Horizontal direction of the electrical axis of the heart. Turns of the heart

What treatment may be required.

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

The electrical activity of the heart is recorded using an ECG. Sensors are applied to various areas of the chest, and in order to find out the direction of the electrical axis, it is possible to represent it (the chest) in the form of a three-dimensional coordinate system.

The direction of the electrical axis is calculated by the cardiologist during the decoding 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. Then he takes the two received numbers and calculates the alpha - the angle according to a special table. It is called the Died 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 a violation of the heart. Diseases that provoke EOS deviation almost always require treatment. After getting rid of the underlying disease, the EOS takes on a more natural position, but sometimes it is impossible to completely cure the disease.

To resolve this problem, contact 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 electric axis, like the anatomical one, is in a semi-vertical position and tends down and to the left.

The norm of the alpha angle is from 0 to +90 degrees.

The norm of the angle alpha EOS

The location of the anatomical and electrical axes to a certain extent depends on the physique. In asthenics (thin people with tall stature and long limbs), the heart (and, accordingly, its axes) is located more vertically, and in hypersthenics (short people with a stocky build) - more horizontally.

The norm of the alpha angle, depending on the physique:

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

A negative angle alpha indicates a deviation to the left: from -90 to 0 degrees. About its deviation to the right - values \u200b\u200bfrom +90 to +180 degrees.

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

Reasons for shifting 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, growth) of the left ventricle (LVH);
blockade of the anterior branch of the left leg of the bundle of His - a violation of the conduction of the impulse in the anterior part of the left ventricle.

Causes of these pathologies:

Symptoms

By itself, the displacement of the EOS has no 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 learn about it and start 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 we repeat once again - the symptoms do not always appear, they usually develop in the later stages of the disease.

Additional diagnostics

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

EchoCG (ultrasound of the heart) - to identify possible organ defects.
Stress EchoCG - ultrasound of the heart with a load - for the diagnosis of ischemia.
Angiography of the coronary vessels - their examination to detect blood clots and atherosclerotic plaques.
Holter monitoring - ECG recording using a portable device throughout the day.

After a detailed examination, appropriate therapy is prescribed.

Treatment

By itself, the 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 a shift in the EOS.

Treatment for LVH depends on what caused myocardial overgrowth

Treatment of the blockade of the anterior branch of the left leg of the bundle of His - the installation of a pacemaker. If arose as a result of a heart attack - surgical restoration of blood circulation in the coronary vessels.

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

What problems will tell the electrical axis of the heart

The resulting vector of all bioelectric oscillations of the heart muscle is called the electrical axis. Most often it coincides with the anatomical. This indicator is used in the analysis of ECG data to assess the predominance of one of the parts of the heart, which may be an indirect sign of myocardial hypertrophy.

Normal electrical axis of the heart

The direction of the axis of the heart is calculated in degrees. To do this, use such a thing as the angle alpha. It is formed by a horizontal line that is drawn through the electrical center of the heart. To determine it, the axis of the first ECG lead is shifted to the center of Einthoven. This is a triangle, its vertices are the hands spread apart to the side and the left foot.

In a healthy person, the electric axis fluctuates within degrees. This is due to the fact that the left ventricle is more developed than the right one, therefore, more impulses come from it. This position of the heart occurs with a normosthenic physique, and the ECG is called a normogram.

And here is more about when people have a heart on the right.

position deviations

Not always a change in the direction of the axis of the heart on the electrocardiogram is a sign of pathology. Therefore, for the diagnosis, its deviations are of auxiliary importance and are used for the preliminary formulation of the conclusion.

right

Rightogram (alpha) on the ECG occurs with an increase in the mass of the myocardium of the right ventricle. The following diseases lead to this condition:

chronic obstructive pulmonary diseases;
bronchitis;
bronchial asthma;
narrowing of the trunk of the pulmonary artery, mitral orifice;
incomplete closure of the tricuspid valve leaflets;
circulatory failure with congestion in the lungs;
cardiomyopathy;
termination of the passage of impulses (blockade) of the left leg of Giss;
thrombosis of pulmonary vessels;
myocarditis;
cirrhosis of the liver.

Cardiomyopathy is one of the causes of deviation of the axis of the heart to the right

Left

Left-side shift of the electrical axis (alpha from 0 to minus 90) occurs quite often. It results in left ventricular hypertrophy. This may be due to the following conditions:

hypertension or secondary hypertension (approximately 90% of all cases);
stenosis and coarctation of the aorta, mitral and aortic insufficiency;
violations of the conduction of impulses inside the ventricle;
excess body weight;
professional sports;
alcoholism and tobacco smoking;
atherosclerosis.

Left ventricular hypertrophy causes the electrical axis of the heart to shift to the left

Vertical and horizontal offset

In thin people, the heart is shifted to a vertical position. This is considered as a variant of the norm and does not require correction or additional examination. In this case, the deviation angle (alpha) is equal to degrees. There is also an intermediate, semi-vertical position of the electrical axis, which is not accompanied by any cardiac pathology.

Hypersthenics, that is, muscular, short people, are characterized by a horizontal and semi-horizontal position with fluctuations in the alpha angle within degrees. All these varieties of the axis of the heart are physiological parameters.

How to determine by ECG

In order to determine the position of the axis, two leads aVL and aVF must be examined. In them, you need to measure the R wave. Normally, its amplitude is equal. If it is high in aVL and absent in aVF, then the position is horizontal, in vertical it will be the other way around.

Left axis deviation will be if R in the first standard lead is greater than S in the third. Rightogram - S1 exceeds R3, and if R2, R1, R3 are located in descending order, then this is a sign of a normogram. For a more detailed study, special tables are used.

Additional Research

If the ECG revealed an axis shift to the right or left, then the following additional examination methods are used to clarify the diagnosis:

stress tests - bicycle ergometry, treadmill test shows exercise tolerance and latent myocardial ischemia;
Holter monitoring - reveals rhythm disturbances, conduction, foci of reduced blood supply to the heart muscle, which could not be detected during conventional diagnostics;
Ultrasound of the heart - helps to identify heart defects and the degree of reverse blood flow, the severity of chamber hypertrophy;
a chest radiograph is used to study the lung fields, the condition of the bronchi, the structure of the main vessels, and determine the configuration of the heart shadow.

Watch the video on determining the electrical axis of the heart:

How dangerous is a child

In children from birth to the third month, the axis of the heart is shifted to the right. On average, the alpha angle approaches 150 degrees. This is because the right ventricle is larger and more active than the left one. Then by one year the axis reaches 90 degrees. The following changes take place:

turn of the heart;
decrease in the area of contact between the right ventricle and the chest;
an increase in the mass of the left parts of the heart;
transition from a right-gram to a normogram;
a decrease in S1 with an increase in S3;
an increase in R1 and a decrease in R3.

In children after two years, the normal position of the electrical axis of the heart is mainly recorded on the ECG. But even a deviation to the right, a vertical or horizontal position, as well as intermediate options do not give the right to make a diagnosis.

What threatens for adults

In itself, the deviation of the electrical axis cannot be considered a disease. When analyzing an electrocardiogram, the heart rhythm, the state of contractile function, the conduction of electrical impulses, the presence of ischemia or myocardial hypertrophy are also taken into account.

If there is only a pathological alpha angle, and no other manifestations on the ECG are detected, the patient does not experience difficulty in breathing, the pulse and pressure are normal, then this condition does not require any further action. This is due to the anatomical feature.

A more unfavorable sign is a rightogram in lung diseases, as well as a leftogram, combined with hypertension. In these cases, the displacement of the axis of the heart can be used to judge the degree of progression of the underlying pathology. If the diagnosis is unknown, and there is a significant deviation of the axis with cardiac symptoms, then the patient should be fully examined to identify the cause of this phenomenon.

And here is more about the blockade of the legs of the bundle of His.

