Semi-vertical electrical position of the heart in a child. ECG horizontal position EOS

The electrical axis of the heart (EOS) is the first word that every person sees when they have a transcript of the cardiogram in their hands. When a specialist next to them adds that the EOS is in a normal position, the person being examined has nothing to worry about his health. But what if the axis takes a different position or has deviations?

It is no secret that the heart is constantly working and producing electrical impulses. The place of their formation is the sinus node, from which they normally pass this way:

Atria.
Ventricles.
Bundle of His.

As a result, the movement is electric vector with strictly marked movement. The electrical axis of the heart represents the projection of the impulse onto the anterior plane, which is in a vertical position.

The placement of the axis is calculated by dividing the circle drawn around the triangle by degrees. The direction of the vector gives the specialist an approximate idea of the location of the heart in the chest.

EOS

The concept of EOS norm

The position of the EOS depends on:

The speed and correctness of impulse movement through the cardiac systems.
Quality of myocardial contractions.
Conditions and pathologies of organs that affect the functionality of the heart.
Heart condition.

For a person who does not suffer from serious diseases, the axis is characteristic:

Vertical.
Horizontal.
Intermediate
Normal.

The normal position of the EOS is located according to Died at coordinates 0 - +90º. For most people, the vector passes the limit of +30 - +70º and is directed to the left and down.

In an intermediate position, the vector passes within +15 - +60 degrees.

According to the ECG, the specialist sees that the positive waves are longer in the second, aVF and aVL leads.

Correct placement of EOS in children

Babies have a strong axis deviation in right side, which during the first year of life turns into a vertical plane. This situation has a physiological explanation: the right side of the heart “overtakes” the left in weight and production of electrical impulses. The transition of the axis to normal is associated with the development of the LV.

Children's EOS standards:

Up to a year - the passage of the axis is between +90 - +170 degrees.
From one to three years - vertical EOS.
6-16 – stabilization of indicators to adult standards.

Measuring indicators using electrocardiography

ECG signs in the analysis of EOS are determined by the rightogram and the leftogram.

A rightogram is finding a vector between indicators 70-900. On electrocardiography it is demonstrated by long R waves in the QRS group. The vector of the third lead is larger than the wave of the second. For the first lead, the RS group is considered normal, where the depth of S exceeds the height of R.

Pravogram

The levogram on an ECG is the alpha angle passing between 0-500. Electrocardiography helps to determine that the usual lead of the first QRS group is characterized by an R-type expression, but already in the third lead it has an S-type shape.

Levogram

Why does deviation occur?

When the axis is deviated to the left, this means that the patient has left ventricular hypertrophy.

The causes of the disease include:

Hypertension. Especially in cases frequent increases HELL.
Ischemic diseases.
Chronic heart failure.
Cardiomyopathy. This disease is the growth of the heart muscle in a mass and expansion of its cavities.
Pathology of the aortic valve. They can be congenital or acquired. They provoke blood flow disturbances and LV reloading.

Important! Very often, hypertrophy worsens in people who spend a lot of time on varied sports activities.

With a strong deviation of the axis to the right, a person may have PR hypertrophy, which is caused by:

High pressure in the arteries of the lungs, which causes bronchitis, asthma and emphysema.
Pathological diseases of the tricuspid valve.
Ischemia.
Heart failure.
Blocking of the posterior branch of the His node.

ECG at " pulmonary heart»

Vertical position of the EOS

A vertical position is characterized by a range of +70 - +90º. Characteristic of tall, thin people with a narrow sternum. According to anatomical indicators, with such a physique, the heart seems to be “hanging.”

On the electrocardiogram, the highest positive vectors are observed in aVF, negative ones - in aVL.

Horizontal position of the EOS

In a horizontal position, the vector passes between +15 - -30º. Most often observed in people with a hypersthenic physique: short stature, wide chest, excess weight. From an anatomical point of view, in this case, the heart is located on the diaphragm.

On the cardiogram, the highest positive waves appear in aVL, and negative ones in aVF.

Horizontal position of the EOS

EOS deviation to the left

Deviation electrical axis to the left is the location of the vector in the range 0 - -90º. A distance of up to -30º in some cases is normal, but the slightest excess of the indicator can be regarded as a symptom of a serious illness. In some people, such indicators are provoked by deep exhalation.

Important! In women, a change in the coordinates of the heart in the chest can be triggered by pregnancy.

Reasons why the axis deviates to the left:

LV hypertrophy.
Disruption or blockage of the His bundle.
Myocardial infarction.
Myocardial dystrophy.
Heart defects.
Violation of CM contractions.
Myocarditis.
Cardiosclerosis.
Calcium accumulations in the organ, blocking normal contraction.

