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

For example, in fig. 5-3 high teeth are 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 the same in leads II and III. On 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, with a simple evaluation of the electrocardiogram, it can be assumed that QRS directed between positive poles leads II and III to the positive pole of aVF (+90°).

Method number 2

On fig. 5-3, the EOS direction can be calculated in another way. Recall that if the wave is perpendicular to the axis of any lead, it registers two-phase complex RS or QR(see section ""). And vice versa, if in any lead from the limbs the complex QRS two-phase, middle electrical axis of the complex QRS should be directed at a 90° angle to this lead. Look again at fig. 5-3. Do you see any two-phase complexes? It is obvious that in lead I there is a two-phase complex RS, so the EOS should be perpendicular to lead I.

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

Rice. 5-4. The QRS angle is -30°.

Method number 3

Another example is in fig. 5-4. At a cursory glance, the average electric 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 RS. Consequently, the axis should be directed at right angles to lead II. It is located at an angle of +60° in the system of six axes, so the angle of the axis 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 number 4

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

Rice. 5-5. QRS angle +60°.

Method number 5

According to fig. 5-5 middle electrical axis of the complex QRS can be calculated differently given the two-phase complex RS-type in lead aVL. The axis should be perpendicular to lead aVL (-30°), i.e. at an angle of -120° or +60°. Obviously, the angle of the axis is +60°. 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 height in leads aVR and aVL, the axis must be located exactly between these leads at an angle of -90°. In addition, in lead I - two-phase complex RS . In this case, the axis should be perpendicular to lead I (0°), i.e. axis angle can be -90° or +90°. Since the axis is directed from the positive pole of lead aVF to its negative pole, the angle of the axis should be -90°.

Look at fig. 5-7.

Rice. 5-7. QRS angle -60°.

Method number 6

Since lead aVR is a two-phase complex RS-type, EOS must be located perpendicular axis of this lead. The angle of the abduction axis 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 angle of the axis is -60°, since in lead aVL the complex is positive, and in lead III it is negative. On fig. 5-7 middle electrical axis of the complex QRS you can also calculate by lead I, where the tooth amplitude R equal to the amplitude of the tooth S II leads. 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 electric axis of the complex QRS . However, this 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 abduction, where the complex QRS close to biphasic, or in two leads, where the amplitudes of the teeth 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 to lead with a greater amplitude. In the same way, if there is a two-phase complex in the lead ( RS or QR) with teeth R and S(or teeth Q and R) of different amplitude, the axis is not exactly perpendicular to this lead. If the prong R more than a tooth S(or prong Q), the axis points are less than 90° away from the lead. If the prong 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 electric axis of the complex QRS located in the middle between the axes of the two leads from the limbs with high teeth R equal amplitude.
2. The average electric axis of the complex QRS directed at a 90° angle to any limb lead with a biphasic complex ( QR or RS) and to a lead that has relatively high teeth R.

With the vertical position of the EOS, 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 that is generated in the sinus node (the main source of cardiac electrical potentials).

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

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

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.

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. 6.1. Wave P. Analysis of the P wave involves determining its amplitude, width (duration), shape, direction and severity in various leads.

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

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

Methods for determining the position of the EOS.

In simple terms, an ECG is a dynamic recording of an electrical charge, thanks to which our heart works (that is, it contracts). 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 study, it is performed for 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. With an increase in heart rate above 91 beats / min, they speak of tachycardia; if the heart rate is 59 beats / min or less, this is a sign of bradycardia.

The electrical axis of the heart (EOS): the essence, the norm of the 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 the norm and does not require treatment.

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

Extrasystole 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 blockade, A-V (AV) blockade - a violation of the impulse from the atria to the ventricles of the heart.

Blockade of the legs (left, right, left and right) of the His bundle (RBNG, BLNG), complete, incomplete - this is a violation of the conduction of an impulse along 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 transferred. In such a situation, the doctor prescribes treatment aimed at preventing a second heart attack and eliminating the cause of circulatory disorders in the heart muscle (atherosclerosis).

Timely detection and treatment of this pathology is necessary. Normal ECG in children aged 1-12 months. Typically fluctuations in heart rate depending on the behavior of the child (increase in crying, anxiety). 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 the position of the EOS can talk about heart disease?

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.

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 is a section of the heart muscle, consisting of the so-called atypical muscle fibers.

Normal ECG

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 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.

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. In itself, the position of the EOS is not a diagnosis.

These defects can be either congenital or acquired. The most commonly acquired heart defects are the result of rheumatic fever.

