N position eos. Sinus rhythm horizontal position eos

The cardiovascular system is a vital organic mechanism that provides various functions. For the diagnosis of heart diseases, various indicators are used, the deviation of which may indicate the presence of a pathological process. One of them is the deviation of the electrical axis, which can indicate various diseases.

Characteristics of the electrical position of the heart

Under electric axis heart (EOS) is understood as an indicator that reflects the nature of the flow of electrical processes in the heart muscle. This definition widely used in the field of cardiology, especially in diagnostics. The electrical axis reflects the electrodynamic abilities of the heart, and is almost identical to the anatomical axis.

The definition of EOS is possible due to the presence of a conducting system. It consists of tissue sections, the components of which are atypical muscle fibers. Them distinguishing feature consists in increased innervation, which is necessary to ensure the synchrony of the heartbeat.


The type of heartbeat of a healthy person is called sinus, since it is in the sinus node that a nerve impulse occurs, which causes compression of the myocardium. In the future, the impulse moves along the atrioventricular node, with further penetration into the bundle of His. This element of the conduction system has several branches into which the nerve signal passes, depending on the heartbeat cycle.

Normally, the mass of the left ventricle of the heart exceeds the right one. This is due to the fact that this organ is responsible for the release of blood into the arteries, as a result of which the muscle is much more powerful. In this regard, the nerve impulses in this area are also much stronger, which explains the natural location of the heart.

The position axis can vary from 0 to 90 degrees. In this case, the indicator from 0 to 30 degrees is called horizontal, and the position from 70 to 90 degrees is considered the vertical position of the EOS.

The nature of the position depends on the individual physiological characteristics, in particular the structure of the body. Vertical OES is most often found in people who are tall and have an asthenic body constitution. The horizontal position is more typical for short people with a wide chest.

Intermediate positions - semi-horizontal and semi-vertical electrical position of the heart are intermediate types. Their appearance is also associated with body features. Any of the options is considered the norm, and is not considered a congenital pathology. However, in some cases, a displacement of the electrical axis may occur, which may indicate illness.

Diseases associated with the displacement of the ECO

The deviation of the electrical position is not an independent pathology. If such a violation is observed, but there are no other pathological symptoms, this phenomenon is not perceived as a pathology. If you have other symptoms cardiovascular disease, in particular lesions of the conduction system, the displacement of the OES may indicate a disease.

Possible diseases:

  • Hypertrophy of the stomach. Marked on the left side. There is an increase in the size of the cardiac section, which is associated with increased blood flow. It usually develops against the background of prolonged hypertension, at the same time as increased vascular resistance. Also, hypertrophy can be triggered by ischemic processes or heart failure.
  • Valve damage. In the event that a lesion of the valvular apparatus develops in the region of the ventricle on the left side, an axis displacement may also occur. This is usually due to a violation of the patency of blood vessels that prevent the ejection of blood. This disorder may be congenital or acquired.
  • Heart block. Pathology associated with a violation of the rhythm of the heartbeat, which is caused by an increase in the interval between the conduction of nerve impulses. Violation can also occur against the background of asystole - a long pause, during which there is no compression of the heart with further ejection of blood.

  • Pulmonary hypertension. It is noted when the EOS deviates in right side. It usually occurs against the background of chronic diseases of the respiratory system, including asthma, COPD. The long-term effect of these diseases on the lungs causes hypertrophy, which in turn provokes a confusion in the position of the heart.
  • Hormonal disorders. Against the background of a hormonal failure, an increase in the heart chambers may occur. This leads to a violation of the nerve patency, deterioration of the ejection of blood.

In addition to these reasons, deviations may indicate congenital heart defects, atrial fibrillation. EOS shift is often observed in people who are actively involved in sports or subject the body to other types of physical activity.

Symptoms and treatment

A change in the position of the heart is not accompanied by any pronounced symptoms. Negative manifestations can occur only with the pathological nature of the disorder. The development of severe symptoms is a direct indication to visit a cardiologist in order to carry out the necessary diagnostic procedures.

Possible symptoms of heart disease:

  • accelerated heartbeat
  • pressure surges
  • dyspnea
  • fast fatiguability
  • swelling of the face
  • increased sweating

Negative manifestations can also occur if the deviation of the position of the heart exceeds the normal value. In this case, there is a possibility of more serious complications requiring surgical treatment.


To determine the reasons for the deviation of the EOS from the norm, a wide range of procedures can be prescribed by a specialist. The main one is ultrasound examination, since it allows you to study in detail the features of the organ, to identify any changes in the anatomical position of the organ, to find out whether the cause of the deviation is hypertrophy or other pathological phenomena.

Also, for diagnostic purposes, a cardiogram is often used, which is produced simultaneously with an additional physical activity. This allows you to identify violations of the rhythm of contractions. This procedure is highly informative, but in some cases it may be contraindicated.