These ailments and pathologies can provoke an increase in the mass and size of the LV. Because of this, the tooth on this side is longer, resulting in a deviation of the electrical axis to the left.

Reasons for EOS deviation to the right

The deviation of the axis to the right is fixed when it passes between +90 - +180º. This shift can be caused by:

Damage to the pancreas by infarction.
The simultaneous occurrence of coronary artery disease and hypertension - they deplete the heart with a vengeance and provoke failure.
Pulmonary diseases of a chronic nature.
Incorrect passage of electrical impulses along the right branch of the His bundle.
Pulmonary emphysema.
Severe strain on the pancreas caused by obstruction pulmonary artery.
Dextrocardia.
Mitral heart disease, which provokes pulmonary hypertension and stimulates the work of the pancreas.
A thrombotic block of blood flow in the lungs, which causes a deficiency of the organ in the blood and overloads the entire right side of the heart.

Because of these pathologies, the specialist determines on electrocardiography that the EOS is deviated to the right.

EOS deviation to the right

What to do if the axis is deviated?

If you are diagnosed with a pathological deviation of the axis, the specialist must resort to new studies. Each ailment that provokes displacement of the EOS is accompanied by several symptoms that require careful analysis. Most often they resort to ultrasound diagnostics of the heart.

Finally

Determining the electrical axis of the heart is just a technique that allows you to understand the location of the heart and diagnose it for the presence of pathologies and ailments. An opinion on it can only be made by a qualified specialist, since a deviation does not always mean the presence of heart problems.

Classification of sinus rhythm: what can a cardiogram tell about the condition of the heart?

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

Features of the conduction system

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

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

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

Parameters in healthy people

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

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

What positions of the electrical axis exist:

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 occur in a person in good health. Finding the reason for such features is quite easy; human physiology explains everything.

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

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

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

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

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

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.
Disturbances in the aortic valve, its insufficiency or stenosis. Pathological process This variety may be acquired or congenital in nature. Such diseases cause disruption of blood flow in the cavities of the organ, which leads to overload of the left ventricle.
People involved in sports activities professionally also often exhibit these disorders.

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

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

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

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

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

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

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

Norms for children

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

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

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

Symptoms

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

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

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

Diagnosis and treatment

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

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

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

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

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

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

What is sinus rhythm on an ECG

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

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

What is sinus rhythm

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

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

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

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

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

What criteria are used to decipher the ECG result?

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

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

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

What sinus rhythm problems can be seen on an ECG?

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

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

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

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

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

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

What can we say about normal indicators?

On an ECG, sinus rhythm is always and without fail compared with certain normal values. Only knowing these indicators completely will the doctor be able to understand the patient’s cardiogram and give the correct conclusion.

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

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

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

Why ECG readings may deviate from the norm

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

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

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

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

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

Why should a person undergo an ECG test?

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

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

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

The sinus rhythm on the cardiogram must coincide with the established norm, and only in this case can a person be considered healthy. If impulses from the heart to other systems diverge too quickly or slowly, then this does not bode well. This means that doctors will have to further clarify the cause of the problem and deal with it. 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 the physiological maturation of the body.

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

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

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

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

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

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

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

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

To resolve this problem, consult a cardiologist.

The location of the electrical axis is normal

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

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

Norm of angle alpha EOS

The location of the anatomical and electrical axes depends to some extent on body type. 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.

Normal alpha angle depending on body type:

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

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

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

Reasons for shift to the left

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

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

Causes of these pathologies:

Symptoms

EOS displacement itself does not have characteristic symptoms.

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

However, sometimes these diseases still make themselves felt.

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

But let us repeat once again - symptoms do not always appear; they usually develop late stages diseases.

Additional diagnostics

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

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

After detailed examination appropriate therapy is prescribed.

Treatment

The deviation of the electrical axis of the heart to the left in itself does not require specific treatment because it is just a symptom of another disease.

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

Treatment for LVH depends on what caused the myocardial growth

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

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

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

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

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

Normal values and causes of violation

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

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

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

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

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

Diagnosis using ECG

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

Alpha angle offset detection

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

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

Visual definition

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

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

Establishing diagnosis

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

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

Diseases that are accompanied by levogram

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

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

Additional Research

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

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

Treatment

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

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

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

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

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

The electrical axis of the heart (EOS) is one of the main parameters of the electrocardiogram. This term is actively used both in cardiology and in functional diagnostics, reflecting the processes occurring in the most important organ human body.

