis, doctors pay attention to the following elements of the ECG:

• 5 teeth (P, Q, R, S and T);
• wave U (may appear, but not for everyone);
• ST segment;
• group of QRS waves.

The above indicators are considered basic. Any deviations from the norm change the voltage of the cardiogram. Pathology can be called changes in just three QRS teeth, which are evaluated in combination.

In other words, a low-voltage potential can be seen on the ECG during the work of the heart at the moment when the three QRS teeth are located below the accepted norms. For an adult, the QRS is considered to be no more than 0.5 mV. If the voltage diagnostic time exceeds the norm, cardiac pathology is unambiguously diagnosed.

An obligatory step in the analysis of the electrocardiogram is the assessment of the distance from the top of the R and S waves. The amplitude of this section should be normal at 0.7 mV.

Doctors divide the voltage into two groups: peripheral and general. Peripheral voltage makes it possible to evaluate parameters only from the limbs. The total voltage takes into account the results of both thoracic and peripheral leads.

Reasons for the appearance

The voltage can change in different directions, but more often it decreases. This is due to the action of cardiac or extracardiac causes. In addition, the metabolic processes that take place in the myocardium may in no way affect the amplitude of the teeth.

A decrease in voltage may indicate the course of heart disease, but sometimes this indicator indicates a pathology of the pulmonary or endocrine sphere. In such cases, the doctor prescribes an additional examination of the patient. The list of diseases associated with low voltage is long.

The most common pathologies:

• pulmonary edema;
• diabetes;
• hypothyroidism;
• cardiac ischemia;
• left ventricular hypertrophy;
• obesity;
• rheumatic myocarditis;
• pericarditis;
• development of sclerotic processes in the heart;
• myxedema;
• myocardial damage;
• dilated cardiomyopathy.

Changes in voltage can occur due to functional disorders in the work of the heart, for example, increased tone of the vagus nerve. Often this condition is diagnosed in professional athletes. The intensity of fluctuations of the teeth on the cardiogram is reduced.

Important! People who have undergone a heart transplant sometimes have low voltage on their ECGs. This indicator indicates the possible development of rejection.

What to do?

Everyone who undergoes an ECG should understand that low or high voltage is not a diagnosis, but only an indicator. To establish an accurate diagnosis, cardiologists refer their patients to additional heart examinations.

If pathological processes are detected, the doctor will prescribe the appropriate treatment. It can be based on taking medications, include dietary nutrition, physiotherapy exercises in the patient's regimen.

Important! In this case, it is impossible to self-medicate, since you can only aggravate the situation of the disease. Only a doctor prescribes and cancels drugs or procedures.

What factors affect the voltage drop?

If the indicators on the cardiogram are higher or lower than normal, then the doctor must determine the cause of the changes. Often the amplitude decreases due to dystrophic pathologies of the heart muscle.

There are a number of reasons that affect this indicator:

• avitaminosis;
• unhealthy diet;
• chronic infections;
• liver and kidney failure;
• orgasmic intoxications, such as those caused by lead or nicotine;
• excessive consumption of alcoholic beverages;
• anemia;
• myasthenia gravis;
• prolonged physical activity;
• malignant neoplasms;
• thyrotoxicosis;
• frequent stress;
• chronic fatigue, etc.

Many chronic diseases can affect the performance of the heart, therefore, at the appointment with a cardiologist, all existing diseases should be taken into account.

How is the treatment going?

First of all, the doctor treats the disease that provokes low voltage on the ECG.

In parallel, a cardiologist may prescribe drugs that strengthen myocardial tissues and improve their metabolic processes. Often such patients are prescribed a reception:

• non-steroidal anti-inflammatory drugs;
• anabolic steroids;
• vitamin complexes;
• cardiac glycosides;
• preparations of calcium, magnesium and potassium.

The main aspect in solving this problem is to improve the nutrition of the heart muscle. In addition to drug treatment, the patient must monitor his daily routine, nutrition and the absence of stressful situations. To consolidate the results of therapy, it is recommended to return to a healthy diet, normal sleep and moderate physical activity, if necessary, for example, in case of obesity.

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Decreased voltage on cardiography - what is it about?

Most of us clearly understand that electrocardiography is a simple, affordable technique for recording, as well as the subsequent analysis of electrical fields that can form during the functioning of the heart muscle.

It's no secret that the ECG procedure is widespread in modern cardiology practice, as it allows you to detect many cardiovascular diseases.

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However, not all of us know and understand what specific terms related to this diagnostic procedure can mean. We are talking, first of all, about such a concept as voltage (low, high) on the ECG.

In today's publication, we propose to understand what ECG voltage is, and to understand whether it is good or bad when this indicator is reduced / increased.

What is this indicator?

A classic or standard ECG displays a graph of the work of our heart, which clearly defines:

1. Five teeth (P, Q, R, S and T) - they can have a different look, be embedded in the concept of the norm or be deformed.
2. In some cases, the U wave is normal and should be barely noticeable.
3. QRS complex formed from individual teeth.
4. ST segment, etc.

