An indicator of hypertension according to ecg. The procedure for conducting and deciphering the results of the ECG in hypertension and hypertensive crisis

An electrocardiogram is a method of instrumental study of the work of the human heart system. The device registers any slightest contraction of the heart muscles and produces a graphic image. With the help of an ECG, you can identify the frequency of contractions, scars, myocardial work.

This type of examination today remains the only one to detect heart diseases and pathologies associated with pressure. It is the most informative, safest way, as well as mobile, since an ECG can be performed in any conditions.

ECG interpretation

The interpretation of the ECG in hypertension is the competence of medical specialists in functional diagnostics.

Important! Only diagnosticians with extensive experience can correctly and quickly decipher the ECG cardiogram in case of a disease, which is extremely important in emergency cases.

But the basics of decoding are included in the arsenal of a doctor of any specialization. The interpretation of the ECG will help for the clinical presentation of the patient, as well as the choice of rational and effective treatment for hypertension.

Diagnosis ticks and ECG readings in hypertension by stages of disease progression

Hypertension (also called arterial hypertension) is the most common disease of the cardiovascular system, from which every third inhabitant suffers. The disease occurs between the ages of 60 and 70. The disease develops asymptomatically for a long time, therefore it occurs unexpectedly and manifests itself as unstable pressure.

At the 1st stage of the disease of hypertension, the ECG does not give results on the ongoing pathologies in the body, therefore, diagnosis is made by measuring blood pressure with a conventional tonometer. At the initial stage of the disease, the symptoms are mild, they can suddenly appear and also disappear.

At grade 2 arterial hypertension, the ECG already recognizes changes associated with the left ventricle (heart section) and impaired blood circulation in the myocardium. Already more pronounced symptoms of the disease: a scarlet complexion, tinnitus, dizziness, disturb the kidneys, hypertensive crises occur.

At the 3rd, most dangerous stage of the disease, there is a constant high pressure and complications on the internal organs. It also happens with a heart attack, hemorrhage in the retina and brain, kidney failure, tachycardia and arrhythmia. At this stage, the ECG accurately detects all possible changes in the heart and damage to internal organs.

Important information about the pressure procedure

For an ECG with arterial hypertension, the patient needs:

• remove clothes to the waist;
• bare your knees;
• take a horizontal position;
• a study in case of illness is carried out only two hours after a meal, and ideally, after a 15-minute rest.

There are no strict restrictions for performing electrocardiography. The procedure can be performed even by small children.

Features of the ECG in the disease

The electrocardiographic study process looks like this:

1. Electrodes are placed on the lower parts of the bare shins and forearms and fixed with clips at three points.
2. Previously, the areas of contact of the body with the electrodes during ECG are treated with a special gel that serves as a conductor of electric currents or napkins soaked in saline are applied.
3. Electrodes for hypertension are applied according to certain rules: to the right hand - a red wire, to the left hand - yellow, to the left leg - green, to the right leg - black and white wire to the chest.

In the process of recording an ECG with a disease, the patient must lie still and breathe calmly, and not talk.

Deciphering the ECG in case of illness

With this method of examination, the state of the work of the heart rhythm and muscles is assessed.

The description of the ECG consists of measurements of the waves, the intervals between them, and the segments connecting the teeth. When deciphering, the location of the teeth, peak height, duration of intervals during muscle contractions, as well as direction are evaluated. The cardiogram is a jagged line arranged horizontally parallel to each other.

Each such ECG line represents a lead. Any deviation of the leads and teeth signals a violation in the work of the cardiovascular system.

An important indicator of the health of the body are:

1. The number of heartbeats per minute (HR). There is a special method for calculating the pulse on an electrocardiogram, when the length of the tape is divided by the distance between the teeth in millimeters. It is important in case of illness to pay attention to the speed of the cardiogram tape length of 25 (55) millimeters per second. When conducting an ECG in a child, the heart rate is considered to be 130-160 beats per minute, and in adolescents and adults it slows down to 80 contractions. A rapid pulse on the ECG indicates diseases such as tachycardia, arrhythmia, extrasystole, bradycardia. The pulse can be lowered by the use of special medications.
2. The regularity of the heart rate. In case of hypertension, at the conclusion of the ECG, the heart rhythm is indicated by the intervals between the R waves, whether they are different or the same.
3. Measurement of each R wave and interval on the ECG. Normally, it, pointed and facing up, should be in all leads, and it does not matter that it can have a different height.

An ECG in case of a disease does not always give a complete picture of the diseases, since there are hidden forms of heart pathologies. In this case, daily monitoring for blood pressure is used, that is, electrocardiography with the use of physical activity. In this case, the patient walks with a portable device attached to the chest during the day. To obtain reliable information, this method will help those who are overcome by excitement before the ECG and the pulse jumps.

Thus, it is quite difficult and not informative to decipher the cardiogram at pressure on your own; only a qualified specialist can make the final conclusion of the ECG. The result of a competent decoding will help doctors in making the correct diagnosis for the disease.

It is impossible to completely cure arterial hypertension, with the help of treatment it is only possible to stabilize the pressure and avoid hypertensive crises. For this, medical specialists in case of illness recommend a diet with pressure.

