I thought for a long time about how to write this section for non-cardiologists and came to the conclusion that the most important thing would be to learn not to miss the signs of a heart attack. I believe that this will be a greater achievement than bothering one’s head with such concepts as: endocardial, epicardial ischemia and the mechanisms of their development, how the stages of infarction of various walls proceed, which arteries are responsible for this or that part of the heart, and so on. Let's leave these “aerobatic maneuvers” to cardiologists; our goals are more earthly.
So let's start with the most important thing - Myocardial infarction with ST elevation. Such a heart attack is accompanied by a very high mortality rate and requires urgent treatment; it is advisable to open the artery within the first 60-90 minutes. Therefore, missing it is an unforgivable mistake. Any doctor at all costs must learn to find ST elevation on an ECG. You may not know how to determine rhythm and blocks, but you need to know ST-elevation infarction in person.
From now on, we will get acquainted with the “pink ECGs” that you are used to seeing every day. As always I will try to use ECG high quality, but during a heart attack and/or when the patient is tossing around in bed from chest pain, “exemplary ECGs” are rarely obtained.
ST elevation and ST elevation infarction
In order to correctly assess the degree of elevation, you need to know where to measure it.
Look at the picture, where will you measure the elevation here? If you take it to the left, it will be less, if you take it to the right, it will be more.
In order to standardize measurements, a technique was introduced into practice for determining the j-junction point, which is located at the place where the S wave ends (if there is no S, then R) and the ST segment begins. If you step back 0.04 s from point j (that is, 2 mm at a belt speed of 50 mm/sec), then you will find point i at which you need to measure the height of elevation or depression.
Normally, elevation does not exceed 1 mm, but in leads V2-V3 it can be up to 2 mm or even 2.5 mm in people under 40 years of age. There are various figures, including those for point i, but I recommend that you use these indicators, even if you are “over-excited” someday, but it’s better than missing it.
Let's see what it looks like in life.
This is what the measurements look like. You can see at least 2 mm of elevation in lead III and almost 1.5 mm in lead AVF
Hover your cursor to enlarge the picture Now, regarding ST elevation infarction
The most important criterion, along with elevation, is reciprocal changes - ST depression in leads opposite to the area of infarction. That is, if there is elevation somewhere, then somewhere nearby there must be depression. In rare cases, reciprocal changes occur in areas that are not visible on regular ECGs, but let's agree right away - you send all patients with ST elevation and related complaints to hospital immediately or present them to a cardiologist.
Situations in which you can solve the problem yourself are limited to cases when you have an ECG on hand for comparison. That is, you can say with 100% confidence that the ECG looked like this before, for example: cases with post-infarction changes or early repolarization syndrome - we’ll talk about this later.
Now let's go back to the previous ECG. This is a heart attack.
ECG No. 1
Elevation is highlighted in red, and depression, which is reciprocal, is green. Such an ECG in 99.9999% of cases indicates acute heart attack in area bottom wall(III, aVF). Remember, to talk about the presence of a heart attack, you need to have changes in the adjacent leads. For example (III, aVF or I, aVL or two adjacent chest leads).
ECG No. 2
Let's look at another ECG with an inferior infarction. Do not pay attention to the small tremor in leads V1-V2 - these are artifacts and they do not mean anything.
Area highlighted in red elevation, green - reciprocal depression . Yellow is also a reciprocal change, but due to the presence of a complete block of the right bundle branch (I hope you noticed it), this statement can be disputed.
ECG No. 3
Well, another ECG with a lateral wall infarction (I, AVL, usually there is also V5-V6, but not always), I think explanations are unnecessary.
ECG No. 4
And the last ECG with anterolateral infarction. There is some isoline drift here, so I chose the most “clean” area for measurements.
ST segment measurement rules
- The ST segment is measured 60 msec (one and a half small cells) from the J point.
- The J point is where the S wave transitions into the ST segment (or the S wave crosses the isoline).
- Normally, ST elevation may be observed in leads V1-V3 with a maximum in V2 up to 0.25 mV.
- In other leads, elevation of 0.1 mV or higher is considered pathological.
