The electrical axis of the heart is vertical in children. What is the electrical axis of the heart? Unstable sinus rhythm upright eos

Date: 04.03.2020

The work of the heart depends on the frequency of electrical signals coming from the cells of the nervous system.

Violation of the supply of nerve impulses leads to problems with the cardiovascular system.

To check the functioning of the heart, doctors send the patient to an ecg.

According to the total vector of electrical signals for one reduction period, the specialist determines the presence or absence of problems.

A healthy heart is characterized by a diagonal arrangement of the vector directed downward and to the left.

In the presence of problems, the vector deviates, but the deviation of the line itself is not considered a diagnosis, since the parameters of the axis are individual for each person.

In overly thin people and adolescents during the growth leap period, the deviation vector can be ninety degrees. For small and very fat people - up to thirty degrees.

The following parameters affect the abnormal position of the vector:

These diseases cause the deviation of the electrical axis to the right side.

Temporary violations in the position of the axis can cause the following phenomena:

oncology of the abdominal organs;
accumulation of fluid in the abdomen;
pregnancy.

Decoding cardiogram

The location of the electrical axis on the electrocardiogram is the main criterion for examining the heart.

Deciphering the data is necessary to diagnose the risk of heart problems in adults and children.

The tilt of the axis shows an R wave in the third thoracic or first lead.

Its increased amplitude indicates a left-sided or right-sided position, which in itself is not an anomaly, but only a manifestation of a disorder of the cardiovascular system.

Deviation of the vector to the left or to the right shows ventricular hypertrophy; to make an accurate diagnosis, the patient is sent for tests and instrumental examination:

x-ray;
coronary angiography.

Additionally, the patient's condition is examined on an ECG under stress. The procedure is necessary if the vector deviation is complemented by arrhythmia or ischemia.

Coronary angiography is used to determine the condition of the coronary arteries. Axis deviation can also be caused by the following reasons:

ischemia;
blockage of arteries;
pulmonary artery stenosis;
atrial fibrillation;
dmp in newborns;
pulmonary heart;
narrowing of the mitral valve;
blockage of a pulmonary artery;
pulmonary hypertension.

If left untreated, the blockage leads to a heart attack a year or two after the blockage.

In addition, the misalignment of the vector is caused by an overdose of antidepressants.

What does eos mean in a child to the right? This position of the axis indicates a possible congenital stenosis of the artery of the lung.

The abnormality interferes with normal blood flow and leads to a change in the state of the myocardium in the child.

The defect is corrected even in newborns in order to prevent the development of severe complications leading to death in infants.

But do not make a diagnosis and panic on your own: in babies in the first three months of life, the deviation of the axis is caused by natural reasons:

electrophysical and anatomical preferential position of the right ventricle;
change in the position of the heart in the chest;
change in the ratio of the activity of the left and right ventricles.

These manifestations go away as the child grows and are not a symptom of problems.

What to do if the electric axis is tilted to the right

A sudden deviation of the axis can indicate problems with the right ventricle. The cardiologist prescribes additional diagnostic procedures and then treatment.

An incorrect position of the eos may indicate the development of right ventricular hypertrophy, which will require identification of the underlying problem and treatment, axis deviation itself is not treated, it is not a disease.

Diseases causing the right-sided axis position:

congenital heart defects;
acquired heart disease;
chronic obstruction of the lungs;
bronchial asthma.

Symptoms accompanying diseases causing eos deviations:

If symptoms appear, you should consult a cardiologist for diagnosis and treatment.

The doctor prescribes drug therapy to relieve symptoms and restore hemodynamics, in severe cases, the patient is sent for surgery.

Conservative therapy can be supplemented with folk remedies, decoctions and herbal infusions.

Folk remedies for the treatment of right ventricular hypertrophy

St. John's wort is considered an effective remedy for traditional healers. To prepare the infusion, you need to take one hundred grams of dry raw materials for two liters of water and hold it on low heat for ten minutes.

Insist for at least an hour, then strain, add a few tablespoons of honey and drink like tea half an hour before meals. The infusion should be kept refrigerated.

