Displacement of the axis of the heart what. EOS deviation to the left: causes, symptoms and treatment

cardiac activity. In many patients, a shift in the electrical axis is detected - a shift either to the right or to the left. How to determine its position, what affects the change in the EOS and why is such a pathology dangerous?

Electrocardiography is used to record the electrical activity of the heart in cardiology. The result of this study is displayed in the form of a graphic record and is called an electrocardiogram.

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

The electrodes are applied in the following sequence:

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

Then six chest electrodes are applied in a certain sequence, from the middle chest to the left armpit. The electrodes are fixed with a special tape or mounted on suction cups.

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

• myocardial contraction rate
• regularity of heartbeats
• physical
• heart muscle damage
• electrolyte disturbance
• violation of cardiac conduction, etc.

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

Electrical axis of the heart: definition and factors of influence

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

Shift of the electrical axis to the left

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

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

Symptoms of a stroke and microstroke, how to recognize in time

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

Shift of the electrical axis to the right

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

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

The main consequence of all causes is an increased load on the right ventricle. As a result, it happens

During the removal of an electrocardiogram, each electrode captures a bioelectrical reaction in a strictly assigned part of the myocardium. Then, doctors, in order to calculate the position and angle of the EOS, present the chest as a coordinate system in order to further project the indicators of the electrodes onto it. Perhaps the horizontal position of the EOS, vertical and a number of other options.

The importance of the conduction system of the heart for the EOS

The conduction system of the heart muscle is atypical muscle fibers that connect different parts of the organ and help it to contract synchronously. Its beginning is considered to be the sinus node, located between the mouths of the vena cava, therefore, in healthy people, the heart rhythm is sinus. When an impulse occurs in the sinus node, the myocardium contracts. If the conduction system fails, the electrical axis changes its position, since it is there that all changes occur before the contraction of the heart muscle.

Axis directions and offset

Since the weight of the left ventricle of the heart muscle in completely healthy adults is greater than the right one, all electrical processes take place there more strongly. Therefore, the axis of the heart is turned towards him.

Normal position. If we project the location of the heart onto the proposed coordinate system, then the direction of the left ventricle from +30 to +70 degrees will be considered normal. But it depends on the characteristics of each person, so the range from 0 to +90 degrees is considered the norm for this indicator for different people.

Horizontal position (from 0 to +30 degrees). It is displayed on the cardiogram in short people with a wide sternum.

vertical position. EOS is in the range from +70 to +90 degrees. It is observed in tall people with a narrow chest.

There are diseases in which the axis shifts:

Deviation to the left. If the axis deviates to the left, this may indicate an increase (hypertrophy) of the left ventricle, which indicates its overload. This condition is often caused by arterial hypertension, which occurs for a long time, when the blood passes through the vessels with difficulty. As a result, the left ventricle works hard. Deviation to the left occurs with various blockades, lesions of the valvular apparatus. With progressive heart failure, when the organ cannot fully perform its functions, the electrocardiogram also fixes an axis shift to the left. All these diseases cause the left ventricle to work for wear, so its walls become thicker, the impulse through the myocardium passes much worse, the axis deviates to the left.

Offset to the right. Deviation of the electrical axis of the heart to the right most often occurs with an increase in the right ventricle, for example, if a person has heart disease. It can be cardiomyopathy, ischemic disease, anomalies in the structure of the heart muscle. The right deviation also causes such problems with the respiratory system as lung obstruction, bronchial asthma.

EOS norm indicators

So, in healthy people, the direction of the axis of the heart can be normal, horizontal, vertical, the heart rate is sinus regular. If the rhythm is not sinus, then this indicates a disease. The sinus rhythm is irregular - this is an indicator of the disease, if it persists during the breath hold. Displacement of the cardiac axis to the left or right may indicate problems with the heart, respiratory organs. In no case should the diagnosis be made only on the basis of EOS displacement. A cardiologist can determine the disease and prescribe treatment after a series of additional studies.

Sinus rhythm

The rhythm of the heart coming from sinus node is called sinus rhythm. In healthy adults, the sinus rate is 60 to 100 beats per minute. Most patients with heart disease also have sinus rhythm.

Signs of sinus rhythm on the ECG are:

The presence of a tooth R in front of each complex QRS;

Prong R positive in leads I, II and negative in aVR;

Constant and normal interval P− Q(0.12−0.20 s).

