What if there is a deviation of the EOS to the left? Determining the position of the electrical axis of the heart - why is it needed.

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 of the human body.

The position of the electrical axis of the heart shows the specialist what exactly is happening at 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 various areas 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 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 pass into those that penetrate the entire heart muscle.

An impulse entering the heart cannot escape the myocardial conduction system. This is a 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 the impulses passing through 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 disorders in the functioning 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 for inpatient 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. The development of such a condition cannot be ruled out in arterial hypertension, accompanied by pathology of large vessels and increased blood pressure. In all these conditions, the left ventricle is forced to work for wear and tear. 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 Similar changes develop in some diseases of the respiratory system (for example, bronchial asthma or Some congenital ones can also cause an 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 the occurrence of such a 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 talk about 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 illnesses and avoid the development of any complications in this area.

Electrical axis of the heart - those words that appear first when deciphering an electrocardiogram. When they write that her position is normal, the patient is satisfied and happy. However, in conclusions they often write about the horizontal, vertical axis, and its deviations. In order not to experience unnecessary anxiety, it is worth having an understanding of EOS: what it is, and what the dangers are if its position is different from the normal one.

General idea of ​​EOS - what is it

It is known that the heart, during its tireless work, generates electrical impulses. They originate in a certain zone - in the sinus node, then normally the electrical excitation passes to the atria and ventricles, spreading along the conductive nerve bundle, called the bundle of His, based on its branches and fibers. In total, this is expressed as an electric vector, which has a direction. EOS is the projection of this vector onto the anterior vertical plane.

Doctors calculate the position of the EOS by plotting the amplitudes of the ECG waves on the axis of the Einthoven triangle formed by standard ECG leads from the limbs:

• the amplitude of the R wave minus the amplitude of the S wave of the first lead is plotted on the L1 axis;
• a similar magnitude of the amplitude of the teeth of the third lead is deposited on the L3 axis;
• from these points, perpendiculars are set towards each other until they intersect;
• the line from the center of the triangle to the intersection point is the graphic expression of the EOS.

Its position is calculated by dividing the circle describing the Einthoven triangle into degrees. Typically, the direction of the EOS roughly reflects the location of the heart in the chest.

The normal position of the EOS - what is it?

Determine the position of the EOS

• speed and quality of passage of the electrical signal through the structural divisions of the conduction system of the heart,
• the ability of the myocardium to contract,
• changes internal organs, which can affect the functioning of the heart, and in particular the conduction system.

For a person who does not have serious problems With health, the electrical axis can occupy a normal, intermediate, vertical or horizontal position.

It is considered normal when the EOS is located in the range from 0 to +90 degrees, depending on constitutional features. Most often, normal EOS is located between +30 and +70 degrees. Anatomically, it is directed down and to the left.

The intermediate position is between +15 and +60 degrees.

On the ECG, positive waves are higher in the second, aVL, aVF leads.

• R2>R1>R3 (R2=R1+R3),
• R3>S3,
• R aVL=S aVL.

Vertical position of the EOS

When verticalized, the electrical axis is located between +70 and +90 degrees.

It occurs in people with a narrow chest, tall and thin. Anatomically, the heart literally “hangs” in their chest.

On the ECG, the highest positive waves are recorded in aVF. Deep negative – in aVL.

• R2=R3>R1;
• R1=S1;
• R aVF>R2,3.

Horizontal position of the EOS

Horizontal position EOS – between +15 and -30 degrees.

It is typical for healthy people with a hypersthenic physique - wide chest, short stature, increased weight. The heart of such people “lies” on the diaphragm.

On the ECG, the highest positive waves are recorded in aVL, and the deepest negative ones in aVF.

• R1>R2>R3;
• R aVF=S aVF
• R2>S2;
• S3=R3.

Deviation of the electrical axis of the heart to the left - what does it mean?