A mixture of garlic and honey helps to restore hemodynamics. Add chopped garlic in equal parts to honey and leave in a dark place for one week. Take a dessert spoon before meals three times a day.

Proper nutrition, rejection of confectionery sweets, animal fats, overly salty foods, fast foods and canned food helps to cope with the disease. A complete rejection of cigarettes and alcohol is required.

With a routine examination, a person after 40 years of age must make a cardiogram in order to identify pathologies of the heart. The location of the teeth allows you to determine the state of the organ during excitation.

A deviation of the electrical axis of the heart to the left indicates some diseases and requires a more accurate diagnosis.

General information about pathology

Registration of the electrical activity of the "motor" of the body is made on the ECG. To imagine what the axis of the heart is, it is necessary to construct a coordinate scale and mark the directions in increments of 300. The semi-vertical position of the organ in the chest, when superimposed on the coordinate system, sets the electrical axis.

The vectors make up the angle, so the EOS direction is measured in degrees from -180 to +1800. In a normal location, it should be within the range of +30 - +69.

If, under the influence of any factors, there is a change in the position of the organ and the signal transmission vector, then one speaks of its change in the coordinate system.

Normally, the heart has a sinus rhythm, the electrical impulse starts from the atrium and then goes to the ventricles. On the electrocardiogram, it is possible to determine the normal position of the organ if the P wave is determined, which speaks of atrial contraction, the QRS complex, the contraction of the ventricles and T, and their repolarization.

The location of the terminals when taking the ECG is the direction of the electrical impulse of the heart. When removing leads, 3 main and 3 auxiliary lines are determined, as well as chest indicators.

We can talk about the normal value of the axis if the R wave has the greatest value in the 2nd main lead, and the R1 value> R3.

If there is a shift of the electrical axis to the left, what does this mean? There are factors due to which there is a preponderance of the organ to the left. A levogram is observed if the axis position is between 0 and -900.

Reasons for rejection

EOS is rejected to the left, not only in cardiac pathologies. The reasons for the deviation are left ventricular hypertrophy, provoked by the following disorders:

heart failure;
hypertension with congestive manifestations;
heart disease;
left bundle branch block;
atrial fibrillation.

During the cardiac cycle, during the first contraction, blood is pushed into the atrium, the valve closes, then it is transmitted to the ventricle, and by the next contraction, all the blood must go into the vessels.

In case of violation of the pumping function, when the organ is not able to contract with such force as to push out all the liquid, part of it constantly remains inside the cavity. It is gradually stretched.

This phenomenon is triggered by cardiomyopathy due to ischemic heart disease due to heart attack, myocarditis.

The second reason for residual fluid accumulation: the valve does not close completely, or there is stenosis, narrowing of the vessel lumen. Then part of the blood comes back or cannot go out into the aorta in one cycle.

Heart disease can be congenital or acquired. In the first case, it is found during examination of a newborn child, in the second in an adult.

If the conduction of the left bundle branch is disturbed, the functioning of the left ventricle is disrupted, which is why it does not contract as it should. In this case, the sinus rhythm is maintained, but the axis deviates.

With arterial hypertension, blood pressure on the vessels increases, which affects their condition. The more often blood pressure rises, the greater the likelihood of a decrease in the elasticity of blood vessels and expansion of the ventricle, which has a large load.

With atrial fibrillation, in addition to changes in the electrical axis of the heart, there is no atrial contraction, and ventricular complexes are formed at different intervals.

Symptoms and manifestations

The deviation itself is not manifested by symptoms, but since the violation is caused by certain reasons, the symptoms appear with a significant spread of the process.

There is a violation of hemodynamics, there are accompanying symptoms.

If the patient has heart failure or heart disease, then this is manifested by the appearance of shortness of breath when walking or climbing stairs, blue discoloration of the limbs and nasolabial triangle, shortness of breath and dizziness.

Atrial fibrillation is manifested by seizures, during which there is not enough breath, a feeling of palpitations, pain behind the breastbone, interruptions in the pulse.

Arterial hypertension is manifested by a headache, mainly in the back of the head, heaviness in the chest, at high values - by the flickering of flies in front of the eyes.

