Vertical arrangement of eos. Horizontal position eos what does it mean

For example, in Fig. 5-3 high teeth visible R in leads II, III, aVF, which is considered as a sign of the vertical position of the EOS (vertical average electrical axis QRS).

Rice. 5-3. The QRS angle is +90°.

In addition, the height of the teeth R is the same in leads II and III. In Fig. 5-3 teeth height R in three leads (II, III and aVF) is the same; in this case, the EOS is directed to the middle lead aVF (+90°). Therefore, a simple assessment of the electrocardiogram can assume that QRS directed between positive poles leads II and III to the positive pole aVF (+90°).

Method No. 2

In Fig. 5-3 the direction of the EOS can be calculated in another way. Remember that if the wave is perpendicular to the axis of any lead, it is recorded two-phase complex R.S. or QR(see section ""). And vice versa, if in any limb lead the complex QRS two-phase, average electrical axis of the complex QRS should be directed at an angle of 90° to this lead. Look again at Fig. 5-3. Do you see any biphasic complexes? It is obvious that in lead I there is a two-phase complex R.S., therefore, the EOS should be perpendicular to lead I.

Since lead I in the six-axis diagram corresponds to 0°, the electrical axis lies at right angles to 0° (angle QRS can be -90° or +90°). If the axis angle were -90°, the depolarization would be directed from the positive pole of lead aVF and the complex QRS would be in it negative. In Fig. 5-3 there is a positive complex in lead aVF QRS(high prong R), so the axis must have an angle of +90°.

Rice. 5-4. The QRS angle is -30°.

Method No. 3

Another example is in Fig. 5-4. At a quick glance, the average electrical axis of the complex QRS horizontal, since in leads I and aVL the complexes are positive, and in leads aVF, III and aVR they are predominantly negative. The exact electrical axis of the heart can be determined by lead II with a biphasic complex R.S.. Hence, the axis should be directed at right angles to lead II. It is located at an angle of +60° in a six-axis system, so the axis angle can be -30° or +150°. If it were +150°, in leads II, III, aVF complexes QRS would be positive. So the axis angle is -30°.

Method No. 4

The next example is in Fig. 5-5. Complex QRS positive in leads II, III and aVF, so the EOS is relatively vertical. Prongs R have equal heights in leads I and III - hence, the average electrical axis of the complex QRS should be located between these two leads at an angle of +60°.

Rice. 5-5. QRS angle +60°.

Method No. 5

According to Fig. 5-5 average electrical axis of the complex QRS can be calculated differently taking into account the two-phase complex R.S.-type in lead aVL. The axis should be perpendicular to lead aVL (-30°), i.e. at an angle of -120° or +60°. Obviously the axis angle is +60°. The EOS should be directed to lead II with a high tooth R.

Consider the example in Fig. 5-6.

Rice. 5-6. QRS angle -90°.

EOS is directed from leads II, III, aVF to leads aVR and aVL, where the complexes QRS positive. Because the teeth R have equal heights in leads aVR and aVL, the axis should be located exactly between these leads at an angle of -90°. In addition, in lead I - two-phase complex R.S. . In this case, the axis should be located perpendicular to lead I (0°), i.e. The axis angle can be -90° or +90°. Since the axis is directed from the positive pole of lead aVF to its negative pole, the axis angle should be -90°.

Look at fig. 5-7.

Rice. 5-7. QRS angle -60°.

Method number 6

Since in lead aVR there is a two-phase complex R.S.-type, EOS should be located perpendicular axis of this lead. The lead axis angle aVR is -150°, so the average electrical axis of the complex QRS in this case it should be -60° or +120°. It is clear that the axis angle is -60°, since in lead aVL the complex is positive, and in lead III it is negative. In Fig. 5-7 average electrical axis of the complex QRS you can also calculate from lead I, where the amplitude of the tooth R equal to the amplitude of the tooth S Lead II. The axis should be located between the positive pole of lead I (0°) and the negative pole of lead II (-120°); The axis angle is -60°.

These examples show basic rules for determining the average electrical axis of the complex QRS . However, such a definition may be approximate. An error of 10-15° has no significant clinical significance. Thus, it is possible to determine the electrical axis of the heart by the lead where the complex QRS close to biphasic, or in two leads, where the amplitudes of the waves R(or S) are approximately equal.

For example, if the amplitudes of the teeth R or S in two leads are only approximately equal, the average electrical axis of the complex QRS does not lie exactly between these leads. The axis is deviated towards the lead with a larger amplitude. In the same way, if there is a two-phase complex in the lead ( R.S. or QR) with teeth R And S(or teeth Q And R) of different amplitudes, the axis is not exactly perpendicular to this lead. If the tooth R more than a tooth S(or prong Q), the axis points are less than 90° from the lead. If the tooth R less than a tooth S or Q, the axis points are more than 90° away from this lead.

Rules for determining the average electrical axis of the complex QRS:

1. The average electrical axis of the complex QRS located in the middle between the axes of the two limb leads with high teeth R equal amplitude.
2. The average electrical axis of the complex QRS directed at an angle of 90° to any limb lead with a biphasic complex ( QR or R.S.) and to a lead that has relatively high teeth R.

When the EOS is in a vertical position, the S wave is most pronounced in leads I and aVL. ECG in children aged 7–15 years. Characterized by respiratory arrhythmia, heart rate 65-90 per minute. The position of the EOS is normal or vertical.

Regular sinus rhythm - this phrase means an absolutely normal heart rhythm, which is generated in the sinus node (the main source of cardiac electrical potentials).

Left ventricular hypertrophy (LVH) is a thickening of the wall and/or enlargement of the left ventricle of the heart. All five position options (normal, horizontal, semi-horizontal, vertical and semi-vertical) occur in healthy people and are not pathological.

What does the vertical position of the heart axis on an ECG mean?

The definition of “rotation of the electrical axis of the heart around an axis” may well be found in descriptions of electrocardiograms and is not something dangerous.

