It is also necessary to know about the QT interval on the EKG, the norms of the date and the appearance of it. EKG interpretation: QT interval Dispersion to qt interval

The genius was seen, which was indicative of the development of the disease, the vivification of the function of cardiomyocytes on the molecular basis and clinical manifestation. The deciphering of mutations of genes, which coding for the complex structural elements of certain ionic channels, made it possible to establish a clear interconnection between the genotype and the phenotype.

Pathophysiology

Syndrome podovzhenogo іntervalu od rozvivaєtsya in zv'yazku of podovzhennyam perіodu repolyarizatsії kardіomіotsitіv shlunochkіv scho proyavlyaєtsya podovzhennyam іntervalu od on ECG, will only be sold to viniknennya shlunochkovih torn down in rhythm viglyadі tahіkardії type "pіruet" fіbrilyatsії shlunochkіv, raptovoї sertsevoї smertі. The potential of cardiomyocyte development is generated for a coordinated robotic system of at least 10 channels (as the main transport of sodium, calcium and calcium across the membrane). functional breakdown Be it from a number of mechanisms (dodged in character, or genetically intelligent), to produce depolarization to the strength of the structure, or weakening the process of repolarization, may lead to development of the syndrome.

Vrogena form of the syndrome

Good vivcheni two declines in the form of this pathology. Most widespread Romano-Ward syndrome (autosomal dominant disease due to penetrant penetrance, as there are not few phenotypic signs) and the development of Jervell-Lange-Nilsen syndrome - autosomal retardation. The current genna classification in the Danish hour replaced it with an eponym. The number of chromosomal loci (LQTS1-6) has been identified, which codes for the number of indicative pathological genes. Skin s genetic syndromes are also characteristic clinical manifestations.

ІSnu zv'yazok mіzh vrodzhenoi and nabutoї forms. In the case of genetic anomalies, the characteristic electrocardiographic signs may or may not appear, however, when the drugs are taken, the QT interval is increased, for example, erithromycin, in such people, death may develop.

Predbane Syndrome

Klinichny show

The characteristic familiar syndrome of podvizhennya іnterval VID є repeated obscurity, which provoked emotional or physical navantazhennym. With a wide range of arrhythmias of the type "fever", which often overwhelm "short-long-short" heart cycles. Such tied with a bradycardia phenomenon is often seen in the presence of a bogus form of ailment. Клінічні signs congenital forms are mutated with additional genetic mutations. It is a pity that the first key manifestation of a disease can be a rapt heart's death.

EKG. The triviality of the corrected VID interval is set at 460 ms or up to 600 ms. The nature of the T wave can be attributed to a specific gene mutation. Normal VID interval in case of manifestation of illness in members of the family does not include the ability of the family. The step of increasing the VID interval varies, so the variance of the VID interval in such patients is also adjusted.

Normal QT correction - OTL / (RR interval) = 0.38-0.46 s (9-11 small squares).

Syndrome of hyperactive QT interval: lykuvannya

Call the type of arrhythmia "feasts" non-trivial and pass independently. Trivial and epizodi, wiklikayut destructed hemodynamics, guilty, but they are guilty of being guilty of the help of cardioversion. In case of recurrent attacks, if necessary, if necessary, to inject the heart into intravenously, and then drop it into magnesium sulfate and then, if necessary, conduct a team-hour cardiac stimulation (frequency 90-110). As a preparatory therapy, before stimulation, I repair the infusion of isoprenal.

tied in form

The reasons for the development of the syndrome of sleep і usunuti. It is necessary to fix the intake of the preparation, so that the VID is increased. Before rejection of the results of blood analyzes, it is necessary to introduce magnesium sulfate. It is necessary to register the amount of calories in syrovattsi blood, gas storage of blood. If the calorie value is lower than 4 mmol / l, it is necessary to correct the calorie up to the upper limit. Trivial lykuvannya is absolutely not necessary, albeit the reason for the pathological stance є the blockade of the heart is not overwhelming, the installation of a permanent cardiac pacemaker is required.

vrogena form

Most of the times are provoked by the growth of the activity of the sympathetic nervous system, Tom, lіkuvannya guilty, but they are directing for such situations. Naybilsh drugs to serve as β-adrenergic blockers. Propranolol reduces the frequency of relapses in patients with clinical manifestations. In case of an absence of an effect or intolerance to β-adrenergic blockers, the alternative is surgical denervation of the heart.