Diagnostics

Bringing together the symptoms of the disorder, functional diagnostics, and other methods help to establish a violation:

Holter monitoring;
x-ray;
coronary angiography.

Thanks to these studies, it is possible to visually assess the organ, its sections, determine the size of the enlarged cavity, and establish the cause of the insufficiency.

With the help of electrocardiography with a load in the form of a cycle track or an exercise bike, it is possible to determine at what point myocardial ischemia occurs.

The doctor prescribes a daily examination if he suspects that the patient has a rhythm disturbance. To "catch" periods of arrhythmia, a person is hung up for a day with an apparatus that registers the contraction of the heart.

Angiocoronary angiography is a study of blood vessels, allowing you to see their condition and circulatory disorders. The picture allows you to determine the expansion of the organ shadow, which indicates hypertrophy.

When additional examination is required

The standard EOS values are approximately the same for everyone, but in a tall person, the size of the heart and its position may be slightly different, although he will not be sick. Therefore, during the initial examination, if a violation is established, additional research methods are required.

Normal parameter changes also occur in athletes.

Because they can withstand significant loads during constant exercise, their heart pumps large volumes of fluid, so the cavities stretch. They may have a horizontal type of deviation when the organ takes a position from -15 to +30.

If a person during the study took a deep breath or changed the position of the body, then even with the norm, the deviation of a healthy heart to the left will be determined.

ECG manifestations

During the examination, it is possible to determine the presence of a deviation to the left by the electrocardiogram. In the diagram, the R wave is the largest in 1 main lead.

An additional feature is the location of the QRS complex below the isoline in the 3rd column, that is, S prevails. If we pay attention to the leads from the arms and legs, then in the AVF the ventricular complex will be the same as III.

What does abrupt deviation mean?

Since the angle of deviation from the norm can be different, then the degrees of the process differ. The change in degree is a gradual process. The more the size of the cavity grows, the more the indicator deviates from the norm. If the deviation is from -450 to -900 degrees relative to the norm, then they say that the organ is sharply displaced to the left.

In adults

A displacement of the axis of the location of the heart in the chest can indicate a violation of the ECG, if the person is feeling well and other health disorders have not been identified.

Normally, it is observed in people who regularly exercise and in athletes.

The pronounced deviation is not accidental, it is a sign of pathology in adults. Congestion may occur and accumulate over several years.

In children

In a child during the neonatal period, a sharp deviation of the axis to the right is observed, this is the norm. If an adult has such a violation, then he has signs of right ventricular hypertrophy.

In a child, this is due to the fact that the right parts of the heart have a large mass, prevailing over the left. By the age of one year, the condition is normalized, and the organ should take an upright position in the chest. During this period, it can rotate around the axis in different directions.

Then the left ventricle gains mass, ceases to adhere to the chest. By the age of 6-7 years, the organ acquires a correct, semi-vertical position.

Do I need treatment

The axis of the heart is a criterion by which a health disorder can be determined, therefore, in case of a deviation, therapy is aimed at combating the cause established during the diagnosis. If you eliminate it, then it will be possible to restore the normal functioning of the heart.

These can be the following procedures:

installation of an artificial valve;
implantation of a pacemaker;
shunting;
the appointment of antihypertensive and antiarrhythmic drugs.

The complex of measures depends on the degree of health impairment..

If the arrhythmia is of a periodic nature and can be eliminated with the help of drugs, then a suitable remedy is selected. When a threat to life appears, the question of installing a pacemaker is decided.

Coronary artery bypass grafting - cleaning of blood vessels from plaque, lipid plaque, which expands their lumen and eliminates ischemia.

In the case of congenital and acquired heart disease or CHF, it helps to establish a normal cardiac cycle. If the pumping function of the heart has suffered, then a weak contractility of the myocardium will still be observed.

Potential consequences and complications

It is not the deviation of the position of the heart that is dangerous, but the reasons why it occurs. Complications of left ventricular hypertrophy:

heart failure;
angina pectoris;
heart failure.

All causes of organ malfunction are interconnected. If a heart defect has led to the expansion of the left ventricle, then with the development of the pathological process, a rhythm disturbance should be expected. If the myocardium becomes so weak that the contraction of the fibers does not lead to the release of blood further, then circulatory failure and cardiac arrest occur.