An unbalanced diet during illness can lead to obesity, which leads to an increase in blood pressure. It is necessary to include fruits and vegetables, lean meat and dairy products, fish in your diet. Avoid coffee, cocoa, strong tea in case of illness.

To live an active lifestyle. Hypertensive patients, even with pressure, are recommended to engage in swimming, hiking. Give up bad habits in case of illness: smoking and alcoholic beverages.

Timely take medications for pressure, selected by a specialist individually according to the degree of the disease.

hyperkinetic crisis

Hyperkinetic type of crisis develops quickly, against the background of good or satisfactory general well-being, without any precursors. There is a sharp headache, often pulsating in nature, sometimes flashing flies before the eyes. There may be nausea, occasionally vomiting. During the crisis, patients are excited, feel a feeling of heat and trembling throughout the body. Red spots often appear on the skin of the face, neck, and sometimes chest. The skin is moist to the touch. Some patients experience pain in the heart and increased heart rate. The pulse is fast. Increased blood pressure, mainly systolic (up to 200-220 mm Hg); diastolic pressure rises moderately (by 30-40 mm Hg, st.). Pulse pressure increases. Quite often crisis comes to an end with a plentiful urination. An ECG can reveal a decrease in the ST segment and a violation of the repolarization phase in the form of a flattening of the T wave. There are no significant changes in the urine, sometimes a slight transient proteinuria, erythrocytes. The content of 11-OKS is increased in the blood. The rate of blood flow increases. Particular attention should be paid to hemodynamic disturbances. Cardiac output is increased, total peripheral resistance is slightly reduced or normal.

The crisis is characterized by a rapid and short course (up to several hours), develops not only in hypertension, but also in some forms of symptomatic hypertension. Complications are rare.

Hypokinetic crisis

Hypokinetic type of crisis characterized by a more gradual development of clinical symptoms. Growing headache, vomiting, lethargy, drowsiness are characteristic. Vision and hearing deteriorate. The pulse is often normal or slow. Arterial pressure rises sharply, especially diastolic (up to 140-160 mm Hg. Art.). The pulse pressure decreases. The ECG shows more pronounced changes than in a hyperkinetic crisis: slowing of intraventricular conduction, a more pronounced decrease in the S-T segment, significant disturbances in the repolarization phase with the appearance of a often biphasic or negative T wave in the left chest leads. After a crisis, protein, erythrocytes, cylinders are excreted in the urine; if they were found before the crisis, then their excretion increases. The blood flow velocity does not change significantly.

The content of 11-OX in the blood is increased. The concentration of adrenaline and, to a lesser extent, noradrenaline in the peripheral blood significantly increases. Studies of the blood kallikreinkinin system indicate its significant activation. Changes in hemodynamics are characterized by a decrease in cardiac output and a sharp increase in total peripheral resistance.

eukinetic crisis

Eukinetic type of crisis develops both in hypertension and in some forms of symptomatic hypertension. Its course is somewhat different than the crises of the hyper- and hypokinetic type. Clinical signs develop rapidly, against the background of increased initial blood pressure, and are most often characterized by cerebral disorders: general movement disorder, severe headache, nausea and vomiting. Significantly increased both systolic and diastolic pressure. The concentration of adrenaline in the blood is increased, as a rule, with a normal content of norepinephrine, as well as the activity of the kallikreinkinin system. There is a moderate increase in total peripheral resistance with normal values ​​of cardiac output.

Prof. A.I. Gritsyuk

The state of the central hemodynamics - Hypertensive crises

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Character hemodynamics in hypertensive crises depends on the stage of the disease, clinical variants of hypertension, age characteristics of patients, the degree of atherosclerotic changes.

The main reason for the increase in blood pressure in hypertension is currently considered to be a violation of its neurohumoral regulation of the smooth muscle tone of small arteries and arterioles, which makes it difficult for blood to flow into the capillary system (G. F. Lang, 1950; V. V. Parin, F. Z. Meyerson , 1960; A. L. Myasnikov, 1965; I. K. Shkhvatsabaya, 1977, etc.).

N. D. Strazhesko (1940) indicates that in the I (“silent”) stage of hypertension, the stroke and minute volume of the heart increases, and the blood circulation accelerates. At the same time, total peripheral resistance (OPS) increases to a lesser extent in a small number of patients.

It has been established (T. G. Vatsadze et al. 1979; V. G. Kavtaradze et al. 1979; S. Belo et al. 1967; S. Dickinson, 1969, etc.) that hypertension in different individuals occurs with different hemodynamic disturbances. In some patients, the disease begins with an increase in the minute volume of blood (MOV) with a normal or even reduced OPS. In the case of progression of the disease and an increase in the tone of the smooth muscles of small arteries and arterioles, the OPS becomes more pronounced. In the II stage of hypertension, as a result of severe hypertrophy of the left ventricle, cardiac output increases. As the disease progresses to stage III due to the weakening of the contractile function of the myocardium, cardiac output decreases (N. K. Furkalo, A. G. Kaminsky, 1976).