Stimulation of the heart reduces symptoms in bradycardia and induction of β-adrenergic blockers, as well as in situations where pauses in the robot provoke key manifestations of the heart (LOT3). at native form Nicoli cardiostimulants do not look like monotherapy. The implantation of the defibrillator is guilty only in case of a high risk of raptus heart death, or at times, if the first manifestation of the disease of a raptus heart is a heart death with a later successful reanimation. Installation of a defibrillator precedes rapid heart death, but does not cause recurrences of tachycardia type "feasts". Repeated discharges with non-trivial episodes can
Significantly reduce the quality of the life of the children. Relative release of patients, immediately assigned β-adrenergic blockers, vibration to the mode of robotic defibrillators, will help to achieve success in finding such patients.

asymptomatic patients

Screening in the middle of the members of the family of the sick allows for the development of patients with the syndrome of an increased VID interval, since none of them had any clinical symptoms. Most of the patients do not go to the syndrome of an increase in the VID interval, but they are not included in the group of risk of a lethal result (the risk of life becomes 13% at a time of life). It is necessary to assess the efficiency of a pre-existing policy with a flexible development side effects and the risk of rapid heart death in a specific skin condition.

Viznachennya risiku rozvitku raptor death- foldable zavdannya, ale, with a precise knowledge of the nature of the genetic anomaly, it becomes simpler. The last few days showed the need for a cob of treatment at LOT1 with an increase in the corrected VID interval of more than 500 ms (both for men and for women); with LQT2 - for all people and women with an increase in the QT interval of more than 500 ms; with LQT3 - for all patients. In skin problems, an individual pidhid is required.

Syndrome podvzhenny to the interval Q-T will rivet to myself I will respect the factor of raptus heart-vascular death, first described by the French cardiologist Dessertin in 1966 r It was established, as if it were inherently, so that the formation of the subordinate Q-T was established heart rhythm, Yaki, in his own heart, to produce to the raptor death.

syndrome lit Q-T The interval is the same as the Q-T interval, which is boosted to the standard ECG, with torsade de pointes (torsade de pointes), which are dangerous for life. Paroxysms of slunk tachycardia of the "feast" type are clinically manifested by episodes of congestion, loss of evidence, and may end up with fibrillation and rapid death.

The Q-T interval is seen from the cob to the QRS complex until the T wave is completed on the EKG curves. From the point of view of electrophysiology, it visualizes the sum of the processes of depolarization (electrically stimulating the change in the charge of the cell) and the additional repolarization (renewal of the electric charge) of the myocardium of the minnow. The triviality of the Q-T interval lies in the frequency of the heart and the status of people. In normal women, the O-T interval is higher in the middle troch, lower in women of the same age. In healthy people in calmness, the variability of the repolarization processes is insignificant, so the change to the Q-T interval is minimal. Raising the Q-T interval is diagnosed in the same way as the middle triviality Q-T perevischuє 0.44 s.

There are two of the most common mechanisms of arrhythmias in the syndrome of hyperactive Q-T interval.

• The first is the internal heart failure of the repolarization of the myocardium, and the sensitivity of the myocardium to the arrhythmogenic effect of adrenaline, norepinephrine and other synthetic adrenomimetics is also increased. So, for example, it is good to see the fact that Q-T is raised in patients with myocardial ischemia and myocardial infarction.
• Another pathophysiological mechanism is an imbalance of sympathetic energy (reduction of right-handed sympathetic energy in cases of weakness, for poorly corrected right malignant ganglion) and especially genetic anomalies. Most of the time, people might not know for an hour about the discovery of such pathology and the condition of the LZ and the other day, which is injected into the Q-T interval.

PREPARATIONS, podovzhuvati interval Q-T

The increase in the Q-T interval can occur during such electrolytic damage, such as hypocalcium, hypocalcemia, hypomagnesemia. Some of the stanzas are determined by the inflow of bagatio factors, for example, with trivial reception of diuretics, especially looped ones (furosemids), as well as strong carrying ones. It is described the development of the shlunochkovo tachycardia of the type "feasts" on the basis of the increase in the Q-T interval with deadly inheritance from females, who were passed on a low-protein day with a decrease in weight and took furosemide. Q-T interval can be increased at the intake of therapeutic doses for a number of LZ, zokrem hinidin, novokainamid, old phenothiazine and in. (Div. Table). The increase in the electric systole of shlunochkіv can be promoted in the case of snuffled leaks and speeches, which show cardiotoxicity and lead to the repolarization process. For example, pachicarpin in toxic doses, a number of alkaloids, which block the active transport of ions (K +, Mg 2+)

HEART І LIKI

It will be an hour to organize the pharmacological examination of the provinces, including the FDA (USA), Australia and Canada, as well as the State Research Center for the development of respect for the development of arrhythmias in the home. lykarskiye zasobami (LZ), which podovzhuyut the QT interval in the cell of the myocardium and nadayut ganglion blocking action. There are also symptoms of an increased Q-T interval and fatal disturbances to the rhythm in case of barbicides, organophosphorus insecticides and mercury, scorpion bites.

