home Adviсe Eos of the heart is normal. Deviation of the alpha - angle. Why is the normal conduction of electrical excitations of the heart so important?

Eos of the heart is normal. Deviation of the alpha - angle. Why is the normal conduction of electrical excitations of the heart so important?

The figure below shows the six-axis Bailey lead system on which the red vector shows electrical axis of the heart, located horizontally (angle α=0..+30°). The dotted line marks the projections of the EOS vector. on the lead axis. Explanations for the figure are given in the table below.

On the page "Automatic EOS detection" a specially designed script will help you determine the location of the EOS according to ECG data from any two different leads.

Signs of the horizontal position of the electrical axis of the heart

lead	Amplitude and tooth shape
Standard Lead I	E.o.s. is maximally parallel to lead I of all standard leads, so the projection of the e.o.s. on the axis of this lead will be the largest, therefore, the amplitude of the R wave in this lead will be the maximum of all standard leads: R I > R II > R III
Standard Lead II	E.o.s. is located relative to the axis II of the standard lead at an angle of 30..60°, so the amplitude of the R wave in this lead will be intermediate: R I > R II > R III
Standard Lead III	EOS projection on axis III of the standard lead is as close as possible to the perpendicular, but still somewhat different from it, therefore, a small predominant negative wave will be recorded in this lead (because the EOS is projected onto the negative part of the lead): S III > R III
Enhanced abduction aVR	The enhanced lead aVR is located towards the e.o.s. as parallel as possible from all amplified leads, while the vector of the e.o.s. is projected onto the negative part of this lead, therefore, in lead aVR, a negative wave of maximum amplitude from all enhanced leads will be recorded, approximately equal to the amplitude of the R wave in standard lead I: S aVR ≈R I
Enhanced abduction aVL	E.o.s. is located in the area of the bisector of the angle formed by the standard lead II (positive half) and enhanced lead aVL (positive half), hence the projection of the e.o.s. on the axis of these leads will be approximately the same: R aVL ≈R II
Enhanced abduction aVF	The axis of the heart is not clearly perpendicular to lead aVF and is projected onto the positive part of the axis of this lead, so a small predominantly positive wave will be recorded in this lead: R aVF >S aVF

Signs of the horizontal position of the e.o.s. ( angle α=0°)

lead	Amplitude and tooth shape
Standard Lead I	E.O.S. direction coincides with the location of the I axis of the standard lead and is projected onto its positive part. Therefore, the positive R wave has the maximum amplitude among all limb leads: R I =max>R II >R III
Standard Lead II	E.o.s. it is equally located in relation to II and III standard leads: at an angle of 60 ° and is projected onto the positive half of lead II and the negative half of the axis of lead III: R I > R II > R III ; S III > R III
Standard Lead III
Enhanced abduction aVR	E.o.s. equally located in relation to the enhanced leads aVR and aVL: at an angle of 30° and is projected onto the negative half of lead aVR and the positive half of aVL: S aVR =R aVL
Enhanced abduction aVL
Enhanced abduction aVF	EOS projection on the axis of the enhanced lead aVF is zero (since the EOS vector is perpendicular to this lead) - the amplitude of the positive R wave is equal to the amplitude of the negative S wave: R aVF =S aVF

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

Rhythm sinus regular - this phrase means absolutely normal heartbeat which is generated in sinus node(the main source of cardiac electrical potentials).

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

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

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

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

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

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

Methods for determining the position of the EOS.

In simple terms, an ECG is a dynamic recording of an electrical charge, thanks to which our heart works (that is, it contracts). The designations of these graphs (they are also called leads) - I, II, III, aVR, aVL, aVF, V1-V6 - can be seen on the electrocardiogram.

An ECG is a completely painless and safe study, it is performed for adults, children and even pregnant women.

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

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

Thin people usually vertical position EOS, and in dense people and obese people - horizontal position. Respiratory arrhythmia is associated with the act of breathing, is the norm and does not require treatment.

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

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

Blockade of the legs (left, right, left and right) of the His bundle (RBNG, BLNG), complete, incomplete - this is a violation of the conduction of an impulse along the conduction system in the thickness of the ventricular myocardium.

by the most common causes hypertrophy are arterial hypertension, heart defects and hypertrophic cardiomyopathy. In some cases, next to the conclusion about the presence of hypertrophy, the doctor indicates - "with overload" or "with signs of overload."

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

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

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

When the position of the EOS can talk about heart disease?

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

If we project the electrodes onto a conditional coordinate system, then we can also calculate the angle of the electric axis, which will be located where the electrical processes are strongest. The conduction system of the heart is a section of the heart muscle, consisting of the so-called atypical muscle fibers.

Normal ECG

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

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

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

In this case, it is necessary to consult a highly qualified sports doctor to decide whether it is possible to continue playing sports.

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

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

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

Deviation of the electrical axis of the heart to the left indicates some diseases and requires clarification of the diagnosis.

