Displacement of the heart. Sinus arrhythmia vertical position eos

The configuration of the QRS complex on the ECG depends on many factors, including the spatial position of the resulting vectors of depolarization and repolarization of the ventricles with respect to the axes of the electrocardiographic leads. This makes it necessary to determine the position of the electrical axis of the heart (EOS) in the analysis of the ECG.

EOS should be understood as the resulting vector of ventricular depolarization . An angle is formed between the direction of the vector and the first standard lead, which is called angle α . The magnitude of the angle α can be used to judge the position of the electrical axis of the heart.

In adults over 18 years of age, the following provisions of the EOS are distinguished:

1. Normal position– angle α from -29° to +89°.

2. Deviation to the left– angle α -30° and less:

2.1. - moderate deviation to the left - angle α from-30° to -44°;

2.2. - pronounced deviation to the left - angle α-45° to -90°.

3. Deviation to the right– angle α from +90 and more

3.1. - moderate deviation to the right – angle α from +90° to +120°;

3.2. - pronounced deviation to the right - angle α from +121° to +180°. If it is impossible to isolate the dominant tooth of the complex

QRS in limb leads, the so-called. ekfivazny QRS complex, the position of the EOS should be considered indefinite.

The position of the EOS can be determined by several methods.

Graphic (planimetric) method. It is required to preliminarily calculate on the electrocardiogram the algebraic sum of the teeth of the ventricular complex (Q + R + S) in I and III standard leads (most often in I and III).

To do this, measure in millimeters the size of each tooth of one ventricular QRS complex, taking into account that the Q and S waves have a minus sign, and the R wave has a plus sign. If any tooth on the electrocardiogram is missing, then its value is equal to zero

(0). Positive or negative value algebraic sum QRS teeth in an arbitrarily chosen scale is deposited on the positive or negative arm of the axis of the corresponding assignment of the six-axis Bailey coordinate system. From the ends of these projections, perpendiculars to the axes of the leads are restored, the intersection point of which is connected to the center of the system. This line will be the exact position of the EOS.

Picture. An example of a graphical method for determining EOS

Tabular method. Special tables R.Ya. are used. Written, diagrams according to Dieude and others, using the principle algebraic addition the amplitudes of the teeth described above.

Visual (algorithmic) method. Less accurate, but the simplest for practical use. Based on the principle that the maximum positive or negative meaning the algebraic sum of the teeth of the QRS complex is observed in the lead, which approximately coincides with the position of the electrical axis of the heart.

Thus, in the normal position of the EOS R II ≥R I ≥R III , in leads III and aVL approximately R=S.

With a deviation to the left - R I > R II > R III, S III > R III (With a moderate deviation, as a rule, RII ≤ SII, with a pronounced deviation to the left -

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

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

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

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

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

Thus, the position of the EOS is affected by the constitution of the body, and for each patient the norm of this indicator is relatively individual.

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

Reasons for change

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

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

In addition to the above reasons, temporary deviations of the EOS can cause phenomena that are not directly related to the heart: pregnancy, ascites (accumulation of fluid in abdominal cavity), intra-abdominal tumors.

How to determine on the electrocardiogram

The EOS angle is considered one of the main parameters that is studied at. For a cardiologist, this parameter is an important diagnostic indicator, the abnormal value of which clearly indicates various violations and pathologies.

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

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

In the normal position of the EOS, the greatest amplitude of the R wave will be observed in the II chest lead.

Diagnosis and additional procedures

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

For more accurate diagnosis the following procedures may apply:

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

What diseases are caused

A pronounced deviation of the electrical axis to the right may indicate the following diseases or pathologies:

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

In addition to the above, the EOS tilt to the right may be a consequence of poisoning with tricyclic antidepressants. The somatotropic effect of such drugs is achieved by the influence of the substances contained in them on the conductive system of the heart, and thus they can harm it.

What to do

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

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

To prevent such situations, should at least stick to general recommendations for the prevention of heart disorders: eat right, do not neglect in a healthy way life, and at least once a year to be examined by a cardiologist.

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

Failure of the functioning of any vital systems of the human body entails Negative consequences. As soon as the slightest "malfunction" occurs in the work internal organs, a person begins to complain of a deterioration in well-being, health problems.