In case of arrhythmias or the threat of guilt, all drugs are used to improve the Q-T interval. Correction of blood electrolytes is necessary, especially calories, calcium and magnesium. In a number of vapors there is enough for normalization of the value and variance to the Q-T interval and for the prevention of lingering disorders to the rhythm.

Domperidone I RAPTOVA SERTSEVA DEATH

In 2012, the Australian Agency for the Control of Medicinal Products (TGA) published the results of pharmacological and epidemiological studies, which could include those who suspected domperidon could be associated with serious diseases of the disease. in additional doses of 30 mg, and for individuals older than 60 years. The doctors confirmed the watchfulness of the Canadian authorities in the pharmacological examination, published in 2007, when the patient with domperidone was found to have a history of heart rhythm disorders, heart failure, heart disease, heart disease, heart disease, heart disease, heart disease. Domperidone, unaffected by the over-the-counter status of the device, is not used by children. It is necessary to consider from a spinal test with CYP3A47 inhibitors, as there may be changes in the plasma, such as іraconazole, amprenavir, atazanavir, fosamprenavir, non-retinalvascular In addition, domperidone is contraindicated for a one-hour consumption of other drugs to increase the QT interval.

AZITROMYCIN TA INSHI macrolide antibiotics

There is also particular relevance of the effects of macrolides, in the presence of azithromycin preparations, available in the form of tablets, capsules, powders for preparing oral suspensions and lyophilisates for injections. On the right, the FDA informed about the development of azithromycin in birch 2013. pathological changes electrical performance of the heart, which can lead to potentially lethal arrhythmias. It is necessary to remember, for a group of patients to become patients with an increase in the Q-T interval in anamnesis, hypocalypse, bradycardia, as well as patients, antihypertensives It is necessary to unify one-hour reception of the medicinal product with azithromycin and other macrolides, so that the development of potential arrhythmias is not possible. When choosing an alternative antibacterial therapy for such patients, it is possible to increase the Q-T interval.

In such a rank, when the given drugs are designated, it is necessary to understand the evidence of evidence and drug insanity. Patients who take certain medications, when they develop interruptions in their robotic heart, or a deterioration in the frequency of the heart rate and heart rhythm (winter, strong heart rate - tachycardia), loss of heart rate, in the case of medical judgment

Likarsky drugs, such as healthy podovzhuvati Q-T interval

relevance... Lack of information among pediatricians, therapists and neurologists about this disease is not easy to bring to tragic inheritance - raptor deaths of ailments with a syndrome of increased QT interval (Long-QT syndrome - LQTS). Also, such patients often have a lack of hyperdiagnostics of the epilepsy of the clinical similarity of syncope (accelerated " convulsive syndrome"), epileptic attacks.

definition... LQTS - is an increase in the QT interval on the EKG (more than 440 ms), on the smallest paroxysms of the tachycardia type "fever". The main thing is that the polyagus is not safe in part of the transformation of the designated tachycardia in the fibrillation of shlunochki, but it is unreasonable to lead to the loss of witness (obscurity), asystole and death of a sick person (before the rapid [in the heart] death). During the last hour, LQTS will bring the rhythm to frequent breakdowns.

Dovidkova information... Interval QT - an hourly display of electrocardiograms (EKG) from the cob of the Q wave until the declining range of the T wave is turned to the isola, which shows the processes of depolarization and repolarization of the myocardium. Interval QT - reception, і, at the same hour, widely discussed the indicator, showing the electric systole of the heart. Wine includes a QRS complex (rapid depolarization and cob repolarization of the myocardium of the middle and right septum), ST segment (repolarization plateau), T wave (repolarization).

An important factor is the triviality of the QT interval, є heart rate (heart rate is very fast). The fallowness is non-linear and is wrapped in a proportional character. The triviality of the QT interval is not consistent in both the individual and the populations. At normal, the QT interval should be no less than 0.36 sec and no more than 0.44 sec. Factors that make it trivial, є: [ 1 ] Heart rate; [ 2 ] Stan of the autonomous nervous system; [ 3 ] Diyu so called sympathomimetics (adrenaline); [ 4 ] electrical balance(Especially Ca2 +); [ 5 ] Deyakі lіkarski preparations; [ 6 ] Вік; [ 7 ] pidlog; [ 8 ] finish the hour.