In addition to the classification of hypertension in stages and phases, I. K. Shkhvatsabaya (1982) proposed to divide the disease into two more periods: formation and stabilization. During the formation of hypertension, sufficient blood supply to the most important systems and organs is ensured due to the compensatory capabilities of the body, leading to an increase in the IOC (hyperkinetic type of blood circulation). At the same time, hemodynamic disturbance is accompanied by an increase in urinary excretion of catecholamines, that is, an increase in the activity of renin in the peripheral blood plasma and an increase in the activity of the pressor system of the kidneys. Consequently, already in the initial period of the disease, the activation of the hypothalamic-pituitary-adrenal system occurs. As the disease progresses, cardiac output gradually decreases, peripheral and renal vascular resistance increases, which leads to depletion of the compensatory reserves of the kidney kinin system, impaired

electrolyte balance, increased production of aldosterone, increased activity of the renin-angiotensive system. All these processes lead to the stabilization of arterial hypertension, increased vascular reactivity and increased pressor influence due to the action of the sympathetic-adrenal and renin-angiotensive systems, increased sodium and catecholamines in the vascular system (IK Shkhvatsabaya, 1977). In the hyperkinetic type of circulation, against the background of an increase in blood pressure, the function of alpha- and beta-adrenergic receptors is enhanced, which, according to modern concepts, is the main link in the formation of hypertension. Further development of the disease can be manifested by a eukinetic type of blood circulation, when PS of the vessels is increased with normal IOC. With a hypokinetic type of hemodynamics, cardiac output decreases and OPS increases excessively.

The main factors that determine the level of systemic arterial pressure are OPS and cardiac output or cardiac output. Depending on the mechanism of occurrence, various forms of arterial hypertension are distinguished: due to an increase in the tone of peripheral vessels, an increase in cardiac output, an increase in both values, or a violation of the normal ratio between them.

The study of hemodynamics in the treatment of hypertension is essential, since modern antihypertensive drugs reduce blood pressure by preferentially reducing PS or cardiac output. Therefore, the determination of the IOC and OPS during a hypertensive crisis is important for diagnosing the type of hypertension and prescribing pathogenetically substantiated therapy.

In patients with hypertension, various changes in central hemodynamic parameters were revealed - with increased, slightly changed and reduced, compared with healthy individuals, cardiac output (A. P. Golikov et al. 1978; K. Yu. Yuldashev et al. 1981, etc. ).

A general pattern in hypertensive crises is an increase in the level of glucocorticoids and catecholamines in the blood (as a result of increased activity of the adrenal cortex and medulla), which occurs during a stress reaction. At the same time, there is an increase in the blood depressor system, which is confirmed by a change in the activation of the kallikrein-kinin system. The study of central hemodynamic parameters in hypertensive crises, as well as long-term clinical observation of such patients, allowed A. P. Golikov (1978) to distinguish three types of uncomplicated crises.

The hyperkinetic type is characterized by an increase in cardiac output (stroke and minute volume) with a normal or reduced OPS of the vessels. The author found that the hyperkinetic type of crisis develops mainly in the early stages (I-II) of hypertension and, according to the clinical course, more often corresponds to a crisis of the first type according to the classification of N. A. Ratner and co-authors (1958). The pulse in such patients is accelerated, blood pressure is increased - mainly systolic to 14.7-16.0 kPa (200-220 mm Hg), pulse pressure increases. There are also characteristic changes on the ECG: a decrease in the S-segment T, violation of the phase of repolarization in the form of a flattening of the tooth T(Fig. 1).

The hypokinetic type of crisis is characterized by an excessive increase in PS, a decrease in stroke and minute volume. The pulse rate changes little, bradycardia is often observed. This type of crisis develops mainly in patients with stage II and III hypertension and, according to clinical manifestations, more often corresponds to a hypertensive crisis of the second type. Nevertheless, A.P. Golikov (1978) found that the clinical manifestation of a hypertensive crisis of the first or second type does not always correspond to a hemodynamic disorder of the hyperkinetic type.

With a hypokinetic type of circulation, blood pressure, especially diastolic, rises to 18.7-21.3 kPa (140-160 mm Hg). The ECG shows more pronounced changes than in patients with hyperkinetic type of crises: slowing of intraventricular conduction, more pronounced decrease in the S-segment T, a significant violation of the phase of repolarization with the appearance of often a two-phase or negative tooth T in the left chest leads. Almost all patients showed signs of left ventricular hypertrophy with systolic overload and insufficiency of coronary circulation (Fig. 2).

In the eukinetic type of crisis, cardiac output does not change significantly, and OPS increases moderately. It develops in patients with hypertension II B and (less often) stage III (according to the classification of A. L. Myasnikov) against the background of increased initial systolic and diastolic pressure. In patients with a eukinetic type of crisis against the background of high blood pressure, cerebrovascular accidents often develop with general motor disorders, severe headache, nausea and vomiting.

On the ECG, a violation of the phase of repolarization is often determined (displacement of the segment 5- T and prong T), progression of dystrophic changes. insufficiency of coronary circulation (Fig. 3).

Rice. 1. ECG of patient K.

Hypertension stage II, state of crisis, hyperkinetic variant of blood circulation. ECG signs of left ventricular hypertrophy and its overload during systole

Rice. 2. ECG of patient 3.