ST segment elevation
ST segment elevation may take different shape depending on the reason that caused it. Most common reasons ST elevation:
- Myocardial infarction with ST elevation
- Early ventricular repolarization syndrome (EVRS)
- Pericarditis
- Post-infarction aneurysm
- Brugada syndrome
- Complete left bundle branch block (LBBB)
- Left ventricular hypertrophy
- Variant angina (Prinzmetal angina)
Below are examples of ST elevation in the diseases listed above. Look at each of the complexes, find the J point and calculate the height of ST elevation 60 milliseconds away. Then check the correct answer:
In the absence of d other signs of myocardial damage (eg, Q waves or deep negative T waves) incurved ST elevation is usually benign, while oblique or convex elevation is usually pathological and associated with myocardial ischemia.
There is a good “memo” for concave and convex forms of ST elevation:
ECG criteria for pathological ST elevation in STEMI
New ST elevation in two or more adjacent leads is considered pathological:
- ≥2.5 mm in V2-V3 and ≥1 mm in other leads in men under 40 years of age
- ≥2.0 mm in V2-V3 and ≥1 mm in other leads in men over 40 years of age
- ≥1.5 mm in V2-V3 and ≥1 mm in other leads among women
- ≥0.5 mm in V7-V9
- ≥0.5mm in V3R-V4R
- If the patient has complete blockade LBP or a pacemaker is installed - it is necessary to use the modified Sgarbossa criteria.
- To distinguish between STEMI in the LAD and early ventricular repolarization syndrome (EVRS), use the Smith formula.
ST segment depression
ST segment depression can be of three types:
Oblique ST depression often occurs against the background of tachycardia (for example, during physical activity) and disappears when the heart rate decreases. Such depression is a variant of the norm. Obliquely ascending depression turning into high-amplitude “coronary” T waves may mean the most acute stage extensive myocardial infarction (so-called De Winter's T-waves).
Horizontal and downward ST depression, depth ≥0.5 mm in two adjacent leads is a sign of myocardial ischemia (all four examples above).
Always note that ST depression may be reciprocal to elevation in mirror leads. Most often, acute posterior myocardial infarction is manifested by horizontal depression V1-V3 and minimal elevation in V6 (to check in such cases, it is necessary to record leads V7-V9), and high lateral infarction - ST depression in II, III, aVF and subtle elevation in aVL (to check, you need to record V4-V6 two intercostal spaces above).
To summarize: ST elevation and depression
- Remember that both ST elevation and depression can be normal.
- Before accepting such changes as normal, rule out all possible pathological causes.
- If you see both depression and ST elevation on the same ECG, then suspect STEMI and evaluate elevation first, as it is much more dangerous. Then analyze ST depression - it may be reciprocal changes.
ST segment measurement rules
- The ST segment is measured 60 msec (one and a half small cells) from the J point.
- The J point is where the S wave transitions into the ST segment (or the S wave crosses the isoline).
- Normally, ST elevation may be observed in leads V1-V3 with a maximum in V2 up to 0.25 mV.
- In other leads, elevation of 0.1 mV or higher is considered pathological.
ST segment elevation
ST segment elevation can take different forms depending on the cause that caused it. The most common causes of ST elevation:
- Myocardial infarction with ST elevation
- Early ventricular repolarization syndrome (EVRS)
- Pericarditis
- Post-infarction aneurysm
- Brugada syndrome
- Complete left bundle branch block (LBBB)
- Left ventricular hypertrophy
- Variant angina (Prinzmetal angina)
Below are examples of ST elevation in the diseases listed above. Look at each of the complexes, find the J point and calculate the height of ST elevation 60 milliseconds away. Then check the correct answer:
In the absence of d other signs of myocardial damage (eg, Q waves or deep negative T waves) incurved ST elevation is usually benign, while oblique or convex elevation is usually pathological and associated with myocardial ischemia.
There is a good “memo” for concave and convex forms of ST elevation:
ECG criteria for pathological ST elevation in STEMI
New ST elevation in two or more adjacent leads is considered pathological:
- ≥2.5 mm in V2-V3 and ≥1 mm in other leads in men under 40 years of age
- ≥2.0 mm in V2-V3 and ≥1 mm in other leads in men over 40 years of age
- ≥1.5 mm in V2-V3 and ≥1 mm in other leads among women
- ≥0.5 mm in V7-V9
- ≥0.5mm in V3R-V4R
- If the patient has a complete LBP block or a pacemaker is installed, it is necessary to use the modified Sgarbossa criteria.
- To distinguish between STEMI in the LAD and early ventricular repolarization syndrome (EVRS), use the Smith formula.