X-ray and coronary angiography are used as auxiliary methods. Such procedures are necessary to obtain additional information about the nature of the disease after receiving the primary diagnosis.

Treatment of diseases that provoke EOS deviation is prescribed in accordance with the nature of the pathology and the reasons for its development. In the absence of any symptoms of the disease, the deviation of the electrical position of the heart does not require treatment.

The semi-vertical electrical position of the heart is one of the types of EOS, which can be natural or provoked by a disease. Diagnosis and treatment is required only if the position shift is of pathogenic origin.

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General idea of ​​EOS - what is it

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

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

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

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

The normal position of the EOS - what is it

Determine the position of the EOS

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

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

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

Intermediate position - between +15 and +60 degrees.

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

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

Vertical position of the EOS

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

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

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

  • R2=R3>R1;
  • R1=S1;
  • R aVF>R2.3.

Horizontal position of the EOS

The horizontal position of the EOS is between +15 and -30 degrees.

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

On the ECG, aVL has the highest positive waves, while aVF has the deepest negative waves.

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

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

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

Pathological conditions accompanied by EOS deviation to the left:

  • hypertrophy of the left ventricle of the heart - a companion and a consequence of a long arterial hypertension;

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

These and similar diseases and conditions lead to an increase in the cavity or mass of the left ventricle. As a result, the excitation vector travels longer on the left side and the axis deviates to the left.

On the ECG in the second, third lead, deep S waves are characteristic.

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

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

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

Possible reasons for this phenomenon:

  • violation of the conduction of electrical excitation along the fibers of the bundle of His, its right branch;
  • myocardial infarction in the right ventricle;
  • overload of the right ventricle due to narrowing of the pulmonary artery;
  • chronic pulmonary pathology, the consequence of which is " cor pulmonale", characterized by intense work of the right ventricle;
  • the combination of coronary artery disease with hypertension - depletes the heart muscle, leads to heart failure;

  • PE - blockage of blood flow in the branches of the pulmonary artery, of thrombotic origin, as a result, the blood supply to the lungs is depleted, their vessels spasm, which leads to a load on the right heart;
  • mitral heart disease valve stenosis causing congestion in the lungs, which causes pulmonary hypertension and increased work of the right ventricle;
  • dextrocardia;
  • emphysema - shifts the diaphragm down.

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

  • R3>R2>R1,
  • S1>R1.

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

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Influence of the anatomical position of the heart on the electrical axis of the QRS complex

Confirmed breathing effect. When a person inhales, the diaphragm descends and the heart takes a more vertical position in the chest, which is normal. accompanied by a vertical displacement of the EOS(to the right). In patients with emphysema, an anatomically vertical position of the heart and an electrically vertical mean electrical axis of the complex are usually observed. QRS. On the contrary, when exhaling, the diaphragm rises and the heart takes a more horizontal position in the chest, which is usually accompanied by a horizontal displacement of the EOS(left).

Influence of the direction of ventricular depolarization

It can be confirmed with incomplete blockade of the anterior branch of the LBBB, when the propagation of impulses along the upper left ventricle is disturbed and the average electrical axis of the complex QRS deviated to the left (see section "Violation of intraventricular conduction"). On the contrary, with hypertrophy of the pancreas, it is deviated to the right.

How to recognize EOS deviation to the right and left

Right axis deviation

It is revealed if the average electric axis of the complex QRS is +100° or more. Remember that with high teeth R equal amplitude in leads II and III, the angle of the axis should be +90°. Approximate Rule indicates a deviation of the axis to the right, if there are high teeth in the II, III leads R, and the tooth R in lead III exceeds the tooth R in lead II. In addition, a complex is formed in lead I RS-type, where the depth of the tooth S more tooth height R(see fig. 5-8; 5-9).

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How can the EOS be located?

It is possible to determine the features of the location of the electrical axis of the heart using an ECG. The following options are usually considered normal:

  • Vertical (location range from 70 to 90 degrees).
  • Horizontal (location range from 0 to 30 degrees).
  • Semi-horizontal.
  • Semi-vertical.
  • No slope.

The figure shows the main options for the passage of the electrical axis of the heart. It is possible to determine what type of axis arrangement is characteristic of a particular person (vertical, horizontal or intermediate) using an ECG.

Often the position of the EOS depends on the physique of a person.

For tall people with a lean physique, a vertical or semi-vertical type of arrangement is characteristic. Short and dense people have a horizontal and semi-horizontal position of the EOS.

Intermediate options for the placement of EOS are formed due to the fact that the physique of each person is individual, and there are many others between a thin and dense body type. This explains the different position of the EOS.

Deviations

Deviation of the electrical axis of the heart to the left or right is not a disease in itself. Most often, this phenomenon is a symptom of another pathology. Therefore, doctors pay attention to this anomaly and conduct diagnostics to determine the reasons why the axis has changed its position.

Axis deviation to the left side is sometimes observed in healthy people who are actively involved in sports.