So, pathological changes in the amplitude of the indicated complex of three QRS teeth are considered to be indicators significantly higher / lower than age norms.

In other words, low voltage, noticeable on a classic ECG, is such a state of a graphical representation of the potential difference (formed during the work of the heart and brought to the surface of the body), in which the amplitude of the QRS complex is below age norms.

Recall that for an average adult, a QRS complex voltage of no more than 0.5 mV in standard limb leads can be considered the norm. If this indicator is noticeably reduced or overestimated, this may indicate the development of a certain cardiological pathology in the patient.

In addition, after classical electrocardiography, physicians must evaluate the distance from the tops of the R waves to the tops of the S waves, analyzing the amplitude of the RS segment.

The amplitude of this indicator in the chest leads, taken as the norm, is 0.7 mV, if this indicator is noticeably reduced or overestimated - this can also indicate the occurrence of cardiological problems in the body.

It is customary to distinguish between peripheral reduced voltage, which is determined exclusively in leads from the limbs, as well as an indicator of general low voltage, when the amplitude of the complexes in question decreases in the chest and peripheral leads.

It cannot be said that a sharp increase in the amplitude of oscillation of the teeth on the electrocardiogram is quite rare, and just like a decrease in the indicators under consideration, it cannot be considered a variant of the norm! The problem can occur with hyperthyroidism, fevers, anemia, heart block, etc.

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Causes

Some decrease in the amplitude of fluctuations of the QRS complexes (low voltage on the ECG) can occur for various reasons and have a radically different value. Most often, such deviations in indicators occur due to cardiac or extracardiac causes.

At the same time, generalized metabolic disorders in the heart muscle may not affect the size of the cardiogram waves at all.

The most common reasons for fixing a drop in the amplitude of records on an electrocardiogram can be associated with the following pathologies:

• pathological hypertrophy of the left ventricle;
• severe obesity;
• the development of emphysema;
• the formation of myxedema;
• development of rheumatic myocarditis, pericarditis;
• the formation of diffuse ischemic, toxic, inflammatory or infectious lesions of the heart muscle;
• the progress of sclerotic processes in the myocardium;
• development of dilated cardiomyopathy.

It should be noted that sometimes, the considered deviation on the ECG records may occur due to purely functional reasons. For example, a decrease in the intensity of cardiogram wave oscillations may be associated with an increase in the tone of the vagus nerve that occurs in professional athletes.

In addition, in patients undergoing heart transplantation, the detection of low voltage on the electrocardiogram can be regarded by physicians as one of the symptoms of the development of rejection reactions.

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What diseases can it be?

It must be understood that the list of diseases, one of the signs of which can be considered the changes described above on the electrocardiogram, is incredibly extensive.

Note that such changes in cardiogram records may be inherent not only in cardiological diseases, but also in pulmonary endocrine or other pathologies.

Diseases, the development of which can be suspected after deciphering the ECG records, may be as follows:

• lung lesions - emphysema, primarily, as well as pulmonary edema;
• endocrine pathologies - diabetes, obesity, hypothyroidism and others;
• problems of a purely cardiological nature - ischemic heart disease, infectious lesions of the myocardium, myocarditis, pericarditis, endocarditis, sclerotic tissue lesions; cardiomyopathy of various origins.

What to do?

Primarily, each examined patient must understand that changes in the amplitude of wave oscillations on cardiograms are not a diagnosis at all. Any changes to the records of this study should only be evaluated by an experienced cardiologist.

It is also impossible not to understand that electrocardiography is not the only and final criterion for establishing any diagnosis. To fix a certain pathology in a patient, a comprehensive comprehensive examination is necessary.

Depending on the health problems discovered after such an examination, doctors may prescribe certain medication or other treatment to patients.

Various cardiac problems can be eliminated with the help of cardioprotectors, antiarrhythmic drugs, sedatives and other medical procedures. In any case, self-treatment, with any changes in the cardiogram, is categorically unacceptable!

In conclusion, we note that any changes in the electrocardiogram should not lead to the patient's panic.

It is categorically unacceptable to independently evaluate the primary diagnostic findings obtained with the help of this study, because the data obtained are always additionally checked by physicians.

Establishing a correct diagnosis is possible only after taking an anamnesis, examining the patient, evaluating his complaints and analyzing the data obtained from certain instrumental examinations.

At the same time, only a doctor and no one else can judge the state of health of a particular patient with a cardiogram, which shows a decrease in the amplitude of indicators.

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On a standard ECG, pathological changes in the amplitude of the QRS complex can be both above and below the age norm.
Low voltage - the amplitude of the QRS complexes below the age norm (in adults, respectively, less than 0.5 mV in the limb leads).