The situation should be alarming when, with a pre-existing position of the EOS, its sharp deviation on the ECG occurs. In this case, the deviation most likely indicates the occurrence of a blockade. 6.1. P wave. Analysis of the P wave involves determining its amplitude, width (duration), shape, direction and degree of severity in various leads.

The always negative wave vector P is projected onto the positive parts of most leads (but not all!).

6.4.2. The degree of severity of the Q wave in various leads.

Methods for determining the position of the EOS.

To put it simply, an ECG is a dynamic recording of the electrical charge that makes our heart work (that is, contract). The designations of these graphs (they are also called leads) - I, II, III, aVR, aVL, aVF, V1-V6 - can be seen on the electrocardiogram.

An ECG is a completely painless and safe test; it is performed on adults, children and even pregnant women.

Heart rate is not a disease or a diagnosis, but just an abbreviation for “heart rate,” which refers to the number of contractions of the heart muscle per minute. When the heart rate increases above 91 beats/min, they speak of tachycardia; if the heart rate is 59 beats/min or less, this is a sign of bradycardia.

Electrical axis of the heart (EOS): essence, norm of position and violations

Thin people usually have a vertical position of the EOS, while thick people and obese people have a horizontal position. Respiratory arrhythmia is associated with the act of breathing, is normal and does not require treatment.

Requires mandatory treatment. Atrial flutter - this type of arrhythmia is very similar to atrial fibrillation. Sometimes polytopic extrasystoles occur - that is, the impulses that cause them come from various parts of the heart.

Extrasystoles can be called the most common ECG finding; moreover, not all extrasystoles are a sign of the disease. In this case, treatment is necessary. Atrioventricular block, A-V (A-V) block - a violation of the conduction of impulses from the atria to the ventricles of the heart.

Block of the branches (left, right, left and right) of the His bundle (RBBB, LBBB), complete, incomplete, is a violation of the conduction of an impulse through the conduction system in the thickness of the ventricular myocardium.

The most common causes of hypertrophy are arterial hypertension, heart defects and hypertrophic cardiomyopathy. In some cases, next to the conclusion about the presence of hypertrophy, the doctor indicates “with overload” or “with signs of overload.”

Variants of the position of the electrical axis of the heart in healthy people

Cicatricial changes, scars are signs of a myocardial infarction once suffered. In such a situation, the doctor prescribes treatment aimed at preventing a recurrent heart attack and eliminating the cause of circulatory problems in the heart muscle (atherosclerosis).

Timely detection and treatment of this pathology is necessary. Normal ECG in children aged 1 – 12 months. Typically, heart rate fluctuations depend on the child’s behavior (increased frequency when crying, restlessness). At the same time, over the past 20 years there has been a clear trend towards an increase in the prevalence of this pathology.

When can the position of the EOS indicate heart disease?

The direction of the electrical axis of the heart shows the total magnitude of bioelectric changes occurring in the heart muscle with each contraction. The heart is a three-dimensional organ, and in order to calculate the direction of the EOS, cardiologists represent the chest as a coordinate system.

If you project the electrodes onto a conventional coordinate system, you can also calculate the angle of the electrical axis, which will be located where the electrical processes are strongest. The conduction system of the heart consists of sections of the heart muscle consisting of so-called atypical muscle fibers.

Normal ECG readings

Myocardial contraction begins with the appearance of an electrical impulse in the sinus node (which is why the correct rhythm of a healthy heart is called sinus). The myocardial conduction system is a powerful source of electrical impulses, which means that electrical changes that precede cardiac contraction occur in it first of all in the heart.

Rotations of the heart around the longitudinal axis help determine the position of the organ in space and, in some cases, are an additional parameter in diagnosing diseases. The position of the EOS itself is not a diagnosis.

These defects can be either congenital or acquired. The most common acquired heart defects are a consequence of rheumatic fever.

In this case, a consultation with a highly qualified sports doctor is necessary to decide on the possibility of continuing to play sports.

A shift in the electrical axis of the heart to the right may indicate right ventricular hypertrophy (RVH). Blood from the right ventricle enters the lungs, where it is enriched with oxygen.

As in the case of the left ventricle, RVH is caused by coronary heart disease, chronic heart failure and cardiomyopathies.

The electrical axis and electrical position of the heart are inextricably linked with the concept of the resulting vector of ventricular excitation in the frontal plane.

The resulting vector of ventricular excitation is the sum of three momentary excitation vectors: the interventricular septum, the apex and base of the heart. This vector has a certain orientation in space, which we interpret in three planes: frontal, horizontal and sagittal. In each of them, the resulting vector has its own projection.

Electrical axis of the heart

The electrical axis of the heart is the projection of the resulting vector of excitation of the ventricles in the frontal plane.

The electrical axis of the heart may deviate from its normal position either to the left or to the right.

The exact deviation of the electrical axis of the heart is determined by the alpha angle (α).

Let us mentally place the resulting vector of ventricular excitation inside Einthoven’s triangle. The angle formed by the direction of the resulting vector and
axis I of the standard lead is the desired alpha angle.

The value of the alpha angle is found using special tables or diagrams, having previously determined on the electrocardiogram the algebraic sum of the teeth of the ventricular complex (Q + R + S) in standard leads I and III.

Finding the algebraic sum of the teeth of the ventricular complex is quite simple: measure in millimeters the size of each tooth of one ventricular QRS complex, taking into account that the Q and S waves have a minus sign (-), since they are below the isoelectric line, and the R wave has a plus sign (+ ). If any wave on the electrocardiogram is missing, then its value is equal to zero (0).

Table for determining the position of the electrical axis of the heart (according to Diede)

If the alpha angle is within 50-70°, we speak of a normal position of the electrical axis of the heart (the electrical axis of the heart is not deviated), or a normogram.

When the electrical axis of the heart deviates to the right, the alpha angle will be determined within 70-90°. In everyday life, this position of the electrical axis of the heart is called a rightogram.