General information about pathology

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

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

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

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

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

Talk about normal value axis is possible if the R wave has highest value in the 2nd main lead, and the value of R1>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 an excess of the body in left side. A levogram is observed if the axis position is between 0 and -900.

Reasons for rejection

EOS is deviated 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;
blockade of the left leg of the bundle of His;
flickering arrhythmia.

In the course of the cardiac cycle, during the first contraction, blood is pushed into the atrium, the valve closes, then it is transferred to the ventricle, and with 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 fluid, part of it constantly remains inside the cavity. It gradually expands.

This phenomenon is provoked by cardiomyopathy due to coronary artery disease due to a heart attack, myocarditis.

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

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

If the conduction of the left branch of the His bundle is disturbed, the functioning of the left ventricle is disrupted, because of which it does not contract as it should. At the same time, sinus rhythm is maintained, but the axis is deviated.

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

At 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 does not manifest itself with symptoms, but since the violation is caused by certain reasons, the signs 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 extremities and nasolabial triangle, shortness of breath and dizziness.

Atrial fibrillation is manifested by attacks, during which there is not enough breathing, there is a feeling of palpitations, pain behind the sternum, pulse interruptions.

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

Diagnostics

Bringing together the symptoms of the disorder helps to identify the disorder. functional diagnostics, other methods:

Holter monitoring;
x-ray;
coronary angiography.

Thanks to these studies, it is possible to visually assess the organ, its departments, 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 bike path or an exercise bike, it is possible to determine at what point myocardial ischemia appears.

The doctor prescribes a daily study if he suspects that the patient has a rhythm disorder. 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 that allows you to see their condition and circulatory disorders. The picture allows you to determine the expansion of the shadow of the organ, which indicates hypertrophy.

When additional testing is required

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

A change in the parameter normally also occurs in athletes.

Since they endure significant stress during constant training, their heart pumps large volumes of fluid, so the cavities stretch. They may show a horizontal type of deviation when the organ occupies a position from -15 to +30.

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

Manifestations on the ECG

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

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

What does drastic deviation mean?

Since the angle of deviation from the norm can be different, the degrees of the process are different. Changing degrees is a gradual process. The larger 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 shifted to the left.

In adults

A shift in the axis of the location of the heart in the chest may indicate a violation of the ECG, if a person good health and no other health problems were identified.

Normally, it is observed in people who regularly engage in physical education and in athletes.

The pronounced deviation is not random, it is a sign of pathology in adults. There may be stagnation that accumulates over several years.

In children

A child in the neonatal period has a sharp deviation of the axis to the right, 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 year, the condition is normalized, and the organ should take a vertical 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, the body acquires a correct, semi-vertical position.

Is treatment needed

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

These may include the following procedures:

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

The set of measures depends on what degree of health impairment is present..

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

Coronary bypass surgery - cleaning of blood vessels from plaques, lipid deposits, 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.

Possible 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;
heart failure.

All causes of disruption of the body are interconnected. If the heart disease led to the expansion of the left ventricle, then with the development pathological process rhythm disturbances are to be expected. If the myocardium becomes so weak that the contraction of the fibers does not lead to the ejection of blood further, then circulatory failure and cardiac arrest occur.

The greatest electrical activity of the myocardium of the ventricles is found during their excitation. In this case, the resultant of the emerging electrical forces (vector) occupies a certain position in the frontal plane of the body, forming an angle  (it is expressed in degrees) relative to the horizontal zero line (I standard lead). The position of this so-called electrical axis of the heart (EOS) is estimated by the size of the teeth of the QRS complex in standard leads, which allows you to determine the angle  and, accordingly, the position of the electrical axis of the heart. Angle  is considered positive if it is below the horizontal line, and negative if it is above. This angle can be determined by geometric construction in Einthoven's triangle, knowing the size of the teeth of the QRS complex in two standard leads. In practice, special tables are used to determine the angle  (the algebraic sum of the teeth of the QRS complex in I and II standard leads is determined, and then the angle  is found from the table). There are five options for the location of the axis of the heart: normal, vertical position (intermediate between the normal position and rightogram), deviation to the right (rightogram), horizontal (intermediate between the normal position and leftogram), deviation to the left (leftogram).

All five options are schematically shown in Fig. 23–9.

Rice.23–9 .Optionsdeviationselectricalaxeshearts. They are assessed by the size of the main (greatest amplitude) teeth of the QRS complex in leads I and III. PR - right hand, LR - left hand, LN - left leg.

 Normogram(normal position of the EOS) is characterized by an angle  from +30° to +70°. ECG signs:

 the R wave prevails over the S wave in all standard leads;

 maximum R wave in standard lead II;

 R waves also predominate in aVL and aVF, and in aVF it is usually higher than in aVL.