Sinus tachycardia - sinus rhythm with a frequency of more than 100 per minute. The causes of sinus tachycardia may be an increase in the tone of the sympathetic nervous system (physical and emotional stress), a decrease in tone vagus nerve, damage to the sinus node, the influence of various toxic agents, infectious factors and fever, taking a number of medications.

Sinus bradycardia - sinus rhythm with a frequency of less than 60 per minute. Causes of sinus bradycardia can be an increase in the tone of the vagus nerve, a decrease in the tone of the sympathetic nervous system, effects on the sinus node (hypoxia, myocardial infarction, especially the posterior wall), infectious and toxic effects (hypothyroidism, typhoid fever, diphtheria, taking cardiac glycosides and antiarrhythmic drugs) .

Sinus arrhythmia - sinus rhythm with interval variability R−R (R− R) 0.16 s or more. Distinguish between respiratory and non-respiratory sinus arrhythmia. With respiratory arrhythmia, there is a clear relationship between the duration of the cardiac cycle and the phases of respiration, which is due to changes in the tone of the sympathetic and parasympathetic nervous systems. Non-respiratory sinus arrhythmia is most often associated with damage to the sinus node itself in coronary heart disease, myocarditis, intoxication with cardiac glycosides.

Ecg 1. Sinus rhythm, Normal

Heart rate = 68 per minute Email 46° axis is normal. P−Q= 0.148 s. P= 0.096 s. QRS= 0.068 s. Q−T= 0.353 s.

Sinus rhythm. The voltage is satisfactory. Normal position of the electrical axis of the heart.

ECG 2. sinus tachycardia

Heart rate = 107 per minute Email axis 85° - vertical. P−Q= 0.160 s. P= 0.098 s. QRS= 0.067 s. Q−T= 0.275 s. Sinus tachycardia. The voltage is satisfactory. Vertical position of the electrical axis of the heart.

ECG 3. Sinus bradycardia

Heart rate = 52 per minute Email 42° axis is normal. P−Q= 0.216 s. P= 0.110 s. QRS= 0.091 s. Q−T= 0.404 s. sinus bradycardia. The voltage is satisfactory. Normal position of the electrical axis of the heart.

ECG 4. Sinus arrhythmia

Heart rate \u003d 89 per minute. Email 60° axis is normal. P−Q= 0.192 s. P= 0.100 s. QRS= 0.074 s. Q−T= 0.316 s. sinus arrhythmia. The voltage is satisfactory. Normal position of the electrical axis of the heart.

Turns of the heart around the sagittal axis (position of the electrical axis of the heart)

The electrical axis of the heart is the average direction of the electromotive force of the heart during the entire period of depolarization. Distinguish:

normal position of the electrical axis of the heart: angle α is equal to +30-+70°;

horizontal position of the electrical axis of the heart: the angle α is 0- +30°:

Deviation of the electrical axis of the heart to the left: the angle α is −30-0°;

A sharp deviation of the electrical axis of the heart to the left: the angle α is less than −30 ° (see "Blockade of the anterior branch of the left leg of the bundle of His");

· vertical position electrical axis of the heart: angle α is equal to +70- +90°:

Deviation of the electrical axis of the heart to the right: the angle α is equal to +90- +120°;

A sharp deviation of the electrical axis of the heart to the right: the angle α is more than + 120 ° (see "Blockade of the posterior branch of the left leg of the bundle of His").

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Cardiology online

Hello! My mother is 67 years old. She did an ECG and the result is as follows: sinus rhythm, the horizontal position of the EOS; LVH. What is it and how dangerous is it? Thank you very much.

Sinus rhythm means normal rhythm. The horizontal position of the electrical axis of the heart is also one of the variants of the norm, your mother is rather fat than thin. And LVH is an abbreviation (abbreviation) for Left Ventricular Hypertrophy - the muscle of the left ventricle of the heart is enlarged, it works with a greater than normal load. The reasons for this may be different: and obesity, and hypertension and heart disease. Depending on the cause and treatment will be different. But this is all beyond the scope of electrocardiography. How dangerous is it? It depends on the cause, and on the degree of LVH, and on the severity of the disease that led to LVH. There is no immediate, momentary danger, but to resolve this issue, you need to show your mother to a cardiologist.

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Electrical axis of the heart: norm and deviations

The electrical axis of the heart - those words that are first encountered when deciphering an electrocardiogram. When they write that her position is normal, the patient is satisfied and happy. However, conclusions often write about the horizontal, vertical axis, its deviations. In order not to experience unnecessary anxiety, it is worth having an idea about the EOS: what it is, and what threatens its situation, which is different from normal.