The displacement of the electrical axis can be to the left and to the right, depending on which of the ventricles of the heart is predominantly active. Such changes on the ECG are an indirect sign of myocardial hypertrophy and are considered in combination with other indicators. If there are complaints about the work of the heart, an additional examination is required. In young children, a rightogram is a physiological condition that does not require intervention.

the axis of the heart is deviated to the right. The electrical axis of the heart remains shifted to the right; in most children, the pulse approaches the vertical position.

departments of the heart contract in a chaotic rhythm, the pulse rate is from 20 to 40 due to insufficient release of blood into the arterial network. Complete blocking of electrical impulses increases the risk of termination.

an increase in one or more parts of the heart. Electrical axis - normally R exceeds S in all leads except aVR, V1 - V2, sometimes V3.

secondary ASD: the electrical axis of the heart (EOS) deviates to the right, there is a blockade of the right leg of the bundle of His (RBBB)

Myocarditis is an inflammatory process that occurs in the muscle tissue of the heart. . prolonged electrical ventricular systole (QT segment)

We will publish information shortly.

Deviation of the electrical axis of the heart to the right: what it depends on, what threatens and what to do

The electrical axis of the heart is an important indicator of cardiac activity. In many patients, a shift in the electrical axis is detected - a shift either to the right or to the left. How to determine its position, what affects the change in the EOS and why is such a pathology dangerous?

Electrocardiography as a method for determining EOS

To record the electrical activity of the heart in cardiology, a special method is used - electrocardiography. The result of this study is displayed in the form of a graphic record and is called an electrocardiogram.

The procedure for taking an electrocardiogram is painless and takes about ten minutes. First, electrodes are applied to the patient, having previously lubricated the skin surface with a conductive gel or by placing gauze pads moistened with saline.

The electrodes are applied in the following sequence:

on the right wrist - red
on the left wrist - yellow
on the left ankle - green
on the right ankle - black

Then six chest electrodes are applied in a certain sequence, from the middle of the chest to the left armpit. The electrodes are fixed with a special tape or mounted on suction cups.

The doctor turns on the electrocardiograph, which records the voltage between two electrodes. The electrocardiogram is displayed on thermal paper and reflects the following parameters of the work and condition of the heart:

myocardial contraction rate
regularity of heartbeats
physical condition of the heart
heart muscle damage
electrolyte disturbance
violation of cardiac conduction, etc.

One of the main electrocardiological indicators is the direction of the electrical line of the heart. This parameter allows you to detect changes in cardiac activity or dysfunction of other organs (lungs, etc.).

Electrical axis of the heart: definition and factors of influence

To determine the electrical line of the heart, the conduction system of the heart is important. This system consists of cardiac conductive muscle fibers that transmit electrical excitation from one part of the heart to another.

An electrical impulse first occurs in the sinus node, then passes to the atrioventricular node and spreads to the atrioventricular bundle along its right and left legs, i.e. excitation is transmitted sequentially, in a given direction.

The resulting excitation can be represented as a total vector, which has a certain direction. The projection of this vector in the anterior plane is called the electrical axis of the heart (EOS).

The electrical axis of the heart is directed in the direction where the excitation is stronger. Normally, the mass of the left ventricle exceeds the mass of the right one, electrical excitation is more pronounced, so the axis is directed towards the left ventricle.

The direction of the EOS is also associated with the state of the surrounding organs and tissues (adjacent vessels, lungs, etc.), under their influence, the electrical axis may deviate.

Thus, the location of the EOS depends on the functioning of the conduction system of the heart, its physical condition, as well as the presence of changes in adjacent organs. Changes in the transmission of electrical excitation, as well as an increase in the mass of the heart departments, lead to a shift in the electrical vector of the heart.

Direction of EOS in a healthy person

Normally, the electrical line of the heart is located almost the same as its anatomical axis, i.e. directed from top to bottom, towards the left ventricle. In thin, tall people, the axis of the heart is directed a little more to the right than in most. In squat, hypersthenic people, the axis deviates more horizontally from the mean.

Numerically, the electric axis is expressed by the angle alpha between the axis itself and the horizontal line of zero degrees. For most people, alpha is between +30⁰ and +70⁰. Accordingly, in asthenic, elongated people, the alpha will be slightly higher - from + 70⁰ to + 90⁰. Hypersthenics have a little less - from 0 to + 30⁰.

All electrical axis values between 0⁰ and 90⁰ are normal. If the EOS is outside the range from 0⁰ to 90⁰, then there is a pathology.

Shift of the electrical axis to the left

The electric axis is strongly deviated to the left if its value is in the range from 0⁰ to -90⁰. This deviation can cause the following violations:

disturbances in the impulse conduction along the left branch of the His fibers (that is, in the left ventricle)
myocardial infarction
cardiosclerosis (a disease in which connective tissue replaces the muscle tissue of the heart)
persistent hypertension
heart defects
cardiomyopathy (changes in the heart muscle)
inflammation in the myocardium (myocarditis)
non-inflammatory myocardial damage (myocardial dystrophy)
intracardiac calcification and others

As a result of all these reasons, the load on the left ventricle increases, the response to overload is an increase in the size of the left ventricle. In this regard, the electrical line of the heart deviates sharply to the left.

Shift of the electrical axis to the right

The EOS value in the range from +90⁰ to +180⁰ indicates a strong deviation of the electrical axis of the heart to the right. The reasons for this change in the position of the axis of the heart can be:

violation of impulse transmission along the right branch of the His fibers (responsible for the transmission of excitation in the right ventricle)
narrowing of the pulmonary artery (stenosis), which prevents blood from moving out of the right ventricle, so pressure builds up inside the right ventricle
ischemic disease in combination with persistent arterial hypertension (ischemic disease is based on a lack of myocardial nutrition)
myocardial infarction (death of myocardial cells of the right ventricle)
diseases of the bronchi and lungs, forming a "cor pulmonale". In this case, the left ventricle does not function fully, there is congestion of the right ventricle
pulmonary embolism, i.e. blockage of the vessel by a thrombus, resulting in a violation of gas exchange in the lungs, narrowing of the vessels of the small blood circle and congestion of the right ventricle
mitral valve stenosis (most often occurs after rheumatism) - fusion of the valve leaflets, preventing the movement of blood from the left atrium, which leads to pulmonary hypertension and increased stress on the right ventricle

The main consequence of all causes is an increased load on the right ventricle. As a result, there is an increase in the wall of the right ventricle and a deviation of the electrical vector of the heart to the right.

The danger of changing the position of the EOS

The study of the direction of the electrical line of the heart is an additional diagnostic method, therefore, making a diagnosis only on the basis of the location of the EOS is incorrect. If a patient has an EOS shift beyond the normal range, a comprehensive examination is carried out and the cause is identified, only then treatment is prescribed.

If, for a long time, the electrical axis was directed in one direction, and when taking an ECG, a sharp deviation to the other side is detected, most likely there was a blockade of the conduction system of the heart. This pathology requires urgent medical care.

What to do if the EOS is strongly rejected?

EOS deviation, as a rule, indicates an increase in the size of the left or right ventricle. An increase in these parts of the heart affects the general condition of the body and is a sign of chronic diseases. An experienced therapist, suspecting the symptoms of a developing disease, will send for a consultation with a cardiologist. The cardiologist, in turn, will conduct a diagnostic examination and prescribe therapy. Additional diagnostic methods may include echocardiography, coronary angiography, ultrasound examination of the heart, daily monitoring, radiography, and others.

Thus, the study of the position of the EOS allows for a more accurate diagnosis, and the identified deviation is just a consequence of the developed disease.

It should be remembered that the best treatment is the prevention of the disease. Proper nutrition, gymnastics, giving up bad habits, good sleep are the key to long-term heart work and a long life.

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Deviation of the electrical axis of the heart to the right: why it occurs and what is dangerous

The heart, like any other human organ, is controlled by packets of impulses coming from the brain through the nervous system. Obviously, any violation of the control system leads to serious consequences for the body.

The electrical axis of the heart (EOS) is the total vector of all impulses observed in the conducting system of this organ in one cycle of contraction. Most often it coincides with the anatomical axis.