If the alpha angle is greater than 90° (for example, 97°), it is considered that this ECG shows a block of the posterior branch of the left bundle branch.

Determining the alpha angle within 50-0° speaks of a deviation of the electrical axis of the heart to the left, or a levogram.

A change in the alpha angle within 0 - minus 30° indicates a sharp deviation of the electrical axis of the heart to the left or, in other words, a sharp leftogram.

And finally, if the value of the alpha angle is less than minus 30° (for example, minus 45°), they speak of blockade of the anterior branch of the left bundle branch.

Determination of the deviation of the electrical axis of the heart by the alpha angle using tables and diagrams is carried out mainly by doctors in functional diagnostics offices, where the corresponding tables and diagrams are always at hand.

However, it is possible to determine the deviation of the electrical axis of the heart without the necessary tables.

In this case, the deviation of the electrical axis is determined by analyzing the R and S waves in standard leads I and III. In this case, the concept of the algebraic sum of the teeth of the ventricular complex is replaced by the concept of the “defining tooth” of the QRS complex, visually comparing the R and S waves in absolute value.

They speak of an “R-type ventricular complex,” meaning that in this ventricular complex the R wave is the higher one. In contrast, in the “S-type ventricular complex,” the defining wave of the QRS complex is the S wave.

If on the electrocardiogram in the first standard lead the ventricular complex is represented by the R-type, and the QRS complex in the third standard lead has an S-type shape, then in this case the electrical axis of the heart is deviated to the left (levogram).

Schematically, this condition is written as RI-SIII.

On the contrary, if in standard lead I we have the S-type of the ventricular complex, and in lead III the R-type of the QRS complex, then the electrical axis of the heart is deviated to the right (rightogram).

Simplified, this condition is written as SI-RIII.

The resulting vector of ventricular excitation is normally located in the frontal plane so that its direction coincides with the direction of axis II of the standard lead.

The figure shows that the amplitude of the R wave in standard lead II is greatest. In turn, the R wave in standard lead I exceeds the RIII wave. Under this condition of the ratio of the R waves in various standard leads, we have a normal position of the electrical axis of the heart (the electrical axis of the heart is not deviated).

A short notation for this condition is RII>RI>RIII.

Electrical position of the heart

Close in meaning to the electrical axis of the heart is the concept of electrical position of the heart. The electrical position of the heart means the direction of the resulting vector of excitation of the ventricles relative to axis I of the standard lead, taking it as if it were the horizon line.

A distinction is made between the vertical position of the resulting vector relative to axis I of the standard lead, calling it the vertical electrical position of the heart, and the horizontal position of the vector - the horizontal electrical position of the heart.

There is also a basic (intermediate) electrical position of the heart, semi-horizontal and semi-vertical. The figure shows all the positions of the resulting vector and the corresponding electrical positions of the heart.

For these purposes, the ratio of the amplitude of the R waves of the ventricular complex in the unipolar leads aVL and aVF is analyzed, keeping in mind the features of the graphical display of the resulting vector with the recording electrode.

Results

1. The electrical axis of the heart is the projection of the resulting vector in the frontal plane.

2. The electrical axis of the heart is capable of deviating from its normal position either to the right or to the left.

3. The deviation of the electrical axis of the heart can be determined by measuring the alpha angle.

4. The deviation of the electrical axis of the heart can be determined visually.

RI-SШ levogram

RII > RI > RIII normogram

SI-RIII spelling

5. The electrical position of the heart is the position of the resulting vector of excitation of the ventricles in relation to axis I of the standard lead.

6. On the ECG, the electrical position of the heart is determined by the amplitude of the R wave, comparing it in leads aVL and aVF.

7. The following electrical positions of the heart are distinguished:

Additional Information

The concept of “inclination of the electrical axis of the heart”

In some cases, when visually determining the position of the electrical axis of the heart, a situation is observed when the axis deviates from its normal position to the left, but clear signs of a leftogram are not detected on the ECG. The electrical axis is, as it were, in a borderline position between the normogram and the levogram. In these cases, they talk about a tendency to levogramma. In a similar situation, deviations of the axis to the right indicate a tendency towards a right-hand grammar.

The concept of “uncertain electrical position of the heart”

In some cases, it is not possible to find on the electrocardiogram the conditions described for determining the electrical position of the heart. In this case, they speak of an uncertain position of the heart.

Many researchers believe that the practical significance of the electrical position of the heart is small. It is usually used for more accurate topical diagnosis of the pathological process occurring in the myocardium and to determine hypertrophy of the right or left ventricle.

The location of the electrical axis must be calculated to determine the total component of the bioelectrical changes that occur in the muscle tissue of the heart during its contractile activity. The main organ is three-dimensional, and in order to correctly determine the direction of the EOS (which means the electrical axis of the heart), you need to imagine the human chest as a system with some coordinates that allow you to more accurately determine the angle of displacement - this is what cardiologists do.

Features of the conduction system

The cardiac conduction system is a collection of sections of muscle tissue in the myocardium, which is an atypical type of fiber. These fibers have good innervation, which allows the organ to contract synchronously. The contractile activity of the heart begins in the sinus node; it is in this area that the electrical impulse originates. Therefore, doctors call the correct heart rate sinus.

Originating in the sinus node, the exciting signal is sent to the atrioventricular node, and then it travels along the His bundle. Such a bundle is located in the section that blocks the ventricles, where it is divided into two legs. The leg extending to the right leads to the right ventricle, and the other, rushing to the left, is divided into two branches - posterior and anterior. The anterior branch is accordingly located in the region of the anterior zones of the septum between the ventricles, in the anterolateral compartment of the wall of the left ventricle. The posterior branch of the left bundle branch is localized in two-thirds of the septal part separating the ventricles of the organ, the middle and lower, as well as the posterolateral and lower walls, located in the area of ​​the left ventricle. Doctors say that the anterior branch is located slightly to the right of the posterior branch.