Remember! The basis for the increase in the QT interval is the correct value and interpretation of the QT interval, but also the heart rate. The triviality of the QT interval in the norm varies in the amount of heart rate. For the growth (correction) of the value of the QT interval from the rate of heart rate (= QTc) Vikoristovuyt ізні formulas (Bazett, Fridericia, Hodges, Framingham formula), tables and nomograms.

The increase in the QT interval shows an increase in the hour of the re-entry of the patient, and in the case of the same impulse, the change of mind is necessary for the formation of the re-entry mechanism (the mechanism of re-entry for the circulation). Such a median of circulating impulses (hyper-impulses) is a building-up to provoke paroxysm of shlunochkovo tachycardia (SHT).

pathogenesis... A short list of basic hypotheses for the pathogenesis of LQTS. One of them is the hypothesis of a sympathetic imbalance of innervation (a decrease in right-handed sympathetic innervation in the face of weakness, for an underappreciated right-handed ganglion and an overload of sympathetic side-to-side infusions). Tsikavim є hypothesis of pathology of the ionic canals. At the same time, the processes of depolarization and repolarization in cardiomyocytes appear in the heart of the cell from the back space and back, controlled by K + -, Na + - and Ca2 + -channels. Let me assume that the basis of all LQTS options is the damaged function of the new channels. For a wide variety of reasons, the collapse of the qih processes, which leads to the increase in the QT interval, may be in vogue and nabuty (div. Dal).

Ethiology... Accepted vidіlyatie congenital and nabutia varіanti syndrome LQTS. Naturalization option is a genetically determined disease, which is developed in one drop per 3 - 5 thousand population, and 60 to 70% of all ailments become women. According to the data of the International Register, approximately 85% of cases of ill health are falloff, at that hour, about 15% of cases are inherited from new spontaneous mutations. On this year, more than ten genotypes have been detected, which indicate the presence of LQTS syndrome (all of them are associated with mutations of genes, which code for structural units of membrane cells in the cardiomyocytes). , LQT2 і LQT3.

Secondary ethological factors of LQTS can be buty drugs (div. Dal), electrolyte damage (hypocalypse, hypomagnese, hypocalc); damaged from the side of the central nervous system(Subarachnoid hemorrhage, trauma, fluff, thrombosis, embolism, infection); heart trouble (mostly heart rhythms [sinus bradycardia], myocarditis, ischemia [especially Prinzmetal's angina], myocardial infarction, cardiopathy, mitral valve prolapse - PMC [the most widespread LQTS given to the syndrome s PMK; the frequency of the increase in the QT interval in individuals with MVP і / abo tricuspid valves in reachє 33%]); that in. malignant causes (low-protein diet, implantation of fatty food, chronic alcoholism, osteogenic sarcoma, carcinoma of the legacy, Cohn's syndrome, pheochromocytoma, cuckold diabet, Hypotermia, operations on dilyantsi shia, vagotomy, family periodic parallel, spitting scorpions, psychomotional stress). The increase in the Q-T interval 3 times and more often is observed in children and is typical for individuals with a large sickness from illnesses, in which there are overgrowth of coronary myocardial lesions.

clinika... Before nayyaskravіshih klіnіchnimi manifest LQTS, in bіlshostі vipadkіv Je pershoprichinoyu zvernennya to lіkarya, slіd vіdnesti attacking vtrati svіdomostі, abo syncope, SSMSC obumovlenі spetsifіchnoyu for LQTS zhіzneugrozhayuschih polіmorfnoї PCS, vіdomoї yak «torsades de pointes» (shlunochkovoї tahіkardії type "pіruet"), abo fibrillation of shlunochkiv (FSH). With the help of the EKG-methods, the most frequent during the period of an attack, a special form of ZT with a chaotic change is rebuilt. electric axis ectopic complexes. Tsya is spindle-like tachycardia, which goes into VF and zupinka heart, was first described in 1966 by F. Dessertene in a sick person from LQTS for an hour of syncope, which I will call "torsades de pointes". Most often, paroxysms (ST) are of a short-term nature, you tend to end spontaneously and may not be perceived (LQTS may not be accompanied by losses of fatigue). However, there is a tendency until the next hour of arrhythmic episodes are repeated, which can lead to obscurity and death.

read also the article "Diagnosis of lingual arrhythmias" by A.V. Strutinskiy, A.P. Baranov, A.G. elderberry; Department of propedeutics of internal ailments of the lykuvalny faculty of the Russian State Medical University (magazine "Likuvalna on the right" No. 4, 2005) [read]