The position of the electrical axis of the heart shows the specialist what exactly is happening in the heart muscle every minute. This parameter is the sum of all bioelectrical changes observed in the organ. When taking an ECG, each electrode of the system registers excitation passing at a strictly defined point. If you transfer these values to a conventional three-dimensional coordinate system, you can understand how the electrical axis of the heart is located and calculate its angle relative to the organ itself.

How is an electrocardiogram taken?

ECG recording is performed in a special room, maximally shielded from various electrical interference. The patient sits comfortably on the couch with a pillow under his head. To take an ECG, electrodes are applied (4 on the limbs and 6 on the chest). An electrocardiogram is recorded during quiet breathing. In this case, the frequency and regularity of heart contractions, the position of the electrical axis of the heart and some other parameters are recorded. This simple method allows you to determine whether there are abnormalities in the functioning of the organ, and, if necessary, refer the patient for a consultation with a cardiologist.

What influences the location of the EOS?

Before discussing the direction of the electrical axis, you should understand what the conduction system of the heart is. It is this structure that is responsible for the passage of impulses through the myocardium. The conduction system of the heart is atypical muscle fibers that connect different parts of the organ. It begins with the sinus node, located between the mouths of the vena cava. Next, the impulse is transmitted to the atrioventricular node, located in the lower part of the right atrium. The next to take up the baton is the His bundle, which quickly diverges into two legs - left and right. In the ventricle, the branches of the His bundle immediately become Purkinje fibers, which penetrate the entire cardiac muscle.

An impulse entering the heart cannot escape the myocardial conduction system. This complex structure with fine settings, sensitively responding to the slightest changes in the body. In case of any disturbances in the conduction system, the electrical axis of the heart can change its position, which will be immediately recorded on the electrocardiogram.

EOS location options

As you know, the human heart consists of two atria and two ventricles. Two circles of blood circulation (large and small) ensure the normal functioning of all organs and systems. Normally, the mass of the myocardium of the left ventricle is slightly greater than that of the right. It turns out that all impulses passing through the left ventricle will be somewhat stronger, and the electrical axis of the heart will be oriented specifically towards it.

If you mentally transfer the position of the organ to a three-dimensional coordinate system, it will become clear that the EOS will be located at an angle from +30 to +70 degrees. Most often, these are the values recorded on the ECG. The electrical axis of the heart can also be located in the range from 0 to +90 degrees, and this, too, according to cardiologists, is the norm. Why do such differences exist?

Normal location of the electrical axis of the heart

There are three main provisions of the EOS. The range from +30 to +70° is considered normal. This option occurs in the vast majority of patients who visit a cardiologist. The vertical electrical axis of the heart is found in thin, asthenic people. In this case, the angle values will range from +70 to +90°. The horizontal electrical axis of the heart is found in short, tightly built patients. On their card, the doctor will mark the EOS angle from 0 to +30°. Each of these options is normal and does not require any correction.

Pathological location of the electrical axis of the heart

A condition in which the electrical axis of the heart is deviated is not a diagnosis in itself. However, such changes in the electrocardiogram may indicate various violations in the work of the most important organ. The following diseases lead to serious changes in the functioning of the conduction system:

Cardiac ischemia;

Chronic heart failure;

Cardiomyopathies of various origins;

Congenital defects.

Knowing about these pathologies, the cardiologist will be able to notice the problem in time and refer the patient to hospital treatment. In some cases, when EOS deviation is registered, the patient requires emergency care in intensive care.

Deviation of the electrical axis of the heart to the left

Most often, such changes in the ECG are observed with enlargement of the left ventricle. This usually occurs with the progression of heart failure, when the organ simply cannot fully perform its function. It is possible that such a condition may develop in arterial hypertension accompanied by pathology large vessels and increased blood viscosity. In all these conditions, the left ventricle is forced to work hard. Its walls thicken, leading to inevitable disruption of the impulse through the myocardium.

Deviation of the electrical axis of the heart to the left also occurs with narrowing of the aortic mouth. In this case, stenosis of the lumen of the valve located at the exit from the left ventricle occurs. This condition is accompanied by a disruption of normal blood flow. Part of it is retained in the cavity of the left ventricle, causing it to stretch and, as a result, thickening of its walls. All this causes a natural change in EOS as a result of improper conduction of the impulse through the myocardium.

Deviation of the electrical axis of the heart to the right

This condition clearly indicates right ventricular hypertrophy. Similar changes develop in certain respiratory diseases (for example, bronchial asthma or chronic obstructive pulmonary disease). Some birth defects hearts can also cause enlargement of the right ventricle. First of all, it is worth noting pulmonary artery stenosis. In some situations, tricuspid valve insufficiency can also lead to a similar pathology.

