Voltage is normal. What does high voltage ecg mean. Where are the lymph nodes in humans, in detail

When taking a cardiogram, they first look at the ECG voltage as a very important indicator. What can be learned when decoding this parameter? Electrocardiography is a recording tape for subsequent decoding and analysis of the indicators of the electric field that is generated by the heart muscle in the course of its activity.

Thanks to ECG studies, it is possible to identify many heart diseases at an early stage of their development and begin adequate and timely treatment. But not everyone understands the terms that are used in this type of diagnosis, including the concept of high or low electrocardiogram voltage. Therefore, it is necessary to understand the very concept of cardiogram voltage, as well as whether it is good or bad if this indicator is reduced or increased.

What is an indicator?

The standard ECG graph reflects the dynamics of changes in the electric field of the heart and consists of such elements as:

1. 1. Teeth P, Q, R, S, T. These elements can be normal or deformed.
2. 2. The normal U wave should be very smooth and barely visible on the ECG.
3. 3. The QRS waves all together form a separate complex or segment.

When the voltage of the electrocardiogram is pathologically low or, on the contrary, it is overestimated, this indicates the beginning of the development of cardiopathy, that is, the pathology of the heart. But, in addition to the voltage indicator, you also need to look at such an indicator as the amplitude of the RS segment. For information: the norm of this parameter in the chest leads is 0.7 mV. Accordingly, with a decrease or, conversely, an increase in the amplitude of RS, they speak of emerging problems with the heart.

It is noted that there is a reduced voltage in the leads of the limbs or a general decrease in the ECG voltage. In this case, there is a decrease in the amplitude of those complexes on the ECG in question. Sharp fluctuations in the amplitude on the cardiogram are not common. But a decrease in performance can never be considered a variant of an individual physiological norm.

What conditions of the body can provoke violations of the amplitude of oscillations? These include fever, anemia, hyperthyroidism, and heart block.

Causes of low voltage on the electrocardiogram

What are the reasons for the low voltage of the QRS complex on the cardiogram? This is due to cardiac (directly related to cardiac pathology) or extracardiac (not related to cardiac pathology) causes. We list the possible pathologies that can cause a drop in the amplitude of the ECG recording. So:

• hypertrophy (overdevelopment) of the left ventricle of the heart;
• severe obesity;
• rheumatic myocarditis or pericarditis in history;
• diffuse ischemic, toxic or infectious damage to the heart muscle;
• dilated cardiomyopathy;
• atherosclerosis of myocardial vessels.

The functional reasons for the occurrence of deviations in the ECG include an increase in the tone of the vagus nerve, which leads to a reduction in the intensity of fluctuations of the teeth on the cardiogram, and also as a symptom of the development of a rejection reaction after a heart transplant operation.

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2) The numbers are written for the doctor to save time (so as not to count again) and have no independent meaning

3) The diagnosis is not made by any one research method, only in the aggregate of data

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 extremities, as well as an indicator of general low voltage, when there is a decrease in the amplitude of the complexes in question in the thoracic 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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Causes and manifestations of low voltage on the ECG

Types of voltage reduction

• emphysema;
• obesity;
• myxedema.

• amyloidosis;
• scleroderma;
• mucopolysaccharidosis.

ECG changes in myocardial dystrophy

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

Treatment of this pathology

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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ECG voltage

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.

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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Definition and essence of the method

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 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 are 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

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 the diagnosis of heart pathology, the P-Q and S-T segments are of great importance. The interval on the electrocardiogram is a complex that includes a wave 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 Latin letters, which also denote 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

• 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.

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.

An example of decoding an electrocardiogram

Checking the regularity of heart beats

Calculation of heart rate (HR)

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

ECG interpretation - rhythms

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

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

The electrical axis of the heart can deviate in various pathological conditions. For example, hypertension leads to a deviation to the right, a conduction disorder (blockade) can shift it to the right or to the left.

Atrial P wave

• 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.

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

• 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

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

Q-T interval

ECG interpretation - norm indicators

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

In pregnant women, a slight deviation of the electrical axis of the heart in late gestation is possible due to compression by the growing uterus. In addition, sinus tachycardia often develops, that is, an increase in heart rate to 110-120 beats per minute, which is a 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

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

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

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

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. A complete examination is required. 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 of the nervous system in a child, which is a consequence of birth trauma.

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

• heart failure;
• arrhythmias.