But most often this phenomenon indicates hypertrophy of the left ventricle. This disease is characterized by an increase in the size of this part of the heart. It may be accompanied by the following diseases:


If the electrical axis of the heart is shifted to the right, this can also be considered normal, but only in the case of a newborn baby. The baby may even have a strong deviation from the norm.

Note! In other cases, this position of the electrical axis is a symptom of right ventricular hypertrophy.

Diseases that cause it:

  • Problems with the respiratory system (asthma, obstructive bronchitis).
  • Heart defects.

The more pronounced hypertrophy, the more EOS changes position.

Also, the electrical axis of the heart can be displaced due to coronary disease or heart failure.

Whether it is necessary to treat?

If the EOS has changed its position, as a rule, there are no unpleasant symptoms. More precisely, they do not arise due to axis deviation. All difficulties are usually associated with the cause that caused the displacement.

Most often, such a cause is hypertrophy, so the symptoms occur are the same as with this disease.

Sometimes no signs of the disease may appear until more serious diseases of the heart and cardiovascular system form due to hypertrophy.

To avoid danger, any person needs to carefully monitor their well-being and pay attention to any discomfort, especially if they are often repeated. You should consult a doctor if you have the following symptoms:


All these signs can indicate the development of heart disease. Therefore, the patient needs to visit a cardiologist and undergo an ECG. If the electrical axis of the heart is displaced, then additional diagnostic procedures must be carried out to find out what caused it.

Diagnostics

To determine the cause of the deviation, the following diagnostic methods are used:

  • Ultrasound of the heart
  • Holter monitoring
  • x-ray
  • Coronary angiography

Ultrasound of the heart

This diagnostic method allows you to identify changes in the anatomy of the heart. It is with its help that hypertrophy is detected, and the features of the functioning of the heart chambers are also determined.

This diagnostic method is used not only for adults, but also for very young children to make sure that they do not have serious pathologies.

Holter monitoring

In this case, the ECG is performed during the day. The patient performs all his usual activities during the day, and the devices record the data. This method is used in case of deviations in the position of the EOS, accompanied by a rhythm outside sinus node.

x-ray

This method also allows you to judge the presence of hypertrophy, since the heart shadow will be expanded in the picture.

ECG during exercise

The method is a conventional ECG, the data of which are recorded while the patient is performing exercise(running, push-ups).

In this way, it is possible to establish coronary heart disease, which can also affect the change in the position of the electrical axis of the heart.

Coronary angiography

I use this method to diagnose problems with blood vessels.

EOS deviation does not imply therapeutic effects. The disease that caused such a defect should be treated. Therefore, after a thorough examination, the doctor must prescribe the necessary therapeutic effects.

This defect, revealed during the examination, needs to be examined, even if the patient does not have any complaints about the heart. Heart diseases often occur and develop asymptomatically, which is why they are detected too late. If the doctor, after diagnosing, prescribed treatment and advised to adhere to certain rules, this must be followed.

The treatment of this defect depends on what disease provoked it, so the methods may be different. The main one is drug therapy.

In extremely life-threatening situations, the doctor may recommend surgery to neutralize the disease-cause.

With the timely detection of the pathology of the EOS, it is possible to return to a normal state, which occurs after the elimination of the underlying disease. However, in most cases, the actions of doctors are aimed at preventing deterioration in the patient's condition.

Also useful as a treatment folk ways with the use of medicinal fees and tinctures. But before using them, you need to ask your doctor if such actions will harm. It is unacceptable to start taking medications on your own.

It is also important to observe measures to prevent heart disease. They are associated with a healthy lifestyle, good nutrition and rest, and a decrease in the amount of stress. It is necessary to perform feasible loads and lead an active lifestyle. From bad habits and abuse of coffee should be abandoned.

Changes in the position of the EOS do not necessarily indicate problems in the human body. But the detection of such a defect requires attention from doctors and the patient himself.

If therapeutic measures are prescribed, then they are associated with the cause of the defect, and not with it itself.

In itself, the incorrect location of the electrical axis does not mean anything.

The electrical axis of the heart is associated with the total vector of the electrodynamic force of the heart. Most often, it coincides with the anatomical axis of the organ. As a rule, the heart has the shape of a cone, it is directed by a narrow part down to the left and forward. In this case, the position of the electric axis is in the range from 0 to 90 degrees.

The presence of an electrical axis is due to the conduction system of the heart, which consists of muscle fibers. Due to their contractions, the heart contracts.

The contraction originates in the sinus node, where an electrical impulse occurs. This impulse passes through the atrioventricular node and is directed to the bundle of His. With disturbances in the conduction system, the electrical axis of the heart can change its position.

How can the EOS be located?

It is possible to determine the features of the location of the electrical axis of the heart using an ECG. The following options are usually considered normal:

  • Vertical (location range from 70 to 90 degrees).
  • Horizontal (location range from 0 to 30 degrees).
  • Semi-horizontal.
  • Semi-vertical.
  • No slope.