Why is changing EOS dangerous?

Most often, deviations of the electrical axis of the heart are associated with hypertrophy of one or another ventricle. This condition is a sign of a long-standing chronic process and, as a rule, does not require emergency assistance cardiologist. The real danger is the change in the electrical axis due to His bundle block. In this case, the conduction of impulses through the myocardium is disrupted, which means there is a risk of sudden cardiac arrest. This situation requires urgent intervention by a cardiologist and treatment in a specialized hospital.

With the development of this pathology, the EOS can be deviated both to the left and to the right, depending on the localization of the process. The blockade may be caused by myocardial infarction, infectious lesion heart muscle, as well as taking certain medications. A regular electrocardiogram allows you to quickly make a diagnosis, which means it allows the doctor to prescribe treatment taking into account all important factors. In severe cases, it may be necessary to install a pacemaker (pacemaker), which will send impulses directly to the heart muscle and thereby ensure normal functioning of the organ.

What to do if the EOS is changed?

First of all, it is worth considering that the deviation of the heart axis itself is not the basis for making a particular diagnosis. The position of the EOS can only give impetus to a more careful examination of the patient. For any changes in the electrocardiogram, you cannot do without consulting a cardiologist. An experienced doctor will be able to recognize normal and pathological conditions and, if necessary, prescribe additional examinations. This may include echocardioscopy for targeted study of the condition of the atria and ventricles, blood pressure monitoring and other techniques. In some cases, consultation with related specialists is required to decide on further management of the patient.

To summarize, several important points should be highlighted:

The normal EOS value is considered to be the range from +30 to +70°.

Horizontal (from 0 to +30°) and vertical (from +70 to +90°) positions of the heart axis are acceptable values and do not indicate the development of any pathology.

Deviations of the EOS to the left or to the right may indicate various disorders in the conduction system of the heart and require consultation with a specialist.

A change in EOS detected on a cardiogram cannot be made as a diagnosis, but is a reason to visit a cardiologist.

The heart is an amazing organ that ensures the functioning of all systems of the human body. Any changes that occur in it inevitably affect the functioning of the whole organism. Regular examinations by a therapist and an ECG will allow timely detection of serious diseases and avoid the development of any complications in this area.

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The electrical axis of the heart is a concept that reflects the total vector of the electrodynamic force of the heart, or its electrical activity, and practically coincides with the anatomical axis. Normally, this organ has a cone-shaped shape, with its narrow end directed downwards, forward and to the left, and the electrical axis has a semi-vertical position, that is, it is also directed downwards and to the left, and when projected onto the coordinate system it can be in the range from +0 to +90 0.

An ECG conclusion is considered normal if it indicates any of the following positions of the heart axis: not deviated, semi-vertical, semi-horizontal, vertical or horizontal. The axis is closer to the vertical position in thin, tall people of asthenic physique, and closer to the horizontal position in strong, stocky people of hypersthenic physique.

Electric axis position range is normal

For example, in the conclusion of an ECG, the patient may see the following phrase: “sinus rhythm, EOS is not deviated...”, or “the axis of the heart is in a vertical position,” this means that the heart is working correctly.

In the case of heart disease, 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 interpreting the ECG, the attending physician must determine the direction of the electrical axis.

Deviations from the norm are 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 electrical axis

Determination of the position of the heart axis is carried out by a doctor 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, then there is a levogram, or deviation of the axis to the left. If there is more in III than in I, then it is a legal grammar. Normally, the R wave is higher in lead II.

Reasons for deviations from the norm

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

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

Deviation of the heart axis 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 entire heart. Hypertrophy can be caused by the following diseases:

cardiomyopathy (increase in myocardial mass or expansion of the heart chambers), caused by anemia, hormonal imbalances in the body, coronary disease heart, post-infarction cardiosclerosis. changes in myocardial structure after myocarditis ( inflammatory process in cardiac tissue);
long-standing arterial hypertension, especially with constantly high blood pressure numbers;
acquired heart defects, in particular stenosis (narrowing) or insufficiency (incomplete closure) of the aortic valve, leading to disruption of intracardiac blood flow and, consequently, increased load on the left ventricle;
congenital heart defects often cause a deviation of the electrical axis to the left in a child;
conduction disturbance along the left bundle branch - complete or incomplete blockade, leading to impaired contractility of the left ventricle, while the axis is deviated, 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 heart axis to the right is a normal variant when conducting an ECG in a newborn child, and in this case a sharp deviation of the axis may occur.