The norm for the electric axis is the position in which the vector is located diagonally, that is, directed down and to the left. However, in some cases this parameter may deviate from the norm. According to the position of the axis, a cardiologist can learn a lot about the work of the heart muscle and possible problems.

Normal position of the EOS

Depending on the physique of a person, there are three main values \u200b\u200bof this indicator, each of which, under certain conditions, is considered normal.

In most patients with a normal physique, the angle between the horizontal coordinate and the vector of electrodynamic activity is from 30° to 70°.
For asthenics and thin people, the normal value of the angle reaches 90 °.
In short, dense people, on the contrary, the value of the angle of inclination is less - from 0 ° to 30 °.

The possible position of the EOS is shown in this photo:

Reasons for change

By itself, the deviation of the vector of electrical activity of the heart muscle is not a diagnosis, but may indicate, among other things, serious disorders. Its position is influenced by many parameters:

congenital defects;
acquired changes in the anatomy of the organ, leading to hypertrophy of the left or right ventricle;
malfunctions of the conductive system of the organ, in particular, the blockade of certain sections of the bundle of His, which is responsible for conducting nerve impulses to the ventricles;
cardiomyopathy due to various reasons;
chronic heart failure;
persistent hypertension for a long time;
chronic respiratory diseases, such as obstructive pulmonary disease or bronchial asthma, can lead to a deviation of the electrical axis to the right.

How to determine on the electrocardiogram

The EOS angle is considered one of the main parameters that is studied when deciphering ECG indicators. For a cardiologist, this parameter is an important diagnostic indicator, the abnormal value of which clearly signals various disorders and pathologies.

By studying the patient's ECG, the diagnostician can determine the position of the EOS by examining the teeth of the QRS complex, which show the work of the ventricles on the graph.

An increased amplitude of the R wave in I or III chest leads of the graph indicates that the electrical axis of the heart is deviated to the left or right, respectively.

Diagnosis and additional procedures

As mentioned earlier, EOS deviation to the right on the ECG is not considered a pathology in itself, but serves as a diagnostic sign of disorders in its functioning. In the vast majority of cases, this symptom indicates that the right ventricle and / or right atrium are abnormally enlarged, and finding out the causes of such hypertrophy allows us to make a correct diagnosis.

For more accurate diagnosis, the following procedures can be used:

ultrasound is a method with the highest information content showing changes in the anatomy of an organ;
chest x-ray may reveal myocardial hypertrophy;
24-hour ECG monitoring is used if, in addition to EOS deviation, there are also rhythm disturbances;
ECG under stress helps in the detection of myocardial ischemia;
Coronary angiography (CAG) diagnoses lesions of the coronary arteries, which can also lead to the tilt of the EOS.

What diseases are caused

A pronounced deviation of the electrical axis to the right can signal the following diseases or pathologies:

Cardiac ischemia. An incurable disease characterized by blockage of the coronary arteries that supply blood to the heart muscle. With uncontrolled development leads to myocardial infarction.
Congenital or acquired pulmonary stenosis. This is the name given to the narrowing of this large vessel, which prevents the normal exit of blood from the right ventricle. It leads to increased systolic blood pressure and, as a result, to myocardial hypertrophy.
Atrial fibrillation. Random electrical activity of the atria, which, as a result, can cause a cerebral stroke.
Chronic cor pulmonale. Occurs when there is a malfunction of the lungs or pathologies of the chest, which lead to the inability of the left ventricle to fully work. Under such conditions, the load on the right ventricle increases significantly, which leads to its hypertrophy.
Atrial septal defect. This defect is expressed in the presence of holes in the septum between the atria, through which blood can be discharged from the left side to the right. As a result, heart failure and pulmonary hypertension develop.
Mitral valve stenosis is a narrowing of the opening between the left atrium and left ventricle, which leads to difficulty in diastolic blood flow. Refers to acquired vices.
Pulmonary embolism. It is caused by blood clots, which, after occurring in large vessels, move through the circulatory system and clog the artery or its branches.
Primary pulmonary hypertension is a permanent high blood pressure in the pulmonary artery, which is caused by various reasons.

What to do

If the electrocardiogram showed an inclination of the electrical axis of the heart to the right, a more extensive diagnostic examination by a doctor should be carried out without delay. Depending on the problem identified during a deeper diagnosis, the doctor will prescribe the appropriate treatment.

The heart is one of the most important parts of the human body, and therefore its condition should be the subject of increased attention. Unfortunately, it is often remembered only when it starts to hurt.

To prevent such situations, you need to adhere to at least general recommendations for the prevention of heart disorders: eat right, do not neglect a healthy lifestyle, and be examined by a cardiologist at least once a year.

If in the results of the electrocardiogram there is a record of the deviation of the electrical axis of the heart, a deeper diagnosis should be immediately carried out to determine the causes of this phenomenon.

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

The electrical axis of the heart (EOS) is a term used in cardiology and functional diagnostics, reflecting the electrical processes occurring in the heart.

The direction of the electrical axis of the heart shows the total amount of bioelectrical 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.

Each electrode, when taking an ECG, registers the bioelectrical excitation that occurs in a certain area of the myocardium. If we project the electrodes onto a conditional coordinate system, then we can also calculate the angle of the electric axis, which will be located where the electrical processes are strongest.

The conduction system of the heart and why is it important to determine the EOS?

The conduction system of the heart is a section of the heart muscle, consisting of the so-called atypical muscle fibers. These fibers are well innervated and provide synchronous contraction of the organ.

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). From the sinus node, the electrical excitation impulse passes to the atrioventricular node and further along the bundle of His. This bundle passes in the interventricular septum, where it is divided into the right, heading to the right ventricle, and the left legs. The left leg of the bundle of His is divided into two branches, anterior and posterior. The anterior branch is located in the anterior sections of the interventricular septum, in the anterolateral wall of the left ventricle. The posterior branch of the left leg of the bundle of His is located in the middle and lower third of the interventricular septum, the posterolateral and lower wall of the left ventricle. We can say that the back branch is somewhat to the left of the front.

The conduction system of the myocardium 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. In case of violations in this system, the electrical axis of the heart can significantly change its position, which will be discussed later.

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

The mass of the cardiac muscle of the left ventricle is normally much greater than the mass of the right ventricle. Thus, the electrical processes occurring in the left ventricle are stronger in total, and the EOS will be directed specifically to it. If we project the position of the heart on the coordinate system, then the left ventricle will be in the region of +30 + 70 degrees. This will be the normal position of the axis. However, depending on the individual anatomical features and physique, the position of the EOS in healthy people ranges from 0 to +90 degrees:

Thus, the EOS in the range from + 70 to + 90 degrees will be considered a vertical position. This position of the axis of the heart is found in tall, thin people - asthenics.
The horizontal position of the EOS is more common in short, stocky people with a wide chest - hypersthenics, and its value ranges from 0 to + 30 degrees.

The structural features for each person are very individual, there are practically no pure asthenics or hypersthenics, more often these are intermediate body types, therefore the electric axis can also have an intermediate value (semi-horizontal and semi-vertical).

All five positions (normal, horizontal, semi-horizontal, vertical and semi-vertical) are found in healthy people and are not a pathology.

So, in the conclusion of an ECG in an absolutely healthy person, it can be said: “EOS is vertical, the rhythm is sinus, the heart rate is 78 per minute”, which is a variant of the norm.

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 the diagnosis of diseases.

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

When the position of the EOS can talk about heart disease?

In itself, the position of the EOS is not a diagnosis. However, there are a number of diseases in which there is a displacement of the axis of the heart. Significant changes in the position of the EOS lead to:

Cardiac ischemia.
Cardiomyopathy of various origins (especially dilated cardiomyopathy).
Chronic heart failure.
Congenital anomalies of the structure of the heart.