Normogram formula: R II > R I > R III.

 verticalposition characterized by an angle  from +70° to +90°. ECG signs:

 equal amplitude of R waves in standard leads II and III (or in lead III slightly lower than in lead II);

 the R wave in the I standard lead is small, but its amplitude exceeds the amplitude of the S wave;

 QRS complex in aVF is positive (high R wave predominates), and in aVL it is negative (deep S wave predominates).

Formula: R II R III > R I , R I > S I .

 Rightgram. Deviation of EOS to the right (right-handed diagram) - anglemore than +90°. ECG signs:

 the R wave is maximal in standard lead III, in leads II and I it progressively decreases;

 QRS complex in lead I is negative (S wave predominates);

 in aVF a high R wave is characteristic, in aVL - deep S with a small R wave;

Formula: R III > R II > R I , S I > R I .

 Horizontalposition characterized by an angle  from +30° to 0°. ECG signs:

 R waves in leads I and II are almost the same, or the R wave in lead I is slightly higher;

 in the III standard lead, the R wave has a small amplitude, the S wave exceeds it (on inspiration, the r wave increases);

 in aVL the R wave is high, but somewhat smaller than the S wave;

 in aVF, the R wave is low, but exceeds the S wave.

Formula: R I  R II > R III , S III > R III , R aVF > S aVF .

 Levogramma. EOS deviation to the left (leftogram) - angle  less than 0° (up to –90°). ECG signs:

 R wave in lead I exceeds R waves in II and III standard leads;

 QRS complex in lead III is negative (the S wave predominates; sometimes the r wave is completely absent);

 in aVL the R wave is high, almost equal to or greater than the R wave in I standard lead;

 in aVF, the QRS complex resembles that in standard lead III.

Formula: R I > R II > R III , S III > R III , R aVF

Papproximate grade provisions electrical axes hearts. To memorize the differences between a right-gram and a left-gram, students use a witty school trick, which consists in the following. When examining their palms, the thumb and forefinger are bent, and the remaining middle, ring and little fingers are identified with the height of the R wave. They “read” from left to right, like a regular line. The left hand is a levogram: the R wave is maximum in standard lead I (the first highest finger is the middle one), decreases in lead II (ring finger), and is minimal in lead III (little finger). The right hand is a rightogram, where the situation is reversed: the R wave grows from lead I to lead III (as well as the height of the fingers: little finger, ring finger, middle finger).

Causes of deviation of the electrical axis of the heart. The position of the electrical axis of the heart depends on both cardiac and non-cardiac factors.

~~ In people with a high position of the diaphragm and / or hypersthenic constitution, the EOS takes a horizontal position or even a levogram appears.~~

~~ In tall, thin people with a low diaphragm, the EOS is normally located more vertically, sometimes up to the right-angle.~~

EOS deviation is most often associated with pathological processes. As a result of the predominance of the mass of the myocardium, i.e. ventricular hypertrophy, EOS deviates towards a hypertrophied ventricle. However, if with hypertrophy of the left ventricle, the deviation of the EOS to the left almost always occurs, then in order to deviate it to the right, the right ventricle must be significantly hypertrophied, since its mass in a healthy person is 6 times less than the mass of the left ventricle. Nevertheless, it must be immediately pointed out that, despite the classical ideas, at present, EOS deviation is not considered a reliable sign of ventricular hypertrophy.

What treatment may be required.
The electrical axis of the heart is a diagnostic criterion that displays the electrical activity of the organ.
The electrical activity of the heart is recorded using an ECG. Sensors are applied to various areas of the chest, and in order to find out the direction of the electrical axis, it is possible to represent it (the chest) in the form of a three-dimensional coordinate system.
The direction of the electrical axis is calculated by the cardiologist during the decoding of the ECG. To do this, he sums the values of the Q, R and S waves in lead 1, then finds the sum of the values of the Q, R and S waves in lead 3. Then he takes the two received numbers and calculates the alpha - the angle according to a special table. It is called the Died table. This angle is the criterion by which it is determined whether the location of the electrical axis of the heart is normal.
The presence of a significant deviation of the EOS to the left or right is a sign of a violation of the heart. Diseases that provoke EOS deviation almost always require treatment. After getting rid of the underlying disease, the EOS takes on a more natural position, but sometimes it is impossible to completely cure the disease.
To resolve this problem, contact a cardiologist.
The location of the electrical axis is normal
In healthy people, the electrical axis of the heart coincides with the anatomical axis of this organ. The heart is located semi-vertically - its lower end is directed down and to the left. And the electric axis, like the anatomical one, is in a semi-vertical position and tends down and to the left.
The norm of the alpha angle is from 0 to +90 degrees.
The norm of the angle alpha EOS
The location of the anatomical and electrical axes to a certain extent depends on the physique. In asthenics (thin people with tall stature and long limbs), the heart (and, accordingly, its axis) is located more vertically, and in hypersthenics (short people with a stocky build) - more horizontally.
The norm of the alpha angle, depending on the physique:
A significant shift of the electrical axis to the left or right side is a sign of pathologies of the conduction system of the heart or other diseases.
A negative angle alpha indicates a deviation to the left: from -90 to 0 degrees. About its deviation to the right - values \u200b\u200bfrom +90 to +180 degrees.
However, it is not necessary to know these numbers at all, since in case of violations in the ECG decoding, you can find the phrase “EOS is rejected to the left (or right)”.
Reasons for shifting to the left
Deviation of the electrical axis of the heart to the left is a typical symptom of problems with the left side of this organ. It could be:
hypertrophy (enlargement, growth) of the left ventricle (LVH);
blockade of the anterior branch of the left leg of the bundle of His - a violation of the conduction of the impulse in the anterior part of the left ventricle.