In adults, such a deviation is usually a sign of right ventricular hypertrophy, which develops in the following diseases:

diseases of the bronchopulmonary system - long-term bronchial asthma, severe obstructive bronchitis, emphysema, leading to increased blood pressure in the pulmonary capillaries and increasing the load on the right ventricle;
heart defects with damage to the tricuspid (three-leaf) valve and the valve of the pulmonary artery, which arises from the right ventricle.

The greater the degree of ventricular hypertrophy, the more the electrical axis is deflected, 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. Impaired health appears in the patient if myocardial hypertrophy leads to severe hemodynamic disturbances and heart failure.

The disease is characterized by pain in the heart area

Signs of diseases accompanied by deviation of the heart axis to the left or right include headaches, pain in the heart area, swelling of the lower extremities and face, shortness of breath, asthma attacks, etc.

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

Diagnostics

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

Ultrasound of the heart is the most informative method, allowing to assess anatomical changes and identify ventricular hypertrophy, as well as determine the degree of impairment of their contractile function. This method is especially important for examining a newborn child for congenital heart pathology.
ECG with exercise (walking on a treadmill - treadmill test, bicycle ergometry) can detect myocardial ischemia, which may be the cause of deviations in the electrical axis.
Daily allowance ECG monitoring in the event that not only an axis deviation is detected, but also the presence of a rhythm not from the sinus node, that is, rhythm disturbances occur.
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 lesions of the coronary arteries in coronary artery disease.

Treatment

Direct deviation of the electrical axis does not require treatment, since it is not a disease, but a criterion by which it can be assumed that the patient has one or another cardiac pathology. If, after further examination, some disease is identified, it is necessary to begin treatment as soon as possible.

In conclusion, it should be noted that if the patient sees in the ECG conclusion 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 sign, even if there are no symptoms does not arise.

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

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

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

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

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

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

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

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

Methods for determining the position of the EOS.

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

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

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

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

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

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

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

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

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

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

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

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

When can the position of the EOS indicate heart disease?

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

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

Normal ECG readings

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

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

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

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

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

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

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The electrical axis of the heart is a conditional vector relative to which the organ is located in the human body. In its direction, the bioelectric processes that occur in the myocardium during heart contraction spread. The concept is used in the analysis of electrocardiograms.

Mechanism of electrical processes

The emergence of motion (electrical) potentials in the tissues of the human body is associated with a change in charge on the inner and outer surfaces of cell membranes. In the heart muscle (myocardium), this process occurs in muscle fibers. Charge transfer occurs during the transport of K+ and Na+ ions.

Potassium cations predominate in the cell cytoplasm, and sodium cations predominate in the extracellular fluid. When the heart is at rest, a positive charge accumulates on the outer surface of the cytolemma, and a negative charge on the inner surface. When an electrical impulse occurs, the permeability of the membrane increases and the flow of Na+ rushes into the cell from the pericellular space. An increase in the number of positively charged particles in the cytoplasm also positively charges inner part membranes.

Accordingly, more anions remain outside and outside surface the biomembrane becomes negatively charged. Membrane depolarization occurs. Reverse transport is also observed: when K+ leaves the cell, the outer membrane again acquires a positive charge, and the inner one, accordingly, a negative one, that is, repolarization of the cell membrane occurs.

All the described processes accompany systole - contraction of the heart muscles. The return to the initial charge distribution - outside "-", inside "+" - is accompanied by relaxation of the myocardium - diastole. The depolarization process, like a chain reaction, spreads to the entire muscular layer of the heart.

An electrical impulse is generated in the pacemaker - the sinus nerve node. From it, excitation passes through the conduction pathways into the atria. From there it spreads to the atrioventricular nerve node. The node inhibits the electrical impulse so that contraction of the ventricles follows immediately after relaxation of the atria. From the atrioventricular node, the electrical impulse migrates along a cluster of nerve fibers, the so-called bundle of His. It is localized in the septum between the ventricles and is dichotomously divided, forming “legs”. The left leg, in turn, is divided into anterior and posterior branches. The latter are divided into Purkin fibers connected into a network.

When the heart muscles are excited, bioaction potentials arise - electrical currents that are characteristic of all muscles of the body. Their occurrence is recorded using an electrocardiograph and recorded on a special tape in the form of an electrocardiogram (ECG).

Coronary angiography of the heart vessels - what is it and how is it done?

Electrical processes on the electrocardiogram

On an ECG, electrical impulses are reflected in the form of multidirectional waves. Positive waves (directed upward relative to the horizontal axis) are designated P, R, T, and negative waves are designated Q and S. Atrial excitation is described by the magnitude of the P peak. Figure P-Q characterizes the process of impulse passage through the atrioventricular node to the ventricles of the heart.