Unfortunately, in recent times doctors record an increase in the incidence of various cardiovascular pathologies. The earlier the disease is detected, the easier it will be for doctors to provide medical care. The patient may personally suspect the onset of the development of problems if he does not ignore the symptoms that appear. However, you can only be sure of specific failures if you undergo a diagnostic examination.

If there is any doubt about cardiovascular disease cardiologists refer patients primarily to an electrocardiogram. One of the indicators that the doctor draws close attention, is the electrical axis of the heart.

Definition and Influencing Factors

By carefully studying the position of the electrical axis of the heart on the electrocardiogram, the cardiologist will be able to get a complete picture of the work of the heart muscle.

Since the human heart is a three-dimensional organ, doctors present chest as coordinate plane, thanks to this they manage to calculate the EOS. When conducting an electrocardiogram, several electrodes are placed on the surface of the chest. This is done in order to fix the bioelectrical changes that occur on certain.

Patients are pleased to hear the information that the electrical axis of the heart has correct position. However, not all patients manage to hear such good news. Sometimes doctors claim that the results of the electrocardiogram indicate certain deviations, that the horizontal EOS or its floor is fixed. vertical position.

Everything that a person does not understand provokes fear, incredible anxiety, therefore it is recommended not to withdraw into yourself, not to immerse yourself in stressful situation, but ask the attending physician to explain what the EOS deviation is, what risks follow. Having information about a specific pathology, it is much easier to get away from extremely undesirable consequences, restructure your lifestyle in order to ensure the restoration of successful functioning. of cardio-vascular system.

Normal position of the EOS

Cardiologists and diagnosticians name three main positions that the electrical axis of the heart can occupy.

Due to the fact that the cardiac muscle of the left ventricle in its mass exceeds the mass of the cardiac muscle of the right ventricle, the electrical signals and processes in the left ventricle will also be more intense, therefore, on the electrocardiogram, the axis will deviate more towards the left ventricle. Most often at healthy people, not facing problems of the cardiovascular system, on the cardiogram, the left ventricle will appear in the region from 30 to 70 degrees.

It is these indicators in cardiology practice that are considered to be the normal position of the EOS. However, there are bound to be exceptions to every rule. So in this case, cardiologists pay attention to the fact that thin and tall people can have a vertical (in the range from 70 to 90 degrees) position of the EOS.

Also, in stocky and squat patients, the horizontal (from 0 to 30 degrees) position of the EOS can be determined.

Considering that in real life quite rarely it is possible to meet pure asthenics or hypersthenics, rather, it is more often necessary to observe an intermediate version of a possible physique, cardiologists also record a semi-horizontal and semi-vertical EOS during an electrocardiogram.

Reasons for change

If, after an ECG, the doctor notices a shift in the electrical axis in left side, he necessarily evaluates how much the axis deviated. With insignificant indicators, no one sounds the alarm, since this may be the norm. In particular, during pregnancy, there is often a deviation of the EOS to the left, what it is and what to do, the attending physician must inform in order to eliminate the stress that arises against the background of misunderstanding.

However, not only during pregnancy, a deviation of the electrical axis of the heart to the left can be observed. Such changes may indicate the development of certain diseases:

heart defects;
myocardial infarction;
cardiomyopathy;
cardiosclerosis;
myocardial dystrophy;
myocarditis.

Due to such pathological diseases, the cavity of the left ventricle increases, respectively, provoking a displacement of the EOS.

Deviation can be observed not only to the left side, often diagnosing a shift in the electrical axis in right side.

Deviation of the EOS during an ECG to the right indicates such pathologies:

overload of the right ventricle;
ischemic heart disease with hypertension;
mitral defect;
pulmonary heart;
chronic pulmonary pathology;
emphysema;
dextrocardia.

Cardiologists warn patients that even if, after the ECG, they were informed that the EOS was deviated to the right or left, only the attending physician can declare the pathology, but he will not rely only on the results of the ECG. Thanks to a carefully conducted analysis, the cardiologist will be able to absolutely accurately point out the pathology, as well as list the reasons that provoked such a deviation.