The conduction system is a powerful source that supplies electrical signals that cause the main part of the body to work normally, in the correct rhythm. Only doctors can calculate any violations in this area; they cannot do this on their own. Both an adult and a newborn baby can suffer from pathological processes of this nature in the cardiovascular system. If deviations occur in the conduction system of the organ, the axis of the heart may become confused. There are certain standards for the position of this indicator, according to which the doctor identifies the presence or absence of deviations.

Parameters in healthy people

How to determine the direction of the electrical axis of the heart? The weight of the muscle tissue of the left ventricle usually significantly exceeds that of the right ventricle. You can find out whether a given measurement is a horizontal or vertical vector using these standards. Since the mass of the organ is distributed unevenly, it means that electrical processes should occur more strongly in the left ventricle, and this shows that the EOS is directed specifically to this section.

Doctors project this data using a specially developed coordinate system, from which we can conclude that the electrical axis of the heart is in the region of +30 and also +70 degrees. However, every person, even a child, has individual body characteristics, its own anatomical characteristics. This shows that the slope of the EOS in healthy people can vary between 0-90 degrees. Based on such data, doctors have identified several areas of this indicator that are considered normal and do not interfere with the functioning of the organ.

What positions of the electrical axis exist:

1. semi-vertical electrical position of the heart;
2. vertically directed electrical position of the heart;
3. horizontal state of the EOS;
4. vertical placement of the electrical axis.

It should be noted that all five positions can occur in a person in good health. Finding the reason for such features is quite easy; human physiology explains everything.

• The horizontal axis of the heart is more often detected in people who have a stocky figure and short stature, and these individuals usually have a wide sternum. This type of appearance is called hypersthenic, and the EOS direction indicator varies from 0 to +30 degrees. The horizontal position of the electrical cardiac axis is often the norm.
• The range of the vertical position of this indicator varies between 70 and 90 degrees. This EOS vector is detected in a person of asthenic figure type, with a thin body structure and tall stature.

Since the body structure of people is different, it is extremely rare to meet a pure hypersthenic or a very skinny individual; usually such types of structure are considered intermediate, and the direction of the heart axis can deviate from normal values ​​(semi-vertical state or semi-horizontal position).

In what cases are we talking about pathology, the causes of violations

Sometimes the direction of the indicator can indicate the presence of a disease in the body. If, as a result of the diagnosis, deviations of the electrical axis of the heart to the left are detected, it means that the person has certain ailments, especially hypertrophic changes in the left ventricle. Often such a violation becomes a consequence of pathological processes, as a result of which the cavity of this section stretches and increases in size.

What diseases cause hypertrophy and a sharp tilt of the EOS to the left:

1. Ischemic damage to the main organ.
2. Arterial hypertension, especially with regular pressure surges to high tonometer values.
3. Cardiomyopathy. The disease is characterized by an increase in the weight of the muscle tissue of the heart and the expansion of all its cavities. This disease often appears after anemia, myocardial infarction, myocarditis or cardiosclerosis.
4. Chronic heart failure.
5. Disturbances in the aortic valve, its insufficiency or stenosis. A pathological process of this type can be acquired or congenital in nature. Such diseases cause disruption of blood flow in the cavities of the organ, which leads to overload of the left ventricle.
6. People involved in sports activities professionally also often exhibit these disorders.

In addition to hypertrophic changes, deviation of the heart axis sharply to the left may indicate problems with the conductive properties of the inner part of the ventricles, which usually arise with various blockades. What it is and what it threatens will be explained by the attending physician.

A blockade found in the left bundle branch is often diagnosed, which also refers to a pathology that shifts the EOS to the left.

The opposite condition also has its own reasons for its occurrence. Deviation of the electrical axis of the heart to the other side, the right, indicates hypertrophy of the right ventricle. There are certain diseases that provoke such a disorder.

What diseases lead to a tilt of the EOS to the right:

• Pathological processes in the triscupid valve.
• Stenosis and narrowing of the lumen of the pulmonary artery.
• Pulmonary hypertension. This disorder often occurs against the background of other ailments, such as obstructive bronchitis, organ damage by emphysema, and bronchial asthma.

In addition, diseases that lead to a shift in the direction of the axis to the left can also cause the EOS to be tilted to the right.

Based on this, doctors conclude: a change in the electrical position of the heart is a consequence of ventricular hypertrophy. In itself, such a disorder is not considered a disease; it is a sign of another pathology.

Norms for children

First of all, it is necessary to note the position of the EOS during the mother's pregnancy. Pregnancy changes the direction of this indicator, as serious changes occur in the body. The rapidly enlarging uterus puts pressure on the diaphragm, which leads to a displacement of all internal organs and changes the position of the axis, as a result of which its direction can become semi-vertical, semi-horizontal or otherwise, depending on its initial state.

As for children, this indicator changes with age. In newborn babies, a significant deviation of the EOS to the right side is usually detected, which is absolutely normal. By adolescence, this angle is already established. Such changes are associated with a difference in the weight ratio and electrical activity of both ventricles of the organ, as well as with a change in the position of the heart in the chest area.

A teenager already has a certain angle of EOS, which normally remains throughout his life.

Symptoms

Changing the direction of the electrical axis cannot cause unpleasant sensations in humans. Disorders of well-being usually provoke hypertrophic damage to the myocardium if they are accompanied by severe hemodynamic disturbances, and also lead to the development of heart failure, which is very dangerous and requires treatment.

• pain in the head and chest area;
• breathing problems, shortness of breath, suffocation;
• swelling of the tissues of the lower, upper extremities and facial area;
• weakness, lethargy;
• arrhythmia, tachycardia;
• disturbance of consciousness.

Determining the causes of such disorders is an important part of all therapy. The prognosis of the disease depends on the correctness of the diagnosis. If such symptoms occur, you should immediately consult a doctor, as cardiac problems are extremely dangerous.

Diagnosis and treatment

Typically, axis deviation is detected on an ECG (electrocardiogram). This method is not more often than others prescribed during a routine examination. The resulting vector and other characteristics of the organ make it possible to evaluate the activity of the heart and calculate deviations in its work. If such a disorder is detected on the cardiogram, the doctor will need to carry out several additional examinations.