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 internal organs, which can affect the work of the heart, and in particular, the conduction system.

In a person who does not have serious health problems, the electric axis can take 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.

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.

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.

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.

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 a "cor pulmonale", characterized by intense work of the right ventricle;
• combination of coronary artery disease with hypertension- exhausts 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.

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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Sinus arrhythmia horizontal position eos what is it

Sinus rhythm of the heart on the ECG - what does it mean and what can it tell

What does it mean and what are the rules

Sinus rhythm of the heart on the ECG - what does it mean and how to determine it? There are cells in the heart that create an impulse due to a certain number of beats per minute. They are found in the sinus and atrioventricular nodes, as well as in the Purkinje fibers that make up the tissue of the heart ventricles.

Sinus rhythm on the electrocardiogram means that this impulse is generated precisely by the sinus node (the norm is 50). If the numbers are different, then the impulse is generated by another node, which gives a different value for the number of beats.

Normally, a healthy sinus rhythm of the heart is regular with varying heart rates depending on age.

Normal indicators in the cardiogram

What do you pay attention to when performing electrocardiography:

1. The P wave on the electrocardiogram necessarily precedes the QRS complex.
2. Distance PQ corresponds to 0.12 seconds - 0.2 seconds.
3. The shape of the P wave is constant in each lead.
4. In an adult, the rhythm frequency corresponds to 60 - 80.
5. The P–R distance is similar to the R–R distance.
6. The P wave in the normal state should be positive in the second standard lead, negative in lead aVR. In all other leads (this is I, III, aVL, aVF), its shape may vary depending on the direction of its electrical axis. Usually, P waves are positive in both lead I and aVF.
7. In leads V1 and V2, the P wave will be 2-phase, sometimes it can be predominantly positive or predominantly negative. In leads V3 to V6, the waveform is predominantly positive, although there may be exceptions depending on its electrical axis.
8. Normally, each P wave must be followed by a QRS complex, a T wave. The PQ interval in adults is 0.12 seconds - 0.2 seconds.

Sinus rhythm, together with the vertical position of the electrical axis of the heart (EOS), shows that these parameters are within the normal range. The vertical axis shows the projection of the position of the organ in the chest. Also, the position of the body can be in semi-vertical, horizontal, semi-horizontal planes.

When the ECG registers sinus rhythm, it means that the patient has no problems with the heart yet. It is very important not to worry and not be nervous during the examination, so as not to receive inaccurate data.

Do not check immediately after physical activity or after the patient has gone up to the third or fifth floor on foot. You should also warn the patient that you should not smoke half an hour before the examination, so as not to get unreliable results.

Violations and criteria for their determination

If the description contains the phrase: sinus rhythm disturbances, then a blockade or arrhythmia is registered. An arrhythmia is any failure in the rhythm sequence and frequency.

Blockades can be caused if the transmission of excitation from the nerve centers to the heart muscle is disturbed. For example, the acceleration of the rhythm shows that with a standard sequence of contractions, the heart's rhythms are accelerated.

If the phrase about an unstable rhythm appears in the conclusion, this is a manifestation of a small heart rate or the presence of sinus bradycardia. Bradycardia adversely affects the human condition, since the organs do not receive the amount of oxygen required for normal activity.

If an accelerated sinus rhythm is recorded, then most likely this is a manifestation of tachycardia. Such a diagnosis is made when the number of strokes is exceeded. heart rate in 110 strokes.

Interpretation of results and diagnosis

In order to make a diagnosis of arrhythmia, it is necessary to compare the obtained indicators with those of the norm. Heart rate for 1 minute should not be more than 90. To determine this indicator, you need to divide 60 (seconds) by R-R duration gap (also in seconds) or multiply the number of QRS complexes in 3 seconds (a section equal to 15 cm long of the tape) by 20.

Thus, the following deviations can be diagnosed:

1. Bradycardia - heart rate / min is less than 60, sometimes fixed P-P increase interval up to 0.21 seconds.
2. Tachycardia - heart rate increases to 90, although other signs of the rhythm remain normal. Often there can be observed slanting depression of the PQ segment, and the ST segment is ascending. At a glance, it may look like an anchor. If the heart rate rises above 150 beats per minute, blockades of the 2nd tbsp occur.
3. Arrhythmia is an irregular and unstable sinus rhythm of the heart, when the R-R intervals differ by more than 0.15 seconds, which is associated with changes in the number of inhalation and exhalation beats. Often found in children.
4. Rigid rhythm - excessive regularity of contractions. R-R differs by less than 0.05 sec. This may be due to a defect in the sinus node or a violation of its neurovegetative regulation.