In the literature, there is a stable connection of provocative officials with syncopal epizodes. When analyzing officials who have syncope, it has been established that, in practice, in 40% of ailments, syncope will begin to reestablish on the smallest of strong emotional anxiety (gniv, fear). Approximately 50% of respondents are provoked by physical calls (including swimming), 20% - by swimming, in 15% of cases of smell, by an hour when they are awakened from a normal sleep, in 5% of respondents are called to phone calls doors and ін.). In the case of a suproduct syncope with a subtle-cloning character with mimic secular depression, inodi - defecation, a differential diagnosis of a syncope with a convulsive component and a great epileptic seizure key manifestations... However, it is respectable to allow the development of the message of the post-transitional period in the sick with LQTS - the update of the quality is good and the level of awareness without amnestic attacks is good. For LQTS, there are no typical types for the ailments on the epilepsy of specialness. the main vidmitnoyu acquaint LQTS followed the connection with the establishment of provocative factors, as well as predisposition to this pathology.

diagnostics... The EKG has little initial significance in the diagnosis of the main clinical variants of the syndrome (the triviality of the QT interval starts at 3 - 5 cycles). An increase in QT interval triviality is less than 50 ms in terms of return to normal values ​​for a given heart rate (HR), which may alert the presenter in the LQTS plan. It is not possible to increase the QT interval, the EKG allows for the development of the skin and other signs of electrical instability of the myocardium, such as the alternation of the T wave (change in the shape, amplitude, triviality or the polarity of the singer's teeth) Interval QT (imaging heterogeneity of triviality to the process of repolarization in the myocardium of shlunochki), as well as disturbance of rhythm and conductivity. Holter monitoring (HM) allows you to set the value of the maximum triviality to the QT interval.

Remember! Vimіryuvannya іntervalu QT Got bike klіnіchne value bunt rank, that scho yogo podovzhennya Mauger asotsіyuvatisya of pіdvischenim rizikom smertі, in addition chislі BCC vnaslіdok rozvitku fatal shlunochkovih aritmіy, zokrema, polіmorfnoї shlunochkovoї tahіkardії [shlunochkovoї tahіkardії type "pіruet» - torsade de pointes, (TdP)]. Raising the QT interval with the help of non-linguistic factors, the middle of a particular respect for the merits of the ineffective treatment of medicines, old zbilshuvati.

Likarski drugs, like viclikyut LQTS: [1 ] Antiarrhythmic drugs: class IA: hinidin, procainamid, disopiramid, giluritmal; IC class: enkainid, flekainid, propafenone; Class III: amiodarone, sotalol, bretylium, dofetilide, sematilide; IV class: bepridil; іnshih antiarrhythmic drugs: adenosine; [ 2 ] Sertsevo-sudinn_ preparations: adrenaline, ephedrine, cavinton; [ 3 ] Antihistamines: astemizole, terfenadine, diphenhydramin, ebastin, hydroxyzine; [ 4 ] Antibiotics and sulfanilamides: erithromicin, clarithromicin, azithromicin, spiramicin, clindamicin, anthramicin, troleandomycin, pentamidine, sulfometaxozole-trimethoprim; [ 5 ] Anti-malaria drugs: nalofantrin; [ 6 ] Antifungal drugs: ketoconazole, fluconazole, іraconazole; [ 7 ] Tricyclic and tetracyclic antidepressants: amitriptyline, norttriptyline, imipramin, desipramin, doxepin, maprotiline, phenothiazin, chlorpromazine, fluvoxamine; [ 8 ] Antipsychotics: haloperidol, chloralhydrate, droperidol; [ 9 ] Serotonin antagonists: ketanserin, zimeldin; [ 10 ] Gastroenterological preparations: cisapride; [ 11 ] Diuretics: indapamide і ін. Preparations, scho viklikayut gіpokalієmiyu; [ 12 ] Іnshі drugs: cocaine, probucol, papaverine, prenilamin, lidoflazin, terodilin, vasopresin, lithium preparations.

More details about LQTS in offensive dzherels:

lecture "Syndrome of the hyperactive QT interval" N.Yu. Kirkina, A.S. Volnyagina; Tula State University, Medical Institute, Tula (journal "Clinical Medicine and Pharmacology" No. 1, 2018 ; p. 2 - 10) [Chitati];

Statute "Clinical Significance of Increasing QT and QTC Intervals for the Use of Drugs" N.V. Furman, S.S. Shmatova; Saratov Scientific-Preceding Institute of Cardiology, Saratov (magazine "Rational Pharmaco-Therapy in Cardiology" No. 3, 2013) [read];

article "Syndrome of increased QT interval - the main clinical and pathophysiological aspects" N.А. Tsibulkin, Kazan State Medical Academy (magazine "Practical Medicine" No. 5, 2012) [read]

article "Syndrome of an increased QT interval" Rosa Khadievna Arsentieva, lykar functional diagnostics the center of psychophysiological diagnostics of the Medical and sanitary part of the Ministry of Internal Affairs of the Russian Federation in the Republic of Tatarstan (journal Bulletin of modern clinical medicine No. 3, 2012) [read];

of the article "Syndrome of an increased QT interval" heading - "Bezpeka lykarsky zasobiv"(The magazine" Zemsky Likar "№1, 2011) [read]