Causes of these pathologies:
Symptoms
By itself, the displacement of the EOS has no characteristic symptoms.
The diseases that accompany it can also be asymptomatic. That is why it is important to undergo an ECG for preventive purposes - if the disease is not accompanied by unpleasant symptoms, you can learn about it and start treatment only after deciphering the cardiogram.
However, sometimes these diseases still make themselves felt.
Symptoms of diseases that are accompanied by a displacement of the electrical axis:
But we repeat once again - the symptoms do not always appear, they usually develop in the later stages of the disease.
Additional diagnostics
To find out the reasons for the deviation of the EOS, the ECG is analyzed in detail. They may also assign:
EchoCG (ultrasound of the heart) - to identify possible organ defects.
Stress EchoCG - ultrasound of the heart with a load - for the diagnosis of ischemia.
Angiography of the coronary vessels - their examination to detect blood clots and atherosclerotic plaques.
Holter monitoring - ECG recording using a portable device throughout the day.

After a detailed examination, appropriate therapy is prescribed.

Treatment
By itself, the deviation of the electrical axis of the heart to the left does not require specific treatment, since it is only a symptom of another disease.
All measures are aimed at eliminating the underlying disease, which is manifested by a shift in the EOS.
Treatment for LVH depends on what caused myocardial overgrowth
Treatment of the blockade of the anterior branch of the left leg of the bundle of His - the installation of a pacemaker. If arose as a result of a heart attack - surgical restoration of blood circulation in the coronary vessels.

The electrical axis of the heart returns to normal only if the size of the left ventricle is returned to normal or the impulse conduction through the left ventricle is restored.
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Sinus bradycardia deviation of eos to the left
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 set the angle of displacement - this is what cardiologists do.
Features of the conductive system
The cardiac conduction system is an accumulation of areas of muscle tissue in the myocardial region, which is an atypical type of fiber. These fibers have good innervation, which allows the organ to contract synchronously. The beginning of the contractile activity of the heart occurs in the sinus node, it is in this area that the electrical impulse originates. Therefore, doctors call the correct heart rate sinus.
Originating in the sinus node, the excitatory signal is sent to the atrioventricular node, and then it goes along the bundle of His. Such a bundle is located in the section that blocks the ventricles, where it is divided into two legs. The leg leaving to the right leads to the right ventricle, and the other, rushing to the left, is divided into two branches - posterior and anterior. The anterior branch, respectively, is located in the region of the anterior zones of the septum between the ventricles, in the anterolateral compartment of the wall of the left ventricle. The posterior branch of the bundle of His left is localized in two-thirds of the partitioning part that separates the ventricles of the organ, the middle and lower, as well as the posterolateral and lower wall, located in the zone of the left ventricle. Doctors say that the anterior branch is slightly to the right of the posterior.
The conduction system is a strong source of electrical signals that make the main part of the body work normally, in the right rhythm. Only doctors are able to calculate any violations in this area, it will not work on their own. Both an adult and a newborn baby can suffer from pathological processes of this nature in the cardiovascular system. If deviations occur in the conducting system of the organ, then the axis of the heart can be mixed. There are certain norms for the position of this indicator, according to which the doctor detects the presence or absence of deviations.
Parameters in healthy people
How to determine the direction of the electrical axis of the heart? The weight of the muscle tissue of the ventricle on the left usually significantly exceeds that of the right ventricle. You can find out whether the horizontal or vertical vector of a given measurement is based on these standards. Since the mass of the organ is unevenly distributed, it means that the electrical processes must occur more strongly in the left ventricle, and this shows that the EOS is directed specifically to this department.
Doctors project these data on a specially designed coordinate system, on the basis of which it can be concluded that the electrical axis of the heart is in the region of +30, as well as +70 degrees. However, each person, even a child, has individual features of the body, its own anatomical characteristics. This shows that the slope of the EOS in healthy people can vary between 0-90 degrees. Based on such data, doctors have identified several areas of this indicator, which are considered normal and do not interfere with the activity of the body.
What positions of the electric axis exist:
semi-vertical electrical position of the heart;
vertically directed electrical position of the heart;
horizontal state of the EOS;
vertical placement of the electrical axis.