The Q peak describes the process of depolarization of the septum between the ventricles. The R wave is the process of repolarization of the cytomembranes of the muscle fibers of the lower and posterior parts of the ventricles. The Q-R-S (ventricular) complex is caused by the propagation of an electrical impulse in the ventricular myocardium during atrial repolarization.

If you connect the two most prominent ones (with the biggest difference in potentials) peak with a line, then it will display the EOS. In space, any body is projected onto 3 planes, including the human heart, and in each of them the EOS has a projection.

EOS tilt characteristics

When taking an electrocardiogram, electrodes are placed in three leads that record the potential difference:

Lead I - on the left and right arm;
Lead II - left leg-right hand;
Lead III - left leg and left arm.

This placement forms a spatial arrangement of electrical potential vectors on the body, called Einthoven's triangle. If we place EOS in the Einthoven triangle, then the angle (α) between it and the horizontal left-right hand(I lead) will characterize the deviation of the EOS.

The value of α is determined from the tables, having first summed up the height of the waves (Q+R+S) in leads I and III on the electrocardiogram, and the sign of the wave is taken into account. Since the Q and S waves are located below the horizontal isotonic axis, they have a negative sign (-), the R wave located above the axis has a positive sign (+). If there is no wave on the ECG, its value is taken as 0. The diagnostician measures the size of the waves on the ECG and sums up their value. Next, substituting the resulting value into the Diede table, the value α is obtained.

This table is a square divided by a vertical and horizontal axis. There are scales on the edges of the square. The upper and lower scales correspond to lead I, and the lateral ones correspond to lead III. The reference point of the scale is horizontal and vertical axis(0). To the left of it are located negative values from 1 to 9, on the right - positive. The square is divided into sectors with the center at the intersection of the axes, the angles of which are measured from the axis -5+5. Above the axis are the values of the angle α from 0° to 180° with a negative sign, below - with a + sign.

The EOS deviation value can be presented in the form of a table:

Without tables, you can also determine the direction of EOS deviation. It is determined visually by the degree of severity of the R and S waves in standard leads I and III. The R-type ventricular complex is characterized by a greater prominence of the R-wave, and the S-type complex, respectively, is characterized by S. If the R wave is expressed in lead I, and the S wave in lead III, then the EOS is tilted to the left. With opposite values - in lead I S, and in lead III -R, the axis deviates to the right.

Electrical position of the heart

The electrical position corresponds to the location of the EOS vector relative to the “horizon axis” (lead I axis). Relative to it, the electrical position of the heart can be vertical or horizontal. In addition, doctors point out that there is a main (intermediate) position: semi-horizontal and semi-vertical.

Most often, the vertical EOS (α = ]+30° +70°[) is located in people of asthenic constitution - thin-boned, tall with low body weight. Horizontal position (α = ]0° +30°[) in hypersthenics (short, large-boned, with a large chest volume). But since pure constitutional types are rare, mixed types have intermediate positions of the electrical position of the heart. All listed positions are a variant of the norm.

Pathologies with deviations

Sometimes deviation of the electrical position of the heart from the vertical can be one of the signs of a number of diseases:

GB and ischemia;
chronic heart diseases;
cardiomyopathy due to cardiosclerosis, heart attack, myocarditis, etc.;
congenital pathologies anatomical structure hearts, etc.

These diseases can cause thickening (hypertrophy) of the myocardium, expansion of the cavity and disruption of the outflow of blood from the left ventricle, which causes the EOS to tilt to the left. Violation of the structure and function of the mitral valve is also accompanied by an axis tilt to the left. When analyzing the ECG together with other abnormalities, this may indicate a blockade of the anterior branch of the left bundle of Hiss.

The same pathologies in the structure and function of the myocardium can cause the heart axis to tilt to the right. Enlargement of the right ventricle of the heart may be due to pulmonary pathology. Chronic diseases of the respiratory system (COPD, bronchial asthma), accompanied by an increase in pulmonary vascular resistance, cause hypertrophy of the ventricular muscles.

In addition, the direction of EOS can be influenced by narrowing of the pulmonary artery and pathology of the tricuspid valve, located between the right atrium and ventricle.

Determination of right-sided deviation of the EOS may indicate complete blockade posterior branch left bundle branch of His.

In children, especially under 6 years of age, the mass of the right ventricle is greater, which is due to physiological characteristics during development. Therefore, a child’s ECG differs from that of an adult, and the heart axis can be located either vertically or with a deviation to the right. Thus, according to studies of healthy newborns, the tilt of the EOS to the right was +180°, and in children in the range of 6-12 years, the axis “straightened” and the deviation to the right was + 110°. These indicators correspond to the age norm.