1. Ultrasound of the organ is considered one of the most informative methods. With the help of such a study, it is possible to identify ventricular hypertrophy, disturbances in the structure of the heart and evaluate its contractile characteristics.
2. X-ray of the chest area, allowing you to see the presence of a shadow of the heart, which usually occurs with myocardial hypertrophy.
3. ECG in the form of daily monitoring. It is necessary to clarify the clinical picture in case of disorders related not only to the axis itself, but also to the origin of the rhythm not from the sinus node area, which indicates a disorder of the rhythmic data.
4. Coronary angiography or coronary angiography. It is used to study the characteristics of damage to the coronary arteries during organ ischemia.
5. An exercise ECG can detect myocardial ischemia, which is usually the cause of a shift in the direction of the EOS.

It is necessary to treat not a change in the electrical axis indicator, but the disease that caused the pathology. Using diagnostics, doctors accurately determine the factors that provoked such disorders.

Changing the angle of the electrical axis of the heart does not require therapy.

No class of medications will help in this case. The disease that led to such changes needs to be eliminated. Drugs are prescribed to patients only after an accurate diagnosis has been made. Depending on the nature of the lesions, medications are used. Sometimes it is advisable to undergo surgery.

In order to determine the functional abilities of the heart, it is necessary to conduct special examination methods. If it turns out that there are disturbances in the conduction system of the organ, there is no need to panic, you must follow all the doctor’s recommendations. Medicine today can eliminate almost any pathology, you just need to seek help in a timely manner.

What is sinus rhythm on an ECG

The human heart is a kind of trigger for the productive work of the whole organism. Thanks to the impulses of this organ, which are issued on a regular basis, blood is able to circulate throughout the body, saturating the body with vital substances. If the heart is normal, then the whole body works as productively as possible, but sometimes you still have to face certain health problems.

If a person comes for an examination to a doctor and the specialist suspects that something is wrong with his heart, he will send the patient for an ECG. Sinus rhythm on an ECG is a very important indicator and clearly provides data on the real state of the human heart muscle. What exactly can be determined by looking at the cardiogram is worth considering in more detail.

What is sinus rhythm

According to medical staff, sinus rhythm of the cardiogram is the norm for the human body. If there are equal spaces between the teeth shown on the cardiogram, and the height of these columns is also the same, then there are no deviations in the functioning of the main organ.

This means that sinus rhythm on the cardiogram is as follows:

• graphical representation of human pulse fluctuations;
• a set of teeth of different lengths, between which there are different intervals, showing the specific rhythm of heart impulses;
• schematic representation of the work of the heart muscle;
• an indicator of the presence or absence of abnormalities in the functioning of the heart and its individual valves.

Normal sinus rhythm is only present when the heart rate is at least 60 and no more than 80 beats per minute. This is the rhythm that is considered normal for the human body. and on the cardiogram it is displayed as teeth of the same size, located at the same distance from each other.

It is clearly worth remembering that the results of a cardiogram can be one hundred percent accurate only if the person is completely calm. Stressful situations and nervous tension contribute to the fact that the heart muscle begins to emit impulses faster, which means that it will definitely not be possible to obtain a reliable result about the state of a person’s health.

What criteria are used to decipher the ECG result?

The results of the cardiogram are deciphered by doctors according to a special scheme. Medical specialists have a clear understanding of which marks on the cardiogram are normal and which are abnormal. The ECG conclusion will be issued only after calculating the results, which were displayed in schematic form. A doctor, when examining a patient’s cardiogram in order to correctly and accurately decipher it, will pay special attention to a number of such indicators:

• the height of the bars displaying the rhythm of heart impulses;
• the distance between the teeth on the cardiogram;
• how sharply the indicators of the schematic image fluctuate;
• what specific distance is observed between the bars displaying the pulses.

A doctor who knows what each of these schematic marks means carefully studies them and can clearly determine what kind of diagnosis needs to be made. Cardiograms of children and adults are deciphered according to the same principle, but normal indicators for people of different age categories cannot be the same.

What sinus rhythm problems can be seen on an ECG?

Electrocardiogram readings can indicate clear signs of problems in the functioning of the heart muscles. With the help of this study, you can notice whether there is weakness of the sinus node, and what kind of health problems this causes. By looking at the cardiogram readings of a particular patient, a medical specialist can decipher the presence of problems of the following nature:

• sinus tachycardia on the ECG, indicating an excess of the contraction rhythm, which is considered normal;
• sinus arrhythmia on the ECG, indicating that the interval between contractions of the heart muscles is too long;
• sinus bradycardia on the ECG, indicating that the heart beats less than 60 times in one minute;
• the presence of too small an interval between the teeth of the cardiogram, which means disturbances in the functioning of the sinus node.

Sinus bradycardia is a common abnormality, especially when it comes to the health of a child. This diagnosis can be explained by many factors, among which may be physiological defects or simply a factor of chronic fatigue.

Deviation of the EOS to the left also indicates that the work of a vital organ is not working properly. Having identified such deviations, the doctor will send the patient for additional examination and ask him to undergo a number of necessary tests.

If a vertical position of the EOS is observed, this means that the heart has a normal location and is in its place, there are no serious physiological abnormalities. This situation is an indicator of the norm, which is also indicated in the conclusion of the doctor who deciphered the cardiogram.

If a horizontal position of the EOS is observed, then this cannot immediately be considered a pathological condition. Such axis indicators are observed in people who are short in stature but have fairly broad shoulders. If the axis deviates to the left or right, and this is very noticeable, then such indicators may indicate a pathological condition of the organ, an enlargement of the left or right ventricles. Axial displacement may indicate that certain valves are affected. If the axis shifts to the left, then the person most likely has heart failure. If a person suffers from ischemia, then the axis shifts to the right side. Such a deviation may also indicate abnormalities in the development of the heart muscle.