It should be noted that all five positions can be found in a person who has good health. Finding the cause of such features is quite easy, the physiology of people explains everything.
The horizontal axis of the heart is more often detected in people with a stocky figure and short stature, and these individuals also have a usually wide sternum. This type of appearance is called hypersthenic, and the EOS direction indicator varies from 0 to +30 degrees. The horizontal position of the electrical cardiac axis is often the norm.
The range of the vertical position of this indicator varies within 70 or 90 degrees. Such an EOS vector is detected in a person with an asthenic body type, who has a thin body structure and high growth.

Since the features of the body composition are different for people, it is extremely rare to meet a pure hypersthenic or a very skinny individual, usually such types of structure are considered intermediate, then the direction of the axis of the heart can deviate from normal values (semi-vertical state or semi-horizontal position).
In what cases is it a pathology, the causes of violations
Sometimes the direction of the indicator can mean the presence of a disease in the body. If, as a result of the diagnosis, deviations of the electrical axis of the heart to the left are found, then the person has certain ailments, in particular, hypertrophic changes in the left ventricle. Often, such a violation becomes the result of pathological processes, as a result of which the cavity of this department is stretched and increases in size.
What diseases cause hypertrophy and a sharp inclination of the EOS to the left:
Ischemic damage to the main organ.
Arterial hypertension, especially with regular pressure surges to high tonometer values.
Cardiomyopathy. The disease is characterized by an increase in the weight of the muscle tissue of the heart and the expansion of all its cavities. This disease often appears after anemia, myocardial infarction, myocarditis or cardiosclerosis.
Chronic heart failure.
Abnormalities in the aortic valve, its insufficiency or stenosis. A pathological process of this kind may be acquired or congenital in nature. Such diseases cause a disorder of blood flow in the cavities of the organ, which leads to an overload of the left ventricle.
Professionally engaged in sports activities, these disorders are also often detected.

In addition to hypertrophic changes, the deviation of the axis of the heart sharply to the left may indicate the presence of problems with the conduction properties of the inner part of the ventricles, which usually occur with various blockades. What is it and what threatens - the attending physician will explain.
Often, a blockade is diagnosed, found in the left leg of the His bundle, which also refers to a pathology that shifts the EOS to the left.
The opposite state also has its causes. Deviation of the electrical axis of the heart to the other side, the right, indicates hypertrophy of the right ventricle. There are certain diseases that provoke such a violation.
What diseases lead to the inclination of the EOS to the right:
Pathological processes in the tricuspid valve.
Stenosis and narrowing of the lumen of the pulmonary artery.
Pulmonary hypertension. This violation often occurs against the background of other ailments, such as obstructive bronchitis, organ damage, emphysema, and bronchial asthma.

In addition, diseases that lead to a shift in the direction of the axis to the left can also cause the EOS to be tilted to the right.
Based on this, doctors conclude that a change in the electrical position of the heart is a consequence of ventricular hypertrophy. In itself, such a disorder is not considered a disease, it is a sign of another pathology.
Norms in children
First of all, it should be noted the position of the EOS during the bearing of the baby by the mother. Pregnancy changes the direction of this indicator, as serious changes take place in the body. The rapidly growing uterus presses on the diaphragm, which leads to displacement of all internal organs and changes the position of the axis, as a result of which its direction may become semi-vertical, semi-horizontal or otherwise, depending on its initial state.
As for children, this indicator changes with age. In newborn babies, a significant deviation of the EOS to the right side is usually detected, which is absolutely normal. By adolescence, this angle is already established. Such changes are associated with the difference in the ratio of weight and electrical activity of both ventricles of the organ, as well as with a change in the position of the heart in the chest area.
A teenager already has a certain EOS angle, which normally persists throughout his life.
Symptoms
A change in the direction of the electrical axis cannot cause discomfort in a person. Disorder of well-being usually provokes hypertrophic damage to the myocardium, if they are accompanied by severe hemodynamic disorders, and also lead to the development of heart failure, which is very dangerous and requires treatment.
pain in the head and chest area;
breathing problems, shortness of breath, choking;
swelling of the tissues of the lower, upper extremities and face area;
weakness, lethargy;
arrhythmia, tachycardia;
disturbance of consciousness.

Determining the causes of such disorders is an important part of all therapy. The prognosis of the disease depends on the correctness of the diagnosis. If such symptoms occur, you should immediately consult a doctor, as cardiac problems are extremely dangerous.
Diagnosis and treatment
Usually, the deviation of the electrical axis is detected on the ECG (electrocardiogram). This method is not more often prescribed than others during a routine examination. The resulting vector and other characteristics of the organ make it possible to evaluate the activity of the heart and calculate deviations in its work. If such a violation is detected on the cardiogram, then the doctor will need to conduct several additional examination measures.
Ultrasound of the organ is considered one of the most informative methods. With the help of such a study, it is possible to identify ventricular hypertrophy, disorders in the structure of the heart and evaluate its contractile features.
X-ray of the chest area, which allows you to see the presence of a shadow of the heart, which usually occurs with myocardial hypertrophy.
ECG in the form of daily monitoring. It is necessary to clarify the clinical picture in case of violations related not only to the axis itself, but also to the origin of the rhythm not from the sinus node zone, which indicates a disorder of rhythmic data.
Coronary angiography or CAG. It is used to study the features of damage to the coronary arteries during organ ischemia.
An exercise ECG can detect myocardial ischemia, which is usually the cause of the direction of the EOS.