EOS deviations to the left

Thus, the deviation of the electrical axis of the heart to the left may indicate left ventricular hypertrophy (LVH), i.e. its increase in size, which is also not an independent disease, but may indicate an overload of the left ventricle. This condition often occurs with long-term arterial hypertension and is associated with significant vascular resistance to blood flow, as a result of which the left ventricle must contract with greater force, the muscle mass of the ventricle increases, which leads to its hypertrophy. Ischemic disease, chronic heart failure, cardiomyopathies also cause left ventricular hypertrophy.

hypertrophic changes in the myocardium of the left ventricle - the most common cause of EOS deviation to the left

In addition, LVH develops when the valvular apparatus of the left ventricle is damaged. This condition leads to stenosis of the mouth of the aorta, in which the ejection of blood from the left ventricle is difficult, insufficiency of the aortic valve, when part of the blood returns to the left ventricle, overloading it with volume.

These defects can be either congenital or acquired. The most commonly acquired heart defects are the result of rheumatic fever. Left ventricular hypertrophy is found in professional athletes. In this case, it is necessary to consult a highly qualified sports doctor to decide whether it is possible to continue playing sports.

Also, the EOS is deviated to the left with violations of intraventricular conduction and various heart blocks. E-mail deviation the axis of the heart to the left, along with a number of other ECG signs, is one of the indicators of the blockade of the anterior branch of the left leg of the bundle of His.

EOS deviations to the right

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. Chronic respiratory diseases accompanied by pulmonary hypertension, such as bronchial asthma, chronic obstructive pulmonary disease with a long course cause hypertrophy. Pulmonary artery stenosis and tricuspid valve insufficiency lead to right ventricular hypertrophy. As with the left ventricle, RVH is caused by coronary heart disease, congestive heart failure, and cardiomyopathies. Deviation of the EOS to the right occurs with a complete blockade of the posterior branch of the left leg of the bundle of His.

What to do if an EOS shift is found on the cardiogram?

None of the above diagnoses can be made on the basis of EOS displacement alone. The position of the axis serves only as an additional indicator in the diagnosis of a particular disease. If the axis of the heart deviates beyond normal values (from 0 to +90 degrees), a consultation with a cardiologist and a series of studies is necessary.

Nevertheless, the main cause of EOS displacement is myocardial hypertrophy. The diagnosis of hypertrophy of one or another part of the heart can be made according to the results of ultrasound. Any disease that leads to a displacement of the axis of the heart is accompanied by a number of clinical signs and requires additional examination. The situation should be alarming when, with the pre-existing position of the EOS, its sharp deviation occurs on the ECG. In this case, the deviation most likely indicates the occurrence of a blockade.

By itself, the displacement of the electrical axis of the heart does not need treatment, it refers to electrocardiological signs and requires, first of all, finding out the cause of the occurrence. Only a cardiologist can determine the need for treatment.

Electrical axis of the heart is the average direction of the electromotive axis of the heart over the period of the entire period of depolarization. The usual direction corresponds to + 59, but even in a healthy heart, a deviation in the location of the electrical axis on a scale from + 20 to + 100 is possible. that the left ventricle has lost its activity.

What is this phenomenon and how can you determine if there is a deviation of the electrical axis?

The position of the axis is determined by the state of the bundle of His and the cardiac ventricular muscle. To some extent, this is influenced by the position of the heart. According to the correct position, the electrical axis is from the apex to the base almost parallel to the anatomical axis of the heart. The direction of the axis depends on such factors:

The location of the heart in the chest;

The ratio between the mass of the myocardium of the ventricles;

Focal lesions of the myocardium;

Violations in the conduction of impulses to the ventricles.

The electrical axis of the heart moves to the right side in such cases:

In people of the asthenic type;

With thromboembolism of the pulmonary artery;

With hypertrophy of the myocardium of the right ventricle. Here the heart deviates to the right for some reason. First of all, in the hypertrophic ventricle, the excitation of an additional number of fibers is very high and therefore its electrical potential has increased. It also takes more time to conduct excitation of the ventricle, when compared with the norm. Therefore, the normal ventricle depolarizes much earlier in time than the hypertrophied ventricle, since it remains electropositive;

With congenital heart defects.

You should be aware of the following factors:

If the axis of the heart is deviated to the right in newborns, then there is no pathology. And this condition cannot be considered as right ventricular hypertrophy, since in newborn babies the deviation angle of +100 is a common phenomenon. Many children in the first months of life have such a manifestation, especially those who live in areas with a harsh climate and in high mountain areas. Deviation to the right occurs in small children with a blockade of the left posterior branch of the bundle of His.

The verified working capacity of the heart is the guarantor of a long human life. And the decoded sinus rhythm and to the left is an indicator of the state of the heart muscle. Thanks to the electrical axis, it is possible to make a diagnosis at an early stage and cure it, prolonging the normal state of the body and the life of a sick person.

According to the deviation of the EOS, you can determine the diagnosis of heart disease

EOS - the electrical axis of the heart - is a cardiological concept that means the electrodynamic strength of an organ, the level of its electrical activity. According to its position, the specialist deciphers the state of the processes taking place in the main organ every minute.

This parameter represents the total amount of bioelectric changes in the muscle. With the help, in which the electrodes fix certain points of excitation, it is possible to mathematically calculate the location of the electrical axis relative to the heart.

The conduction system of the heart and why it is important to determine the EOS

The part of muscle tissue formed from atypical fibers that regulate the synchronization of organ contractions is called the conduction system of the heart.

The contractile property of the myocardium consists of the sequence of stages:

Organization of an electrical impulse in the sinus node
The signal enters the ventricular atrial node.
From there it is distributed along the bundle of His, located in the interventricular septum and divided into 2 branches
The activated bundle drives the left and right ventricles
With normalized signal wiring, both ventricles contract synchronously

The cardiac conduction system is a kind of energy supplier for the functioning of the body. It is in it that electrical changes initially occur, provoking the contraction of muscle fibers.

With a dysfunction of the wiring system, the electric axis changes its location. This point is easily determined.

What is sinus rhythm on an ECG

Sinus rhythm on an electrocardiogram shows that the signal of an electrical nature is produced only in the sinus node. This site is located in the right-sided atrium under the membrane and is directly supplied with arterial blood.

The cells of this organ are spindle-shaped and are collected in small bundles. The low level of the ability to contract is compensated by the production of electrical impulses, the analogues of which are nerve signals.

The sinus node produces low-frequency signals, but is able to deliver them at high speed to the muscle fibers. A run of 60-90 shocks in 60 seconds is considered an indicator of the quality functioning of the organ.

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

The most common semi-vertical and semi-horizontal position of the EOS

The state of the norm corresponds to the predominance of the left-sided mass over the right-sided ventricle. Thanks to this, the processes of the electrical nature of the former are stronger in total, and the EOS will be directed precisely at it.

When projecting the location of the cardiac organ onto the coordinate system, it will become noticeable that the left ventricle will be in the range from +30 to +70 °. This situation is considered to be the norm.

Nevertheless, on an individual basis, due to the anatomical features of the body structure, the location may vary and be in the range from 0 to + 90 °.

The location of the cardiac electrical axis is divided into 2 main types:

Vertical - an interval from +30 to +70 ° - This is typical for people of great stature, thin build.
Horizontal – range from 0 to +30°. It is observed in a person with small stature, dense body build with a wide chest.

Since the physique and height are indicators of an individual plan, the most common are the intermediate subspecies of the location of the EOS: semi-vertical and semi-horizontal.

Rotations of the heart along the longitudinal axis reflect the location of the organ in the body, and their number becomes an additional indicator in the diagnosis of cardiovascular diseases.

Diagnostics on the ECG

Usually the position of the EOS is determined using an ECG.

An electrocardiogram is the most accessible, simple and painless way to determine the source of impulses for the heart, as well as their frequency and rhythm. ECG is characterized as the most informative method for obtaining data on the functioning of the heart muscle.

Procedure process:

The examined person takes a supine position on a couch parallel to the floor, having previously exposed the torso, wrists and ankles.