What can we say about normal indicators?

On the ECG, sinus rhythm is always and in mandatory is compared with certain norm indicators. Only knowing these indicators completely will the doctor be able to understand the patient’s cardiogram and give the correct conclusion.

Normal indicators for children and adults are completely different factors. If we consider the norms for different age categories, they will be something like this:

• in children from birth to the first year of life, the direction of the axis is vertical, the heart beats with a heart rate of 60 to 150 beats per minute;
• children from one year to six years have a mainly vertical axis, but it can also be horizontal, without indicating deviations from the norm. Heart rate from 95 to 128;
• children from seven years of age and adolescents should have a normal or vertical axis position on the cardiogram, the heart should contract from 65 to 90 beats per minute;
• adults should have a normal axis direction on the cardiogram, the heart contracts at a frequency of 60 to 90 times per minute.

The above indicators fall under the category of the established norm, but if they are slightly different, this does not always become a sign of the presence of some serious pathologies in the body.

Why ECG readings may deviate from the norm

If the result of the electrocardiogram does not always correspond to the norm, this means that this state of the body could be provoked by the following factors:

• the person regularly drinks alcoholic beverages;
• the patient has been smoking cigarettes on a regular basis for quite a long time;
• a person is regularly exposed to various types of stressful situations;
• the patient often uses antiarrhythmic drugs;
• a person has problems with the functioning of the thyroid gland.

Of course, an accelerated heart rate or too slow may indicate problems of a more serious nature. If the results of the cardiogram are not normal, this may indicate acute heart failure, valve displacement, or congenital heart defects.

If the sinus rhythm is within the established norm, then the person should not worry, and the doctor will be able to make sure that his patient is healthy.

The sinus node regularly emits impulses that cause the heart muscles to contract correctly and carry the necessary signals throughout the body. If these impulses are given irregularly, which can be clearly recorded by a cardiogram, then the doctor will have every reason to assume that the person has health problems. After studying the heart rate, the doctor will determine the exact cause of all deviations and will be able to offer the patient competent treatment.

Why should a person undergo an ECG test?

The sinus rhythm, which is displayed on the ECG, clearly indicates whether there are deviations in the functioning of the heart and in which directions the problem is observed. Not only adults, but also children need to undergo such research regularly. The results of a completed cardiogram will help a person obtain the following information:

• does he have any congenital pathologies or diseases;
• What pathologies in the body cause heart problems;
• could a person’s way of life become the cause of disturbances in the functioning of the main organ;
• whether the heart is in the correct position and whether its valves are working correctly.

Normal sinus rhythm on an ECG is displayed as waves of the same size and shape, and the distance between them is also the same. If any deviations from this norm are observed, then the person will have to be further examined.

The sinus rhythm on the cardiogram must coincide with the established norm, and only in this case can a person be considered healthy. If impulses from the heart to other systems diverge too quickly or slowly, then this does not bode well. This means that doctors will have to further clarify the cause of the problem and engage in comprehensive treatment. If an uneven rhythm is observed on a teenager’s cardiogram, then this cannot be considered a pathological deviation, because such a condition may be associated with hormonal changes and the physiological maturation of the body.

If the sinus rhythm is within normal limits, then you will not have to undergo additional tests or repeat studies. Normal heart function, as well as pathological abnormalities, are always recorded by a cardiogram.

The sinus rhythm on the ECG should be smooth and clear, without any intermittent lines or too long or short intervals. If the presented indicators are normal, then we can safely say that the person is completely healthy. Deviations in the cardiogram are a reason for doctors to perform additional studies and prescribe tests. Only after additional examinations can we understand the exact cause of the deviations and begin treatment. A normal sinus rhythm is reflected by a clear and evenly spaced cardiogram. Additional attention will have to be paid to the location of the axis, regarding the parameters of which medical standards have also been established.

Please note that all information posted on the site is for reference only and

not intended for self-diagnosis and treatment of diseases!

Copying of materials is permitted only with an active link to the source.

Deviation of EOS to the left: causes, diagnosis and treatment

From this article you will learn what EOS is and what it should be normally. When the EOS is deviated slightly to the left - what does this mean, what diseases can it indicate. What treatment may be required.

The electrical axis of the heart is a diagnostic criterion that reflects the electrical activity of the organ.

The electrical activity of the heart is recorded using an ECG. Sensors are placed on different areas of the chest, and to find out the direction of the electrical axis, it (the chest) can be represented as a three-dimensional coordinate system.

The direction of the electrical axis is calculated by the cardiologist during the interpretation of the ECG. To do this, he sums the values ​​of the Q, R and S waves in lead 1, then finds the sum of the values ​​of the Q, R and S waves in lead 3. Next, it takes the two obtained numbers and calculates the alpha angle using a special table. It's called the Diede table. This angle is the criterion by which it is determined whether the location of the electrical axis of the heart is normal.

The presence of a significant deviation of the EOS to the left or right is a sign of cardiac dysfunction. Diseases that provoke EOS deviation almost always require treatment. After getting rid of the underlying disease, the EOS takes a more natural position, but sometimes it is impossible to completely cure the disease.

To resolve this problem, consult a cardiologist.

The location of the electrical axis is normal

In healthy people, the electrical axis of the heart coincides with the anatomical axis of this organ. The heart is located semi-vertically - its lower end is directed down and to the left. And the electrical axis, like the anatomical one, is in a semi-vertical position and tends down and to the left.

The standard alpha angle is from 0 to +90 degrees.

Norm of angle alpha EOS

The location of the anatomical and electrical axes depends to some extent on body type. In asthenics (thin people with tall stature and long limbs), the heart (and, accordingly, its axes) is located more vertically, while in hypersthenics (short people with a stocky build) it is more horizontal.

Normal alpha angle depending on body type:

A significant displacement of the electrical axis to the left or right is a sign of pathologies of the conduction system of the heart or other diseases.

A deviation to the left is indicated by a minus alpha angle: from -90 to 0 degrees. About its deviation to the right - values ​​from +90 to +180 degrees.