It is necessary to treat not a change in the index of the electrical axis, but the disease that caused the pathology. With the help of diagnostics, doctors accurately determine the factors that provoked such violations.
Changing the angle of the electrical axis of the heart does not require therapy.
No class of drugs will help in this case. You need to eliminate the disease that led to such changes. Drugs are prescribed to patients only after an accurate diagnosis has been made. Depending on the nature of the lesions, medications are used. Sometimes it is advisable to perform surgery.
In order to determine the functional abilities of the heart, it is necessary to conduct special examination methods. If it turned out that there were violations in the conducting system of the organ, you should not panic, you must follow all the recommendations of the doctor. Medicine today can eliminate almost any pathology, you just need to seek help in a timely manner.
What is sinus rhythm on an ECG
The human heart is a kind of trigger for the productive work of the whole organism. Thanks to the impulses of this organ, which are issued on a regular basis, the blood has the ability to circulate throughout the body, saturating the body with vital substances. If the heart is normal, then the whole body works as productively as possible, but sometimes you still have to face certain health problems.
If a person comes for an examination to a doctor and the specialist has suspicions that something is not right with his heart, then he sends the patient to an ECG. Sinus rhythm on the ECG is a very important indicator and clearly gives data on the real state of the human heart muscle. What exactly can be determined by looking at the cardiogram, it is worth considering in more detail.
What is sinus rhythm
In the concept of medical staff, the sinus rhythm of the cardiogram is the norm for the human body. If there are identical gaps between the teeth depicted on the cardiogram, the height of these columns is also the same, then there are no deviations in the work of the main organ.
So, the sinus rhythm on the cardiogram is the following:
graphic representation of human pulse jumps;
a set of teeth of different lengths, between which there are different intervals, showing a specific rhythm of heart impulses;
schematic representation of the work of the heart muscle;
an indicator of the presence or absence of abnormalities in the work of the heart and its individual valves.

Normal sinus rhythm is only present when the heart rate is between 60 and 80 beats per minute. It is this rhythm that is considered normal for the human body. and on the cardiogram it is displayed by teeth of the same size, located at the same distance from each other.
It is clearly worth remembering that the results of the cardiogram can be one hundred percent accurate only if the person is completely calm. Stressful situations and nervous tension contribute to the fact that the heart muscle begins to emit impulses faster, which means that it will definitely not be possible to obtain a reliable result about the state of human health.
What are the criteria for deciphering the result of the ECG
Deciphering the results of the cardiogram is performed by doctors according to a special scheme. Medical specialists have a clear idea of which marks on the cardiogram are the norm and which are deviations. The conclusion of the ECG will be set only after the calculation of the results, which were displayed in a schematic form. The doctor, when examining the patient's cardiogram, in order to correctly and accurately decipher it, will pay special attention to a number of such indicators:
the height of the bars displaying the rhythm of cardiac impulses;
the distance between the teeth on the cardiogram;
how sharply the indicators of the schematic image fluctuate;
what is the specific distance observed between the columns displaying the pulses.

A doctor who knows what each of these schematic marks means, carefully studies them and can clearly orient himself in what kind of diagnosis should be made. The cardiograms of children and adults are deciphered according to the same principle, but the norm indicators for people of different age categories cannot be the same.
What sinus rhythm problems can be seen on an ECG
Electrocardiogram readings can indicate clear signs of problems in the functioning of the heart muscles. With the help of this study, you can see if there is a weakness of the sinus node, and what kind of health problems this causes. Considering the indicators of the cardiogram of a particular patient, a medical specialist can decipher the presence of problems of the following nature:
sinus tachycardia on the ECG, indicating an excess of the rhythm of contractions, which is considered normal;
sinus arrhythmia on the ECG, indicating that the interval between contractions of the heart muscles is too long;
sinus bradycardia on the ECG, indicating that the heart contracts less than 60 times in one minute;
the presence of too small an interval between the teeth of the cardiogram, which means a violation in the sinus node.