On these parts of the body with the help of suction cups, through which data on electrical impulses will go to the computer. A specialized program reads these signals during normal breathing and during its delay.

The condition for the procedure is complete relaxation of the body. ECG removal is carried out with various loads, but this occurs with an in-depth study of the work of the heart to establish a diagnosis, as well as when checking progress from therapeutic measures. After data collection, the printer prints an ECG graph on thermal paper. This printout, in turn, is deciphered by a medical professional who has completed special courses.

The cardiogram is a summary graph of arcuate and acute-angled lines, each of which reflects a certain process during the contraction of the heart. First of all, decipher the line denoting sinus rhythm.

If the number of contractile actions of the heart does not meet the standards of the norm, then the source of the signal is indicated not as sinus, and the study of the work of the heart is deepened.

Deciphering the electrocardiogram graph

Having deciphered the cardiogram, the specialist can make a diagnosis

The ECG graph consists of teeth, gaps and segmental segments. For these indicators, a range is clearly defined, beyond which it signals a violation of the heart.

Mathematical calculations of cardiogram lines determine the following indicators:

The rhythm of the heart muscle
The frequency of contractile processes of the body
pacemaker
Wiring quality
cardiac electrical axis

Thanks to these data, as well as a detailed description of the meaning of the teeth, spaces and segmental segments, the specialist will be able to take an anamnesis, clarify the disease and establish appropriate therapeutic measures.

When the position of the EOS can talk about heart disease

EOS may be tilted to the left in cardiac ischemia

The tilt of the cardiac axis is not a symptom of the disease, but its deviation from the standard gives a signal of organ dysfunction. A non-standard slope of the EOS may indicate the presence of the following diseases:

Heart disease
Various origins
Chronic course of the heart
Congenital pathologies and non-standard structure of the heart

Reasons for deviating to the left

The side to which the axis is tilted also helps to determine the diagnosis.

The tilt of the EOS to the left most often occurs with left ventricular hypertrophy. In this case, there is an increase in the load on the functioning of the left side of the organ. The reason for the increase may be:

Long, indicating high blood pressure
Insufficient performance of the heart
Dysfunction and abnormal structure of the valvular apparatus in the left heart ventricle
rheumatic fever
Dysfunction within the ventricular conduction system
heart muscle

Causes of deviation to the right side

The tilt of the EOS to the right occurs with a hypertrophied state of the right-sided ventricular heart. The reason for this is:

Bronchitis
Asthma
Chronic obstructive pulmonary disease
pulmonary artery
Abnormal structure of the heart organ from the moment of birth
Insufficient performance of the tricuspid valve
Blockade of the posterior branch of the left leg of the bundle of His

Symptoms

Diseases in which the EOS is tilted to the left are accompanied by chest pain

EOS displacement has no independent symptoms. In addition, there is a possibility of asymptomatic axis deviation. To prevent diseases of the heart and blood vessels, diagnosing them at the initial stage, regular electrocardiograms are taken.

Symptoms of diseases associated with left-sided deviation of the EOS:

Pain in the chest area
Difficulty in breathing
Arrhythmia and
Dystonia blood pressure
Headache
Violation
Dizziness
Fainting state
- slow heart rate
face and limbs

Additional diagnostics

EchoCG is used for additional diagnostics when the EOS is tilted

To determine the reasons that provoked the deviation of the EOS, a number of additional studies are carried out:

Echocardiogram, abbreviated. This procedure consists in the study of contractile and other abilities and the work of the main organ using special sound waves, determines the presence of probable heart defects.
Stress echocardiogram, stress echocardiogram. It is expressed in the study of ultrasonic waves of the functioning of the heart with an additional load, most often squats. Diagnose ischemic disease.
coronary vessels. This test detects blood clots and atherosclerotic plaques in the arteries and veins.
Holter mount, abbreviated. This procedure collects electrocardiogram data during the day. This method of research became possible after the creation of a portable ECG apparatus, which is distinguished by its small weight and size. However, with this method of verification, there are a number of limitations: constraint in movement, a ban on water procedures and a distance from pets. At the same time, the day of wearing a holter should be ordinary, without non-standard situations.

Treatment

Changing the slope of the EOS does not require self-treatment. To restore the position of the axis, it is necessary to eradicate the main sources of tilt - cardiovascular or pulmonary disease.

Therapeutic procedures, medications and other measures are prescribed by the attending physician after the diagnosis is established. The main points of the treatment process depend on the type of disease:

- prescribed antihypertensive drugs that normalize blood pressure. Representatives of medicinal drugs are substances that help prevent vasoconstriction and increase the level of pressure: calcium channel antagonists, beta-blockers.
Aortic stenosis - surgery in the form.
– surgical installation of a valve prosthesis.
Ischemia - drugs - ACE inhibitors, beta-blockers.
- surgery for thinning of the myocardium.
Blockade of the anterior branch of the left leg of the bundle of His - installation.
A similar blockade that occurred during the restoration of blood circulation of the coronary vessels by surgical intervention.

It is possible to return the normal location of the electrical axis of the heart only if the size of the left ventricle is normalized or the path of the impulse along it is restored.

Preventive measures to deviate EOS from the norm

A balanced healthy diet will help prevent changes in the position of the EOS and the occurrence of cardiovascular diseases.

By following a number of simple rules, it is possible to avoid dysfunction of the vessels and the heart muscle and prevent the EOS from deviating from its normal position.

Prevention measures will be:

Balanced healthy diet
Clear and even daily routine
Lack of stressful situations
Replenishment of the level of vitamins in the body

The body can get the required amount in two ways: taking a vitamin complex of medical origin and eating certain foods. Products - sources of antioxidants and trace elements:

Citrus fruit
dried grapes
Blueberries
Onions and green onions
cabbage leaves
Spinach
Parsley and dill
Chicken eggs
red sea fish
Dairy

The last method of prevention, but one of the most important in terms of value, will be moderate and regular physical activity. Sports, the plan of which is made taking into account the characteristics of the human body and its standard of living, will strengthen the heart muscle and allow it to function smoothly.

All these methods of prevention of disorders of the heart, and, consequently, deviations of the EOS from the norm can be called a healthy lifestyle. Subject to this principle, not only the well-being of a person will improve, but also his appearance.

In the following video, see what an electrocardiogram looks like in normal conditions:

Timely diagnosis and detection of deviations in the position of the EOS is the key to health and long life of a person. An annual cardiological study of the work of the heart contributes to the early detection of diseases, as well as their speedy cure.

The electrical axis of the heart (EOS) is a term used in cardiology and functional diagnostics, reflecting the electrical processes occurring in the heart.

The conduction system of the heart and why is it important to determine the EOS?

The conduction system of the myocardium 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. With violations in this system, the electrical axis of the heart can significantly change its position., which will be discussed next.

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

The mass of the cardiac muscle of the left ventricle is normally much greater than the mass of the right ventricle. Thus, the electrical processes occurring in the left ventricle are stronger in total, and the EOS will be directed specifically to it. If we project the position of the heart on the coordinate system, then the left ventricle will be in the region of +30 + 70 degrees. This will be the normal position of the axis. However, depending on the individual anatomical features and physique the position of the EOS in healthy people ranges from 0 to +90 degrees:

So, vertical position EOS will be considered in the range from + 70 to + 90 degrees. This position of the axis of the heart is found in tall, thin people - asthenics.
Horizontal position of the EOS more common in short, stocky people with a wide chest - hypersthenics, and its value ranges from 0 to + 30 degrees.

All five positions (normal, horizontal, semi-horizontal, vertical and semi-vertical) are found in healthy people and are not a pathology.

So, in the conclusion of an ECG in an absolutely healthy person, it can be said: "EOS vertical, sinus rhythm, heart rate - 78 per minute", which is a variant of the norm.

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 the diagnosis of diseases.

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

When the position of the EOS can talk about heart disease?