In this case, it is necessary to consult a highly qualified sports doctor to decide whether it is possible to continue playing 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 with the left ventricle, RVH is caused by coronary heart disease, congestive heart failure, and cardiomyopathies.

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

The resulting ventricular excitation vector is the sum of three momentum excitation vectors: interventricular septum, 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 can 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 angle alpha (α).

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

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

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 teeth have a minus sign (-), since they are below the isoelectric line, and the R wave is a plus sign (+ ). If any tooth 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 Died)

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

If 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°), consider that on this ECG there is a blockade of the posterior branch of the left branch of the His bundle.

Determining the alpha angle within 50-0 °, one 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 levogram.

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

Determination of the deviation of the electrical axis of the heart by the angle alpha using tables and diagrams is mainly carried out by doctors in functional diagnostics rooms, 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 found by analyzing the R and S waves in I and III standard leads. At the same time, 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 teeth in absolute value.

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

If on the electrocardiogram in standard lead I the ventricular complex is R-type, and the QRS complex in standard lead III is S-type, 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 the I standard lead we have the S-type of the ventricular complex, and in the III lead of 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 ventricular excitation vector is normally located in the frontal plane so that its direction coincides with the direction of the axis II of the standard lead.

The figure shows that the amplitude of the R wave in the II standard lead is the largest. 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).

The shorthand 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 the electrical position of the heart. Under the electrical position of the heart is meant the direction of the resulting vector of excitation of the ventricles relative to the axis I of the standard lead, taking it as if for the horizon line.

A distinction is made between the vertical position of the resulting vector relative to the I-axis of the standard lead, which is called 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 main (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 unipolar leads aVL and aVF is analyzed, keeping in mind the features of the graphical display of the resulting vector by 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 able to deviate from its normal position either to the right or to the left.

3. It is possible to determine the deviation of the electrical axis of the heart by measuring the angle alpha.

4. It is possible to determine the deviation of the electrical axis of the heart visually.

RI-SH levogram

RII > RI > RIII normogram

SI-RIII rightgram

5. The electrical position of the heart is the position of the resulting vector of excitation of the ventricles in relation to its 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 there are no clear signs of a levogram on the ECG. The electrical axis is, as it were, in a borderline position between the normogram and the levogram. In these cases, one speaks of a tendency to a levogram. In a similar situation, axis deviations to the right indicate a tendency to right-handedness.

The concept of "uncertain electrical position of the heart"

In some cases, the electrocardiogram fails to find the conditions described for determining the electrical position of the heart. In this case, one speaks of an indefinite 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 a more accurate topical diagnosis of the pathological process occurring in the myocardium, and to determine the 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 set the angle of displacement - this is what cardiologists do.

Features of the conductive system

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 of 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:

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 be found in a person who has good health. Finding the cause of such features is quite easy, the physiology of people explains everything.

• The horizontal axis of the heart is more often detected in people with a stocky figure and short stature, and these individuals also have a usually 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 within 70 or 90 degrees. Such an EOS vector is detected in a person with an asthenic body type, who has a thin body structure and high growth.

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:

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. 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.
6. 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.

Norms in children

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.

• 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.

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, disorders in the structure of the heart and evaluate its contractile features.
2. 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.
3. 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.
4. Coronary angiography or CAG. It is used to study the features of damage to the coronary arteries during organ ischemia.
5. 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.

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 pulses of this organ, which are issued on a regular basis, the blood has the ability 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 has suspicions that something is not right with his heart, then he sends the patient to an ECG. Sinus rhythm on the ECG is a very important indicator and clearly gives data on the real state of the human heart muscle. What exactly can be determined by looking at the cardiogram, it is worth considering in more detail.

What is sinus rhythm

In the concept of medical staff, the sinus rhythm of the cardiogram is the norm for the human body. If there are identical gaps between the teeth depicted on the cardiogram, the height of these columns is also the same, then there are no deviations in the work of the main organ.

So, the sinus rhythm on the cardiogram is the following:

• graphic representation of human pulse jumps;
• a set of teeth of different lengths, between which there are different intervals, showing a 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 work of the heart and its individual valves.

Normal sinus rhythm is only present when the heart rate is between 60 and 80 beats per minute. It is this rhythm that is considered normal for the human body. and on the cardiogram it is displayed by teeth of the same size, located at the same distance from each other.

It is clearly worth remembering that the results of the 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 human health.