The figure shows the main options for the passage of the electrical axis of the heart. It is possible to determine what type of axis arrangement is characteristic of a particular person (vertical, horizontal or intermediate) using an ECG.

Electrical axis of the heart

Often the position of the EOS depends on the physique of a person.

For tall people with a lean physique, a vertical or semi-vertical type of arrangement is characteristic. Short and dense people have a horizontal and semi-horizontal position of the EOS.

Intermediate options for the placement of EOS are formed due to the fact that the physique of each person is individual, and there are many others between a thin and dense body type. This explains the different position of the EOS.

Deviations

Deviation of the electrical axis of the heart to the left or right is not a disease in itself. Most often, this phenomenon is a symptom of another pathology. Therefore, doctors pay attention to this anomaly and conduct diagnostics to determine the reasons why the axis has changed its position.

Axis deviation to the left side is sometimes observed in healthy people who are actively involved in sports.

But most often this phenomenon indicates hypertrophy of the left ventricle. This disease is characterized by an increase in the size of this part of the heart. It may be accompanied by the following diseases:


If the electrical axis of the heart is shifted to the right, this can also be considered normal, but only in the case of a newborn baby. The baby may even have a strong deviation from the norm.

Note! In other cases, this position of the electrical axis is a symptom of right ventricular hypertrophy.

Diseases that cause it:

  • Problems with the respiratory system (asthma, obstructive bronchitis).
  • Heart defects.

The more pronounced hypertrophy, the more EOS changes position.

Tetralogy of Fallot (blemish)

Also, the electrical axis of the heart can be displaced due to coronary disease or heart failure.

Whether it is necessary to treat?

If the EOS has changed its position, as a rule, there are no unpleasant symptoms. More precisely, they do not arise due to axis deviation. All difficulties are usually associated with the cause that caused the displacement.

Most often, such a cause is hypertrophy, so the symptoms occur are the same as with this disease.

Sometimes no signs of the disease may appear until more serious diseases of the heart and cardiovascular system form due to hypertrophy.

Hypertrophy of the heart

To avoid danger, any person needs to carefully monitor their well-being and pay attention to any discomfort, especially if they are often repeated. You should consult a doctor if you have the following symptoms:


All these signs can indicate the development of heart disease. Therefore, the patient needs to visit a cardiologist and undergo an ECG. If the electrical axis of the heart is displaced, then additional diagnostic procedures must be carried out to find out what caused it.

Diagnostics

To determine the cause of the deviation, the following diagnostic methods are used:

  • Ultrasound of the heart
  • Holter monitoring
  • Coronary angiography



Ultrasound of the heart

This diagnostic method allows you to identify changes in the anatomy of the heart. It is with its help that hypertrophy is detected, and the features of the functioning of the heart chambers are also determined.

This diagnostic method is used not only for adults, but also for very young children to make sure that they do not have serious pathologies.

Holter monitoring

In this case, the ECG is performed during the day. The patient performs all his usual activities during the day, and the devices record the data. This method is used in case of deviations in the position of the EOS, accompanied by a rhythm outside the sinus node.

This method also allows you to judge the presence of hypertrophy, since the heart shadow will be expanded in the picture.

ECG during exercise

The method is a conventional ECG, the data of which are recorded while the patient is performing physical exercises (running, push-ups).

In this way, it is possible to establish coronary heart disease, which can also affect the change in the position of the electrical axis of the heart.

Coronary angiography

I use this method to diagnose problems with blood vessels.

EOS deviation does not imply therapeutic effects. The disease that caused such a defect should be treated. Therefore, after a thorough examination, the doctor must prescribe the necessary therapeutic effects.

This defect, revealed during the examination, needs to be examined, even if the patient does not have any complaints about the heart. Heart diseases often occur and develop asymptomatically, which is why they are detected too late. If the doctor, after diagnosing, prescribed treatment and advised to adhere to certain rules, this must be followed.

The treatment of this defect depends on what disease provoked it, so the methods may be different. The main one is drug therapy.

In extremely life-threatening situations, the doctor may recommend surgery to neutralize the disease-cause.

With the timely detection of the pathology of the EOS, it is possible to return to a normal state, which occurs after the elimination of the underlying disease. However, in most cases, the actions of doctors are aimed at preventing deterioration in the patient's condition.

As a treatment, folk methods with the use of medicinal fees and tinctures can also be useful. But before using them, you need to ask your doctor if such actions will harm. It is unacceptable to start taking medications on your own.

It is also important to observe measures to prevent heart disease. They are associated with a healthy lifestyle, good nutrition and rest, and a decrease in the amount of stress. It is necessary to perform feasible loads and lead an active lifestyle. From bad habits and abuse of coffee should be abandoned.

Changes in the position of the EOS do not necessarily indicate problems in the human body. But the detection of such a defect requires attention from doctors and the patient himself.