The deviation of the EOS to the left is its location in the range from 0 to -90 degrees. Up to – 30 degrees can still be considered a variant of the norm, but a more significant deviation indicates a serious pathology or significant change location of the heart. for example, during pregnancy. Also observed with maximally deep exhalation.

Pathological conditions accompanied by deviation of the EOS to the left:

• hypertrophy of the left ventricle of the heart is a companion and consequence of prolonged arterial hypertension;
• violation, blockade of conduction along the left leg and fibers of the His bundle;
• left ventricular myocardial infarction;
• heart defects and their consequences that change the conduction system of the heart;
• cardiomyopathy, which impairs the contractility of the heart muscle;
• myocarditis - inflammation also impairs the contractility of muscle structures and the conduction of nerve fibers;
• cardiosclerosis;
• myocardial dystrophy;
• calcium deposits in the heart muscle, preventing it from contracting normally and disrupting innervation.

These and similar diseases and conditions lead to enlargement of the left ventricular cavity or mass. As a result, the excitation vector takes longer on the left side and the axis deviates to the left.

The ECG in the second and third leads is characterized by deep S waves.

• R1>R2>R2;
• R2>S2;
• S3>R3;
• S aVF>R aVF.

Deviation of the electrical axis of the heart to the right - what does it mean?

Eos is deviated to the right if it is in the range from +90 to +180 degrees.

Possible reasons for this phenomenon:

• violation of the conduction of electrical excitation along the fibers of the His bundle, its right branch;
• myocardial infarction in the right ventricle;
• overload of the right ventricle due to narrowing of the pulmonary artery;
• chronic pulmonary pathology, the consequence of which is “ cor pulmonale", characterized by intense work of the right ventricle;
• the combination of coronary artery disease with hypertension - depletes the heart muscle, leading to heart failure;
• PE - blocking of blood flow in the branches of the pulmonary artery, of thrombotic origin, as a result the blood supply to the lungs is depleted, their vessels spasm, which leads to a load on the right side of the heart;
• mitral heart disease, valve stenosis, causing congestion in the lungs, which causes pulmonary hypertension and increased work of the right ventricle;
• dextrocardia;
• emphysema – moves the diaphragm down.

On the ECG, a deep S wave is noted in the first lead, while in the second and third it is small or absent.

• R3>R2>R1,
• S1>R1.

It should be understood that a change in the position of the heart axis is not a diagnosis, but only signs of conditions and diseases, and only an experienced specialist should understand the reasons.

Let's understand in simple, accessible words what is the electrical axis of the heart? If we imagine the propagation of electrical impulses from the sinus node to the underlying parts of the conduction system of the heart in the form of vectors, it becomes obvious that these vectors spread to different parts of the heart, first from the atria to the apex, then the excitation vector is directed slightly upward along the side walls of the ventricles. If the direction of the vectors is added or summed, you get one main vector that has a very specific direction. This vector is the EOS.

1 Theoretical basis of definition

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

Let's consider another concept necessary to determine the position of the EOS - the alpha angle (

2 Practical basis for definition

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

1. With a normal axis, the R wave in the second lead is larger than the R wave in the first lead, and the R wave in the first lead is larger than the R wave in the third: R II>RI>RIII;
2. The deviation of the EOS to the left on the cardiogram looks like this: the largest R wave is in the first lead, a little smaller in the second, and the smallest in the third: R I>RII>RIII;
3. A rotation of the EOS to the right or a shift of the heart axis to the right on the cardiogram appears as the largest R in the third lead, somewhat smaller in the second, the smallest in the first: R III>RII>RI.

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

1. We find QRS complexes in leads I and III;
2. We sum up the height of the teeth in the first lead;
3. Let's sum up the height in the third lead;

   Important point! It should be remembered when summing that if the tooth is directed downward from the isoline, its height in mm will be with a “-” sign, if upward – with a “+” sign

4. We substitute the found two sums into a special table, find the place where the data intersects, which corresponds to a certain radius with degrees of the alpha angle. Knowing the norms of the alpha angle, it is easy to determine the position of the EOS.