What are the criteria for deciphering the result of the ECG

Deciphering the results of the cardiogram is performed by doctors according to a special scheme. Medical specialists have a clear idea of ​​which marks on the cardiogram are the norm and which are deviations. The conclusion of the ECG will be set only after the calculation of the results, which were displayed in a schematic form. The doctor, when examining the 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 cardiac impulses;
• the distance between the teeth on the cardiogram;
• how sharply the indicators of the schematic image fluctuate;
• what is the specific distance observed between the columns displaying the pulses.

A doctor who knows what each of these schematic marks means, carefully studies them and can clearly orient himself in what kind of diagnosis should be made. The cardiograms of children and adults are deciphered according to the same principle, but the norm 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 see if there is a weakness of the sinus node, and what kind of health problems this causes. Considering the indicators of the cardiogram 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 rhythm of contractions, 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 contracts less than 60 times in one minute;
• the presence of too small an interval between the teeth of the cardiogram, which means a violation in the sinus node.

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

The deviation of the EOS to the left also indicates that the work of the vital organ is not set up correctly. Having determined such deviations, the doctor will send the patient for an additional examination and ask him to pass a number of necessary tests.

If the vertical position of the EOS is observed, then 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 rather 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 increase in the left or right ventricles. Axial misalignment may indicate that there is damage to certain valves. 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. Such a deviation can also tell about anomalies in the development of the heart muscle.

What can be said about the indicators of the norm

On the ECG, sinus rhythm is always and in without fail compared with certain norms. Only knowing these indicators completely, the doctor will be able to deal with the patient's cardiogram and give the correct conclusion.

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

• in children from birth to the first year of life, the orientation 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 old have a mostly vertical orientation of the axis, but it can also be horizontal, without indicating deviations from the norm. Heart rate from 95 to 128;
• children from seven years old and adolescents on the cardiogram should have a normal or vertical axis position, the heart should contract from 65 to 90 beats per minute;
• adults should have a normal direction of the axis 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, then this does not always become a sign of the presence of some serious pathologies in the body.

Because of what, ECG readings may deviate from the norm

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

• a person regularly consumes alcoholic beverages;
• the patient smokes cigarettes for quite a long time on a regular basis;
• a person is regularly exposed to various kinds 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 can indicate problems of a more serious nature. If the results of the cardiogram do not correspond to the norm, then this may indicate acute heart failure, valve displacement, 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 study?

The sinus rhythm, which is displayed on the ECG, clearly indicates whether there are deviations in the work of the heart and in which directions the problem is observed. Regularly undergo such a study is necessary not only for adults, but also for children. The results of the performed cardiogram will help a person get the following information:

• whether he has pathologies and diseases of a congenital nature;
• due to what pathologies in the body heart problems begin;
• whether a person's way of life can become a cause of disturbances in the work of the main organ;
• whether the heart is in the correct position and whether its valves work correctly.

Normal sinus rhythm on the ECG is displayed in the form of teeth of the same size and shape, while the distance between them is also the same. If any deviations from this norm are observed, then the person will have to be additionally 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 the 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 deal with its complex 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 physiological maturation of the body.

If the sinus rhythm is within the normal range, then you will not have to take additional tests and undergo repeated studies. Normal work of the heart, as well as pathological deviations, is always recorded by a cardiogram.

The sinus rhythm on the ECG should be even and clear, without any broken lines, 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 the reason for doctors to perform additional studies and prescribe tests. Only after additional examinations can the exact cause of the deviations be understood and treatment can begin. A normal sinus rhythm displays a clear and even cardiogram in terms of the location of the lines. Additional attention will have to be paid to the location of the axis, with respect to the parameters of which medical standards are also 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 materials is allowed only with an active link to the source.

EOS deviation to the left: causes, diagnosis and treatment

From this article you will learn what EOS is, what it should be like in the norm. When the EOS is deviated slightly to the left - what does this mean, what diseases can this indicate. 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:

1. EchoCG (ultrasound of the heart) - to identify possible organ defects.
2. Stress EchoCG - ultrasound of the heart with a load - for the diagnosis of ischemia.
3. Angiography of the coronary vessels - their examination to detect blood clots and atherosclerotic plaques.
4. 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.

Treatment of the heart and blood vessels © 2016 | Site map | Contacts | Privacy 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 in the electrocardiogram. Allows you to evaluate the electrical processes that set the heart muscle in motion 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 of its 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 position +59 0 is considered the average norm. But the normogram options 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 exert pressure on the diaphragm;
• with a high-standing diaphragm - observed in hypersthenics (short, strong people).