Hypertension stage II, state of crisis, hypokinetic variant of circulation. ECG signs of left ventricular hypertrophy, pronounced myocardial changes and coronary circulation disorders

Rice. 3. ECG of patient L.

Hypertension stage II, state of crisis, eukinetic variant of the circulation of blood circulation. ECG signs of left ventricular hypertrophy with systolic overload and dystrophic changes in the myocardium

For a more complete characterization of hemodynamic disturbances in hypertensive crises, an indicator characterizing the contractile function of the myocardium was studied - a change in the phases of left ventricular systoles (V. G. Kavtaradze et al. 1981). It has been established that the duration of the period of exile fluctuates within the proper values ​​calculated from the heart rate; mechanical systole was prolonged in all cases. The intrasystolic index and the volumetric ejection rate in patients during the crisis were more in line with normal values. The volumetric rate of increase in intraventricular pressure in patients with eu- and hyperkinetic type of circulation is increased. In the hypokinetic type of circulation, a combination of myocardial hypodynamia syndrome with a decrease in cardiac output, stagnation in the pulmonary circulation, a low coefficient of circulation efficiency, and a severe form of the clinical course of the disease were observed.

Hypertensive crises, accompanied by impaired cerebral and coronary circulation, always occur with a sharp deterioration in the condition of patients, with aggravation of neurovascular, hormonal and humoral changes (DI Panchenko, 1954). With a transient disorder of cerebral hemodynamics, ECG changes are often the main clinical manifestations of a hypertensive crisis. At the same time, as A. L. Myasnikov (1965) points out, in patients with frequent hypertensive crises accompanied by typical attacks of angina pectoris, cardiac asthma, ECG regularly showed changes characteristic of acute coronary circulation disorders, and in the absence of these phenomena, these disorders obscured by brain disorders. In patients with type II hypertensive crisis, the ECG showed a decrease in the S-G interval, a two-phase or negative wave T, widening of the QRS complex (N. A. Ratner et al. 1958).

S. G. Moiseev (1976) described in sufficient detail the disturbances of cardiac activity with a sharp increase in blood pressure, which were not accompanied by brain disorders. The resulting myocardial hypoxia and overload of the left ventricle can provoke acute left ventricular failure with attacks of cardiac asthma, and in severe cases, with pulmonary edema. Therefore, all these data allowed the author to single out separately the cardiac forms of a hypertensive crisis, the occurrence of which is facilitated by all those known factors that play a role in increasing blood pressure under normal conditions: physical and mental overload, sudden changes in meteorological conditions, hormonal disorders (climacteric period), etc. .

To characterize hemodynamic disturbances, Yu. S. Gaiduk, an employee of our clinic, compared them with brain changes that occur during a hypertensive crisis. 88 patients (men - 36, women - 52) aged 35-65 years were examined. The duration of the disease is from 2 to 18 years. Arterial pressure during the crisis increased significantly: systolic - up to 34.7 kPa (200 mm Hg) and diastolic - up to 21.3 kPa (160 mm Hg). IOC was determined by the method of rheography (MI Tishchenko et al. 1973) - non-traumatic and informative enough for comparative studies. Recorded using a 4RG-1A rheographic attachment and an Alvar electroencephalograph. Mean arterial pressure was calculated according to the Savitsky formula, OPS - according to the Franck-Poiseuille formula. To standardize the obtained values, the IOC and OPS were recalculated per 1 m2 of the body surface in the form of a cardiac index (CI) and specific peripheral resistance (RPS). The results of the examination were compared with the data of 20 practically healthy individuals (Table 1).

When comparing the neurological status and the severity of the hypertensive crisis, the patients were divided into 2 groups.

Table 1. Some indicators of general hemodynamics in the examined (M + t)

SYNDROMES AND EMERGENCY DISEASES OF THE CARDIOVASCULAR SYSTEM

4.1 HYPERTENSION CRISIS

DEFINITION.

Hypertensive crisis (HC) is a sudden increase in systolic and diastolic blood pressure (SBP and DBP) above individually habitual figures, accompanied by dysfunction of the autonomic nervous system and increased disturbance of cerebral, coronary and renal circulation.

ETIOLOGY AND PATHOGENESIS.

A sudden increase in blood pressure can be provoked by neuropsychic trauma, alcohol consumption, sharp fluctuations in atmospheric pressure, the abolition of antihypertensive therapy, etc. GC can be caused by two main mechanisms:

1. Vascular - an increase in total peripheral resistance with an increase in vasomotor (neurohumoral influences) and basal (with sodium retention) arteriolar tone.

2. Cardiac mechanism - an increase in cardiac output, as well as an increase in blood flow with an increase in heart rate, an increase in circulating blood volume (CBV), myocardial contractility, as well as an increase in the filling of the heart chambers with valvular pathology, accompanied by regurgitation.

CLINICAL PICTURE AND CLASSIFICATION.

Clinically, GC is manifested by subjective and objective symptoms.

Subjective symptoms of a crisis: headache, non-systemic dizziness, nausea and vomiting, blurred vision, cardialgia, palpitations and interruptions in the work of the heart, shortness of breath

Objective symptoms of a crisis: agitation or lethargy, chills, muscle tremors, increased humidity and flushing of the skin, subfebrile condition, transient symptoms of focal disorders in the central nervous system; tachy- or bradycardia, extrasystole; clinical and ECG signs of left ventricular hypertrophy; accent and splitting of the II tone over the aorta; signs of systolic overload of the left ventricle on the ECG.