Reasons for deviations

The most common causes of rhythm disturbances can be considered:

• excessive alcohol abuse;
• any heart disease;
• smoking;
• long-term use of glycosides and antiarrhythmic drugs;
• protrusion of the mitral valve;
• functional pathology thyroid gland, including thyrotoxicosis;
• heart failure;
• myocardial diseases;
• infectious lesions of valves and other parts of the heart - a disease of infective endocarditis (its symptoms are quite specific);
• overload: emotional, psychological and physical.

Additional Research

If the doctor, when examining the results, sees that the length of the area between the P waves, as well as their height, are unequal, then the sinus rhythm is weak.

To determine the cause, the patient may be recommended to undergo additional diagnostics: the pathology of the node itself or problems of the nodal autonomic system can be detected.

Then Holter monitoring is prescribed or a drug test is performed, which allows you to find out whether there is a pathology of the node itself or if the regulation of the vegetative system of the node is disturbed.

For more details about the syndrome of weakness of this node, see the video conference:

If it turns out that the arrhythmia was the result of disturbances in the node itself, then corrective measurements of the vegetative status are assigned. If for other reasons, then other methods are used, for example, the implantation of a stimulator.

Holter monitoring is a common electrocardiogram, which is carried out during the day. Due to the duration of this examination, specialists can examine the state of the heart at different degrees of stress. When conducting a conventional ECG, the patient lies on the couch, and when conducting Holter monitoring, it is possible to study the state of the body during physical exertion.

Treatment tactics

Sinus arrhythmia does not require special treatment. The wrong rhythm does not mean that there is any of the listed diseases. Cardiac arrhythmia is a common syndrome characteristic of any age.

To avoid heart problems, the right diet, daily routine, and lack of stress can help in many ways. It will be useful to take vitamins to maintain the work of the heart and improve the elasticity of blood vessels. In pharmacies, you can find a large number of complex vitamins containing all the necessary components and specialized vitamins to maintain the functioning of the heart muscle.

In addition to them, you can enrich your diet with foods such as oranges, raisins, blueberries, beets, onions, cabbage, spinach. They contain many antioxidants that regulate the number free radicals, an excessive amount of which can cause myocardial infarction.

For the smooth functioning of the heart, the body needs vitamin D, which is found in parsley, chicken eggs, salmon, and milk.

If you make a diet correctly, stick to the daily routine, you can achieve a long and uninterrupted work of the heart muscle and not worry about it until old age.

Finally, we suggest you watch a video with questions and answers about heart rhythm disorders:

Classification of sinus rhythm: what can a cardiogram tell about the state of the heart?

The sinus rhythm of the heart is just one of many indicators that are paid attention to when analyzing a cardiogram. Any deviation from the norm may be evidence of a developing disease or already running problems. Often, patients with unstable sinus rhythm do not even feel it. In order not to miss a symptom, it is worth visiting the clinic at least once a year. This is especially recommended for people:

• in the family of which cases of such diseases have already been recorded;
• working in stressful conditions;
• leading a sedentary lifestyle.

Of course, stress and sitting at a computer for a long time does not always mean that an irregular sinus rhythm or other disorders will be found in a patient, this only puts him at risk.

Read more about what the heart rhythm is, what is its norm, what threatens its violations, and what diseases it can signal - later in the article.

What is sinus rhythm on an ECG, why is it so important?

An ECG can be used to judge the condition of the heart and its problems. As a result of taking a cardiogram, the doctor receives information about the following points:

• the functioning of the nodes of the conducting system;
• heart rate (HR);
• the presence of pathological processes;
• functional disorders.

A patient who does not have the necessary knowledge is unlikely to be able to give an objective assessment of a cardiac cardiogram. Therefore, you should not worry if the doctor does not give the cardiogram and is going to take it to a specialist on his own. If a visitor has a serious problem, such as acute heart failure or myocardial infarction, then he is immediately taken to a cardiologist.

On an ECG, sinus rhythm indicates that the heart is beating correctly. Any violations can signal that the sinus node is weak and cannot cope with its functions. This is fraught with violations of the normal frequency of beats per minute and their regularity.