3 Why do I use a pencil to diagnose or when I don’t need to look for the alpha angle?

There is another method, the simplest and most beloved by students, of determining the position of the EOS using a pencil. It is not effective in all cases, but sometimes it simplifies the determination of the cardiac axis, makes it possible to determine whether it is normal or whether there is a displacement. So, with the non-writing part, we apply the pencil to the corner of the cardiogram near the first lead, then in leads I, II, III we find the highest R.

We direct the opposite pointed part of the pencil to the R wave in the lead where it is maximum. If the non-writing part of the pencil is in the upper right corner, but the pointed tip of the writing part is in the lower left, then this position indicates the normal position of the heart axis. If the pencil is located almost horizontally, we can assume a shift of the axis to the left or its horizontal position, and if the pencil takes a position closer to vertical, then the EOS is deviated to the right.

4 Why determine this parameter?

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

1. Blockade of the anterosuperior branch of the left bundle branch;
2. Right ventricular hypertrophy. A characteristic feature its increase is the deviation of the axis to the right. But if left ventricular hypertrophy is suspected, a displacement of the heart axis is not at all necessary and the determination of this parameter does not help much in its diagnosis;
3. Ventricular tachycardia. Some of its forms are characterized by deviation of the EOS to the left or its uncertain position; in some cases, a turn to the right occurs;
4. Block of the posterosuperior branch of the left bundle branch.

5 What is the normal EOS?

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

6 Normal in children

In newborns and infants, there is a pronounced deviation of the EOS to the right on the electrocardiogram; by the age of one year, in most children, the EOS moves to a vertical position. This is explained physiologically: the right parts of the heart are somewhat more dominant than the left ones both in mass and in electrical activity, and changes in the position of the heart can also be observed - rotations around its axes. By the age of two, many children still have vertical axis, but in 30% it becomes normal.

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

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

7 Reasons for EOS deviation to the left

A deviation of the EOS at an angle from -15 to -30 is sometimes called a slight deviation to the left, and if the angle is from -45 to -90, they speak of a significant deviation to the left. What are the main reasons this state? Let's take a closer look at them.

1. Variant of the norm;
2. GSV of the left bundle branch;
3. Left bundle branch block;
4. Positional changes associated with the horizontal position of the heart;
5. Some forms of ventricular tachycardia;
6. Malformations of endocardial cushions.

8 Reasons for EOS deviation to the right

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

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

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

1. Variant of the norm;
2. Blockade of the posterosuperior branching;
3. Pulmonary embolism;
4. Dextrocardia (right-sided location of the heart);
5. Variant of the norm at positional changes associated with the vertical position of the heart due to emphysema, COPD, and other pulmonary pathologies.

It should be noted that the doctor may be alerted by a sharp change in the electrical axis. For example, if the patient has a normal or semi-vertical position of the EOS on previous cardiograms, and when taking an ECG on this moment— pronounced horizontal direction of the EOS. Such sudden changes may indicate any disturbances in the functioning of the heart and require immediate attention. additional diagnostics and further examinations.

The medical concept of “electrical axis of the heart” is used by cardiologists to reflect the electrical processes occurring in this organ. The location of the electrical axis must be calculated to determine the total component of the bioelectrical changes that occur in the muscle tissue of the heart during its contractile activity. Main body 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 one.

The conduction system is a powerful source of electrical signals that cause the main part of the body to work 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 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 characteristics body, its anatomical characteristics. This shows that the slope of the EOS in healthy people can vary between 0-90 degrees. Based on such data, doctors have identified several areas of this indicator that are considered normal and do not interfere with the functioning of the organ.

What positions of the electrical axis exist:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Symptoms

Changing the direction of the electrical axis cannot cause discomfort 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.

Symptoms:

• pain in the head and chest area;
• breathing problems, shortness of breath, suffocation;
• swelling of the lower tissues, upper limbs and facial areas;
• 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.