ST segment depression
ST segment depression can be of three types:
Oblique ST depression often occurs against the background of tachycardia (for example, during physical activity) and disappears when the heart rate decreases. Such depression is a variant of the norm. Obliquely ascending depression, turning into high-amplitude “coronary” T waves, may indicate the most acute stage of extensive myocardial infarction (the so-called De Winter's T-waves).
Horizontal and downward ST depression, depth ≥0.5 mm in two adjacent leads is a sign of myocardial ischemia (all four examples above).
Always note that ST depression may be reciprocal to elevation in mirror leads. Most often, acute posterior myocardial infarction is manifested by horizontal depression V1-V3 and minimal elevation in V6 (to check in such cases, it is necessary to record leads V7-V9), and high lateral infarction - ST depression in II, III, aVF and subtle elevation in aVL (to check, you need to record V4-V6 two intercostal spaces above).
To summarize: ST elevation and depression
- Remember that both ST elevation and depression can be normal.
- Before accepting such changes as normal, rule out all possible pathological causes.
- If you see both depression and ST elevation on the same ECG, then suspect STEMI and evaluate elevation first, as it is much more dangerous. Then analyze ST depression - it may be reciprocal changes.
A downward displacement of the ST segment relative to the isoelectric line (depression) is a reason for a more detailed examination of the patient, since the presence of such a change allows one to suspect ischemia of the heart muscle.
It should be remembered that analysis of this segment alone in isolation from the overall picture of the electrocardiogram is not informative enough. A correct conclusion is possible only after a comprehensive detailed analysis recordings in all leads.
What is the ST segment?
A segment on a cardiogram is a section of the curve located between adjacent teeth. The ST segment is located between negative tooth S and T wave.
The ST segment is a fragment of the electrocardiogram waveform that reflects the period during which both ventricles of the heart are fully involved in the excitation process.
The duration of the ST segment on the ECG depends on the frequency heart rate and changes with it (the higher the heart rate, the shorter the duration of this section on the cardiogram).
Each section of the electrocardiographic curve has its own diagnostic value:
Element | Meaning |
The same shape and size of a positive P wave and its presence before each QRS complex is an indicator of normal sinus rhythm, the source of excitation in which is localized in the atrio-sinus node. With a pathological rhythm, the P wave is modified or absent |
|
Determined by the process of excitation of the interventricular septum (depolarization of the interventricular septum) |
|
Reflects the excitation of the apex of the heart and adjacent areas of the heart muscle (depolarization of the main part of the ventricular myocardium) in leads v 4, 5, 6, and in leads v1 and v2 - reflects the process of excitation of the interventricular septum |
|
It is a reflection of the excitation of the interventricular septum adjacent to the atria (basal) (depolarization of the base of the heart). On a normal electrocardiogram it is negative, its depth and duration increase with complete blockade of the left bundle branch, as well as the anterior branch of the left bundle branch. |
|
Is a manifestation of the processes of repolarization of the ventricular myocardium |
|
An unstable element of the electrocardiographic curve, recorded after the T wave and appearing due to short-term hyperexcitability of the ventricular myocardium after their repolarization |
|
PQ segment | The duration of this interval indicates the speed of electrical impulse transmission from the atrial myocardium to the cardiac muscle of the ventricles of the heart. |
QRS complex | Displays the progress of the process of distribution of excitation throughout the ventricular myocardium. Lengthens with right bundle branch block |
ST segment | Reflects the saturation of myocardial cells with oxygen. Changes in the ST segment indicate oxygen starvation (hypoxia, ischemia) of the myocardium |
P-Q interval | Conducting electrical impulses; an increase in the duration of the segment indicates a disruption in the conduction of impulses along the atrioventricular pathway |
QT interval | This interval reflects the process of excitation of all parts of the ventricles of the heart; it is commonly called electrical ventricular systole. Prolongation of this interval indicates a slowdown in impulse conduction through the atrioventricular junction |
On normal cardiogram in the limb leads, the ST segment has a horizontal direction and is located on the isoelectric line. However, its position is also recognized as a variant of the norm, slightly above the isoelectric line (one and a half to two cells). This picture on the electrocardiogram is often combined with an increase in the amplitude of the positive T wave.
When analyzing an electrocardiogram, the greatest attention is paid to this segment when coronary heart disease is suspected and when diagnosing this disease, since this section of the curve is a reflection of oxygen deficiency in the heart muscle. Thus, this segment reflects the degree of myocardial ischemia.