The shift of the indicator to the right in the absence of pathology is observed in such situations:

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

Diagnostics on the ECG

An electrocardiogram is the main tool for determining EOS. To detect 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 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, the positive or negative value of a particular tooth is taken into account.

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

Visual Definition

A simpler and more visual way to determine the 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 one speaks of an R-type ventricular complex. If vice versa, 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, which lead to the development of the disease. The deviation of the electrical axis to the left indicates such violations:

• an increase in the size of the left ventricle - hypertrophy (LVH);
• malfunctions of the valves of the left ventricle, due to which the ventricle is overloaded with blood volume;
• cardiac blocks, such as left bundle branch block (it looks like this on the ECG, which you can learn about from another article);
• conduction disturbances within the left ventricle.

Diseases that are accompanied by a levogram

If a deviation of the EOS is found in a patient, then this may be the result of diseases such as:

In addition to diseases, certain medications can lead to blockade of the conduction system of the heart.

Additional Research

The detection on the cardiogram of the EOS deviation to the left side is not in itself the basis for the final conclusion of the doctor. 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. With the help of ultrasound, the degree of ventricular hypertrophy and violations of their contractile function are assessed.
• 24-hour Holter ECG monitoring. The cardiogram is removed during the day. Assign in cases of rhythm disturbance, which is accompanied by a deviation of the EOS.
• X-ray examination of the chest. With significant hypertrophy of myocardial tissues, an increase in the cardiac shadow in the picture is observed.
• Angiography of the coronary arteries (CAG). Allows you to determine the degree of damage to the coronary arteries in diagnosed coronary disease.
• Echocardioscopy. Allows you to purposefully determine the state of the patient's ventricles and atria.

Treatment

Deviation of the electrical axis of the heart to the left of the normal position in itself is not a disease. This is a sign determined with the help of instrumental research, which allows you to identify violations in the work of the heart muscle.

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

In severe cases, surgery is required, for example, with congenital or acquired heart defects. If the conduction system is severely damaged, it may be necessary to transplant a pacemaker, which will send signals directly to the myocardium and cause it to contract.

Most often, the deviation is not a threatening symptom. But if the axis changes its position abruptly, reaches values ​​of more than 90 0, then this may indicate a blockade of the legs of the Hiss bundle and threatens with 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 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 identification of the cause of this condition. Annual scheduled electrocardiography allows you to timely detect abnormalities in the work of the heart and immediately begin 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. Determining the direction of the 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 on the entire chest.

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

The impulses pass through. It consists of atypical fibers that are located in certain areas of the body.

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

When any violations occur in the conductor system, then the EOS changes its direction.

Axis location

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

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

If we indicate 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 axle arrangement.

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

The doctor may conclude:

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

All of these conclusions are the norm.

As for individual characteristics, it is noted that in people of high stature and thin build, the EOS is in a semi-vertical position, and in people who are lower and at the same time they are of a stocky build, the EOS has 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 state, the cavity is stretched, increases in size. Sometimes this is due to overload, but it can also be the result of a disease.

Diseases that cause hypertrophy are:

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

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

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

This pathology can be caused by such diseases:

As well as diseases characteristic of LV hypertrophy:

• ischemia of the heart;
• 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 the norm.

It can be concluded 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. An axis change is simply an ECG sign of some kind of disease.

It is important to timely determine these indications and diseases.

Deviation of the axis of the heart does not cause any symptoms, the symptomatology manifests itself from hypertrophy, which disrupts the hemodynamics of the heart. The main symptoms are headaches, chest pains, swelling of the extremities and face, suffocation and shortness of breath.

With the manifestation of symptoms of a cardiological nature, you should immediately undergo an electrocardiography.

Definition 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 high R waves in the QRS complex. In this case, the R wave in lead III exceeds the wave in lead II. There is an RS complex in lead I, 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 the standard lead I, the QRS complex is expressed as an R-type, and in lead III, its form is S-type. In this case, the S tooth has a depth greater than the height R.

With blockade of the posterior branch of the left leg of His, the alpha angle is 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 tall R wave (III, aVF).

When blocking the anterior branch of the left leg of His, the values ​​will be from -300 and more. On the ECG, signs of this are a late R wave (lead aVR). Leads V1 and V2 may have a small r wave. At the same time, the QRS complex is not expanded, and the amplitude of its teeth is not changed.

Blockade of the anterior and posterior branches of the left leg of His (complete blockade) - 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 expanded, and its top is serrated. Near the high R wave 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 diseases of a cardiological nature.