Diagnostic methods:

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

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

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

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

In order to determine functional abilities hearts must be held special methods examinations. 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 vitality. important 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. By looking at the cardiogram readings of a particular patient, a medical specialist can decipher the presence of problems of the following nature:

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

Sinus bradycardia is a common abnormality, especially if we're talking about about the child's health. This diagnosis can be explained by many factors, among which may be physiological defects or simply a factor of chronic fatigue.

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

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

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

What can we say about normal indicators?

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

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

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

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

Why ECG readings may deviate from the norm

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

• the person regularly drinks alcoholic beverages;
• the patient 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, accelerated heartbeat or too slow may indicate problems of a more serious nature. If the results of the cardiogram do not correspond to the norm, this may indicate acute heart failure, valve displacement, congenital defects hearts.

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 exact reason all deviations and will be able to offer the patient competent treatment.

Why should a person undergo an ECG test?

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

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

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

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

If the sinus rhythm is within normal limits, then take additional tests and you won’t have to undergo repeated tests. Normal operation heart problems, as well as pathological abnormalities, are always recorded by a cardiogram.

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

What treatment may be required.

The electrical axis of the heart is diagnostic criterion, which displays the electrical activity of the organ.

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

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

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

To resolve this problem, consult a cardiologist.

The location of the electrical axis is normal

In healthy people, the electrical axis of the heart coincides with the anatomical axis of this body. 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 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:

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

After a detailed examination, appropriate therapy is prescribed.

Treatment

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

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

Treatment for LVH depends on what caused the myocardial growth

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

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

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

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

Electrocardiography as a method for determining EOS

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

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

Electrodes are applied in the following sequence:

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

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

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

• myocardial contraction frequency
• systematic heartbeat
• physical condition of the heart
• heart muscle damage
• disturbance of electrolyte metabolism
• cardiac conduction disturbance, etc.

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

Electrical axis of the heart: definition and influencing factors

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

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

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

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

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

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

Direction of EOS in a healthy person

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

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

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

Shift the electrical axis to the left

The electrical axis is strongly deflected to the left if its value is in the range from 0⁰ to -90⁰. This deviation can be caused by the following violations:

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

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

Shift of the electrical axis to the right side

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

• violation of impulse transmission along the right branch of His fibers (responsible for the transmission of excitation in the right ventricle)
• a narrowing of the pulmonary artery (stenosis) that prevents blood from flowing out of the right ventricle, so the pressure inside it increases
• ischemic disease in combination with persistent arterial hypertension (coronary disease is based on a lack of myocardial nutrition)
• myocardial infarction (death of myocardial cells of the right ventricle)
• diseases of the bronchi and lungs that form the “pulmonary heart”. In this case, the left ventricle does not function fully, and congestion occurs in the right ventricle
• pulmonary embolism, i.e. blockage of a vessel by a thrombus, resulting in impaired gas exchange in the lungs, narrowing of the vessels of the small blood circulation and congestion of the right ventricle
• Mitral valve stenosis (most often occurs after rheumatism) - fusion of the valve leaflets, preventing the movement of blood from the left atrium, which leads to pulmonary hypertension and increased load on the right ventricle

The main consequence of all causes is increased load on the right ventricle. As a result, the wall of the right ventricle increases and the electrical vector of the heart deviates to the right.

Danger of changing the position of the EOS

Studying the direction of the electrical line of the heart is an additional diagnostic method, so making a diagnosis based only on the location of the EOS is incorrect. If a patient is found to have an EOS displacement outside the normal range, a comprehensive examination is carried out and the cause is identified, only then treatment is prescribed.

If, for a long time, the electrical axis was directed in one direction, and when taking an ECG, a sharp deviation in the other is revealed, most likely a blockage of a part of the conduction system of the heart has occurred. This pathology requires urgent provision medical care.

What to do if the EOS is severely deviated?

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

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

It should be remembered that best treatment- This is a disease prevention. Proper nutrition, gymnastics, refusal bad habits, good sleep is the key to long-term heart function and a long life.