Sinus bradycardia is a common abnormality, especially when it comes to the health of the child. This diagnosis can be explained by many factors, among which physiological defects or simply a factor of chronic fatigue may be hidden.
The deviation of the EOS to the left also indicates that the work of the vital organ is not set up correctly. Having determined such deviations, the doctor will send the patient for an additional examination and ask him to pass a number of necessary tests.
If the vertical position of the EOS is observed, then this means that the heart has a normal location and is in its place, there are no serious physiological abnormalities. This situation is an indicator of the norm, which is also indicated in the conclusion of the doctor who deciphered the cardiogram.
If a horizontal position of the EOS is observed, then this cannot immediately be considered a pathological condition. Such axis indicators are observed in people who are short in stature, but have rather broad shoulders. If the axis deviates to the left or right, and this is very noticeable, then such indicators may indicate a pathological condition of the organ, an increase in the left or right ventricles. Axial misalignment may indicate that there is damage to certain valves. If the axis shifts to the left, then the person most likely has heart failure. If a person suffers from ischemia, then the axis shifts to the right. Such a deviation can also tell about anomalies in the development of the heart muscle.
What can be said about the indicators of the norm
On the ECG, the sinus rhythm is always and without fail compared with certain indicators of the norm. Only knowing these indicators completely, the doctor will be able to deal with the patient's cardiogram and give the correct conclusion.
Normal indicators for children and adults are completely different factors. If we consider the questions of the norm for different age categories, then they will be something like this:
in children from birth to the first year of life, the orientation of the axis is vertical, the heart beats with a heart rate of 60 to 150 beats per minute;
children from one year to six years old have a mostly vertical orientation of the axis, but it can also be horizontal, without indicating deviations from the norm. Heart rate from 95 to 128;
children from seven years old and adolescents on the cardiogram should have a normal or vertical axis position, the heart should contract from 65 to 90 beats per minute;
adults should have a normal direction of the axis on the cardiogram, the heart contracts at a frequency of 60 to 90 times per minute.

The above indicators fall under the category of the established norm, but if they are slightly different, then this does not always become a sign of the presence of some serious pathologies in the body.
Because of what, ECG readings may deviate from the norm
If the result of the electrocardiogram does not always correspond to the norm, then this means that such a state of the body could be triggered by the following factors:
a person regularly consumes alcoholic beverages;
the patient smokes cigarettes for quite a long time on a regular basis;
a person is regularly exposed to various kinds of stressful situations;
the patient often uses antiarrhythmic drugs;
a person has problems with the functioning of the thyroid gland.

Of course, an accelerated heart rate or too slow can indicate problems of a more serious nature. If the results of the cardiogram do not correspond to the norm, then this may indicate acute heart failure, valve displacement, congenital heart defects.
If the sinus rhythm is within the established norm, then the person should not worry, and the doctor will be able to make sure that his patient is healthy.
The sinus node regularly emits impulses that cause the heart muscles to contract correctly and carry the necessary signals throughout the body. If these impulses are given irregularly, which can be clearly recorded by a cardiogram, then the doctor will have every reason to assume that the person has health problems. After studying the heart rate, the doctor will determine the exact cause of all deviations and will be able to offer the patient competent treatment.
Why should a person undergo an ECG study?
The sinus rhythm, which is displayed on the ECG, clearly indicates whether there are deviations in the work of the heart and in which directions the problem is observed. Regularly undergo such a study is necessary not only for adults, but also for children. The results of the performed cardiogram will help a person get the following information:
whether he has pathologies and diseases of a congenital nature;
due to what pathologies in the body heart problems begin;
can a person's way of life cause disturbances in the work of the main organ;
whether the heart is in the correct position and whether its valves work correctly.