If therapeutic measures are prescribed, then they are associated with the cause of the defect, and not with it itself.

In itself, the incorrect location of the electrical axis does not mean anything.

In contact with

Since the task of determining the electrical axis of the heart according to ECG data is purely geometric, it is not difficult to automate this process. Below is a script that, according to any two different leads, determines the patient's EOS. For this you need:

  • in the "Projection value" field, enter the value of the amplitude of the largest tooth of the QRS complex (the number of small cells from the isoline to the top of the tooth), while if the tooth is located above the isoline, then a positive number is entered, if below - a negative one;
  • in the "lead" drop-down list located to the right of the "Projection value" field, you must select the lead from which the data is taken;
  • press the "Calculate" button, after which the script will calculate the value of the total EMF vector and its direction (angle alpha);
  • for a more accurate determination of EOS, it is recommended to enter data from those leads where the QRS complex wave has the maximum amplitude.

ATTENTION! If in all three standard leads a negative wave is recorded in combination with a small amplitude of the entire QRS complex (the electrical axis of the heart of the type S I-S II-S III), then it is believed that this type of EOS is caused by a posterior rotation of the apex of the heart (Q I -Q II -Q III - anterior rotation of the apex of the heart). With this position of the axis, the angle alpha is not defined. EOS type S I-S II-S III occurs in patients with lung diseases, with right ventricular hypertrophy, as well as in healthy people, especially with asthenic physique.

The average electric axis of the complex QRS- the main measurement required for each electrocardiogram. In most healthy individuals, it is between -30° and +100°. An angle of -30° or more negative is described as left axis deviation, and an angle of +100° or more positive as right axis deviation. In other words, the deviation of the axis to the left is the changed position of the average electrical axis of the complex QRS in people with a horizontal position of the electrical axis of the heart. Deviation of the axis to the right is an altered position of the middle electrical axis of the complex QRS in people with a vertical position of the electrical axis of the heart.

The position of the average electrical axis of the complex QRS depends on the anatomical position of the heart and the direction of impulse propagation through the ventricles (the direction of ventricular depolarization).

Influence of the anatomical position of the heart on the electrical axis of the QRS complex

Confirmed breathing effect. When a person inhales, the diaphragm descends and the heart takes a more vertical position in the chest, which is normal. accompanied by a vertical displacement of the EOS(to the right). In patients with emphysema, an anatomically vertical position of the heart and an electrically vertical mean electrical axis of the complex are usually observed. QRS. On the contrary, when exhaling, the diaphragm rises and the heart takes a more horizontal position in the chest, which is usually accompanied by a horizontal displacement of the EOS(left).

Influence of the direction of ventricular depolarization

It can be confirmed with incomplete blockade of the anterior branch of the LBBB, when the propagation of impulses along the upper left ventricle is disturbed and the average electrical axis of the complex QRS deviated to the left (see section "Violation of intraventricular conduction"). On the contrary, with hypertrophy of the pancreas, it is deviated to the right.

How to recognize EOS deviation to the right and left

Right axis deviation

It is revealed if the average electric axis of the complex QRS is +100° or more. Remember that with high teeth R equal amplitude in leads II and III, the angle of the axis should be +90°. Approximate Rule indicates a deviation of the axis to the right, if there are high teeth in the II, III leads R, and the tooth R in lead III exceeds the tooth R in lead II. In addition, a complex is formed in lead I RS-type, where the depth of the tooth S more tooth height R(see fig. 5-8; 5-9).

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The conduction system of the heart and why is it important to determine the EOS?

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

Myocardial contraction begins with the appearance of an electrical impulse in the sinus node (which is why the correct rhythm of a healthy heart is called sinus). From the sinus node, the electrical excitation impulse 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 to the right ventricle, and the left legs. The left leg 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 leg of the bundle of His is located in the middle and lower third of the interventricular septum, the posterolateral and lower wall of the left ventricle. We can say that the back branch is somewhat to the left of the front.

The myocardial conduction system is a powerful source electrical impulses, which means that in it, first of all, electrical changes occur in the heart, preceding the heartbeat. With violations in this system, the electrical axis of the heart can significantly change its position., which will be discussed next.

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

The mass of the cardiac muscle of the left ventricle is normally much greater than the mass of the right ventricle. Thus, the electrical processes occurring in the left ventricle are stronger in total, and the EOS will be directed specifically to it. If we 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 position of the axis. 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 EOS will be considered in the range from + 70 to + 90 degrees. This position of the axis of the heart is found in tall, thin people - asthenics.
  • Horizontal position of the EOS 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 positions (normal, horizontal, semi-horizontal, vertical and semi-vertical) are found in healthy people and are not a pathology.

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.

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.

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 the position of the EOS can talk about heart disease?

In itself, the position of the EOS is not a diagnosis. but There are a number of diseases in which there is a displacement of the axis of the heart. Significant changes in the position of the EOS lead to:

  1. Coronary artery disease.
  2. Cardiomyopathy of various origins (especially dilated cardiomyopathy).
  3. Chronic heart failure.
  4. Congenital anomalies of the structure of the heart.