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

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

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

When taking an ECG, each electrode records bioelectrical excitation occurring in a certain area of ​​the myocardium. 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.

Conducting system of the heart and why is it important for determining EOS?

The conduction system of the heart consists of sections of the heart muscle consisting of so-called atypical muscle fibers. These fibers are well innervated and provide synchronous contraction of the organ.

Myocardial contraction begins with the appearance of an electrical impulse in the sinus node (which is why the correct rhythm healthy heart called sinus). From the sinus node, the electrical impulse travels to the atrioventricular node and further along the His bundle. This bundle passes through the interventricular septum, where it divides into the right, heading towards the right ventricle, and the left legs. The left bundle branch is divided into two branches, anterior and posterior. The anterior branch is located in the anterior sections of the interventricular septum, in the anterolateral wall of the left ventricle. The posterior branch of the left bundle branch is located in the middle and lower third of the interventricular septum, the posterolateral and inferior wall of the left ventricle. We can say that the posterior branch is located slightly to the left of the anterior one.

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. If there are disturbances in this system, the electrical axis of the heart can significantly change its position, as will be discussed below.

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

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

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

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

All five position options (normal, horizontal, semi-horizontal, vertical and semi-vertical) occur in healthy people and are not pathological.

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

Rotations of the heart around the longitudinal axis help determine the position of the organ in space and, in some cases, are an additional parameter in diagnosing diseases.

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.

When can the position of the EOS indicate heart disease?

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

1. Cardiac ischemia.
2. Cardiomyopathies of various origins(especially dilated cardiomyopathy).
3. Chronic heart failure.
4. Congenital anomalies of the heart structure.

EOS deviations to the left

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

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

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

These defects can be either congenital or acquired. The most common acquired heart defects are a consequence of previous rheumatic fever. Left ventricular hypertrophy is found in professional athletes. In this case, a consultation with a highly qualified sports doctor is necessary to decide on the possibility of continuing to play sports.

Also, the EOS can be deviated to the left in cases of intraventricular conduction disorders and various heart blocks. Deviation el. the axis of the heart to the left, together with a number of other ECG signs, is one of the indicators of blockade of the anterior branch of the left bundle branch.

EOS deviations to the right

A shift in the electrical axis of the heart to the right may indicate right ventricular hypertrophy (RVH). Blood from the right ventricle enters the lungs, where it is enriched with oxygen. Chronic diseases respiratory organs, accompanied pulmonary hypertension, such as bronchial asthma, chronic obstructive pulmonary disease with long term cause hypertrophy. Pulmonary stenosis and tricuspid valve insufficiency lead to right ventricular hypertrophy. As in the case of the left ventricle, RVH is caused by coronary heart disease, chronic heart failure and cardiomyopathies. Deviation of the EOS to the right occurs with complete blockade of the posterior branch of the left bundle branch.

What to do if EOS displacement is found on the cardiogram?

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

And yet, the main reason for the displacement of the EOS is myocardial hypertrophy. The diagnosis of hypertrophy of a particular part of the heart can be made based on ultrasound results. Any disease leading to a displacement of the heart axis is accompanied by a number of clinical signs and demands additional examination. 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.

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

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

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

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

Normal values ​​and causes of violation

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

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

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

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

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

Diagnosis using ECG

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

Alpha angle offset detection

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

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

Visual definition

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

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

Establishing diagnosis

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

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

Diseases that are accompanied by levogram

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

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

Additional Research

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

• Bicycle ergometry (electrocardiogram while walking on a treadmill or on an exercise bike). Test to detect ischemia of the heart muscle.
• Ultrasound. 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 adherence to diet and a healthy lifestyle 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 department intensive care. 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.

What is the electrical axis of the heart?

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

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

Parameters in healthy people

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

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

What positions of the electrical axis exist:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Norms for children

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

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

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

Symptoms

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

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

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

Diagnosis and treatment

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

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

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

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

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

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