Establishing diagnosis

The EOS offset is not independent disease. This deviation is caused by other pathological processes. For this reason, if it was possible to determine the deviation of the electrical axis on the electrocardiogram, an accurate diagnosis cannot be made from the ECG alone. The patient is advised to undergo an additional diagnostic examination.

Modern clinics have at their disposal the appropriate tools, using which it is possible to specify the exact reasons that provoke the EOS shift. As instrumental diagnostics apply:

bicycle ergometry (the state of the heart muscle is assessed after an additional load, for which patients are offered a treadmill or exercise bike);
(the structure of the organ is visualized, the degree of violations is assessed);
cardiogram;
chest x-ray;
angiography (the condition of the arteries is assessed);
echocardioscopy (assessed condition of the ventricles of the heart).

Determining the misalignment of the electrical axis of the heart and the exact reasons for this misalignment will allow the doctor to develop a treatment plan.

Treatment

Since the shift of the electrical axis of the heart is not independent pathology, doctors develop a treatment plan aimed at eliminating the underlying disease that provoked such a deviation.

In this case, hypertensive drugs that regulate can be prescribed. Also, all patients who are diagnosed with heart disease are advised to follow a strict diet.

Unfortunately, some heart diseases are not treatable. therapeutic treatment, therefore it is necessary to carry out surgical intervention, assuming:

stenting;
installation of a damaged valve prosthesis;
reduction in myocardial thickness;
installation of a pacemaker.

If it is possible to completely eliminate the root cause, the electrical axis also returns to normal, which is confirmed during the next ECG.

So, any changes, symptoms and research results should not be analyzed by the patient himself. Such an analysis should be entrusted to experienced doctors who will understand the circumstances, develop a treatment plan that contributes to full recovery health.

DlyaSerdca → Diagnostics → Positions of the electrical axis of the heart: norm and pathology

The electrical axis of the heart 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.

Impulses travel through the conduction system of the heart. It consists of atypical fibers that are located in certain areas of the body.

This system starts at 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.

Concerning individual characteristics, then they note 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 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.

Concerning pathological deviation 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 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

Rightgram. 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.

Levogram. 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. noted deep prong S (aVL, V6) and 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 the 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 serious illnesses cardiological nature.

The definition of these diseases begins with an ECG, and then methods such as echocardiography, radiography, coronary angiography are prescribed. And also an ECG with a load and daily monitoring according to the Holter can be performed.

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The range of position of the electrical axis is normal

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

In the case of heart disease, the electrical axis of the heart, along with heart rate, is one of the first ECG - criteria that the doctor pays attention to, and when deciphering the ECG the attending physician must determine the direction of the electrical axis.

How to determine the position of the electric axis

Determining the position of the axis of the heart 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 one, then there is a levogram, or a deviation of the axis to the left. If there is more in III than in I, then a rightogram. Normally, the R wave is higher in lead II.

Causes of deviations from the norm

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

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

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

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

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

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

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

Symptoms

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

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

Of the signs of diseases accompanied by a deviation of the axis of the heart to the left or right, headaches, pain in the region of the heart, swelling are characteristic. lower extremities and on the 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 found on the cardiogram, an additional examination should be performed to establish the cause of this condition, especially if it is found in a child.

Diagnostics

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

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

Treatment

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

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

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The location of the electrical axis is normal

In healthy people, the electrical axis of the heart coincides with the anatomical axis this body. 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. Asthenics ( thin people tall and long limbs) the heart (and, accordingly, its axis) 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 on late stages diseases.

Additional diagnostics

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

After detailed examination prescribe appropriate therapy.

Treatment

By itself, the deviation of the electrical axis of the heart to the left does not require specific treatment because it's just 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 caused by a heart attack surgical recovery circulation in the coronary arteries.

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.

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How is an electrocardiogram taken?

The ECG is recorded in a special room, shielded as much as possible from various electrical interferences. The patient is comfortably positioned 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 with 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 if there are abnormalities in the functioning of the organ, and, if necessary, refer the patient for a consultation with a cardiologist.

What affects 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 the impulse 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. Further, the impulse is transmitted to the atrioventricular node, localized in the lower part of the right atrium. The next baton is taken by the bundle of His, which quickly diverges into two legs - left and right. In the ventricle, the branches of the bundle of His immediately pass into the Purkinje fibers, penetrating the entire heart muscle.