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 (a large amount of connective tissue in the heart, replacing muscle). In addition, this symptom 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 - it 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

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 interpretation in a private medical center ranges from 800 rubles to 3600 rubles. You should not assume that bad specialists work in an ordinary clinic or hospital - it’s just that a doctor in a state institution, as a rule, has a very large amount of work, so he simply has no time to talk with each patient in great detail.

Reducing the amplitude of the teeth(low voltage) can have a different meaning. Along with extracardiac causes (exudative pericarditis), emphysema (low voltage, mainly in precordial leads), it can be based on both widespread myocardiofibrosis (decrease in myocardial potential) and general metabolic disorders (myxedema, cachexia).

The duration of the propagation of excitation from the atrium to the ventricle (atrioventricular conduction time, which should be no more than 0.20 seconds) also allows you to make a conclusion about the state of the myocardium. Atrioventricular conduction time can be prolonged for a number of reasons. This includes:

a) purely functional reasons (for example, increased vagal tone in athletes),
b) the action of foxglove,
c) rheumatic myocarditis and
d) sclerotic processes.

General metabolic disorders in the myocardium, on the contrary, do not affect the duration of the conduction time.
Primary Endpoint Changes parts of the ventricular complex due to a violation of the process of exit of the ventricles from the state of excitation. They reflect metabolic disorders in the myocardium in the broadest sense of the word.

Pathological changes in the terminal part ventricular complex are due to two factors:
1) localization of damage and
2) the duration of the monophasic current emanating from the damaged area of ​​the myocardium. It can be shortened (eg, with hypoxemia, digitalis effect) or lengthened (eg, in the late period of myocardial infarction, with pericarditis, general non-hypoxemic metabolic disorders).

Damage, causing a shortening of the action of the monophasic current, are accompanied by a decrease or rise in the S-G segment, and in case of damage leading to a prolongation of the current action, along with possible changes in the S-T segment, negative teeth 7 are observed. In some injuries (myocardial infarction, pericarditis), to distinguish between early - hypoxemic and late - necrotic - phases. Since the localization of damage does not change, early and late changes are found in the same leads.
The following changes to the final parts of the ventricular complex talking about myocardial damage.

The descent of the S-T segment below the isoline in I, II and less often in III chest leads.
The rise of the segment S - T in the leads from the limbs and in the chest.
Flattened or negative T waves in I, II, less often in III, and in chest leads.

Changes the duration of the interval Q - T should also be considered as a sign of myocardial damage in the broad sense of the word.
On the image Schematically depicts changes at different localization of damage.
Myocardial damage may be due primarily to the following factors.

A) transient hypoxemia due to coronary insufficiency. Since hypoxemia shortens the effect of monophasic current, the ECG shows a decrease in the S-T segment and flattening or even disappearance of T waves, but negative T waves are not observed. These changes, depending on the localization of the site of hypoxemia, are expressed in different leads. The most common type of ECG is characteristic of damage to the inner layer, since the latter is damaged the most (Buechner).

b) Prolonged hypoxemia leading to necrosis (myocardial infarction). Since the monophasic current is slowed down in the area of ​​necrosis and in the areas of the myocardium adjacent to it, in the early stage of hypoxemia this leads to the formation of a negative T wave with Q-T prolongation.

There are no complaints whatsoever. The pressure is usually 100/60 (110/70). Cholesterol was raised, but dietary regulation seems to have helped to overcome this problem. Height 165, weight 67. Without sharp dynamics.

VSD. Holter shows single extrasystoles. Intercostal neuralgia. I will be very grateful for the answer.

2) The numbers are written for the doctor to save time (so as not to count again) and have no independent meaning

3) The diagnosis is not made by any one research method, only in the aggregate of data

Of greater importance is the ratio of the amplitudes of the R wave in different leads. But it is better to discuss this with a specialist who sees the ECG.

In practical electrocardiography, the ratio of the amplitudes of the R wave in various leads is often of great importance than its absolute value. This is due to the influence of extracardiac factors on the amplitude characteristics of the ECG (emphysema, obesity).

For a complete conclusion based on the ECG, it is important to analyze the entire set of data and the ratio of the amplitudes of various teeth.

If the amplitude of only the R wave is reduced, then this may indicate the development of limited foci of necrosis in the thickness of the myocardium.

The simultaneous presence of a necrosis zone, damage and ischemia are most often caused by the occurrence of myocardial infarction, and the dynamics of their mutual combination makes it possible to distinguish signs of 3 stages: acute, subacute and cicatricial.