Depending on the characteristics of central hemodynamics, hyper- and hypokinetic crises are distinguished (Table 2.).

Table. 2 Characteristics of hyper- and hypokinetic crises.

Currently, it is quite difficult for doctors and patients to imagine cardiology without first conducting an electrocardiogram (or simply an ECG). This method of determining the work of the heart is considered safe, painless, simple, and also affordable.

With the help of the procedure, you can get a lot of information about the work of the heart - which is why patients are often prescribed an ECG for hypertension, which is characterized by a frequent increase in pressure indicators.

With the help of electrocardiography, it is possible to assess the electrical fields of the heart muscle, which appear as a result of the active work of the myocardium. Although such a procedure is not difficult, it is characterized by some features and if they are not followed, then it will not be possible to achieve the correct result, which clearly reflects the functioning of the heart.

Proper ECG for hypertension will help to identify not only the condition of the diseased organ, but also to understand what kind of treatment the patient needs. When deciphering the result of the tests, the doctor studies a specific schedule by which it is possible to evaluate the work of the myocardium.

The main features of the echocardiographic procedure are the following factors that you need to pay special attention to before diagnosing:

1. The procedure is carried out using special equipment, the name of which is an electrocardiograph. In its “composition” there is a device that records the data of the work of the heart, as well as a device that increases the bioelectric potential of the heart muscle.
2. An ECG can be performed in a hospital facility, as well as at home, since the device for assessing the work of the heart is small in appearance. As a rule, each ambulance should be equipped with it. It is especially important to have an electrocardiographic device in the event that a hypertensive patient has applied for help, in which blood pressure indicators are greatly exceeded.
3. If an ECG for arterial hypertension and other diseases is performed in a hospital, the office must be isolated from various electrical interferences, otherwise the conclusion after the echocardiogram will be unreliable.

The procedure should only be carried out by an experienced specialist who can correctly measure cardiac current impulses. Sometimes the analysis shows unreliable information, since the patient’s too emotional state, as well as the conditions for diagnosing, can change it.

The conclusion of the ECG in hypertension and other heart diseases is presented in the form of a graphic drawing on which a curved line is located - it is she who characterizes the work of the heart, or rather the right and left ventricles and myocardium.

Who needs an electrocardiogram

With the help of such a technique that detects heart disease, it is possible to obtain maximum information about the state of human health, as well as to appreciate the risk of complications due to the course of hypertension. Also, an important criterion is the correct determination of the degree of hypertension, on which the treatment of the patient directly depends.

As a rule, an ECG in a hypertensive crisis is a prerequisite. Using the technique, it will be possible to identify the stage of the disease, as well as assess the level of pressure. However, today the procedure is prescribed not only for people with high blood pressure. An ECG is also performed to make an accurate diagnosis in diseases of the vessels, heart, respiratory system, and during pregnancy.

Often, such diagnostics are prescribed for preventive purposes to people over 40-45 years old, thanks to which it is possible to detect a particular disease in a timely manner.

Preparation Rules for Accurate Results

To make a reliable diagnosis, the patient needs to properly prepare for it before the procedure. Cardiologists strongly prohibit before the test:

1. To be very tired and tired, to perform physical activity.
2. Eat before bed if the ECG is scheduled for the morning. It is best to do the test on an empty stomach.
3. Take medicines that affect the work of the central nervous system, the heart.
4. Often exposed to stressful situations.
5. Drink plenty of fluids before going to the hospital.
6. Take coffee, tea, energy drinks and alcohol throughout the day before the procedure.
7. Take a morning shower, washing with hygiene products - soap, gel, and so on (the oil film formed on the skin will delay the electrical impulse, as a result of which the graph cannot be considered reliable). It is better to rinse only with running water.

Disadvantages and difficulties of the procedure

The difficulty of this technique lies in the fact that the pressure in a hypertensive patient can increase for a small amount of time, so it is advisable to carry out the procedure during the onset of an attack. Otherwise, the ECG results will be positive, as the patient's pressure rises for a short time. As a result, diagnostics will not be able to identify health problems, although hypertension will actually develop slowly in a person, greatly aggravating his health condition.

For a number of reasons, ECG results are not always reliable. They may be affected by:

• The general condition of the patient (excitement, impaired breathing, overeating, etc.).
• Interference and power outages.
• Poor quality sensors.
• Conditions for conducting diagnostics and low level of personnel training (incorrect location of electrodes, violation of device operation, etc.).

As an additional examination technique, doctors advise to undergo an ultrasound of the heart. This procedure will allow you to identify the presence of neoplasms, noises and defects, which will not be revealed by means of an ECG.

Conventionally, all the actions of medical personnel can be divided into several stages:

1. Correct position of the patient on the couch.
2. Installation of electrodes on the required zones.
3. Tracking the work of the cardiograph.
4. Removing sensors.
5. Collection and interpretation of the received data.