At the same time, the distance from the top of the R wave to the top of the S wave (RS amplitude) is measured. To meet the low voltage criterion, the chest lead amplitude must be less than 0.7 mV. Distinguish between peripheral low voltage, which is determined only in the limb leads, and general low voltage with a decrease in amplitudes in the chest leads. The causes of peripheral low voltage can be varied. The most common are extracardiac causes that cause a decrease in potentials recorded from the body surface. These include, for example, severe obesity, pulmonary emphysema and myxedema. Also, the sagittal location of the electrical axis of the heart, which occurs in adolescents, may cause peripheral low voltage due to deviation total vector in the frontal plane.
A general low voltage in all leads can be observed in diseases of the pericardium and myocardium. Pericardial causes: pericardial effusion and pericardial adhesions. Cardiac causes occur in diffuse ischemic, toxic, inflammatory and infectious lesions of the myocardium, as well as in metabolic diseases (amyloidosis, scleroderma and mucopolysaccharidosis). An example of cardiac etiology is also considered low voltage in dilated cardiomyopathy as a sign of myocardial damage (Fig. 16-1) or during therapy with cardiotoxic antimetabolites (daunorubicin, doxorubicin). In the latter case, low voltage may occur acutely or over time and is usually accompanied by severe myocardial dysfunction. In patients after heart transplantation, a new low voltage can be regarded as a symptom of a rejection reaction.

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Rice. 16-1. Peripheral low voltage in a 7-year-old boy with dilated cardiomyopathy.

An increase in the amplitude of the QRS complexes is referred to as high voltage. At the same time, the amplitudes in the leads from the extremities are 2-3 mm higher than normal, in the chest leads they can be even higher. General high voltage is generally rare. The reason is the small distance between the heart and the anterior chest wall (for example, with an asthenic physique or in premature babies, as well as with anomalies in the position of the heart). Less commonly observed in hyperthyroidism, anemia, or fever due to an increase in cardiac output (MOV).
It is necessary to differentiate the high amplitude of the QRS complex, which occurs due to abnormal propagation of excitation through the myocardium. Examples are bundle branch blocks, preexcitation syndromes, and pacemaker-induced ventricular pacing.

Usually lateral walls of both ventricles depolarize at the same time because both legs A-B beam conduct a cardiac impulse to the ventricular myocardium at the same time. As a result, the potentials arising in both ventricles (in two opposite sides of the heart) neutralize each other. Blockade of one of the legs of the bundle leads to the fact that the cardiac impulse begins to propagate in the normal ventricle long before it begins to spread in the other ventricle. Thus, the depolarization of the two ventricles does not develop simultaneously, and the emerging potentials cannot neutralize each other, therefore, a deviation of the electrical axis of the heart occurs.

Vector Analysis deviations of the electrical axis of the heart in the blockade of the left leg of the A-B bundle. With blockade of the left leg of the A-B bundle, the depolarization of the right ventricle proceeds 2-3 times faster than the depolarization of the left ventricle. Consequently, a significant part of the left ventricular myocardium remains unexcited for 0.1 sec after complete depolarization of the right ventricle. In other words, the right ventricle becomes electronegative while the left ventricle remains mostly electropositive.

A powerful vector is being formed, directed from right to left, which leads to a deviation of the electrical axis of the heart to the left up to -50 °. It should be added that the slow depolarization of the affected part of the heart leads not only to the deviation of the electrical axis to the left, but also to an increase in the duration of the QRS complex. Significant widening of the QRS complex on an electrocardiogram is important feature, helping to distinguish the blockade of one of the legs of the A-B bundle from the hypertrophy of one of the ventricles.

Vector analysis of deviation of the electrical axis of the heart with blockade of the right leg of the A-B bundle. With blockade of the right leg of the A-B bundle, the left ventricle depolarizes much faster than the right ventricle, so the left ventricle becomes electronegative 0.1 sec earlier than the right one. This leads to the formation of a powerful vector directed from left to right (from the electronegative left ventricle to the electropositive right). There is a deviation of the electrical axis of the heart to the right, as shown in the figure, where the position of the electrical axis corresponds to + 105 ° (instead of the usual + 59 °). Also noteworthy is the increase in the duration of the QRS complex associated with delayed conduction.

ECG voltage increase

In three standard leads, the voltage, measured from the top of the R wave to the top of the S wave, is 0.5 to 2.0 mV. The smallest amplitude of the teeth is noted in standard lead III, and the largest - in lead II. However, this ratio can vary even in the norm. In general, if the sum of the voltages of all QRS waves in all three leads is greater than 4 mV, the patient is considered to have a high-amplitude electrocardiogram.

Cause high voltage QRS complex most often there is an increase muscle mass heart associated with hypertrophy of one or another part of the heart in response to increased load. For example, right ventricular hypertrophy develops in patients with pulmonary valve stenosis, and left ventricular hypertrophy in patients with high blood pressure. An increase in the muscle mass of the heart contributes to the emergence of stronger currents in the heart and surrounding tissues. As a result, the electrical potentials recorded in the electrocardiographic leads are larger than normal.