Electrocardiography retains its high diagnostic significance even despite the emergence of new methods for studying the function and structure of the heart. A doctor of any profile can interpret the results. The electrical axis of the heart, or EOS, roughly tells the doctor what condition the organ is in and whether there are any pathological changes. It may move. More often, deviation of the electrical axis of the heart is detected to the left.

Normal EOS options

The described parameter is functional. It reflects cardiac activity depending on the size and types of disturbances in its functioning. The electrical axis is the result of all biopotentials of the organ in relation to the midline of the human body. It practically coincides with the anatomical axis of the organ’s location.

There are five normal variants of EOS. Most often you can find a normogram. The normal position of the electrical axis of the heart is diagnosed when the summing alpha angle is from +30 to +70 degrees. Only functional diagnosticians can calculate it.

Semi-vertical and vertical, semi-horizontal and horizontal positions of the electrical axis of the heart are normal variants. The vertical position is characterized by an alpha angle, the value of which ranges from 69 to 89 degrees. It is detected in patients with asthenic complexion.

The horizontal and semi-horizontal position of the EOS is set by functionalist doctors when the alpha angle is from 0 to + 29 degrees. This is considered normal for stocky or obese individuals.

The causes of the appearance of levogram or pravogram are various heart diseases. A shift of the EOS to the left or right is not considered normal.

Reasons for deviation to the left

The main reason for changes in the location of the heart axis is left hypertrophy. In this case, there is a predominance of the left parts of the heart. This situation is possible with the following pathologies:

Arterial hypertension, accompanied by remodeling of the cardiac chambers;
Defects of the aortic and mitral valves;
Coronary heart disease, including heart attack and post-infarction cardiosclerosis;
Inflammation of the heart muscle (myocarditis);
Myocardial dystrophy;
Cardiomyopathy (ischemic, dilated, hypertrophic).

In all of the listed clinical situations, the wall thickness or volume of the left ventricle increases, and with decompensation, the left atrium. As a result, the electrocardiogram shows a shift of the electrical axis to the left.

Symptoms

Displacement of the electrical axis of the heart is not an independent diagnosis. This is only a functional parameter that reflects the activity of the organ at a given time and guides the doctor to search for pathology.

The levogram tells the general practitioner or cardiologist that the patient needs to be examined for diseases such as:

Hypertonic disease;
Heart valve defects;
Ischemic or hypertrophic;
Myocardial dystrophy;
Hypertensive or remodeled heart;
Heart failure.

When examining and collecting anamnestic data and complaints, attention is paid to symptoms such as headache, flashing spots before the eyes, pain behind the sternum, shortness of breath, swelling of the lower extremities in the area of the feet and legs. The specialist correlates all received data with each other and makes a diagnostic hypothesis. Further, based on the situation, a number of additional studies are prescribed and medications, if they are necessary.

Diagnosis using ECG

There are several methods for determining the location of the electrical axis of the heart. The most common of them is based on comparing the size of the teeth in standard leads. The R and S waves are assessed. If the first of them has a greater amplitude in lead 1, then they speak of the R-type of this lead. Detection of R-type in 1 standard lead and maximum deep tooth S in lead 3 indicates a shift in the electrical axis of the heart to the left.

Diagnosis of levogram on ECG

The second method is less reliable. It is based on comparing the size of the R waves in the first three leads. If in the first of them the amplitude of the tooth is maximum, and in the third - minimum, they say from the levogram.

More complex ways are based on the calculation of the alpha angle. To do this, functional diagnostic doctors use tabular data. They are setting up required values, calculate the value of the desired angle in degrees. Ultimately, the location of the heart axis is judged depending on the result obtained. The most famous table is the Diede table.

Independent determination of the alpha angle is difficult. It is necessary to have a very good understanding of ECG lead projections and the anatomical structures of the heart. This is what functional diagnostic doctors do.

Establishing diagnosis

After conducting electrocardiography, the functionalist writes his conclusion. It includes data on cardiac activity, indicates the presence or absence focal changes and writes about EOS.

A shift of the heart axis to the left is not a diagnosis. This is a specialist opinion that helps the internist navigate in terms of further diagnostic measures. It does not appear either in the diagnosis or in the International Classification of Diseases (ICD).

Diseases accompanied by levogram

The most common heart disease that leads to a shift of the EOS to the left is hypertension. At constant high blood pressure the hemodynamic load falls on the left parts of the heart: first on the ventricle, and then on the atrium. The myocardium becomes more massive, it hypertrophies.