Statute "Nabutia Syndrome Podvzhennym Q-T Interval" E.V. Mironchik, V.M. Pirochkin; Department of hospital therapy, EE "Grodno State Medical University" (Journal of the State Medical University №4, 2006) [read];

of the article "Syndrome of increased QT interval - clinical diagnosis and diagnosis" L.А. Bokeriya, A.Sh. Revishvili, I.V. Pronicheva Science Center heart-vascular surgery im. A.N. Bakul'va RAMS, Moscow (journal "Annals of arrhythmology" No. 4, 2005) [read]

© Laesus De Liro

• We are less respectful for the QT interval, if the EKG is used to rehearse the best women. If there is only one anomaly on the EKG є the QT interval is increased, when you think about three of the most common reasons:

• Hypercalculus should be produced to shorten the QT interval. Hypercalcemia is important to be recognized at the EKG and to begin to show yourself only with even higher values ​​of syrovat calcium (> 12 mg / dl).
• Інші, Mensh parts of the cause raising the QT interval - ischemia, myocardial infarction, blockade of the Gis bundle knives, hypothermia, alkalosis.
• To change the QT interval, the input is vibrated, in which the end of the T wave is clearly visible (the second input), or the input, in which QT is the most advanced (V2-V3).
• Clinically, it is often necessary to achieve a normal, near-cordonny or increase in the QT interval.
• The great U waves are not to blame for the QT interval.

• On the basis of Bazett's formula, Bouley calculated the multipliers for easy value Correction QT up to frequency:

1. Multiply by 1,0 at the frequency of the rhythm ~ 60 beats / hv
2. Multiply by 1,1 at the frequency of the rhythm ~ 75 beats / hv
3. Multiply by 1,2 at the frequency of the rhythm ~ 85 beats / hv
4. Multiply by 1,3 at the frequency of the rhythm ~ 100 beats / hv

• Yaksho EKG will show the frequency of the rhythm of 60 beats / hv, the correction to the interval is not required, QT = QTc.
• Normal QTc values ​​in people< 440ms, for women< 460ms. Аномально короткий интервал QTc < 350 ms.
• QTc interval> 500 ms ovishnom rizik development potentially unsafe for the life of the feasting tachycardia (Torsades de Pointes).The QTc interval> 600 ms is even more reliable, and it is not only the correct provocative officials, but the active methods of treatment.

• BURN UVAGU!"Okay," normal QT is responsible for becoming less than half of the front RR interval(Ale tse vіrno tilki for frequency and rhythm 60-100 beats / hv) .

• Yakscho vihіdnі EHC patsієnta on yakіy bi vimіryali іnterval the QT, nemozhlivo viznachiti rhythm polіmorfnoї shlunochkovoї tahіkardії (PMZHT) od pіruetnoї tahіkardії Torsades de Pointes (Yak Je PMZHT of podovzhenim іntervalom the QT) i to lіkuvannya їh guilty Buti odnakovim - spryamovanim on skorochennya іntervalu QT.

• The one who found the QT interval was determined by the QRS, completing the compensator with a pause by the slunk extrasystole.
• When the QRS triviality is more than 120 ms, the change in value is not included in the QT interval (tobto QT = QT- (QRS width is 120 ms).

- genetically heterogeneous declining stance, which is characterized by damage to the structure and functionality of these canals in the cardiomyocytes. The variability of the manifestations of pathology rises in arched wide boundaries - from a practically asymptomatic course (only electrocardiological signs appear) to important deafness, obtuseness and arrhythmias. The diagnosis of the syndrome of an increased QT interval is carried out at the presentation of the given electrocardiological information and molecular genetic analyzes. Likuvannya to accumulate in the form of pathology and may include a long-term course of beta-andrenoblockers, drugs in magnesium and calcium, as well as the installation of a defibrillator-cardioverter.

Country houses

Syndrome of an inflated QT interval is a group of cardiological disorders of a genetic nature, when the passage of these struma in cardiomyocytes breaks down, which usually leads to arrhythmias, obscurity and rapid heart death. For the first time, an increase was made in 1957 by the Norwegian doctors A. Jervell and F. Lange-Nilsen, who described a recent deafness, syncope attacks and an increase in the QT interval. Three of them, in 1962-64, the rock of the boule showed similar symptoms in patients, but there was a normal hearing - these types of boules were described just one way of one K. Romano and O. Ward.