Read more about how to decipher the cardiogram of the heart, read further in the article.

ECG decoding: general rules

What does sinus rhythm of a particular nature mean, only a doctor can judge. However, he focuses on the norms of indicators - in adults and children they are somewhat different. This article discusses an adult electrocardiogram.

On the latter, several sections are distinguished, which are signs of sinus rhythm:

• the P wave in the second standard lead is positive and necessarily precedes the QRS complex;
• the PQ interval in duration is 0.12-0.2 seconds, the same throughout the entire cardiogram;
• the shape of the P waves has the same appearance in one lead;
• the distance R-R is equal to the distance R-R.

All this indicates a relatively normal functioning of the heart. You need to pay attention to the fact that the heart rate on the ECG of an adult should be within beats in 60 seconds. For children under 12, this figure is different. You can see it in the table below.

Note! As you can see, in adults the norm is much stricter. Any deviations can indicate violations in the rhythm.

The results of the ECG can be considered favorable if the rhythm is sinus, the heart rate is in order and the EOS - the electrical axis of the heart is vertical. If the EOS is rejected, then this may indicate some problems. A change in position can provoke pressure on some areas, thereby preventing the normal functioning of the heart.

In fact, the deviation of the EOS to the left or to the right is not critical. The axis of the heart can be in the position:

However, a certain reversal of the heart can signal problems. If the axis is tilted to the left, this may indicate left ventricular hypertrophy, hypertension, heart block, or intraventricular conduction disturbances. If the position of the electrical axis of the heart is deviated to the right, left ventricular hypertrophy or blockade may also be noted. The altered position of the electrical axis of the heart is considered normal, but at the first detection it is recommended to undergo a thorough examination.

Some patterns are interesting:

• the vertical position of the EOS is characteristic of tall and thin people of the asthenic type;
• the horizontal position of the EOS is typical for short and dense people with a wide chest.

The position of the axis of the heart must be taken into account when drawing up the conclusion.

What can a violation in sinus rhythm on a cardiogram indicate?

First of all, it is worth understanding that the normal rhythm of the heart is easily spoiled by the slightest stress or hassle. Before making a diagnosis, the doctor will have to make sure that the ECG abnormalities are not caused by external factors. This is especially true for children who are afraid of sensors - their cardiogram may be incorrect.

Attention: the sinus rhythm of the heart is the norm, which indicates the correct operation of the conduction system of this organ.

The following deviations in the contractions of the heart are distinguished:

1. Bradycardia. The heart rate decreases, the patient feels dizzy, tired, apathetic, tends to faint. The P-P interval is extended to 0.21 seconds.
2. Tachycardia. With a normal heart rate of 70 beats, the performance of such a patient may be above 90 even in a calm state. Such a pulse can cause a blockade of the 2nd level. There is an accelerated sinus rhythm.
3. Arrhythmia. It is characterized by irregular intervals R-R (more than 0.15 seconds). In this case, the patient may feel discomfort, severe anxiety, be sensitive to pressure drops. Normal heart rate in patients at rest is 75, 80 or 85 beats per second. This uneven rhythm is often found in children - this is the norm, and the vast majority outgrow this condition.
4. ectopic rhythm. In this case, the rhythm is not set by the sinus node, but by other conducting fibers. Atrial rhythm, AV node rhythm, ventricular idioventricular rhythm, and coronary sinus or coronary sinus rhythm are distinguished when the site of excitation is very close to the coronary sinus (registered only by ECG).

It is important to understand that normosystole speaks about the health of the heart muscle.

Any changes in the normal sinus rhythm are reflected in the ECG, so that a professional can easily diagnose the disease.

What affects the contractions of the heart?

When the doctor deciphers the data, he takes into account not only what value he sees on paper, but also the patient's lifestyle. Negatively affect cardiac activity:

• stress;
• smoking;
• alcohol consumption;
• taking antiarrhythmic drugs;
• physical overload.

Often the situation is normalized when a person gets into a calm environment. More than half of heart rate problems go away with stress relief. As a percentage, this figure is 62%. It is important to understand that most patients feel discomfort due to busy work. Regardless of the reasons, if there are clear signs of a violation, it is recommended to visit a doctor.

The number of beats per minute also depends on age. So, for children, 160 beats per minute can be the norm, while for adults (over 12), this figure should be 75 beats per minute.

Sometimes, to clarify the details of the rhythm, doctors prescribe a daily study. In this case, sensors and a memory device are attached to the patient, which he must wear all day. This allows you to track the behavior of the heart muscle throughout the day in various conditions.