The patient goes to the diagnostic room. He will need to remove all clothes above the waist and expose his shins, lie down on the couch and take a horizontal position (it is required to lie on his back). The legs and arms are extended along the body and relaxed.

Next, the doctor prepares individual parts of the body on which the electrodes will be fixed. Such zones need to be degreased in order to eventually get the correct indicator, and lubricated with a special gel. Degreasing is carried out using an isotonic solution of sodium chloride, alcohol or other liquid based on this component.

After preparing the human body for the procedure, the specialist fixes sensors (electrodes) on it. They are installed in the following areas:

• chest area;
• lower leg (the sensor must be installed on the inside);
• Forearm.

Changes in such areas should not be, as this can lead to a distortion of the result.

The sensors read the necessary information and transmit it to a special device - an electrocardiograph, which groups the data and transfers them to a paper tape in the form of a graphic curve or to a specialist's computer.

Electrocardiography should only be carried out by an experienced doctor who is able to carry out the procedure in accordance with all the rules, as well as adequately read the results. It is important to note that they are affected not only by the work of the heart muscle, but also by the conditions for diagnosing and the mood of a person. The patient must breathe evenly and calmly so as not to spoil the results of the graph.

The whole process takes about 15 minutes. At the end, the doctor disconnects the sensors, and the patient can get up, cleanse the body of the remaining gel and get dressed.

After the ECG, a special line remains on paper, which makes it clear to the doctor about the patient's state of health. On the chart, he estimates the length of some segments, as well as the number of peak fluctuations. The length of such segments to the next peak reflects the number and rhythm of contractions.

A normal rhythm is one whose segments do not differ in length by more than 1/10 of a part. If the segments differ significantly from each other, then the heartbeat is unstable. In any case, the final diagnosis should be made by a doctor who knows how to decipher the ECG graph well, given:

• gender of the patient;
• age;
• height and weight;
• body type;
• the presence of diseases in a chronic form.

Hypertension requires mandatory correct decoding. The first thing the doctor needs to do is to identify the development of a heart attack, coronary disease, and also to determine violations in the contraction of the heart.

Hypertension on the ECG is characterized by:

• The R element is enlarged.
• The S element is deepened.
• Element T has a gentle descent and a sharp rise.
• The ST segment is shifted down.

For diagnosis, the PQ and ST regions are most important. Normally, their intervals should be the same, and a difference of 10% or more indicates the presence of pathologies.

Signs of a hypertensive crisis

To understand how it is possible to identify the hypertensive state of the patient, it is necessary to detect the signs of this disease in a timely manner, because without them the patient will not go to the doctor, since arterial hypertension often occurs without pronounced symptoms.

During the first stage of hypertension, the patient will notice the following symptoms:

1. Slight and quickly passing dizziness.
2. Redness of the skin, which is caused by increased pressure on the blood vessels, arteries and capillaries.
3. Minor headaches.
4. Spontaneous urination.

During the second and subsequent stages of GB, the pressure can quickly rise to 210/120 mm Hg. Art. - such indicators are considered especially dangerous for humans, and untimely assistance causes serious health complications.

The most striking signs of the course of a certain stage of hypertension are the following features:

• The left ventricle is heavily overworked or enlarged.
• The graph shows manifestations of ischemia of individual parts of the heart or the entire muscle.

Based on the stage of hypertension, the indications of the ECG graph are as follows:

Judging by the description of the stages of the disease, it becomes clear that the higher it is, the more difficult it is to cure the disease. That is why it is required to detect hypertension in a timely manner, until it causes negative health consequences.

According to the conclusion that the doctor makes, based on the ECG graph, the patient's diagnosis will be clear and on the basis of this the doctor will be able to prescribe the right treatment for the patient.

Since the ECG is not able to detect noises and defects of the heart muscle, it is advisable for the patient to undergo additional diagnostics using an ultrasound of the heart, which will give the most accurate picture of the disease.

In addition, the identified cardiac pathologies can be supplemented by:

1. Examination of the fundus by an ophthalmologist.
2. Laboratory blood tests (if secondary hypertension is suspected, the level of aldosterone and renin is determined).
3. Ultrasound of the kidneys.
4. Holter or ambulatory blood pressure monitoring.
5. Duplex scanning of blood vessels.

One of the most important diagnostic methods that allows assessing the degree of efficiency of the functioning of the heart muscle and indicators of its future capabilities is ECG in hypertension. It is especially necessary in the second and third stages of the disease. When deciphering the data on paper, the specialist determines the presence of such pathologies as coronary heart disease, tachycardia, angina pectoris, displacement of the heart along the axis or its hypertrophy.

Deciphering the ECG in hypertension according to the stages of the disease

The first stage of hypertension is almost asymptomatic, only occasionally can a headache or blood pressure rise against the background of stressful situations, unrest, physical or mental overload. At the very beginning, the disease has unstable, barely pronounced symptoms. They appear quickly, just as quickly on their own and disappear.

There is no arterial hypertension, that is, persistent high blood pressure, yet. Most often, the disease is diagnosed by a specialist during the examination and diagnostics for other pathologies, quite by accident.