ST segment depression
The conclusion about ST segment depression is made when it is located below the isoelectric line.
Dropping of the ST segment below the isoline (its depression) can also be recorded on the cardiogram healthy person, in this case the position of the electrocardiogram curve on section S-T does not fall below half a millimeter of the isoelectric line.
Causes
When analyzing an electrocardiogram, it is necessary to take into account that modifications of some of its elements can be caused by medications that the patient is taking, as well as deviations in the electrolyte composition of the blood.
Downward displacement of the ST segment relative to the isoelectric line is a nonspecific sign. This electrocardiographic phenomenon is observed in various leads in a number of conditions:
- Subendocardial or acute transmural ischemia (in acute myocardial infarction).
- Acute myocardial ischemia of the anterior wall of the left ventricle. This may also be indicated by ST elevation in the precordial leads.
- Acute ischemia of the lower wall.
- Impact result medicines class of cardiac glycosides.
- Hyperventilation of the lungs (excess oxygen in them).
- Reduced potassium content in the peripheral blood (hypokalemia) - in this case, there is a possibility of an additional U wave.
- Hypertrophic changes in the left ventricle, which in some cases can be interpreted as a sign of its overload.
- The horizontal displacement of this segment downwards is specific to chronic course coronary circulatory failure with myocardial ischemia.
- Vegetovascular dystonia.
- Pregnancy. During this period, a shift of the ST segment below the isoelectric line may be recorded against the background of tachycardia; the degree of depression in these cases does not exceed 0.5 mm.
A change in the ST-T complex in the form of its displacement down relative to the isoelectric line can be caused by a complex of reasons. For example, in a patient with myocardial hypertrophy (of any origin) and receiving therapy in the form of cardiac glycosides, there is a possibility of acute subendocardial ischemia.
Detection of ST segment depression is the reason for a thorough analysis of the electrocardiogram recording in all leads for a more accurate diagnosis of the location of the lesion.
Clinical manifestations
In typical cases, myocardial ischemia (hypoxia) is manifested by pressing pain, discomfort, and burning in the chest area. Irradiation is characteristic pain in the back and left area upper limb. A painless form of myocardial ischemia is also possible, manifested by feelings of discomfort in the chest space, tachycardia, a decrease or increase in blood pressure, heartburn, and shortness of breath.
At differential diagnosis ischemic myocardial damage with VSD, the features are taken into account clinical picture: For vegetative-vascular dystonia ST depression is typical in a young patient, more often in women, against the background of an increase in heart rate, in the absence of symptoms typical of angina pectoris. In this case, changes in the electrocardiogram are regarded as “nonspecific” or as “signs increased influence sympathetic nervous system".
With transient ischemia, Holter monitoring (recording an ECG during the day) helps make a diagnosis. All episodes are displayed on Holter oxygen starvation heart muscle of patients that occurred throughout the day.
Application of Holter
Treatment of conditions accompanied by ST segment depression
In order for treatment to be effective, it is necessary to act directly on the cause of hypoxia, which is determined using special methods examinations. Possible reasons are:
- atherosclerotic vascular damage;
- unbalanced diet containing excessive amounts of cholesterol;
- emotional stress;
- Availability bad habits;
- sedentary lifestyle;
- excessive physical activity when the body is unprepared;
- metabolic disorders in the body leading to obesity;
- diabetes.
When treating myocardial ischemia, complex therapeutic regimens are used, consisting of the following drugs described in the table:
Group | Drug names | Effect |
Antiplatelet agents | Acetylsalicylic acid, Thrombo ACC, Cardiomagnyl | Prevent aggregation shaped elements blood, improve its rheological properties |
Nitroglycerin, Nitrosorbide, Nitrospray, Nitromint, Isoket | Dilate coronary vessels and improve blood supply to the myocardium |
|
Adrenergic blockers | Metoprolol, Atenolol, Propranolol | Normalize arterial pressure and heart rate |
Simvastatin, Atorvastatin | Reduce blood cholesterol levels to prevent atherosclerotic vascular disease |
In case of insufficient efficiency conservative therapy apply surgical methods treatment:
- stenting coronary arteries and (or) their branches;
- coronary artery bypass grafting.