The impulse that came to the heart cannot escape the conduction system of the myocardium. it complex structure with fine settings, sensitively reacting to the slightest changes in the body. With any disturbances in the conduction system, the electrical axis of the heart is able to change its position, which will immediately be 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 larger than that of the right one. In this case, 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 precisely 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 of +30 to +70 degrees. Most often, these values are recorded on the ECG. The electrical axis of the heart can also be located in the range from 0 to +90 degrees, and this, according to cardiologists, is also the norm. Why are there such differences?

Normal location of the electrical axis of the heart

There are three main provisions of the EOS. The normal range is from +30 to +70°. This variant 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, densely built patients. In their card, the doctor will mark the EOS angle from 0 to + 30 °. Each of these options is the norm 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 in itself a diagnosis. However, such changes on the electrocardiogram may indicate various disorders in the work of the important body. The following diseases lead to serious changes in the functioning of the conduction system:

Cardiac ischemia;

Chronic heart failure;

Cardiomyopathy 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 registering a deviation of the EOS, the patient needs emergency assistance in intensive care.

Deviation of the electrical axis of the heart to the left

Most often, such changes on the ECG are noted with an increase in the left ventricle. This usually happens with the progression of heart failure, when the organ simply cannot fully perform its function. It is possible that such a state may develop 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 the inevitable violation of the passage of the impulse through the myocardium.

Deviation of the electrical axis of the heart to the left also occurs with narrowing of the aortic orifice. In this case, there is a stenosis of the lumen of the valve located at the outlet of the left ventricle. This condition is accompanied by a violation of the normal blood flow. Part of it lingers in the cavity of the left ventricle, causing it to stretch, and, as a result, compaction of its walls. All this causes a regular change in the 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 some diseases of the respiratory system (for example, with bronchial asthma or chronic obstructive pulmonary disease). Some congenital heart defects can also cause an enlarged right ventricle. First of all, here it is worth noting stenosis of the pulmonary artery. In some situations, tricuspid valve insufficiency can also lead to the occurrence of a similar pathology.

What is the danger of changing the EOS?

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 chronic process and usually does not require emergency assistance cardiologist. The real danger is the change in the electrical axis in connection with the blockade of the bundle of His. In this case, the conduction of the impulse along the myocardium is disrupted, which means that there is a risk sudden stop cardiac activity. This situation requires urgent intervention by a cardiologist and treatment in a specialized hospital.

With the development of this pathology, EOS can be rejected both to the left and to the right, depending on the localization of the process. Myocardial infarction can be the cause of the blockade, infection heart muscle, as well as taking certain drugs. A conventional electrocardiogram allows you to quickly make a diagnosis, and therefore, enable 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 provide normal work organ.

What to do if the EOS is changed?

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

Summing up, several important points should be highlighted:

The normal value of EOS is the interval 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.

EOS deviations to the left or right may indicate various disorders in the conduction system of the heart and require specialist advice.

The change in the EOS, revealed on the cardiogram, cannot be set 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 occurring in it inevitably affect the work of the whole organism. Regular examinations of the therapist and the passage of an ECG will allow timely detection of the appearance of serious diseases and avoid the development of any complications in this area.

Let's see what this conclusion implies, and whether it is worth sounding the alarm if a shift in the cardiac electrical axis is observed on your cardiogram.

1 Cardiac axis and ECG

The human heart has the ability to contract. Electrical impulses sequentially cover the cardiac chambers, originating in the atrial sinus node. If we represent the course of these impulses in the form of directed vectors, then we can see that they have a similar direction. By summing the directions of the vectors, you can get one main vector. This will be the electrical axis of the heart (EOS).

Doctors of functional diagnostics determine the EOS according to the cardiogram, often visually, but it is more accurate to do this using special tables. If you carefully look at the QRS complex in leads I, II, III on the ECG, you can see that R II> RI> R III, which means that the EOS on the cardiogram is normal.

If it is difficult for a doctor to visually determine the axis of the heart, he determines the alpha angle and calculates the EOS using special tables. Without delving into the course of measurements, we note that for a normal EOS, the alpha angle (RII> RIII, then the doctor’s conclusion will be as follows: deviation of the electrical axis of the heart to the left. EOS deviation is confirmed when the alpha angle is in the range from 00 to -900.