Normal sinus rhythm on the ECG is displayed in the form of teeth of the same size and shape, while the distance between them is also the same. If any deviations from this norm are observed, then the person will have to be additionally examined.
The sinus rhythm on the cardiogram must coincide with the established norm, and only in this case can a person be considered healthy. If the impulses from the heart to other systems diverge too quickly or slowly, then this does not bode well. This means that doctors will have to further clarify the cause of the problem and deal with its complex treatment. If an uneven rhythm is observed on a teenager's cardiogram, then this cannot be considered a pathological deviation, because such a condition may be associated with hormonal changes and physiological maturation of the body.
If the sinus rhythm is within the normal range, then you will not have to take additional tests and undergo repeated studies. Normal work of the heart, as well as pathological deviations, is always recorded by a cardiogram.
The sinus rhythm on the ECG should be even and clear, without any broken lines, too long or short intervals. If the presented indicators are normal, then we can safely say that the person is completely healthy. Deviations in the cardiogram are the reason for doctors to perform additional studies and prescribe tests. Only after additional examinations can the exact cause of the deviations be understood and treatment can begin. A normal sinus rhythm displays a clear and even cardiogram in terms of the location of the lines. Additional attention will have to be paid to the location of the axis, with respect to the parameters of which medical standards are also established.
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What is the electrical axis of the heart?
The electrical axis of the heart is a concept that reflects the total vector of the electrodynamic force of the heart, or its electrical activity, and practically coincides with the anatomical axis. Normally, this organ has a conical shape, with its narrow end pointing down, forward and to the left, and the electrical axis has a semi-vertical position, that is, it is also directed down and to the left, and when projected onto a coordinate system, it can be in the range from +0 to +90 0.
An ECG conclusion is considered normal, which indicates any of the following positions of the axis of the heart: not rejected, has a semi-vertical, semi-horizontal, vertical or horizontal position. Closer to the vertical position, the axis is in thin, tall people of asthenic physique, and to the horizontal position, in strong stocky faces of hypersthenic physique.
The range of position of the electrical axis is normal
For example, in the conclusion of the ECG, the patient may see the following phrase: "sinus rhythm, EOS is not rejected ...", or "the axis of the heart is in a vertical position", which means that the heart is working correctly.
In the case of heart diseases, the electrical axis of the heart, along with the heart rhythm, is one of the first ECG criteria that the doctor pays attention to, and when deciphering the ECG by the attending physician, it is necessary to determine the direction of the electrical axis.
How to determine the position of the electrical axis
Determining the position of the axis of the heart is carried out by a doctor of functional diagnostics, deciphering the ECG, using special tables and diagrams, according to the angle α ("alpha").
The second way to determine the position of the electrical axis is to compare the QRS complexes responsible for the excitation and contraction of the ventricles. So, if the R wave has a greater amplitude in the I chest lead than in the III one, then there is a levogram, or a deviation of the axis to the left. If there is more in III than in I, then a rightogram. Normally, the R wave is higher in lead II.
Causes of deviations from the norm
Axis deviation to the right or to the left is not considered an independent disease, but it can indicate diseases that lead to disruption of the heart.
Deviation of the axis of the heart to the left often develops with left ventricular hypertrophy
Deviation of the axis of the heart to the left can occur normally in healthy individuals who are professionally involved in sports, but more often develops with left ventricular hypertrophy. This is an increase in the mass of the heart muscle with a violation of its contraction and relaxation, necessary for the normal functioning of the whole heart. Hypertrophy can be caused by such diseases:
cardiomyopathy (increase in mass of the myocardium or expansion of the heart chambers) caused by anemia, hormonal disorders in the body, coronary heart disease, postinfarction cardiosclerosis, changes in the structure of the myocardium after myocarditis (inflammatory process in the heart tissue);
long-term arterial hypertension, especially with constantly high pressure figures;
acquired heart defects, in particular stenosis (narrowing) or insufficiency (incomplete closure) of the aortic valve, leading to disruption of intracardiac blood flow, and, consequently, increased load on the left ventricle;
congenital heart defects are often the cause of the deviation of the electrical axis to the left in a child;
violation of conduction along the left leg of the bundle of His - complete or incomplete blockade, leading to impaired contractility of the left ventricle, while the axis is rejected, and the rhythm remains sinus;
atrial fibrillation, then the ECG is characterized not only by axis deviation, but also by the presence of non-sinus rhythm.

In adults, such a deviation, as a rule, is a sign of right ventricular hypertrophy, which develops with such diseases:
diseases of the bronchopulmonary system - prolonged bronchial asthma, severe obstructive bronchitis, 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 deviated the electrical axis, respectively, sharply to the left and sharply to the right.
Symptoms
The electrical axis of the heart itself does not cause any symptoms in the patient. Disorders of well-being appear in a patient if myocardial hypertrophy leads to severe hemodynamic disturbances and to heart failure.
The disease is characterized by pain in the region of the heart
Of the signs of diseases accompanied by a deviation of the axis of the heart to the left or right, headaches, pains in the region of the heart, swelling of the lower extremities and on the face, shortness of breath, asthma attacks, 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 found in a child.
Diagnostics
To determine the cause, if the ECG axis of the heart deviates to the left or right, a cardiologist or therapist may prescribe additional research methods:
Ultrasound of the heart is the most informative method that allows you to evaluate anatomical changes and identify ventricular hypertrophy, as well as determine the degree of violation of their contractile function. This method is especially important for examining a newborn child for congenital heart disease.
ECG with exercise (walking on a treadmill - treadmill test, bicycle ergometry) can detect myocardial ischemia, which can be the cause of deviations of the electrical axis.
24-hour ECG monitoring in the event that not only axis deviation is detected, but also the presence of a rhythm not from the sinus node, that is, there are rhythm disturbances.
Chest X-ray - with severe myocardial hypertrophy, an expansion of the cardiac shadow is characteristic.
Coronary angiography (CAG) is performed to clarify the nature of coronary artery lesions in coronary artery disease a.

Treatment
Directly, the deviation of the electrical axis does not need treatment, since this is not a disease, but a criterion by which it can be assumed that the patient has one or another cardiac pathology. If any disease is detected after the additional examination, it is necessary to begin its treatment as soon as possible.
In conclusion, it should be noted that if the patient sees in the conclusion of the ECG the phrase that the electrical axis of the heart is not in a normal position, this should alert him and prompt him to consult a doctor to find out the cause of such an ECG - a sign, even if there are no symptoms does not occur.
The information on the site is provided for informational purposes only and is not a guide to action. Do not self-medicate. Consult with your physician.

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