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

Unfortunately, in recent years, doctors have recorded 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 assistance. The patient may personally suspect the beginning 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 a suspicion of cardiovascular disease, cardiologists refer patients primarily to an electrocardiogram. One of the indicators that a doctor pays close attention to 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 represent the chest in the form of a coordinate plane, thanks to which they are able 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 bioelectric changes that occur on certain ones.

Patients are pleased to hear the information that the electrical axis of the heart is in the correct position. However, not all patients are able to hear such good news. Sometimes doctors declare that the results of the electrocardiogram indicate certain deviations, that a horizontal EOS or its semi-vertical position is recorded.

Everything that a person does not understand provokes fear, incredible anxiety, therefore it is recommended not to withdraw into oneself, not to plunge into a stressful situation, but to 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 avoid extremely undesirable consequences, to rebuild your lifestyle in order to ensure the restoration of the successful functioning of the cardiovascular system.

EOS normal position

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

Due to the fact that the heart muscle of the left ventricle in its mass exceeds the mass of the heart muscle of the right ventricle, electrical signals, 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, in healthy people who do not face 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 cardiological practice that are considered to be the normal position of the EOS. However, there are always 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 it is quite rare to find pure asthenics or hypersthenics, rather, it is more often necessary to observe an intermediate variant of a possible physique, cardiologists also record a semi-horizontal and semi-vertical EOS during an electrocardiogram.

Reasons for change

If, after conducting an ECG, the doctor notices a shift in the electrical axis to the left, he will necessarily assess how much the axis has deviated. With insignificant indicators, no one beats 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 can there be a deviation of the electrical axis of the heart to the left. Such changes may indicate the development of certain diseases:

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

As a result of 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, often diagnosed with a shift of the electrical axis to the right.

The deviation of the EOS during the ECG to the right signals the following pathologies:

overload of the right ventricle;
Ischemic heart disease with hypertension;
mitral valve disease;
pulmonary heart;
chronic pulmonary pathology;
emphysema of the lungs;
dextrocardia.

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

Establishing diagnosis

EOS displacement is not an independent disease. Such a deviation is provoked 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 recommended to undergo an additional diagnostic examination.

Modern clinics have at their disposal the appropriate tools, using which it is possible to concretize the exact reasons provoking a shift in the EOS. The following are used as instrumental diagnostics:

veloergometry (the state of the heart muscle is assessed after additional stress, as 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 (the condition of the ventricles of the heart is assessed).

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

Treatment

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

In this case, hypertensive regulating drugs may be prescribed. Also, all patients diagnosed with heart disease are advised to follow a strict diet.

Unfortunately, some heart diseases are not amenable to therapeutic treatment, so surgical intervention has to be performed, which involves:

stenting;
installation of a damaged valve prosthesis;
decrease in the thickness of the myocardium;
installation of a pacemaker.

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

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

Quite often, after passing the ECG, the examinee can put a record such as the vertical position of the EOS in the card. The degree of the ratio and the physique (according to Chernorutsky) of a person are also indicated there. What does the position of the electrical axis of the heart indicate and why did doctors generally introduce this term into medical practice? What does the vertical position of the EOS mean and does it indicate that the person has any problems in the work of the cardiovascular system?

General concepts

So, the electrical axis of the heart is a concept from the field of cardiology, which describes the position of the heart. To describe it, the line of the resulting vector to the frontal axis along the QRS is used. The angle itself in a healthy person is formed in the ratio from 0 to 90 degrees, possibly with a small deviation from the norm. All this indicates that a person does not have problems in the work of the cardiovascular system. However, such a parameter as the physique of the subject is also taken into account. Depending on this, the normal position of the electrical axis of the heart for him can vary from vertical to horizontal. The first corresponds to those with an asthenic physique (mostly thin). The gender of a person to the position of EOS does not make any difference. That is, for both guys and girls with a lean body structure, the normal position of the electrical axis is vertical. If it is horizontal or with a huge deviation from the norm, this is considered a pathology.