Target organs: heart, lungs, kidneys, brain - are not affected yet. Therefore, an electrocardiogram, radiograph or echocardiogram will not show any abnormalities. Usually, in the first stage of hypertension, they are limited to measuring blood pressure with a tonometer and monitoring their condition.

But the first stage of hypertension, if no measures are taken to treat it or, most likely, prevent it at this stage, slowly but surely passes into its next stage.

At the next, second stage of the disease, changes in the functions of the heart muscle and its left ventricle are already characteristic. Against the background of a combination of many symptoms and a sharp jump in blood pressure, hypertensive crises occur that are dangerous to the health and life of the patient.

The first thing the doctor who comes to the house does is conduct an ECG and decipher the results.

The specialist sees on paper the changes that characterize left ventricular hypertrophy, cardiac arrhythmias, coronary circulation and cardiac conduction.

Later, if the patient is admitted to a hospital, the same changes can be seen on the x-ray and echogram.

Diagnostic studies at the second stage also include examinations of the fundus by an ophthalmologist for their negative changes.

In the third, last stage of hypertension, a professional ECG transcript can show significant abnormalities in the coronary circulation and left ventricular function.

ECG for hypertension: how to properly prepare

Cardiologists advise:

• a few days before the scheduled procedure, try to be as nervous as possible, avoid stressful situations;
• the day before, the patient should ensure complete rest, not perform physical or mental work that requires a lot of strength, try not to get tired that day and have a good rest;
• make an exception in the morning and do not perform a physical exercise complex;
• sleep, sleep should be at least eight hours;
• you should not have a hearty breakfast, and even better if you carry out the procedure on an empty stomach;
• if the ECG session is scheduled for the second half of the day, then the meal should be at least two hours before it;
• limit fluid intake, including coffee, tea or energy drinks that stimulate the heart muscle;
• you can take a shower, but at the same time refuse to apply care products to the body, otherwise the greasy film on its surface will have a bad effect on the contact of the electrodes with the skin;
• a few minutes before the procedure, try to relax, calm down, normalize the pulse, so that the diagnostic readings are as objective and reliable as possible.

The procedure is absolutely safe for the health of patients, it is characterized by comfortable performance and reliability of indications. It has no contraindications even during pregnancy.

Moreover, for people whose professional activities are associated with physical exertion or dangerous working conditions, the procedure can be carried out almost daily, which once again emphasizes its complete safety. The order of the procedure:

• the patient is offered to remove outer clothing, stay in underwear, release the shins and chest;
• those places where the electrodes will be attached are treated with alcohol, and then smeared with a special compound;
• the next step is to attach ten cuffs with electrodes to the area of ​​the ankles, arms and chest. They will take readings of the work of the heart;
• after turning on the biocardiograph, it begins to note the electrical impulses of the heart and issue a graph of ongoing processes, the so-called electromotive force of the heart.

At the end of the procedure, the doctor deciphers the indicators on paper and detects the presence of:

• ischemic heart disease;
• tachycardia, arrhythmias;
• myocardial infarction.

Since this method is absolutely safe for the body, it should be carried out without any fear as prescribed by the doctor. And if you do not yet suffer from hypertension, then after the age of forty, do this at least once a year, and when you reach a more mature age - once every three months. You should contact your doctor if you experience:

• pain in the chest area;
• shortness of breath and heart rhythm disturbances;
• rapid heart rate with severe stress;
• frequent cases of increased blood pressure.

People prone to obesity should do this as often as possible. Contact your doctor even for preventive purposes.

And if something still bothers you, and you suspect the first symptoms of hypertension, then a visit to the doctor is simply necessary. On the basis of an interview and anamnesis, he will prescribe you a diagnostic study, which must include an ECG.

Prevent the disease in time. If the electrocardiogram shows abnormalities in the work of the heart, then you will be prescribed appropriate treatment or recommended preventive measures: change your diet and daily routine, get rid of existing bad habits and lead a healthy lifestyle.

Hypertensive disease is characterized by an increase in the R wave in leads I, AVL, V 4-6, a deepening of the S V 1-V2 wave. Segment ST 1, AVL, V 4-6 is shifted down, ST AVR, V 1-V 2 - up. Wave T 1 , AVL, V 4-6 reduced or negative, T AV R , VI-V2 positive; T V 1 > T V 6 (Fig. 22). In contrast to the "coronary" T wave in hypertension, the negative T wave has a gentle descent and a steeper rise. The time of local electronegativity in hypertension is often not increased.

ECG WITH PULMONARY HEART

It is characterized by signs of hypertrophy of the right ventricle and atrium. The electrical axis of the heart is deviated to the right. P II, III, AVF high with a sharp apex. The interval S-T II - III is shifted down, T II - III is negative, ECG type S 1 -Q III, less often S I - II - III. In the chest leads, R V 1-V 2 is high, S V 5-V 6 is deep, or S waves are expressed in all chest leads (Fig. 23).

ECG FOR ACQUIRED AND CONGENITAL HEART DISEASES

Mitral valve insufficiency. The ECG is usually normal. Sometimes there is a deviation of the electrical axis to the left, as well as signs of left ventricular hypertrophy in the chest leads.