In itself, the position of the EOS is not a diagnosis. However There are a number of diseases in which there is a displacement of the axis of the heart. Significant changes in the position of the EOS lead to:

Cardiac ischemia.
Cardiomyopathy of various origins (especially dilated cardiomyopathy).
Chronic heart failure.
Congenital anomalies of the structure of the heart.

EOS deviations to the left

EOS deviations to the right

What to do if an EOS shift is found on the cardiogram?

But still The main cause of EOS displacement is myocardial hypertrophy. The diagnosis of hypertrophy of one or another part of the heart can be made according to the results of ultrasound. Any disease that leads to a displacement of the axis of the heart is accompanied by a number of clinical signs and requires additional examination. The situation should be alarming when, with the pre-existing position of the EOS, its sharp deviation occurs on the ECG. In this case, the deviation most likely indicates the occurrence of a blockade.

By itself, the displacement of the electrical axis of the heart does not need treatment, refers to electrocardiological signs and requires, first of all, finding out the cause of the occurrence. Only a cardiologist can determine the need for treatment.

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1Theoretical foundations of the definition

How to learn to determine EOS by electrocardiogram? A little theory first. Let's imagine Einthoven's triangle with the axes of the leads, and also supplement it with a circle that passes through all the axes, and indicate the degrees or coordinate system on the circles: along the line I of the lead -0 and +180, above the line of the first lead there will be negative degrees, with a step at -30, and positive degrees are projected downward, in increments of +30.

Consider another concept necessary to determine the position of the EOS - the angle alpha (2Practical bases for determining

You have a cardiogram in front of you. So, let's proceed to the practical determination of the position of the axis of the heart. We carefully look at the QRS complex in the leads:

With a normal axis, the R wave in the second lead is greater than the R in the first lead, and R in the first lead is greater than the R wave in the third: R II> RI> R III;
EOS deviation to the left on the cardiogram looks like this: the largest R wave in the first lead, a little smaller in the second, and the smallest in the third: R I> RII> RIII;
The turn of the EOS to the right or the displacement of the axis of the heart to the right on the cardiogram manifests itself as the largest R in the third lead, somewhat less - in the second, the smallest - in the first: R III> RII> RI.

But it is not always visually easy to determine the height of the teeth, sometimes they can be approximately the same size. What to do? After all, the eye can fail ... For maximum accuracy, the alpha angle is measured. They do it like this:

We find QRS complexes in leads I and III;
We summarize the height of the teeth in the first lead;
Sum the height in the third lead;

Important point! When summing, it should be remembered that if the tooth is directed downward from the isoline, its height in mm will be with the “-” sign, if upward - with the “+” sign
We substitute the two sums found in a special table, we find the place of intersection of the data, which corresponds to a certain radius with degrees of the alpha angle. Knowing the norms of the angle alpha, it is easy to determine the position of the EOS.

3Why does a diagnostician need a pencil or when is it not necessary to look for the alpha angle?

There is one more simple and favorite method for students to determine the position of the EOS using a pencil. It is not effective in all cases, but sometimes it simplifies the definition of the cardiac axis, allows you to determine whether it is normal or there is an offset. So, with the non-writing part of the pencil, we apply it to the corner of the cardiograms near the first lead, then in leads I, II, III we find the highest R.

We direct the opposite pointed part of the pencil to the R wave in the lead where it is maximum. If not the writing part of the pencil is in the upper right corner, but the pointed tip of the writing part is in the lower left, then this position indicates the normal position of the axis of the heart. If the pencil is located almost horizontally, one can assume that the axis is shifted to the left or its horizontal position, and if the pencil takes a position closer to vertical, then the EOS is deflected to the right.

4Why define this parameter?

Issues related to the electrical axis of the heart are discussed in detail in almost all books on ECG, the direction of the electrical axis of the heart is an important parameter that must be determined. But in practice, it helps little in the diagnosis of most heart diseases, of which there are more than a hundred. Deciphering the direction of the axis turns out to be really useful for diagnosing 4 main conditions:

Blockade of the anterior-upper branch of the left leg of the bundle of His;
Hypertrophy of the right ventricle. A characteristic sign of its increase is the deviation of the axis to the right. But if there is a suspicion of left ventricular hypertrophy, the displacement of the axis of the heart is not necessary at all, and the determination of this parameter does not help much in its diagnosis;
Ventricular tachycardia. Some of its forms are characterized by a deviation of the EOS to the left or its indefinite position, in some cases there is a turn to the right;
Blockade of the posterior superior branch of the left leg of the bundle of His.

5What can be the EOS in the norm?

In healthy people, the following descriptions of EOS take place: normal, semi-vertical, vertical, semi-horizontal, horizontal. Normally, as a rule, the electrical axis of the heart in people over 40 years old is located at an angle of -30 to +90, in people under 40 years old - from 0 to +105. In healthy children, the axis can deviate up to +110. In most healthy people, the indicator ranges from +30 to +75. In thin, asthenic faces, the diaphragm is low, the EOS is more often deviated to the right, and the heart occupies a more vertical position. In obese people, hypersthenics, on the contrary, the heart lies more horizontally, there is a deviation to the left. In normosthenics, the heart occupies an intermediate position.

6 Norm in children

In newborns and infants, there is a pronounced deviation of the EOS to the right on the electrocardiogram; by the year, in most children, the EOS goes into a vertical position. This is explained physiologically: the right heart sections somewhat predominate over the left ones both in mass and in electrical activity, and changes in the position of the heart can also be observed - rotations around the axes. By two years, many children still have a vertical axis, but in 30% it becomes normal.

The transition to the normal position is associated with an increase in the mass of the left ventricle and cardiac rotation, in which there is a decrease in the fit of the left ventricle to the chest. In preschool children and schoolchildren, the normal EOS prevails, the vertical, less often horizontal, electrical axis of the heart may be more common. Summarizing the above, the norm in children is:

during the neonatal period, EOS deviation from +90 to +170
1-3 years - vertical EOS
school, adolescence - half of the children have a normal position of the axis.

7 Reasons for EOS deviation to the left

The deviation of the EOS at an angle of -15 to -30 is sometimes called a slight deviation to the left, and if the angle is from -45 to -90, they speak of a significant deviation to the left. What are the main causes of this condition? Let's consider them in more detail.

Variant of the norm;
GSV of the left leg of the bundle of His;
Blockade of the left leg of the bundle of His;
Positional changes associated with the horizontal location of the heart;
Some forms of ventricular tachycardia;
Malformations of endocardial cushions.

8 Reasons for EOS deviation to the right

Criteria for deviation of the electrical axis of the heart in adults to the right:

The axis of the heart is located at an angle from +91 to +180;
Deviation of the electric axis at an angle of up to +120 is sometimes called a slight deviation to the right, and if the angle is from +120 to +180 - a significant deviation to the right.

The most common reasons for EOS deviation to the right can be:

Variant of the norm;
Hypertrophy of the right ventricle;
Blockade of the posterior superior branching;
Pulmonary embolism;
Dextrocardia (right-sided location of the heart);
Variant of the norm with positional changes associated with the vertical location of the heart due to emphysema, COPD, and other pulmonary pathologies.

It should be noted that a sharp change in the electrical axis may alert the doctor. For example, if a patient has a normal or semi-vertical position of the EOS on previous cardiograms, and when taking an ECG at the moment, there is a pronounced horizontal direction of the EOS. Such drastic changes may indicate any disturbances in the functioning of the heart and require the earliest possible additional diagnostics and additional examination.

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Medical indicators

Using the electrical axis of the heart, cardiologists evaluate the electrical processes that set the heart muscles in motion. The direction of the EOS depends on various anatomical and physiological factors. The average rate of the indicator is +590. Normally, the EOS value fluctuates between +200 ... +1000.

The patient is examined in a specialized room, which is shielded from various electrical interferences. The patient takes a supine position, a pillow is placed under the head. To take an ECG, electrodes are applied. The data is recorded during quiet breathing. At the same time, the device registers the frequency and regularity of heart contractions, including the position of the EOS and other parameters.