EOS deviations to the left

Thus, the 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 vascular resistance to blood flow, as a result of which the left ventricle must contract with greater force, the muscle mass of the ventricle increases, which leads to its hypertrophy. Ischemic disease, chronic heart failure, cardiomyopathies also cause left ventricular hypertrophy.

In addition, LVH develops when the valvular apparatus of the left ventricle is damaged. This condition leads to stenosis of the aortic mouth, in which the ejection of blood from the left ventricle is difficult, insufficiency aortic valve 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 rheumatic fever. Left ventricular hypertrophy is found in professional athletes. In this case, it is necessary to consult a highly qualified sports doctor to decide whether it is possible to continue playing sports.


Also, the EOS is deviated to the left with violations of intraventricular conduction and various heart blocks. E-mail deviation the axis of the heart to the left, along with a number of other ECG signs, is one of the indicators of the blockade of the anterior branch of the left leg of the bundle of His.

EOS deviations to the right

A shift in the electrical axis of the heart to the right may indicate right ventricular hypertrophy (RVH). Blood from the right ventricle enters the lungs, where it is enriched with oxygen. Chronic respiratory diseases associated with 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, RVH is caused by coronary heart disease, congestive heart failure, and cardiomyopathies. Deviation of the EOS to the right occurs with a complete blockade of the posterior branch of the left leg of the bundle of His.

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

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



But still The main cause of EOS displacement is myocardial hypertrophy. The diagnosis of hypertrophy of one or another part of the heart can be made according to the results of ultrasound. Any disease that leads to a displacement of the axis of the heart is accompanied by a number of clinical signs and requires further investigation. 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.

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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Normal values ​​and causes of violation

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

Healthy Electric Axis shifts to the left under the following conditions:

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

Indicator shift to the right in the absence of pathology observed in such situations:

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

Diagnostics on the ECG

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

Alpha Offset Detection

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



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

Visual Definition

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

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

Establishing diagnosis

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

  • an increase in the size of the left ventricle - hypertrophy (LVH);
  • malfunctions of the valves of the left ventricle, due to which the ventricle is overloaded with blood volume;
  • cardiac blocks, such as left bundle branch block (it looks like this on the ECG, which you can learn about from another article);
  • conduction disturbances within the left ventricle.

Diseases that are accompanied by a levogram

If a patient has an EOS deviation, then this may be due to diseases such as:

  • ischemic heart disease (CHD);
  • cardiopathy of various origins;
  • chronic heart failure (CHF) of the left ventricular type;
  • congenital heart defects;
  • myocardial infarction;
  • myocardial infection.

In addition to diseases, the intake of certain drugs can lead to blockade of the conduction system of the heart. medicines.

Additional Research

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

  • Bicycle ergometry(electrocardiogram while walking on a treadmill or on an exercise bike). Test to detect ischemia of the heart muscle.
  • ultrasound. With the help of ultrasound, the degree of ventricular hypertrophy and violations of their contractile function are assessed.
  • 24-hour Holter ECG monitoring. The cardiogram is removed during the day. Assign in cases of rhythm disturbance, which is accompanied by a deviation of the EOS.
  • X-ray examination chest. With significant hypertrophy of myocardial tissues, an increase in the cardiac shadow in the picture is observed.
  • Angiography of the coronary arteries (CAG). Allows you to determine the degree of damage to the coronary arteries in diagnosed coronary disease.
  • echocardioscopy. Allows you to purposefully determine the state of the patient's ventricles and atria.

Treatment

Deviation of the electrical axis of the heart to the left of the normal position in itself is not a disease. This is a sign determined with the help of instrumental research, which allows you to identify violations in the work of the heart muscle.

Ischemia, heart failure, and some cardiopathies are treated with drugs. Additional diet and healthy lifestyle leads to the improvement of the patient's condition.

In severe cases, surgery is required, for example, with congenital or acquired heart defects. If the conduction system is severely damaged, it may be necessary to transplant a pacemaker, which will send signals directly to the myocardium and cause it to contract.

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

Detection of displacement of the electrical axis of the heart is not a cause for concern. But if this symptom is detected, you should immediately consult a doctor for further examination and identify the cause of this condition. Annual scheduled electrocardiography allows you to timely detect abnormalities in the work of the heart and immediately begin therapy.

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Axis location

In a healthy person, the left ventricle has a larger mass than the right one.

This means that stronger electrical processes occur precisely in the left ventricle, and, accordingly, the electrical axis is directed there.

If we indicate this in degrees, then the LV is in the region of 30-700 with a value of +. This is considered the standard, but it should be said that not everyone has this axle arrangement.

There may be a deviation of more than 0-900 with a value of +, since it is necessary to take into account the individual characteristics of the body of each person.