Tse, as well as other indications, caused the syndrome of an increased QT interval to be divided into two key options - Romano-Ward and Jervell-Lange-Nilsen. The first to settle down on an autosomal dominant mechanism, its frequency in the population becomes 1 type per 5000 population. The severity of the syndrome of an increased QT interval of the Jervell-Lange-Nilsen type occurs in the boundaries of 1-6: 1,000,000; According to some data, all forms of the syndrome of an increased QT interval are predicted for a third of the rate of rapt heart death and close to 20% of rapt baby death.

Reasons and classification

In an hour, the identification of 12 genes is far away, mutations in which can lead to the development of the syndrome of an increased QT interval, all the smells are coded, either of them, even to enter the warehouse of the natal channels of the cardiomyocytes, streams In the distance, you can also know the reasons for the key interruption tsyo zhvoryuvannya. Autosomal dominant Romano-Ward syndrome of mutation if one gene is deprived of one gene, and it can be asymptomatic, or, as a minimum, hearing impairment occurs. With the type of Jervell-Lange-Nilsen - a defect of two genes - tsey variants, in addition to cardiological symptoms, one is susceptible to double-sided neurosensory deafness. On the current day, mutations of some genes increase the development of the syndrome of an increased QT interval:

1. Hypnotic QT syndrome type 1 (LQT1) mutation of the KCNQ1 gene mutated on chromosome 11. Defective gene most often appears when this disease is present. Win code the last of the alpha-subunit of the same in the appearance of the cardiomyocyte canals (lKs)
2. Hyperactive QT syndrome type 2 (LQT2) To suffer from defects in the KCNH2 gene, such as localization on the 7th chromosome and the amino acid code of the amino acid sequence - the alpha subunit of the second type of caliber channels (lKr).
3. Hypnotic QT syndrome type 3 (LQT3) mutations of the SCN5A gene, rosted on the 3rd chromosome. On the basis of the previous variants of pathology, when the robot is damaged in the cardiomyocyte channels, so as the given gene code is the sequence of the alpha subunit of the natural channel (lNa).
4. Hypnotic QT syndrome type 4 (LQT4)- to finish the rіdkіsny variant of the stan, wicked by the mutation of the ANK2 gene, such as rosetting on the 4th chromosome. The product of this expression is the ankyrin B block, which in the human body takes part in the stabilization of the structure of the microtubules of myocytes, as well as to be seen in the cells of the neuroglia and the eyes of the eye.
5. Hyperactive QT syndrome type 5 (LQT5)- a type of sickness, a yak surrounded by a defect in the KCNE1 gene, localized on the 21st chromosome. Win code is one of the white channels - the beta subunit of the calibrated channels of the lKs type.
6. Hyperactive QT syndrome type 6 (LQT6) to get a mutation in the KCNE2 gene, which is also rocked on the 21st chromosome. The product of this expression is a beta subunit of calibrated channels in the lKr type.
7. Type 7 puffy QT syndrome(LQT7, the name is Andersen's syndrome, in honor of the pediatrician E. D. Andersen, who described the process of becoming ill in the 70s) of a defect in the KCNJ2 gene, which is localized on the 17th chromosome. Yak and in the range of the foregoing variants of pathology, the whole gene code is one of the white lancers of the calyve channels.
8. Type 8 puffy QT syndrome(LQT8, іnsha name - Timothy syndrome, in honor of K. Timothy, described the process of becoming ill) of the CACNA1C gene mutation, which grows on the 12th chromosome. Tsey gene code is alpha-1-subunit of calcium channel L-type.
9. Hypnotic QT syndrome type 9 (LQT9) mummification with a defect in the CAV3 gene, localized on the 3rd chromosome. The product of this expression is block caveolin 3, which takes care of the fate of the form-free structures on the surface of the cardiomyocytes.
10. Flushed QT syndrome type 10 (LQT10)- the reason for the development of a mutation in the SCN4B gene, which grows on the 11th chromosome and is suspected of being amino acid after the beta subunit of certain channels.
11. Hypnotic QT syndrome type 11 (LQT11) suffer from defects in the AKAP9 gene, which is rosted on the 7th chromosome. Vin code specific block - A-kinase centrosome and Golgi complex. Functional protein for the current day of vaccination is insufficient.
12. Flushed QT syndrome type 12 (LQT12) mutations of the SNTA1 gene localized on chromosome 20. Win the code of alpha-1-subunit of the sintrophin block, which takes a part in the regulation of the activity of the natural channels of the cardiomyocytes.