However, it is not at all necessary to know these numbers, since in case of violations in the ECG interpretation you can find the phrase “EOS is deviated to the left (or right).”

Reasons for shift to the left

Deviation of the electrical axis of the heart to the left is a typical symptom of problems with the left side of this organ. It could be:

• hypertrophy (enlargement, proliferation) of the left ventricle (LVH);
• blockade of the anterior branch of the left bundle branch - a violation of impulse conduction in the anterior part of the left ventricle.

Causes of these pathologies:

Symptoms

EOS displacement itself does not have characteristic symptoms.

The diseases that accompany it can also be asymptomatic. That is why it is important to undergo an ECG for preventive purposes - if the disease is not accompanied by unpleasant symptoms, you can find out about it and begin treatment only after deciphering the cardiogram.

However, sometimes these diseases still make themselves felt.

Symptoms of diseases that are accompanied by a displacement of the electrical axis:

But let us repeat once again - symptoms do not always appear; they usually develop in the later stages of the disease.

Additional diagnostics

To find out the reasons for the EOS deviation, the ECG is analyzed in detail. They may also assign:

1. EchoCG (ultrasound of the heart) - to identify possible organ defects.
2. Stress echocardiography – ultrasound of the heart under stress – for diagnosing ischemia.
3. Angiography of the coronary vessels - their examination to identify blood clots and atherosclerotic plaques.
4. Holter monitoring – recording an ECG using a portable device throughout the day.

After a detailed examination, appropriate therapy is prescribed.

Treatment

In itself, deviation of the electrical axis of the heart to the left does not require specific treatment, since it is only a symptom of another disease.

All measures are aimed at eliminating the underlying disease, which is manifested by displacement of the EOS.

Treatment for LVH depends on what caused the myocardial growth

Treatment for blockade of the anterior branch of the left bundle branch is installation of a pacemaker. If it occurs as a result of a heart attack, surgical restoration of blood circulation in the coronary vessels is required.

The electrical axis of the heart returns to normal only if the size of the left ventricle is returned to normal or the conduction of impulses through the left ventricle is restored.

Treatment of the heart and blood vessels © 2016 | Sitemap | Contacts | Personal Data Policy | User Agreement | When citing a document, a link to the site indicating the source is required.

Deviation of the electrical axis of the heart to the left: everything you need to know about it

The electrical axis of the heart (EOS) is a clinical parameter that is used in cardiology and is reflected on the electrocardiogram. Allows you to evaluate the electrical processes that move the heart muscle and are responsible for its correct operation.

From the point of view of cardiologists, the chest is a three-dimensional coordinate system in which the heart is enclosed. Each contraction is accompanied by a number of bioelectrical changes, which determine the direction of the cardiac axis.

Normal values ​​and causes of violation

The direction of this indicator depends on various physiological and anatomical factors. The average norm is considered to be +59 0. But the variants of the normogram fall into a wide range from +20 0 to +100 0.

In a state of health, the electrical axis shifts to the left under the following conditions:

• at the moment of deep exhalation;
• when the body position changes to horizontal, the internal organs put pressure on the diaphragm;
• with a high-standing diaphragm - observed in hypersthenics (short, strong people).

A shift of the indicator to the right in the absence of pathology is observed in the following situations:

• at the end of a deep breath;
• when changing body position to vertical;
• For asthenics (tall, thin people), the norm is the vertical position of the EOS.

Diagnosis using ECG

An electrocardiogram is the main tool for determining EOS. To identify changes in the location of the axis, two equivalent methods are used. The first method is more often used by diagnosticians, the second method is more common among cardiologists and therapists.

Alpha angle offset detection

The value of the alpha angle directly shows the displacement of the EOS in one direction or another. To calculate this angle, find the algebraic sum of the Q, R and S waves in the first and third standard leads. To do this, measure the height of the teeth in millimeters, and when adding, take into account whether a particular tooth has a positive or negative value.

The value of the sum of teeth from the first lead is found on the horizontal axis, and from the third - on the vertical axis. The intersection of the resulting lines determines the alpha angle.

Visual definition

A simpler and more visual way to determine EOS is to compare the R and S waves in the first and third standard leads. If the absolute value of the R wave within one lead is greater than the value of the S wave, then we speak of an R-type ventricular complex. If on the contrary, then the ventricular complex is classified as S-type.

When the EOS deviates to the left, a picture of RI - SIII is observed, which means the R-type of the ventricular complex in the first lead and the S-type in the third. If the EOS is deviated to the right, then SI - RIII is determined on the electrocardiogram.

Establishing diagnosis

What does it mean if the electrical axis of the heart is deviated to the left? EOS displacement is not an independent disease. This is a sign of changes in the heart muscle or its conduction system that lead to the development of the disease. Deviation of the electrical axis to the left indicates the following violations:

• an increase in the size of the left ventricle - hypertrophy (LVH);
• malfunction of the left ventricular valves, which causes the ventricle to be overloaded with blood volume;
• cardiac blockades, for example, blockade of the left bundle branch (on the ECG this looks like this, which you can learn about from another article);
• disturbances in electrical conductivity inside the left ventricle.

Diseases that are accompanied by levogram

If a patient has a deviation in EOS, this may be a consequence of diseases such as:

In addition to diseases, blockage of the conduction system of the heart can result from taking certain medications.

Additional Research

The detection of a deviation of the EOS to the left side on the cardiogram is not in itself the basis for the doctor’s final conclusion. In order to determine what specific changes occur in the heart muscle, additional instrumental studies are required.

• Bicycle ergometry (electrocardiogram while walking on a treadmill or on an exercise bike). Test to detect ischemia of the heart muscle.
• Ultrasound. Using ultrasound, the degree of ventricular hypertrophy and disturbances in their contractile function are assessed.
• 24-hour Holter ECG monitoring. The cardiogram is taken within 24 hours. Prescribed in cases of rhythm disturbance, which is accompanied by deviation of the EOS.
• X-ray examination of the chest. With significant hypertrophy of myocardial tissue, an increase in the cardiac shadow in the image is observed.
• Coronary artery angiography (CAG). Allows you to determine the degree of damage to the coronary arteries with diagnosed ischemic disease.
• Echocardioscopy. Allows targeted determination of the condition of the patient’s ventricles and atria.