What, in principle, is the definition of the electrical axis of the heart used for? To describe the rhythm of his work. After all, the contractions of the heart muscle in each individual person occur with a different rhythm. In thin people, it is faster than in those with increased muscle mass, although here it is more about whether a person is involved in sports or completely neglects his physical form.

If during the ECG the vertical axis of the heart is indicated, and the doctor also makes a note in the card about the presence of a regular sinus rhythm, this indicates that, in principle, no problems with the work of the cardiovascular system have been found. A person is conventionally considered healthy if the ECG did not show any pathologies and abnormalities during the study. Deviation of sinus rhythm is a complete destabilization of the contractions of the heart muscle. This already carries a rather high risk to human health.

Do I need to know my electrical axis?

A reasonable question arises, is it necessary for a healthy person to know his EOS? What will the knowledge of the angle of the electrical axis of the heart give him and does it help in any way in the diagnosis of diseases of the cardiovascular system? There is no need for a healthy person to understand all such concepts. If he has never had a heartache, there is no increased or low blood pressure, then the position of the electrical axis in any case for his body will be considered normal. You need to understand that the location of the heart for each individual person is individual. After all, science knows even those cases when the heart muscle was not located at all in the chest area, but shifted to the hypochondrium, or even to the abdominal cavity. In such cases, as a rule, complete chaos in the arrangement of organs is determined, but this only indirectly threatens human health.

Why can the position of the heart in the chest area change? Because the heart muscle is not attached to any organ, let alone the abdominal cavity. At its core, it is always suspended and held by the movement of the diaphragm, lungs, bronchi and alimentary tract. In this case, the blood vessels are connected to the heart in the upper part, which again acts as an elastic support.

Who needs to know the axis of their heart? Those who are regular clients of a cardiologist and who have previously been diagnosed with hypertension or deviation from normal body weight. After all, the horizontal position is normal only in cases where the patient has problems with being overweight. If it is established in a person with an asthenic physique, then here we are talking either about incorrectly located organs, or about poor fit of the lungs to the peritoneum (due to which the muscles descend to the diaphragm and partial squeezing of the blood vessels occurs).

And it should be understood that initially the concept of the electrical axis meant not just the position of the heart muscle, but the direction of the action of the electromotive force of the heart at the moment of contraction. However, this indicator also directly affects the position of the muscle itself, because the squeezing of the contents of the muscle is performed only in one direction (from the vein to the aorta and artery). In the opposite direction, the electromotive force cannot be directed, since this already indicates the presence of atrophy of the sphincter and heart valve. The electrical axis of the heart is diagnosed according to the results of the ECG and the graph, which looms when the heart muscle contracts. There are no diagnostic methods for checking the position of the heart. In addition, the statement of the horizontal axis does not mean that the heart muscle is turned sideways. Nothing of the kind - it is always located with the upper chambers up. The deviation from this position can be no more than 10-20 degrees.

What is the research data used for?

The establishment of EOS is not used to diagnose diseases of the cardiovascular system, but to determine the risk of their occurrence in the future or when a factor aggravates. For example, if a study found that sinus rhythm deviated from the norm by 20 percent towards the minus (that is, a slow contraction), then this may indicate that in the future, the problem with transmitting a signal for contraction from the brain to the heart will worsen. ... All this together leads to a violation of the heart rhythm and an increase or a sharp decrease in blood pressure. It is also important that the deviation can be the cause of a sharp reaction of the human body to a change in weather. It is just that the failure to comply with the normal indicators of the electrical axis of the heart muscle most often causes headaches when weather conditions worsen. Until now, many mistakenly believe that migraine is the culprit, although it is in no way related to blood pressure.

Also, the position of the electrical axis of the heart is an important indicator when making a diagnosis of arrhythmia. The fact is that it does not always indicate the presence of any pathologies in the work of the cardiovascular system. For certain categories of people, it is to some extent normal:

for residents of mountainous regions;
for those who work as a pilot, pilot (the cardiovascular system is constantly exposed to excessive loads);
for the indigenous inhabitants of Africa, in whom the rhythm of the heart muscle changes during the day, which is explained by the intensity of ultraviolet radiation, due to which the skin partially loses the ability to secrete sweat.