There is an irregular rhythm on the ECG: how to treat?

If the heart rhythm deviates from the norm, then this does not mean pathological changes. Only if the doctor has made a diagnosis can we talk about prescribing medications. The conclusion of the ECG only gives a direction for additional research, but does not become a sentence.

Often problems with cardiac rhythm are eliminated by organizing the correct mode of work and rest, normalizing nutrition, and eliminating stress.

Preventing problems is best, so it's important to:

It is worth noting that the patient does not have to understand what this or that disease means. It is enough for him to adhere to the treatment plan and the recommendations of the attending doctor.

If the rhythm (sinus) is somewhat abnormal, it can be normalized with medication. They are prescribed by a cardiologist.

These products strengthen the cardiovascular system, reduce the risk of rhythm interruptions. A well-chosen diet at the same time will reduce the likelihood of myocardial infarction, which is especially important for older people.

When should you visit a cardiologist?

Cardiology is a developed branch of medicine, and now almost all diseases are amenable to drug treatment. Normally, it is worth visiting a doctor at least once a year - this will help to detect the onset of the pathological process in a timely manner. Even in paid clinics, the average cost of a comprehensive consultation is 1,100 rubles, which is affordable for most people.

In any case, the ECG, the interpretation of which should be carried out only by a doctor, is considered the basis for recognizing the cause of the disease. Each number from the electrocardiogram carries a certain meaning. What they mean - the cardiologist will help you figure it out.

Note! It should be remembered that in children, some symptoms appear differently. Therefore, the SPR (Union of Pediatricians of Russia) has its own prescriptions for the treatment of such diseases in children.

Sinus Rhythm Disorder: Summary

Sinus rhythm accompanies the normal functioning of the heart, its changes: tachycardia, bradycardia. arrhythmias indicate disturbances in the conduction system and require careful study of the ECG by a cardiologist.

It is worth warning about the peculiarities of the location of the organ in advance, since the deviation of the heart along the axis makes some adjustments to the cardiogram. Otherwise, you will have to re-pass a thorough examination each time. Knowing the characteristics of the patient's body, the doctor can make an accurate conclusion.

To prevent rhythm disturbance, it is worth reconsidering lifestyle and diet. This will reduce the risk of symptoms. It is recommended to visit a cardiologist at least once a year. If there are already violations, you need to go to the appointment strictly according to plan. The doctor appoints the dates of visits, based on the severity of the disease. In severe cases, special sensors are attached to a person, which immediately record critical changes and inform others about it.

Even if there are no complaints, a visit to a cardiologist should not be neglected. Some diseases are hidden, without causing inconvenience to the patient until a certain time.

Please note that all information posted on the site is for reference only and

not intended for self-diagnosis and treatment of diseases!

Copying materials is allowed only with an active link to the source.

The definition of EOS is a diagnostic method that displays the electrical parameters of the heart. The value that determines the position of the electrical axis of the heart is a summed indicator of bioelectrical processes that occur during heart contractions. In cardiac diagnostics, the direction of the EOS is important.

The heart is a three-dimensional organ with volume. Its position in medicine is represented and determined in a virtual coordinate grid. Atypical myocardial fibers during their work intensively generate electrical impulses. It is an integral, electrically conductive system. It is from there that electrical impulses originate, causing the movement of parts of the heart and determining the rhythm of its work. For fractions of a second before contractions, changes in the electrical nature appear, forming the magnitude of the EOS.

EOS parameters, sinus rhythm shows a cardiogram; indicators are taken by a diagnostic apparatus with electrodes that are attached to the patient's body. Each of them picks up bioelectrical signals emitted by segments of the myocardium. By projecting the electrodes onto a coordinate grid in three dimensions, the angle of the electrical axis is calculated and determined. It passes through the places of localization of the most active electrical processes.

Concept and specificity

There are several options for the location of the electrical axis of the heart, it changes its position under certain conditions.

This does not always indicate disorders and diseases. In a healthy organism, depending on the anatomy, body composition, EOS deviates from 0 to +90 degrees (+30 ... +90 is considered the norm, with normal sinus rhythm).

The vertical position of the EOS is observed when it is in the range from +70 to +90 degrees. This is typical for people of thin build with high growth (asthenics).

Intermediate types of body composition are often observed. Accordingly, the position of the electrical axis of the heart also changes, for example, it becomes semi-vertical. Such displacements are not a pathology, they are inherent in people with normal body functions.