Stenosis of the left venous opening. The ECG rarely remains normal, usually there is a deviation of the electrical axis to the right or a pronounced rightogram with a S-T II, ​​III, AVF shift from top to bottom. P 1, II broadened, split (P-pulmonale). Lead V1 often has a biphasic P wave with a wide negative phase. Atrial fibrillation is characteristic. In some cases, there is an incomplete or complete blockade of the right leg of the bundle of His.

With a combination of mitral valve insufficiency with mild stenosis of the left atrioventricular orifice, the ECG remains normal or there is a deviation of the electrical axis to the right.

AORTIC VALVES INSUFFICIENCY AND AORTIC STENOSIS

Severe insufficiency of the aortic valves, as well as stenosis of the aortic orifice, is electrocardiographically characterized by signs of left ventricular hypertrophy.

With combined mitral-aortic defects, ECG changes depend on which defect prevails.

Tricuspid valve insufficiency is usually combined with other defects. With isolated insufficiency of the tricuspid valve, a rightogram is observed.

Ventricular septal defect differs from other congenital heart defects by a pronounced levogram. Rarely marked right. There may be signs of hypertrophy of both ventricles. P-wave and P-Q interval are enlarged.

Fallot's notebook. ECG changes are determined by the degree of narrowing of the pulmonary artery. Sharply expressed rightgram. Sometimes there is a blockade of the right leg of the bundle of His.

Non-closure of the ductus arteriosus. ECG shows signs of hypertrophy of both ventricles. T-wave inversion can occur in all leads.

Caorctation of the aorta is electrocardiographically characterized by a pronounced deviation of the axis of the heart to the left, a levogram.

II. PHONOCARDIOGRAPHY

NORMAL FCG

A phonocardiogram (PCG) is a graphic representation of the sounds of the heart that occur during its contraction. FCG consists of I and II heart sounds that occur during systole (Fig. 22). They are called normal systolic tones. Among the non-permanent are III, IV and V tones that occur in diastole. IV and V tones are extremely rare and have no great practical significance:

I tone has a muscular-valvular-vascular origin and consists of three components: the first, or initial part, arises due to the tension of the ventricular myocardium and consists of oscillations with a low frequency; the second or central part is of valvular origin (closing of the mitral and tricuspid valves, opening of the aortic and pulmonary artery valves), represents high-frequency vibrations; the third or final part is due to the vibration of the walls of large vessels and consists of low-frequency vibrations.

I tone normally begins 0.02 "-0.06" after the start of the QRS complex on the ECG, and its beginning corresponds to the top of R or follows through 0.01 "-0.03" after it. The oscillation frequency of 1 tone occupies the range from 30 to 120 Hz. The amplitude of the I tone is 1-2.5 mV. The maximum amplitude of the I tone is recorded at the Botkin point and at the apex of the heart, the minimum - at the base of the heart. The duration of the I tone is 0.08 "-0.14". Asynchronous contraction of the myocardium of both ventricles causes physiological splitting of the first tone (occurs in 10-22%). At the same time, the total duration of the first tone remains normal (no more than 0.-14 "), the interval between both parts of the tone does not exceed 0.06" or is completely free from fluctuations or contains low-amplitude fluctuations.

It is important to determine the interval Q-1 tone from the beginning of the Q wave of the ECG to the first pronounced oscillations of 1 tone. Normally, the duration of the Q interval is 1 tone 0.02 "-0.06".

In complex II of the rut, 3 parts are also distinguished: the initial low-frequency one, preceding the closing of the valves; the central high-frequency part, reflecting the closure of the valves of the aorta and pulmonary artery; and a final low-frequency part corresponding to the opening of the tricuspid and mitral valves.

The beginning of the II tone coincides with the end of the T wave of the ECG. Sometimes it appears 0.01"-0.04" later or earlier. Oscillation frequency II tone from 70 to 150 Hz. Amplitude 0.6-1.5 mV. In norm-40 me, the II tone is most intense in the II intercostal space on the left side of the sternum. The duration of the II tone is from 0.05 "to 0.1". Physiological bifurcation of the II tone occurs in 6-15% of cases. It is best seen at the base of the heart.

III and IV heart sounds are not always recorded (Fig. 23). They are physiological in children and adolescents. In adults, they usually appear when the muscles of the left ventricle are weakened.

The third tone consists of one or two small oscillations (1/3 or 1/4 of the second tone), appearing 0.12-0.18 "after the start of the second tone. The best place for registration is the apex of the heart. The frequency of the third tone is from 10 to 70 Hz .Duration - 0.02" - 0.06".

IV top consists of the same fluctuations as III tone. Equal to 1 / z or 1/4 of the I tone. Occurs 0.06-0.14 "after the beginning of the ECG P wave or 0.06" precedes the I tone. The place of the best registration is in the fourth intercostal space on the left parasternally. Oscillation frequency from 2 to 30 Hz. Duration - 0.04-0.06".

V tone is recorded extremely rarely. Consists of one or one and a half oscillations, occurs through 0.20 "-0.30" after the II tone. Has no practical value. t

The intervals between heart sounds depend on the heart rate. So, at 75-80 contractions per minute, the interval I-II tone is 0.28-0.32 "; II-III tone is 0.12-0.18".

Intervals III-IV tone and IV-V tone vary depending on ventricular diastole.