The doctor may conclude:

  • no deviations;
  • semi-vertical position;
  • semi-horizontal position.

All of these conclusions are the norm.

As for individual characteristics, it is noted that in people of high stature and thin build, the EOS is in a semi-vertical position, and in people who are lower and at the same time they are of a stocky build, the EOS has a semi-horizontal position.

The pathological condition looks like a sharp deviation to the left or right.

Reasons for rejection

When the EOS deviates sharply to the left, this may mean that there are certain diseases, namely LV hypertrophy.

In this state, the cavity is stretched, increases in size. Sometimes this is due to overload, but it can also be the result of a disease.

Diseases that cause hypertrophy are:


In addition to hypertrophy, the main causes of left axis deviation are conduction disturbances inside the ventricles and blockades of various types.

Quite often, with such a deviation, the blockade of the left leg of His, namely its anterior branch, is diagnosed.

As for the pathological deviation of the axis of the heart sharply to the right, this may mean that there is hypertrophy of the pancreas.

This pathology can be caused by such diseases:


As well as diseases characteristic of LV hypertrophy:

  • ischemia of the heart;
  • chronic heart failure;
  • cardiomyopathy;
  • complete blockade left leg of His (posterior branch).

When the electrical axis of the heart is sharply deviated to the right in a newborn, this is considered the norm.

It can be concluded that the main cause of pathological displacement to the left or right is ventricular hypertrophy.

And the greater the degree of this pathology, the more EOS is rejected. An axis change is simply an ECG sign of some kind of disease.

It is important to timely determine these indications and diseases.

Deviation of the axis of the heart does not cause any symptoms, the symptomatology manifests itself from hypertrophy, which disrupts the hemodynamics of the heart. The main symptoms are headaches, chest pains, swelling of the extremities and face, suffocation and shortness of breath.

With the manifestation of symptoms of a cardiological nature, you should immediately undergo an electrocardiography.

Definition of ECG signs

Rightgram. This is the position at which the axis is within the range of 70-900.

On the ECG, this is expressed as high R waves in the QRS complex. In this case, the R wave in lead III exceeds the wave in lead II. There is an RS complex in lead I, in which S has a greater depth than the height of R.

Levogram. In this case, the position of the alpha angle is within the range of 0-500. The ECG shows that in the standard lead I, the QRS complex is expressed as an R-type, and in lead III, its form is S-type. In this case, the S tooth has a depth greater than the height R.

With blockade of the posterior branch of the left leg of His, the alpha angle is greater than 900. On the ECG, the duration of the QRS complex may be slightly increased. There is a deep S wave (aVL, V6) and a tall R wave (III, aVF).

When blocking the anterior branch of the left leg of His, the values ​​will be from -300 and more. On the ECG signs of this are the late R wave (lead aVR). Leads V1 and V2 may have a small r wave. At the same time, the QRS complex is not expanded, and the amplitude of its teeth is not changed.

Blockade of the anterior and posterior branches of the left leg of His (complete blockade) - in this case, the electrical axis is sharply deviated to the left, and can be located horizontally. On the ECG in the QRS complex (leads I, aVL, V5, V6), the R wave is expanded, and its top is serrated. Near the high R wave is a negative T wave.

It should be concluded that the electrical axis of the heart can be moderately deviated. If the deviation is sharp, then this may mean the presence of serious cardiological diseases.

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

Cardiac pathologies are among the most difficult to diagnose, so a whole range of techniques is used to detect them. The most common and simple method is to perform an electrocardiogram (ECG). One of the important indicators of the study is the electrical axis of the heart (EOS).

The heart is not only made up of typical muscle cells that are responsible for its contraction. The composition of the myocardium includes specific muscle fibers that are capable of generating and propagating nerve impulses. Due to their presence, the heart can contract on its own.

All these specific fibers are part of the conduction system - the cardiac complex, which provides excitability and autonomous activity of the myocardium. The conduction system of the heart (PCS) consists of 3 main formations that are interconnected and provide a coordinated contraction of all parts of the myocardium.

conduction system of the heart

Normally, the impulse occurs in the sinoatrial node - the initial formation of the PSS. Then the impulse wave propagates through the fibers and reaches the interatrial node. Further, nervous excitation spreads to the ventricles along the bundle of His and its legs. Thus, the PSS ensures the propagation of a nerve impulse throughout all parts of the heart muscle. This results in a coordinated heartbeat.

EOS is a projection of a vector that reflects all electrical processes occurring in the myocardium. According to this indicator, one can judge changes in any component of the myocardial conduction system. The position of the EOS may vary, depending on the level of the lesion.

EOS is an indicator that is determined when decoding an electrocardiogram. If a deviation of this indicator is determined, then this indicates the presence of a pathology. There are several options for the normal position of the EOS.

The position is determined by the alpha angle. It is formed by the direction of the vector and the axis I of the lead. The alpha angle is determined from a special table. To do this, you need to determine 2 indicators - the sum of all QRS teeth in leads I and III.