Treatment

Deviation of the electrical axis of the heart to the left from the normal position is not in itself a disease. This is a sign determined using instrumental research, which allows us to identify disturbances in the functioning of the heart muscle.

Ischemia, heart failure and some cardiopathy are treated with medications. Additional adherence to diet and a healthy lifestyle leads to normalization of the patient’s condition.

In severe cases, surgical intervention is required, for example, with congenital or acquired heart defects. In case of severe disruption of the conduction system, it may be necessary to transplant a pacemaker, which will send signals directly to the myocardium and cause its contraction.

Most often, deviation is not a threatening symptom. But if the axis changes its position abruptly and reaches values ​​of more than 90 0, then this may indicate a blockade of the Hiss bundle branches and threatens cardiac arrest. Such a patient requires urgent hospitalization in the intensive care unit. A sharp and pronounced deviation of the electrical axis of the heart to the left looks like this:

Detection of a displacement of the electrical axis of the heart is not a cause for concern. But if this symptom is detected, you should immediately consult a doctor for further examination and identify the cause of this condition. Annual planned electrocardiography allows for timely detection of cardiac dysfunction and immediate initiation of therapy.

is a term that means the electrical activity of an organ, that is, the total indicator of its average vector during depolarization. This is an indicator of the electrical processes of the heart.

This concept is used in cardiology and in functional diagnostics. Determination of the direction of EOS is carried out using an ECG.

In the direction of the axis, the doctor determines the bioelectrical changes that occur in the myocardium during contraction.

To determine the direction of the EOS, there is a coordinate system that is located throughout the chest.

With electrocardiography, the doctor can install the electrodes according to the coordinate system, and it will be clear where the axis angle is located, that is, the places where the electrical impulses are strongest.

Impulses travel along. It consists of atypical fibers that are located in certain areas of the organ.

This system begins in the sinus node. The impulse then passes to the atria and ventricles and to the bundle of His.

When any disturbances occur in the conduction system, the EOS changes its direction.

Axis location

In a healthy person, the left ventricle has a larger mass than the right.

This means that stronger electrical processes occur in the left ventricle, and accordingly the electrical axis is directed there.

If we denote this in degrees, then the LV is in the region of 30-700 with a value of +. This is considered the standard, but it should be said that not everyone has this axis arrangement.

There may be a deviation greater than 0-900 with a value of +, since it is necessary to take into account the individual characteristics of each person’s body.

The doctor may make the following conclusion:

• no deviations;
• semi-vertical position;
• semi-horizontal position.

All these conclusions are the norm.

As for individual characteristics, it is noted that in people who are tall and have a thin build, the EOS is in a semi-vertical position, and in people who are shorter and have a stocky build, the EOS is in a semi-horizontal position.

The pathological condition looks like a sharp deviation to the left or right.

Reasons for rejection

When the EOS deviates sharply to the left, this may mean that there are certain diseases, namely LV hypertrophy.

In this condition, the cavity stretches and increases in size. Sometimes this occurs due to overload, but it can also be a consequence of a disease.

Diseases that cause hypertrophy are:

In addition to hypertrophy, the main causes of axis deviation to the left are conduction disorders inside the ventricles and during blockades of various types.

Quite often, with such a deviation, blockade of the left leg of His, namely its anterior branch, is diagnosed.

As for the pathological deviation of the heart axis sharply to the right, this may mean that there is RV hypertrophy.

This pathology can be caused by the following diseases:

As well as diseases characteristic of LV hypertrophy:

• cardiac ischemia;
• chronic heart failure;
• cardiomyopathy;
• complete blockade of the left leg of His (posterior branch).

When the electrical axis of the heart is sharply deviated to the right in a newborn, this is considered normal.

We can conclude that the main cause of pathological displacement to the left or right is ventricular hypertrophy.

And the greater the degree of this pathology, the more EOS is rejected. A change in the axis is simply an ECG sign of some disease.

It is important to carry out timely identification of these indications and diseases.

Deviation of the heart axis does not cause any symptoms; symptoms manifest themselves from hypertrophy, which disrupts the hemodynamics of the heart. The main symptoms are headaches, chest pain, swelling of the limbs and face, suffocation and shortness of breath.

If cardiac symptoms occur, you should immediately undergo electrocardiography.

Determination of ECG signs

This is the position at which the axis is within the range of 70-900.

On the ECG this is expressed as tall R waves in the QRS complex. In this case, the R wave in lead III exceeds the wave in lead II. In lead I there is an RS complex, in which S has a greater depth than the height of R.

In this case, the position of the alpha angle is within the range of 0-500. The ECG shows that in standard lead I the QRS complex is expressed as R-type, and in lead III its form is S-type. The S wave has a depth greater than the height R.

With blockade of the posterior branch of the left leg of His, the alpha angle has a value greater than 900. On the ECG, the duration of the QRS complex may be slightly increased. There is a deep S wave (aVL, V6) and a high R wave (III, aVF).

With blockade of the anterior branch of the left leg of His, the values ​​will be from -300 or more. On the ECG, signs of this are a late R wave (lead aVR). Leads V1 and V2 may have a small r wave. In this case, the QRS complex is not expanded, and the amplitude of its waves is not changed.

Blockade of the anterior and posterior branches of the left leg of His (complete block) - in this case, the electrical axis is sharply deviated to the left and can be located horizontally. On the ECG in the QRS complex (leads I, aVL, V5, V6), the R wave is widened and its apex is jagged. Near the high R wave there is a negative T wave.

It should be concluded that the electrical axis of the heart can be moderately deviated. If the deviation is sharp, then this may mean the presence of serious cardiac diseases.