In a healthy person, the deviation of the electrical axis of the heart to the left is allowed when:

deep exhalation;
change in body position;
body features (hypersthenic).

EOS shifts to the right in a healthy person with:

the end of a deep breath;
body features (asthenic).

The location of the EOS is determined by the mass of 2 parts of the ventricle. The definition of the indicator under consideration is carried out by 2 methods.

In the first case, the specialist detects a shift in the alpha angle. The value of the main indicator is calculated using a special table according to Died.

In the second case, the specialist compares the R and S waves in leads 1 and 3. A sharp deviation of the EOS in any direction is not an independent pathology.

The electrical axis, shifted to the left, indicates the following problems:

left ventricular hypertrophy;
impaired functioning of the left ventricular valve;
cardiac block.

The above phenomena lead to incorrect work of the left ventricle. Any deviation of the EOS indicates pathologies such as ischemia, CHF, congenital heart disease, heart attack. The blockade of the conduction system of the main organ is associated with the intake of certain medications.

Additional diagnostic methods

If a deviation of the electrical axis to the left is registered on the cardiogram, an additional instrumental examination of the patient is performed. It is recommended to have an electrocardiogram while walking on a treadmill or on an exercise bike. With the help of ultrasound, the degree of ventricular hypertrophy is assessed.

If the sinus rhythm is disturbed, EOS is rejected, 24-hour Holter ECG monitoring is performed. Data is recorded throughout the day. If the myocardial tissue is significantly hypertrophied, a chest x-ray is performed. With the help of angiography of the coronary arteries, the degree of damage to the vessels during the current ischemia is determined. Echocardioscopy allows you to determine the condition of the atria and ventricles of the heart.

Therapy of the phenomenon under consideration is aimed at eliminating the main disease. Some heart conditions are treated medically. In addition, it is recommended to eat right and lead a healthy lifestyle.

In severe cases of the disease, surgical intervention is required. If the conduction system is seriously disturbed, a pacemaker transplant is performed. This device sends signals to the myocardium, causing it to contract.

Most often, the phenomenon under consideration does not threaten human life. But, if a sharp change in the position of the axis is diagnosed (a value greater than +900), this can lead to cardiac arrest. Such a patient must be urgently hospitalized in intensive care. To prevent this condition, annual scheduled examinations by a cardiologist are shown.

Changes to the right

Axis deviation to the right is not an independent pathology, but is a diagnostic symptom of a disorder in the functioning of the main organ. Most often, such a clinic indicates an abnormal increase in the right atrium or ventricle. After finding out the exact cause of the development of this anomaly, the doctor makes a diagnosis.

If necessary, the patient is prescribed additional diagnostics:

1. Ultrasound - provides information about changes in the anatomy of the main organ.
2. Chest x-ray - reveals myocardial hypertrophy.
3. Daily ECG - performed with concomitant rhythm disturbance.
4. ECG during exercise - helps to detect myocardial ischemia.
5. CAG - is performed to diagnose the lesion of the coronary artery.

Axis deviation to the right can be triggered by the following pathologies:

1. Ischemia is an incurable pathology in which there is a blockage of the coronary arteries. If left untreated, the disease can lead to myocardial infarction.
2. Acquired or congenital stenosis of the pulmonary artery - due to the narrowing of the vessel, the normal outflow of blood from the right ventricle stops, which provokes an increase in blood pressure.
3. Atrial fibrillation - can provoke a brain stroke.
4. Chronic cor pulmonale - observed with impaired lung function, pathology of the chest. Under such conditions, hypertrophy can develop.
5. The presence of a hole in the septum between the atria, through which blood is ejected from left to right. This provokes the development of heart failure.
6. Valve stenosis - manifests itself as a narrowing of the opening between the left ventricle and the corresponding atrium, which makes diastolic blood flow difficult. This pathology is acquired.
7. Thromboembolism of the pulmonary artery - provoked by blood clots that occur in large vessels. Then they move through the system, blocking the artery and its branches.
8. Primary pulmonary hypertension, which is accompanied by high blood pressure caused by various reasons.

Risk factors

Axis tilt to the right is a consequence of poisoning with a tricyclic antidepressant. The somatotropic effect of these drugs is observed due to the presence in them of substances that affect the conductive system of the heart. If the ECG diagnosed a deviation of the axis to the right side, a deeper diagnosis of the patient is required.

There is a direct relationship between the anatomical position of the main organ and the EOS of the QRS complex. This relationship is confirmed by the effect of respiration. When inhaling, the diaphragm lowers, the heart changes its position, which provokes a shift of the EOS to the right. In patients with emphysema, the anatomical position of the main organ is observed. On the contrary, when exhaling, the diaphragm rises, the heart takes a horizontal position, shifting the axis to the left.

There is also a direct influence of the direction of ventricular depolarization on the EOS value. This phenomenon is confirmed by partial blockade of the LBPH. In this case, the impulses propagate along the upper left ventricle, which provokes a deviation of the axis to the left.

If the value of the parameter in question in a newborn baby deviates from the norm to the right, there is no pathology.

Doctors do not consider this condition as right ventricular hypertrophy. This is explained by the fact that the deviation angle of +100 is a normal phenomenon observed in many newborns. This is especially true for those who live in harsh climatic conditions and in the mountains.

But the deviation of the axis to the right in the baby may be associated with the blockade of the LBPH. Therefore, when a considered diagnostic symptom is detected, a complete examination of a small patient is carried out.

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The range of position of the electrical axis is normal

For example, in the conclusion of the ECG, the patient may see the following phrase: "sinus rhythm, EOS is not rejected ...", or "the axis of the heart is in a vertical position", which means that the heart is working correctly.

In the case of heart diseases, the electrical axis of the heart, along with the heart rhythm, is one of the first ECG criteria that the doctor pays attention to, and when deciphering the ECG by the attending physician, it is necessary to determine the direction of the electrical axis.

Deviations from the norm are the deviation of the axis to the left and sharply to the left, to the right and sharply to the right, as well as the presence of a non-sinus heart rhythm.

How to determine the position of the electric axis

Determining the position of the axis of the heart is carried out by a doctor of functional diagnostics, deciphering the ECG, using special tables and diagrams, according to the angle α ("alpha").

The second way to determine the position of the electrical axis is to compare the QRS complexes responsible for the excitation and contraction of the ventricles. So, if the R wave has a greater amplitude in the I chest lead than in the III one, then there is a levogram, or a deviation of the axis to the left. If there is more in III than in I, then a rightogram. Normally, the R wave is higher in lead II.

Causes of deviations from the norm

Axis deviation to the right or to the left is not considered an independent disease, but it can indicate diseases that lead to disruption of the heart.

Deviation of the axis of the heart to the left often develops with left ventricular hypertrophy

Deviation of the axis of the heart to the left can occur normally in healthy individuals who are professionally involved in sports, but more often develops with left ventricular hypertrophy. This is an increase in the mass of the heart muscle with a violation of its contraction and relaxation, necessary for the normal functioning of the whole heart. Hypertrophy can be caused by such diseases:

cardiomyopathy (increase in mass of the myocardium or expansion of the heart chambers) caused by anemia, hormonal disorders in the body, coronary heart disease, postinfarction cardiosclerosis, changes in the structure of the myocardium after myocarditis (inflammatory process in the heart tissue);
long-term arterial hypertension, especially with constantly high pressure figures;
acquired heart defects, in particular stenosis (narrowing) or insufficiency (incomplete closure) of the aortic valve, leading to impaired intracardiac blood flow, and, consequently, increased stress on the left ventricle;
congenital heart defects are often the cause of the deviation of the electrical axis to the left in a child;
violation of conduction along the left leg of the bundle of His - a complete or incomplete blockade, leading to a violation of the contractility of the left ventricle, while the axis is rejected, and the rhythm remains sinus;
atrial fibrillation, then the ECG is characterized not only by axis deviation, but also by the presence of non-sinus rhythm.

Deviation of the axis of the heart to the right is a variant of the norm when conducting an ECG in a newborn child, and in this case there may be a sharp deviation of the axis.