That is, the indication of the electrical axis when diagnosing arrhythmia allows you to accurately establish whether this factor really has a negative effect on the functioning of the body or is it normal for a particular person.

What does the displacement indicate, and what to do in such a situation?

It can be assumed that during an EKG (cardiogram setting) a person was found that his EOS was deviated from the norm according to the schedule. What to do in this case? How to restore a normal schedule and minimize possible negative effects on the body? The first step is to look for associated symptoms. And quite often doctors establish hypertrophy or thickening of the myocardial wall. It is because of her that the schedule is shifted. But this practically does not have a negative effect on the body of a healthy person.

To obtain more detailed information about the work of the heart muscle, doctors recommend recording an ultrasound examination of the chest organs after an ECG. Even then, the exact position of the heart muscle is established, and its physiological shape is determined, and the process of contraction, impulse squeezing of blood into the artery is investigated. Why is not an ultrasound performed immediately? Because it is impossible to establish a heart rate with it. After all, a deviation of a few milliseconds can already cause the development of numerous pathologies of the cardiovascular system. And with the help of ultrasound, the heart is in fact examined only visually, there is a contraction of the chambers, the work of the valves and the sphincter, which prevents the reverse flow of blood.

And the displacement of the EOS does not always indicate heart problems.

Quite a lot of cases are known when a deviation from the norm is diagnosed throughout a person's life, but at the same time he never complains of heart problems.

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

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

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

The conduction system of the heart and why is it important for the determination of EOS?

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

The contraction of the myocardium begins with the appearance of an electrical impulse in the sinus node (which is why the correct rhythm of a healthy heart is called sinus). From the sinus node, an impulse of electrical excitation passes to the atrioventricular node and further along the bundle of His. This bundle passes in the interventricular septum, where it is divided into the right, heading towards the right ventricle, and the left leg. The left pedicle of the bundle of His is divided into two branches, anterior and posterior. The anterior branch is located in the anterior sections of the interventricular septum, in the anterolateral wall of the left ventricle. The posterior branch of the left 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 slightly to the left of the anterior one.

The conducting system of the myocardium is a powerful source of electrical impulses, which means that in it, first of all, electrical changes occur in the heart that precede the heartbeat. In case of disturbances in this system, the electrical axis of the heart can significantly change its position., which will be discussed below.

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

The mass of the heart 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 in total stronger, and the EOS will be directed precisely at it. If you project the position of the heart on the coordinate system, then the left ventricle will be in the region of +30 + 70 degrees. This will be the normal axis position. However, depending on the individual anatomical features and physique the position of the EOS in healthy people ranges from 0 to +90 degrees:

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

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

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

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

Rotation of the heart around the longitudinal axis helps to determine the position of the organ in space and, in some cases, is an additional parameter in the diagnosis of diseases.

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

When can the EOS position speak of heart disease?

By itself, the position of the EOS is not a diagnosis. but there are a number of diseases in which there is a shift in the axis of the heart. Significant changes in the position of the EOS are caused by:

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

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. its increase in size, which is also not an independent disease, but may indicate an overload of the left ventricle. This condition often occurs with long-term arterial hypertension and is associated with significant resistance of blood vessels 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. Coronary artery disease, chronic heart failure, cardiomyopathies also cause left ventricular hypertrophy.

In addition, LVH develops when the left ventricular valve apparatus is affected. This condition is caused by stenosis of the aortic orifice, in which the ejection of blood from the left ventricle is difficult, 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 commonly acquired heart defects are the result of previous rheumatic fever. Left ventricular hypertrophy is found in professional athletes. In this case, it is necessary to consult a highly qualified sports doctor to resolve the issue of the possibility of continuing to play sports.

Also, the EOS can be rejected to the left with violations of intraventricular conduction and various heart blockages. Deviation email 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 displacement of 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.

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

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

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

But still 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 the results of ultrasound. Any disease leading to a displacement of the heart axis is accompanied by a number of clinical signs and requires additional examination. The situation should be alarming when, with a pre-existing position of the EOS, there is a sharp deviation on the ECG. In this case, the deviation most likely indicates the occurrence of a blockage.