In the treatment of vegetative-vascular dystonia, the main role belongs to the normalization of the excitability of the nervous system. The amino acid Glycine is capable of normalizing the metabolism of nervous tissue. The beneficial effect of this substance on nervous tissue helps to reduce the astheno-neurotic component.
It is also advisable to use nootropic drugs with additional sedative effect.
If tachycardia or tachyarrhythmia is present in vegetative-vascular dystonia, the use of Corvaldin, Corvalol, and potassium preparations is indicated.
For effective treatment vegetative-vascular dystonia requires compliance protective regime: giving up bad habits, a balanced diet, combating physical inactivity, eliminating stress. High efficiency, especially when combined complex therapy, show massage, physiotherapy and acupuncture.
ST segment elevation is a rise above the isoline on the electrocardiogram. In this article we will tell you what diseases this disorder occurs in and how these diseases can be prevented and treated.
What is ST segment elevation?
Using a cardiogram, you can evaluate the rhythm and conductivity of the heart by the position of the segments and teeth of the graph.
ST segment elevation is a deviation above the isoline on the electrocardiogram. Slight elevation is observed with tachycardia, more pronounced with ischemic heart disease and pericarditis. With pericarditis, the S wave is preserved, and its ascending limb is raised. In myocardial infarction, ST segment elevation reverses within 2 weeks. During the course of a heart attack, the T wave rises and becomes sharper. After 6 months, a previous myocardial infarction can be recognized by the disappearance of the R wave.
Causes of ST segment elevation
ST segment elevation in children
The greatest concern is the increase in the number of children with congenital anomalies heart and hypotension. The heart of children is larger than that of adults in relation to the body and has a number characteristic features. Both ventricles are equal, the openings between the parts of the heart are larger than in adults.
Treatment of ST segment elevation
Today the medical community great attention focuses on the earliest management of a patient with myocardial infarction, in which ST segment elevation is observed on the ECG. If you have had a heart attack before, or if you are sick diabetes mellitus, you are at greater risk of having a heart attack than others.
First of all, you need to ensure daily monitoring ECG. Therapy should begin with taking aspirin. Aspirin should be taken in a dosage of 100 mg once a day. Contraindications for use: age under 21 years, pathology of the liver and kidneys, tendency to bleeding. Aspirin is not prescribed to patients with stomach ulcers, gastritis, or colitis. Contraindicated during pregnancy, the drug should be stopped several days before the planned surgical intervention. It is rational to use enteric forms of the drug. They are best taken with food to reduce Negative influence aspirin on the gastrointestinal tract. Enteric aspirin is taken without chewing. There is also regular tablet aspirin and effervescent one.
Nitroglycerin is prescribed intravenously. It is used for emergency care with myocardial infarction over 100 years. Intravenous infusions of nitroglycerin reduce the infarction area and prevent left ventricular remodeling. Nitroglycerin therapy has been shown to reduce complications of myocardial infarction. It reduces the mortality rate of patients by a third. Intravenous administration nitroglycerin is indicated in the first 2 days for patients with myocardial ischemia.
Also appointed ACE inhibitors, for example, valsartan. The drug is rapidly absorbed from gastrointestinal tract. The maximum concentration in the blood is reached after 2 hours. Half-life is 9 hours. Contraindicated during pregnancy. Side effects: weakness, dizziness and nausea. The recommended dosage is 80 mg once a day.
Another reason why ST segment elevation may occur is coronary heart disease. It cannot be cured completely, but proper treatment it can be slowed down. It is important to change your lifestyle and think about your diet. Attacks of arrhythmia and angina require hospitalization; you also need to go to the hospital if cardiac edema increases.
Treatment coronary disease hearts should be lifelong. Unfortunately, without maintenance therapy, IHD progresses.
Angiotensin receptor blockers stop cardiac hypertrophy. Examples of drugs: losartan, candesartan.
Losartan is an angiotensin receptor blocker. Reduces pressure in the pulmonary circulation and prevents sodium retention. Makes the heart more resilient to physical activity. A stable drop in blood pressure is achieved 2 months after the start of the course. It is rapidly absorbed, and the maximum concentration is reached after 2 hours. Most of the drug is excreted by the intestines. Do not use in pregnant women. Side effects: dizziness, asthenia, headache, memory and sleep disorders. The drug is prescribed in a dose of 50 mg 1 time per day.