In adults, such a deviation, as a rule, is a sign of right ventricular hypertrophy, which develops with such diseases:

diseases of the bronchopulmonary system - prolonged bronchial asthma, severe obstructive bronchitis, pulmonary emphysema, leading to an increase in blood pressure in the pulmonary capillaries and increasing the load on the right ventricle;
heart defects with damage to the tricuspid (tricuspid) valve and the valve of the pulmonary artery extending from the right ventricle.

The greater the degree of ventricular hypertrophy, the more deviated the electrical axis, respectively, sharply to the left and sharply to the right.

Symptoms

The electrical axis of the heart itself does not cause any symptoms in the patient. Disorders of well-being appear in a patient if myocardial hypertrophy leads to severe hemodynamic disturbances and to heart failure.

The disease is characterized by pain in the region of the heart

Of the signs of diseases accompanied by a deviation of the axis of the heart to the left or right, headaches, pains in the region of the heart, swelling of the lower extremities and on the face, shortness of breath, asthma attacks, etc. are characteristic.

If any unpleasant cardiac symptoms appear, you should consult a doctor for an ECG, and if an abnormal position of the electrical axis is found on the cardiogram, an additional examination should be performed to establish the cause of this condition, especially if it is found in a child.

Diagnostics

To determine the cause, if the ECG axis of the heart deviates to the left or right, a cardiologist or therapist may prescribe additional research methods:

Ultrasound of the heart is the most informative method that allows you to assess anatomical changes and identify ventricular hypertrophy, as well as determine the degree of violation of their contractile function. This method is especially important for examining a newborn child for congenital heart disease.
ECG with exercise (walking on a treadmill - treadmill test, bicycle ergometry) can detect myocardial ischemia, which can be the cause of deviations of the electrical axis.
24-hour ECG monitoring in the event that not only axis deviation is detected, but also the presence of a rhythm not from the sinus node, that is, there are rhythm disturbances.
Chest X-ray - with severe myocardial hypertrophy, an expansion of the cardiac shadow is characteristic.
Coronary angiography (CAG) is performed to clarify the nature of coronary artery lesions in coronary artery disease a.

Treatment

Directly, the deviation of the electrical axis does not need treatment, since this is not a disease, but a criterion by which it can be assumed that the patient has one or another cardiac pathology. If any disease is detected after the additional examination, it is necessary to begin its treatment as soon as possible.

In conclusion, it should be noted that if the patient sees in the conclusion of the ECG a phrase that the electrical axis of the heart is not in a normal position, this should alert him and prompt him to consult a doctor to find out the cause of such an ECG - a sign, even if there are no symptoms does not occur.

cardio-life.ru Pulse in children is normal

The medical concept of "electrical axis of the heart" is used by cardiologists to reflect the electrical processes occurring in this organ. 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 set the angle of displacement - this is what cardiologists do.

The cardiac conduction system is an accumulation of areas of muscle tissue in the myocardial region, which is an atypical type of fiber. These fibers have good innervation, which allows the organ to contract synchronously. The beginning of the contractile activity of the heart occurs 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 excitatory signal is sent to the atrioventricular node, and then it goes along the bundle of His. Such a bundle is located in the section that blocks the ventricles, where it is divided into two legs. The leg leaving 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, respectively, is 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 bundle of His left is localized in two-thirds of the partitioning part that separates the ventricles of the organ, the middle and lower, as well as the posterolateral and lower wall, located in the zone of the left ventricle. Doctors say that the anterior branch is slightly to the right of the posterior.

The conduction system is a strong source that supplies electrical signals that make the main part of the body work normally, in the right rhythm. Only doctors are able to calculate any violations in this area, it will not work 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 conducting system of the organ, then the axis of the heart can be mixed. There are certain norms for the position of this indicator, according to which the doctor detects 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 ventricle on the left usually significantly exceeds that of the right ventricle. You can find out whether the horizontal or vertical vector of a given measurement is based on these standards. Since the mass of the organ is unevenly distributed, it means that the electrical processes must occur more strongly in the left ventricle, and this shows that the EOS is directed specifically to this department.

Doctors project these data on a specially designed coordinate system, on the basis of which it can be concluded that the electrical axis of the heart is in the region of +30, as well as +70 degrees. However, each person, even a child, has individual features of the body, 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, which are considered normal and do not interfere with the activity of the body.

What positions of the electric axis exist:

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

It should be noted that all five positions can be found in a person who has good health. Finding the cause of such features is quite easy, the physiology of people explains everything.

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

In what cases is it a pathology, the causes of violations

Sometimes the direction of the indicator can mean 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 found, then the person has certain ailments, in particular, hypertrophic changes in the left ventricle. Often, such a violation becomes the result of pathological processes, as a result of which the cavity of this department is stretched and increases in size.

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

Ischemic damage to the main organ.
Arterial hypertension, especially with regular pressure surges to high tonometer values.
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.
Chronic heart failure.
Abnormalities in the aortic valve, its insufficiency or stenosis. A pathological process of this kind may be acquired or congenital in nature. Such diseases cause a disorder of blood flow in the cavities of the organ, which leads to an overload of the left ventricle.
Professionally engaged in sports activities, these disorders are also often detected.

In addition to hypertrophic changes, the deviation of the axis of the heart sharply to the left may indicate problems with the conduction properties of the inner part of the ventricles, which usually occur with various blockades. What is it and what threatens - the attending physician will explain.

Often, a blockade is diagnosed, found in the left leg of the His bundle, which also refers to a pathology that shifts the EOS to the left.

The opposite state also has its causes. 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 violation.

What diseases lead to the inclination of the EOS to the right:

Pathological processes in the tricuspid valve.
Stenosis and narrowing of the lumen of the pulmonary artery.
Pulmonary hypertension. This violation often occurs against the background of other ailments, such as obstructive bronchitis, organ damage, 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 that 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.

First of all, it should be noted the position of the EOS during the bearing of the baby by the mother. Pregnancy changes the direction of this indicator, as serious changes take place in the body. The rapidly growing uterus presses on the diaphragm, which leads to displacement of all internal organs and changes the position of the axis, as a result of which its direction may 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 the difference in the ratio of weight 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 EOS angle, which normally persists throughout his life.

Symptoms

A change in the direction of the electrical axis cannot cause discomfort in a person. Disorder of well-being usually provokes hypertrophic damage to the myocardium, if they are accompanied by severe hemodynamic disorders, and also lead to the development of heart failure, which is very dangerous and requires treatment.

Symptoms:

pain in the head and chest area;
breathing problems, shortness of breath, choking;
swelling of the tissues of the lower, upper extremities and face 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

Usually, the deviation of the electrical axis is detected on the ECG (electrocardiogram). This method is not more often prescribed than others 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 violation is detected on the cardiogram, then the doctor will need to conduct several additional examination measures.

Diagnostic methods:

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, disorders in the structure of the heart and evaluate its contractile features.
X-ray of the chest area, which allows you to see the presence of a shadow of the heart, which usually occurs with myocardial hypertrophy.
ECG in the form of daily monitoring. It is necessary to clarify the clinical picture in case of violations related not only to the axis itself, but also to the origin of the rhythm not from the sinus node zone, which indicates a disorder of rhythmic data.
Coronary angiography or CAG. It is used to study the features of damage to the coronary arteries during organ ischemia.
An exercise ECG can detect myocardial ischemia, which is usually the cause of the direction of the EOS.

It is necessary to treat not a change in the index of the electrical axis, but the disease that caused the pathology. With the help of diagnostics, doctors accurately determine the factors that provoked such violations.

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

No class of drugs will help in this case. You need to eliminate the disease that led to such changes. 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 perform surgery.

In order to determine the functional abilities of the heart, it is necessary to conduct special examination methods. If it turned out that there were violations in the conducting system of the organ, you should not panic, you must follow all the recommendations of the doctor. Medicine today can eliminate almost any pathology, you just need to seek help in a timely manner.