In the acute stage, which lasts 2-3 weeks, two substages are distinguished. The first (stage of ischemia) lasts from several hours to 3 days) is manifested by the appearance of initially ischemia (usually subendocardial) with a transition to damage, accompanied by a rise in the ST segment, up to merging with the T wave (monophasic curve).

In the second phase of the acute stage, the damage zone is partially transformed into a necrosis zone (a deep Q wave appears, up to the QT complex), partially, along the periphery - into an ischemia zone (a negative T wave appears).

The isoelectric position of the ST segment with the presence of a deep coronary negative T reflects the transition to the subacute stage, lasting up to 3 weeks and characterized by the reverse development of the QRS complex, especially the T wave, with a stable location on the isoline of the ST segment.

The cicatricial stage is characterized by the stability of the ECG signs that persisted by the end of the subacute period. The most constant manifestations are a pathological Q wave and a reduced R wave.

What factors affect the voltage drop?

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.

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.

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.

Applied for practical purposes in the 70s of the 19th century by the Englishman A. Waller, an apparatus that records the electrical activity of the heart continues to faithfully serve humanity to this day. Of course, for almost 150 years it has undergone numerous changes and improvements, but the principle of its operation, based on the recording of electrical impulses propagating in the heart muscle, has remained the same.

Now almost every ambulance team is equipped with a portable, lightweight and mobile electrocardiograph, which allows you to quickly take an ECG, not lose precious minutes, diagnose acute cardiac pathology and promptly deliver the patient to the hospital.

For large-focal myocardial infarction, pulmonary embolism and other diseases requiring emergency measures, minutes count, so an urgent electrocardiogram taken daily saves more than one life.

Deciphering the ECG for the doctor of the cardiology team is a common thing, and if it indicates the presence of an acute cardiovascular pathology, then the team immediately, turning on the siren, goes to the hospital, where, bypassing the emergency room, they will take the patient to the intensive care unit for urgent care. The diagnosis with the help of an ECG has already been made and no time has been lost.

FKG or phonocardiographic research method allows you to depict the sound symptoms of the heart graphically, objectify it and correctly correlate tones and noises (their forms and duration) with the phases of the cardiac cycle.

In addition, phonography helps in determining some time intervals, for example, Q - I tone, mitral valve opening tone - II tone, etc. With FCG, an electrocardiogram is also recorded synchronously (mandatory condition).

The method of phonocardiography is simple, modern devices make it possible to isolate high- and low-frequency components of sounds and present them as the most convenient for the perception of the researcher (comparable to auscultation).

Phonocardiography is prescribed in cases where it is necessary to clarify the origin of heart murmurs or the diagnosis of valvular heart disease, to determine indications for surgical intervention for heart disease, and also if unusual auscultatory symptoms appear after myocardial infarction.

A dynamic study using FCG is needed in the case of active rheumatic heart disease in order to find out the pattern of formation of heart defects, and in infective endocarditis.

Good afternoon I went to the doctor with a complaint of a burning sensation in the chest (in the middle - the intercostal junction), a lump in the throat below the Adam's apple, making it difficult to breathe, squeezing pain from the left shoulder blade to the left collarbone, while driving to the doctor - two seconds, but severe colic in the region of the heart, dizziness, increased blood pressure to 120 with a normal 90/60.

Hello! If the doctor said that everything is in order on the ECG, then most likely it is so. Your symptoms may be associated with other causes - intercostal neuralgia, autonomic dysfunction. To exclude the pathology of the heart, you need to consult a cardiologist, who himself will prescribe all the necessary examinations.

Hello! According to the ECG - diffuse changes in the myocardium of the left ventricle and signs of its hypertrophy, no rhythm disturbances. Your symptoms resemble those of angina pectoris, and given that they are relieved by nitroglycerin, ischemic changes in the heart muscle can be assumed.

Most likely, the cause is high blood pressure, which caused thickening of the myocardium and insufficient blood supply. To clarify the anatomical features of the organ, you need to do an ultrasound (Echo-KG).

These results should be consulted with a cardiologist. Only a face-to-face conversation and analysis of your ECG and complaints can help in making an accurate diagnosis. Do not ignore increased anxiety, it aggravates your condition, can provoke a hypertensive crisis and an attack of pain in the heart, so try to calm down, you can take light sedatives, and also consult a psychotherapist about the need to use tranquilizers.

Paid for a consultation! 4 days waiting for an answer! how to understand?