Candesartan is a drug to prevent increases in blood pressure and decrease heart rate. Increases blood flow in the kidneys. The maximum concentration in the blood is reached after 4 hours. The half-life is 9 hours. It is excreted by the kidneys and bile. Contraindicated during pregnancy. Side effect manifests itself in the form of headache, cough, pharyngitis, nausea. Take 8-16 mg 1 time per day.
Prevention of ST segment elevation
500,000 people a year in Ukraine die from coronary heart disease. Most often, IHD occurs in people over 45 years of age. 50% of patients with ischemia developed the disease due to arterial hypertension. Reducing alcohol consumption and increasing potassium intake can correct mild forms of arterial hypertension. The best prevention all CVD – reduction in stress intensity.
Unconscious harm to health is the main cause of all human diseases. A city dweller can afford to do exercises in the morning, wake up earlier in the morning to prepare a full breakfast, but does not do this. After 40 years preventive examinations hearts should become the norm, but do we often visit the clinic if nothing hurts?
Our heart is a very powerful pump. When we are calm, it contracts 70-85 times per minute. But if we give it physical activity, it is capable of pumping not 4 liters of blood per minute, as usual, but all 40! Trained people have a lower heart rate, which means their heart wears out and ages later.
Cardiovascular diseases are the leading cause of disability and death in the world. Their cause is atherosclerosis, which develops gradually. Whether you will get coronary syndrome, myocardial infarction, or coronary heart disease depends on what gender you are, what your blood pressure and blood glucose levels are. A total of 40 CVD risk factors were identified.
According to 2009 data, 18 million people worldwide died from CVDs. This year a “record” was set - every third person completed his life path due to a diseased heart or blood vessels.
Poor diet and tobacco smoking are the leading causes of CVD. The consequences of an unhealthy diet - high blood sugar and obesity - ultimately cause 85% of heart damage. You should definitely be alerted to pain in chest, elbows, arms, back, difficulty breathing, nausea, dizziness.
The cause of myocardial infarction with ST segment elevation and acute coronary syndrome often becomes atherosclerosis. Prevention of atherosclerosis is healthy eating, physical activity and blood glucose control. To prevent obesity, we recommend that you limit your calorie intake in your diet. Reduce the amount of carbohydrates and fats you consume and eat smaller meals. Avoid eating foods rich in cholesterol. There is especially a lot of it in yolks, so 4 yolks per week is enough. Limit liver, caviar, sausage, milk. Cook and bake dishes in the oven. Food should be varied with plenty of fruits, cereal grains and meat, wholemeal bread. Avoid animal fat. It is recommended to limit fatty meats, butter and yolks. Fish from the northern seas are useful: herring, mackerel, salmon. Drink high quality raw water. Avoid stress and keep your blood pressure under control. Salt your food less. Take preventive measures and remember that the heart is a very delicate organ. If you have high blood pressure, you need courses of antihypertensive therapy, anti-ischemic therapy if you have ischemic heart disease. Complete smoking cessation also helps prevent heart disease. Only about 30% of adults are not at risk for CVD. Half of the population has several risk factors that, when combined, cause heart and vascular disease.
Arterial hypertension and lipid metabolism disorders almost always lead to the development of coronary heart disease. Nicotine is the cause of vasospasm. Smoking people most often die from myocardial infarction and oncological diseases. If you cannot cope with the addiction yourself, it may be worth contacting a narcologist for help. qualified help– today there are many ways to get rid of addiction: nicotine chewing gum, reflexology. Let the best motivator for you be that each cigarette “steals” 20 minutes of your life.
Running, swimming and skiing, hiking, and gymnastics are useful. All this not only tones the heart, but also develops muscle strength, joint mobility, and the ability to breathe correctly. The most common physical activity for everyone is ordinary walking. Only by combining all methods of preventing CVD can you be sure that the threat will pass you. Paradoxically, the problem of heart disease is more often encountered in developed countries with large cities and good infrastructure. This is because the automation of production and everyday life freed people from physical activity. As a result, the elasticity of blood vessels decreases. And lifestyle modification can significantly slow down the development of many diseases. Of course, medicine needs to say a huge thank you for such rapid growth and development modern methods treatment, but without understanding that everyone creates their own life, the fight against disease cannot be successful. Only behavior change can help humanity in this fight. Changing behavior and increasing awareness, awareness of responsibility for one’s health. Everyone can do this.
ST segment elevation on the ECG is just one of the signs serious problems with heart.