With prolonged course without adequate control, the heart remodels. The thickness of the wall of the interventricular septum, the left ventricle (especially its back wall). Then the chamber itself becomes more voluminous. Left ventricular hypertrophy occurs. The predominance of the left chambers of the heart will lead to a displacement of the electrical axis of the heart.

Hypertrophic cardiomyopathy is less common than hypertension. With this pathology, myocardial hypertrophy is detected, but it is clearly asymmetrical in nature. The reasons for the displacement of the heart axis are identical to those described above.

Valvular defects in adults are often non-rheumatic. They are based on atherosclerotic changes. Levogram is observed in patients with damage to the aortic and mitral valve. In this case, the hemodynamic load at the initial stages falls on the left chambers of the heart. Only during decompensation is hypertrophy of the right sections possible.

Levogram is found in myocarditis. This is an inflammatory change in the myocardium of the heart walls. Not every disease can be confirmed medical institution. This requires a scintigraphic study.

Additional Research

Additional examination when identifying a levogram is always required, since the electrical axis of the heart and its location is a nonspecific ECG sign that occurs in various heart diseases.

The first thing that can be prescribed in this situation in terms of diagnosis is echocardioscopy. Another name is ultrasound of the heart. The study allows you to assess the condition of the heart chambers and its valve structures. Hemodynamic parameters, including ejection fraction, can be determined. This indicator is very important for determining the presence and its severity.

Using ECHO-CS or ultrasound of the heart, it is easy to determine the presence of valve defects and their degree of compensation. Based on the size of the interventricular septum and the posterior wall of the left ventricle, it is possible to confirm or reject a hypertensive heart, hypertrophic or dilated cardiomyopathy. In case of a heart attack, a history of ischemic cardiomyopathy is established.

If the patient is bothered by headaches or blurred vision, including transient ones, it is necessary to examine him for the presence of hypertension. For this purpose, there is daily blood pressure monitoring in a hospital setting: therapeutic or cardiological. Alternative option– 24-hour Holter monitoring. A cuff is placed on the arm, which measures blood pressure at certain time intervals.

If myocarditis is suspected, myocardial scintigraphy or puncture biopsy is prescribed. With this disease, a displacement of the electrical axis of the heart to the left can also be detected.

Treatment

Therapy is prescribed only if the cause that caused the displacement of the electrical axis is identified. Simply deviation of the EOS to the left is not an indication for starting treatment.

If hypertension or a hypertensive heart is detected, adequate combinations of antihypertensive drugs are prescribed. They can be purchased separately or as part of combination drugs. These same groups of drugs, but in different doses, are used in the treatment of cardiomyopathies. Heart failure is a reason to shift the emphasis towards diuretic therapy, especially with severe fluid stagnation.

How to determine heart rate and electrical axis of the heart:

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Semi-vertical electrical position of the heart in a child. ECG horizontal position EOS

The concept of EOS norm

Correct placement of EOS in children

Measuring indicators using electrocardiography

Why does deviation occur?

Vertical position of the EOS

Horizontal position of the EOS

EOS deviation to the left

Reasons for EOS deviation to the right

What to do if the axis is deviated?

Finally

More:

Features of the conduction system

Parameters in healthy people

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

Norms for children

Symptoms

Diagnosis and treatment

What is sinus rhythm on an ECG

What is sinus rhythm

What criteria are used to decipher the ECG result?

What sinus rhythm problems can be seen on an ECG?

What can we say about normal indicators?

Why ECG readings may deviate from the norm

Why should a person undergo an ECG test?

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

The location of the electrical axis is normal

Reasons for shift to the left

Symptoms

Additional diagnostics

Treatment

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

Normal values ​​and causes of violation

Diagnosis using ECG

Alpha angle offset detection

Visual definition

Establishing diagnosis

Diseases that are accompanied by levogram

Additional Research

Treatment

How is an electrocardiogram taken?

What influences the location of the EOS?

EOS location options

Normal location of the electrical axis of the heart

Pathological location of the electrical axis of the heart

Deviation of the electrical axis of the heart to the left

Deviation of the electrical axis of the heart to the right

Why is changing EOS dangerous?

What to do if the EOS is changed?

Electric axis position range is normal

How to determine the position of the electrical axis

Reasons for deviations from the norm

Symptoms

Diagnostics

Treatment

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

Methods for determining the position of the EOS.

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

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

When can the position of the EOS indicate heart disease?

Normal ECG readings

Mechanism of electrical processes

Electrical processes on the electrocardiogram

EOS tilt characteristics

Electrical position of the heart

Pathologies with deviations

Reasons for deviation to the left

Symptoms

Diagnosis using ECG

Establishing diagnosis

Diseases accompanied by levogram

Additional Research

Treatment

Normal values and causes of violation