2 When does the axis of the heart "walk to the left"?

The conclusions of the doctor of functional diagnostics about the deviation of the cardiac axis to the left are not an independent diagnosis. But they always give reason to wonder why the axis of the heart "went to the left." A slight displacement of the EOS up to -190, as well as its semi-vertical position, in some cases is not considered a pathology. This position of the axis can be observed in healthy, tall, thin people, in athletes with a trained heart, in asthenic children, with a high standing dome of the diaphragm.

If the cardiac axis is significantly deviated to the left side, then this pathological condition indicates problems with the heart, the cause of such a shift must be established. After all this symptom sometimes it can be the first "bell" in the pathology of the heart and blood vessels. According to some reports, the deviation of the electrical axis of the heart to the left up to -29-300 is sometimes called a small deviation, and if the angle is from -450 to -900, they speak of a sharp deviation.

3 Pathological causes of EOS shift to the left

As mentioned above, a slight deviation of the EOS to the left can be considered by doctors as a variant of the norm, if, upon a more thorough examination, the doctor did not reveal any diseases in the patient and the patient is in good health. If the EOS deviates significantly to the left, or with small ECG changes, the patient has health problems, the following should be suspected pathological conditions, in which the displacement to the left of the cardiac axis occurs most often:

4 Left ventricular hypertrophy

The deviation of the cardiac axis to the left with an increase in the left ventricle is quite understandable, because physiologically this chamber of the heart is already the most powerful in terms of mass. And this means that the vector of the heart will “take over” exactly the left ventricle. And the more it will increase in size and grow, the more the EOS will “go to the left”. This pathology occurs at high pressure or arterial hypertension, when the chambers of the heart, unable to withstand high blood pressure and loads, begin to gain weight compensatory - to hypertrophy. Hypertrophy as one of the symptoms occurs in heart failure, atherosclerotic vascular changes, angina pectoris, cardiac asthma, cardiomyopathies.

5 Conduction disorders

Disturbances in the conduction system will lead to a change in the cardiac vector and a deviation of the cardiac axis. Most often this is observed with the blockade of the left leg of the Bundle of His, or with the blockade of its anterior-superior branching. There are other ECG signs, thanks to which this type of arrhythmia can be diagnosed. Holter monitoring of the ECG will also help in establishing the diagnosis.

6 Special forms of ventricular tachycardia

Some forms ventricular tachycardia can also be the reason that the EOS values are far from the norm.

7 Heart defects

Heart defects, the ECG symptom of which can be a left-sided axis of the heart, by their nature can be both congenital and acquired. Defects of any etiology, accompanied by an overload of the left heart sections, will be characterized by this ECG symptomatology.

Based on the above reasons for the deviation of the EOS, we can conclude that the displacement to the left of the cardiac axis is not such a harmless ECG sign. It may indicate the presence in the patient's body enough serious problems. But at the same time, don't panic! If the patient feels well, stable ECG for several years, in the absence of supporting data on pathological change heart and blood vessels after a thorough examination, a slight deviation of the cardiac axis to the left may be a variant of the norm! But the conclusion that this is the norm can be made by a doctor after a thorough examination of the patient, and in the absence of data on the pathology of the cardiovascular system. What examinations should be prescribed by a doctor who diagnosed a patient with a displacement to the left of the axis of the heart?

8 A set of examinations to clarify the diagnosis

It should be understood that the deviation of the EOS to the left is not a diagnosis, but an ECG sign, which can be both a variant of the norm and a symptom of numerous diseases. The conclusion about what information this symptom carries can only be made by a doctor, after the complex diagnostic procedures.

9 Should an axle bent to the left be treated?

As the only isolated ECG sign, no. If this symptom is one of the others in the presence of a disease in the human body, the disease, of course, needs to be treated. The tactics of treatment depends directly on the disease that caused changes in the direction of the cardiac axis. With hypertension, which led to an increase in the left ventricle, an adequate selection of antihypertensive drugs is necessary. With arrhythmias - antiarrhythmic medicines, or, if there are indications, implantation of an artificial pacemaker. With diagnosed heart defects - surgical treatment according to indications.