An example of the wording in the conclusion of the ECG may sound like this: “EOS is vertical, the rhythm is sinus, the heart rate is 77 per minute.” - is considered normal. It should be noted that the term "EOS rotation around the axis", which can be noted in the electrocardiogram, does not indicate any pathologies. By itself, such a deviation is not regarded as a diagnosis.

There is a group of ailments for which vertical EOS is characteristic:

• ischemia;
• cardiomyopathy of various nature, especially in dilated form;
• chronic heart failure;
• congenital anomalies.

Sinus rhythm in these pathologies is disturbed.

Left and right position

When the electrical axis is shifted to the left, the left ventricle and its myocardium are hypertrophied (LVH). This is the most common specific deviation. Such a pathology acts as an additional symptomatology, and not independently, and indicates an overload of the ventricle and a change in the process of its work.

These problems appear with prolonged arterial hypertension.

The violation is accompanied by a significant load on the vessels that deliver blood to the organ, so the contractions of the ventricle occur with excessive force, its muscles increase and hypertrophy. The same is observed with ischemia, cardiomyopathy, etc.

The left location of the electrical axis and LVH is also observed in violations of the valvular system, while the sinus rhythm of contractions is also disturbed. The pathology is based on the following processes:

• aortic stenosis, when the exit of blood from the ventricle is difficult;
• weakness of the aortic valve, when some of the blood flows back into the ventricle and overloads it.

Marked violations - acquired or congenital. Often the cause of the first - transferred rheumatism. A change in the volume of the ventricle is also observed in people who are professionally involved in sports. They are strongly advised to consult a doctor to determine whether physical activity will cause irreparable harm to health.

Deviation to the left is also detected with impaired conduction inside the ventricle, during blockade disorders in the heart.

Hypertrophic processes of the right ventricle (HRH) accompany the right deviation of the EOS. The right side of the heart is responsible for the flow of blood to the lungs, where it is saturated with oxygen. BPH is characteristic of pathologies of the respiratory system: asthma, chronic obstructive processes in the lungs. If the disease proceeds for a long time, it causes hypertrophic changes in the ventricle.

Other causes of the pathology are the same as for the left deviation: ischemia, disturbed rhythm, heart failure in chronic form, cardiomyopathy and blockade.

Consequences of displacement and their specifics

EOS shift is found on the cardiogram. Consultation with a cardiologist and additional studies are required when the deviation is outside the normal range, which is set in the range from 0 to +90 degrees.

The processes and factors involved in the displacement of the axis of the heart, accompanied by clinically pronounced symptoms, require additional examinations without fail. Particular attention should be paid to the circumstances when, with previously stable indicators of axis deviation, a change in the ECG suddenly occurs or the sinus rhythm is disturbed. This is one of the blockade symptoms.

By itself, the deviation of the EOS does not need therapeutic measures, it is classified as a cardiological parameter, requiring, first of all, to determine the cause of the occurrence. Only the cardiologist decides whether treatment is necessary in each individual case.

VERTICAL POSITION EOS

You can use the special option of the site "Say thanks" and thank the consultant.

rhythm: izushka of the right atrium ("-" Z.R in avR, avL, V-2)

Heart rate: 75-76 (on inspiration up to 72)

EOS position: vertical

Conclusion: rhythm from the right atrial appendage, normosystole.

What does this diagnosis mean, do I need to contact a cardiologist?

I was diagnosed on the ECG (I write as it is written on the certificate):

EOS vertical. Sinus rhythm, right. overload of the left ventricle. Incomplete blockade of the right n.p.Gisa.

Kindly let me know how serious this is. Have appointed or nominated uzi of heart, I shall make only 9.11. then only to the cardiologist for an appointment (I'm worried). I am 30 years old, I work out in the gym with weights. Until then, judo. Can I practice?

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

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

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

Each electrode, when taking an ECG, registers the bioelectrical excitation that occurs in a certain area of ​​the myocardium. 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 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 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. In case of violations in this system, the electrical axis of the heart can significantly change its position, which will be discussed later.

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:

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

The structural features for each person are very individual, there are practically no pure asthenics or hypersthenics, more often 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 pathological.

So, in the conclusion of an ECG in an absolutely healthy person, it can be said: “EOS is vertical, the rhythm is sinus, the heart rate is 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. However, 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.