Electrical axis of the heart

The horizontal position of the EOS is a variant of the norm. This variant is often found in people with a hypersthenic constitution. The chest in such people is wide, has a lower height. Accordingly, the heart is located in the chest cavity more horizontally. This is a feature of the structure of the body and does not indicate the presence of pathological changes. You can determine the horizontal position by the alpha angle. With this option, its value will be in the range from 0 to +30.

Vertical position EOS also refers to physiological variants. In this case, the alpha angle index ranges from +70 to +90. The vertical position of the heart is determined in people with asthenic body structure. Their chest is narrow, high, so the heart is located more vertically. Such an arrangement is not considered pathological, and does not threaten health. The horizontal position is also an individual feature of a person.

Intermediate. In the building human body rarely there are borderline options, that is, a purely vertical or horizontal position. Intermediate options are more often identified, that is, semi-horizontal or semi-vertical. Such variants are also physiological and do not indicate the presence of pathology. In this case, the angle α is determined in the range from +30 to +70.

Causes of bias

EOS displacement is not a separate disease or pathological syndrome. However, this symptom may indicate a pathology of the cardiovascular system. If a shift of the EOS in any direction is detected, it is necessary to undergo an examination, which often includes the use of other additional methods, in addition to electrocardiography.

EOS can deviate both to the left and to the right. Taking into account the side of the deviation are determined possible reasons and consequences, depending on the primary disease.

Left

EOS deviation to the left on the ECG is determined by the angle α. In this case, the indicator ranges from 0 to -90. Axial displacement to the left is pathological and requires further examination. The main reason for the displacement of the EOS is hypertrophy of the left parts of the heart, in particular left ventricular hypertrophy. This condition is not a separate pathology and occurs in many diseases of the cardiovascular system.

Often, the EOS deviation to the left is a sign of a long-term increase blood pressure, for example when hypertension or secondary hypertension. In this case, hypertrophy of the left parts of the heart develops as a compensatory response to an increase in pressure in the aorta. The higher the pressure in the aorta, the more force the left ventricle must push the blood out. Over time, the mass of the myocardium increases, hypertrophy develops. On the ECG, this is manifested by the deviation of the EOS.

EOS shift to the left

Another disease in which EOS shifts are observed is cardiomyopathy. Regardless of the cause, in cardiomyopathy, myocardial damage is observed, in some cases manifested in the form of hypertrophy.

If axis deviation is detected to the left side, other ECG indicators should be evaluated. In the future, it may be necessary to consult a cardiologist, the use of additional studies, such as echocardiography. The consequences depend on the primary disease. In some cases, EOS deviation is not accompanied pathological changes and does not pose a threat to life.

right

Deviation to the right is pathological and may indicate myocardial damage. Such changes on the ECG occur mainly due to damage to the right heart. The reason may be various diseases myocardium, malformations of the heart and large vessels, pathology of the respiratory system.

Often, the axis shift to the right occurs due to chronic diseases lung tissue. As a result of prolonged pulmonary hypertension, myocardial hypertrophy develops compensatory. The right parts of the heart, mainly the right ventricle, are growing.

Axis shift to the right side may also indicate acute decompensation of respiratory activity. For example, such a symptom is characteristic of pulmonary embolism (PE). The electric axis can also shift due to a violation heart rate. The most common cause is blockade of the right bundle branch block.

If this symptom is detected on the ECG, an additional examination is required. Various instrumental and laboratory research methods are used to identify the cause.

For this purpose, 24-hour ECG monitoring, stress tests are prescribed - this will reveal whether the changes in the electrocardiogram are functional or irreversible.

To determine the presence of heart or lung damage, a plain chest x-ray is prescribed. On the x-ray, you can see an increase in the size of the heart, signs of pulmonary hypertension. Additionally, echocardiography is prescribed - a method that allows you to assess the condition of the heart and the degree of dysfunction.

The prognosis for detecting axis deviation varies depending on the primary condition. In some cases, the outcome is favorable: if other studies have not revealed pathology, medical intervention is not required. If pathological signs of pulmonary hypertension, pulmonary embolism, arrhythmia, cardiomyopathy are detected, the underlying disease should be treated.

Electrical impulses on the ECG, decoding

Electrocardiography is a method of additional research that reflects the electrical processes occurring in the myocardium. In addition to EOS, other indicators can be evaluated on the ECG.

First of all, teeth, segments and intervals are evaluated on the electrocardiogram. It is important to know not only normal indicators, but also what they indicate, that is, their decoding.


In addition to the analysis of individual teeth and intervals ECG interpretation also includes the determination of the source of excitation, the correctness and frequency of the rhythm, the assessment of conduction and rhythm.

EOS is an important indicator that is determined when decoding an electrocardiogram. Axial misalignment often indicates the presence of cardiac pathology. But it is impossible to differentiate diseases using this indicator. To do this, you need to use other, more specific, studies.