Unimportant on a wide genetic variability of the syndrome of an increased QT interval, of the lateral pathology of the pathogenesis in general for the skin forms. It is given to bring canalopathies to the group through those that are the reason for breaking down in Budov's still quiet canals. As a result, the process of repolarization of the myocardium is seen unevenly and frequently in the small parts of the shlunochki, which becomes the reason for the increase in the QT interval. In addition, the sensitivity of the myocardium is signi fi cantly increased to the level of sympathetic nervous system, which becomes the cause of frequent tachyarrhythmias, which can lead to life-threatening fibrillation of slugs. With a large number of genetic types in the syndrome of a puffy QT interval, the sensitivity to quietness is indicated. For example, LQT1 is characterized by syncope attacks and arrhythmias in case of physical disturbance, in case of LQT2 analogous manifestations are prevented in case of loud and sharp sounds, for LQT3, navpaki, more characteristic arrhythmia development.

Symptoms of increased QT interval

Manifest the syndrome of a puffed up QT interval to reach dementia. For more important to the classy type Jervell-Lange-Nilsen in ailments is deafness, part of obscurity, foulness, weakness. In addition, in a number of cases, at the same time, epileptic-like ship attacks are reestablished, so it is not easy to lead to an incorrect diagnosis of this. According to the facts of the genetics, from 10 to 25% of the ailments with the syndrome of the hypochondriacal interval of QT, they will recognize the wrong treatment, and they develop a raptus heart or a child's death. The diagnosis of tachyarrhythmias and syncopal stagnation occurs from the outbreak - for example, with LQT1 it is possible to see physical navantazhennya With LQT2, there is a loss of quality and fibrillation of lunches in any number of loud and loud sounds.

big easy form Syndrome of an increased QT interval (Romano-Ward type) is characterized by passing syncope (uncomfortable) and occasional attacks of tachyarrhythmia, hearing impairment with a wide range of vision. In a number of vypadkіv, the form of getting sick in zagalі doesn’t show itself, behind a vignette of electrocardiographic tributes, and in a vignette for medical care... On the other hand, with such an interruption of the syndrome of an increased QT interval, the risk of raptus heart death through fibrillation of shlunochki in a lot of developing food, but not in a healthy person. This is a type of pathology for medical treatment and prophylactic treatment.

diagnostics

Diagnosis of the syndrome of an increased QT interval is carried out on the basis of anamnesis of the sick person, electrocardiological and molecular genetic diagnostics. When questioning the patient, it is often possible to see if it is unpleasant, it is so bad, it seems like a heartache, but in case of mild forms of pathology, it may or may not be. In some analogy, show yourself to be suspicious of someone else's relatives of the patient, so that you can cast on the family's temper.

If there is a form of a syndrome of an increased QT interval, there will be changes on the EKG - an increase in the QT interval of up to 0.6 seconds or more, it is possible to increase the amplitude of the T wave. In addition, it is often necessary to carry out a heart-to-heart monitoring of the robot to detect possible attacks of tachyarrhythmias. The diagnosis of the syndrome of an increased QT interval for additional methods of modern genetics on the current day is more than practical of all genetic types of the disease.

Elimination of QT interval syndrome

Therapy for the syndrome of an increased QT interval is easy to reach, it is very difficult to recommend a lot of problems with one scheme and one that is indicated, if only one protocol is used to eliminate the pathology of pathology. Beta-adrenergic blockers are used as universal drugs, which reduce the risk of development of tachyarrhythmias and fibrillation, as well as reduce the steps of pretty infusions on the myocardium, albeit with LQT3, the stench is ineffective. In case of type 3 hyperarhythmia syndrome type 3, antiarrhythmic drugs of class B1 are more reasonable. The particularity of the disease is driving the need for molecular genetic diagnostics for the type of pathology. At times of frequent attacks of tachyarrhythmias and high rhiziku The development of fibrillation is recommended to implantation of a cardiostimulator or a defibrillator-cardioverter.

forecast

The prognosis of the syndrome of an increased QT interval, on the thought of a large number of faults, non-values, as it is characterized by a wide range swelling of symptoms. In addition, the presence of pathological manifestations, behind a vignette of electrocardiographic donations, is not a guarantee of the rapid development of fatal fibrillation of shlunochki in the presence of a internal officials... When the syndrome of an increased QT interval is detected, it is necessary to carry out a cardiological examination and genetic identification of the type of discomfort. On the basis of these data, the scheme of treatment is developed, the reduction of the speed of the rapt heart death, or the decision about the implantation of the cardiac stimulator, is taken into account.