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

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1Theoretical basis of the definition

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

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

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

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

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

Find QRS complexes in leads I and III;
We summarize the height of the teeth in the first assignment;
We summarize the height in the third assignment;

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

3What is a pencil for a diagnostician or when you don't need to look for an alpha angle?

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

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

4 Why define this parameter?

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

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

5 What can be normal EOS?

In healthy people, the following EOS descriptions take place: normal, semi-vertical, vertical, semi-horizontal, horizontal. Normally, as a rule, the electrical axis of the heart in persons over 40 years old is located at an angle of -30 to +90, in persons under 40 years old - 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 persons, the diaphragm is located low, the EOS is deflected more often to the right, the heart occupies a more vertical position. In obese people, hypersthenics, on the contrary, the heart lies more horizontally, there is a deviation to the left. In normostenics, the heart occupies an intermediate position.

6 Norm in children

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

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

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

7 Reasons for EOS deviation to the left

The 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 causes of this condition? Let's consider them in more detail.

A variant of the norm;
GSV of the left bundle branch;
Left bundle branch block;
Positional changes associated with the horizontal location of the heart;
Some forms of ventricular tachycardia;
Malformations of the endocardial pillows.

8 Reasons for deviation of EOS to the right

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

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

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

A variant of the norm;
Right ventricular hypertrophy;
Posterior-superior bifurcation block;
Pulmonary embolism;
Dextrocardia (right-sided heart);
A variant of the norm for 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 at the moment, there is a pronounced horizontal direction of the EOS. Such abrupt changes may indicate any disturbances in the work of the heart and require an early additional diagnosis and further examination.

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Medical indicators

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

The examination of the patient is carried out in a specialized room, which is shielded from various electrical interferences. The patient is in a prone position, a pillow is placed under the head. To take an ECG, electrodes are placed. The data is recorded with calm breathing. At the same time, the device records the heart rate and regularity, including the position of the EOS and other parameters.

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

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

EOS shifts to the right in a healthy person when:

ending a deep breath;
body features (asthenic).

The location of the EOS is determined by the mass of 2 parts of the ventricle. The definition of the indicator under consideration is made according to 2 methods.

In the first case, the specialist detects the displacement in the alpha angle. The value of the main indicator is calculated using a special Dieoude table.

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

An electric axis shifted to the left indicates the following problems:

left ventricular hypertrophy;
impaired operation of the left ventricular valve;
cardiological blockade.

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

Additional diagnostic techniques

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

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

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

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

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

Changes to the right side

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

If necessary, the patient is prescribed additional diagnostics:

1. Ultrasound - provides information about changes in the anatomy of the main organ.
2. Chest X-ray - reveals myocardial hypertrophy.
3. Daily ECG - performed with concomitant rhythm disturbance.
4. ECG during exercise - helps to identify myocardial ischemia.
5. CAH - is performed to diagnose CA lesions.

Deviation of the axis to the right can be triggered by the following pathologies:

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

Risk factors

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

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

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

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

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

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

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Electric axis position range is normal

For example, in the conclusion of the ECG, the patient may see the following phrase: “sinus rhythm, EOS is not deflected ...”, 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 the heart rate, is one of the first ECG criteria that the doctor pays attention to, and when decoding the ECG by the attending physician, it is imperative to determine the direction of the electrical axis.

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

How to determine the position of an electrical axis

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

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

Reasons for deviations from the norm

Deviation of the axis to the right or to the left is not considered an independent disease, but it can speak of diseases that lead to disruption of the heart.

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

Deviation of the heart axis to the left can normally occur 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, which are necessary for the normal functioning of the whole heart. Hypertrophy can be caused by the following diseases:

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

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

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

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

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

Symptoms

The electrical axis of the heart itself does not cause any symptoms in the patient. 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 to the right, headaches, pain in the region of the heart, edema of the lower extremities and on the face, shortness of breath, attacks of suffocation, etc. are characteristic.

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

Diagnostics

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

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

Treatment

Direct deviation of the electrical axis does not need treatment, since it is not a disease, but a criterion by which one can assume that a patient has one or another cardiac pathology. If, after an additional examination, some disease is revealed, it is necessary to start treatment as soon as possible.

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