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

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 accompanied by pulmonary hypertension, such as bronchial asthma, chronic obstructive pulmonary disease with a long course cause hypertrophy. Pulmonary artery stenosis and tricuspid valve insufficiency lead to right ventricular hypertrophy. As with the left ventricle, 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.

Nevertheless, 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, it 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.

Sinus arrhythmia vertical position eos what is it

Sinus (sinusoidal) cardiac arrhythmia

Cardiac arrhythmias are often a manifestation of various diseases, but in some cases is not associated with the pathological process. Myocardial contraction originates automatically in the sinus node, then spreading to the atria, and then to the ventricles along the legs of the His bundle and Purkinje fibers.

In some conditions, the focus located in the myocardium becomes the source of excitation, then atrial or ventricular arrhythmia develops. If the contraction cycle is not broken, then sinus arrhythmia occurs. It can be accompanied by a fast (tachycardia), slow (bradycardia), or irregular heartbeat.

Causes

Sinus arrhythmia can occur due to a number of reasons. Leads to tachycardia:

• anemia;
• hormonal disorders;
• hyperthermia;
• increased stress on the body (physical and emotional);
• activation of the sympathetic nervous system under the influence of reception medicines or other stimulants.

Causes of bradycardia can be:

• an overdose of drugs that depress the automatism of the sinus node (for example, beta-blockers);
• hypothermia of the body;
• deficiency of thyroid hormones;
• in professional athletes;
• in the elderly due to impaired blood supply;
• sick sinus syndrome, which is a sign of a number of diseases.

Irregularity of heartbeats in sinus arrhythmia is usually associated with breathing and is not a pathology if the fluctuations do not exceed 10%. In some people, rhythm disturbance is caused by a change in body position from horizontal to vertical. In this case, cardiac arrhythmia serves as a compensatory response of the body to acute orthostatic hypotension (vertical sinus arrhythmia).

Manifestations

Sinusoidal arrhythmia can produce different symptoms depending on the heart rate. With an increase in their number, it is noted:

• feeling of pulsation in the region of the heart and in the temples;
• pain in the left half of the chest or behind the sternum due to increased stress on the myocardium;
• feeling short of breath.

If bradycardia develops, then patients complain of a feeling of fading of the heart, weakness, dizziness.

With moderate arrhythmias, there may be no symptoms, and the diagnosis is made on the basis of examination data.

Diagnostics

The main method for diagnosing arrhythmia is electrocardiography, which can be recorded once, or during the day (Holter monitoring).

With arrhythmia, the P wave must be present on the ECG, indicating that the sinus node is the source of contraction. The heart rate is usually changed up or down. To exclude the influence of the respiratory cycle on the ECG results, during the manipulation, the patient is asked to hold his breath at the height of inspiration.

To exclude organic pathologies of the heart, an ECHO-KG is performed. With the help of ultrasound, it is possible to determine the state of various structures and measure the dimensions of the chambers. With an invasive electrophysiological study, stimulation or inhibition of the sinus node is carried out and its response is evaluated. It is performed infrequently and only under strict indications.

Treatment Methods

Quite often, cardiac arrhythmias resolve on their own after the causes that caused them are eliminated, that is, they do not require specific treatment. However, severe sinus arrhythmia can lead to impaired blood supply to vital organs. Therefore, therapeutic methods and pacing can be used to treat it.

The choice of a particular drug is determined by individual characteristics and should be carried out by a doctor. With stress-related sinus tachycardia, sedatives, including those of natural origin, are used for treatment.

In case of arrhythmia with a heart rate of less than 45 per minute (in professional athletes, less than 35 per minute), which is accompanied by a violation of central hemodynamics, it is necessary to decide on the installation of a pacemaker. This miniature device is placed under the skin in the subclavian region. With the help of special programs, an electrical impulse is conducted along the electrodes to the ventricles and atria. In this case, the device starts to work when the natural frequency of contractions decreases below the established critical level.

Heart rhythm disturbances are not always associated with the disease, they can be caused by physiological processes and increased activity of the nervous system. Only a significant deviation from the noma of the heart rate can be manifested by serious hemodynamic disturbances. For the treatment of these conditions, drug methods or electrocardiostimulation are used. Preventive actions do not differ from the generally accepted ones and are aimed at maintaining a healthy lifestyle.

Normal heart rate in children and adults

Sinus arrhythmia in children: features of treatment

The child's body is not yet strong enough to fully resist external and internal factors. Sinus arrhythmia in children is considered the most common consequence of their exposure. The appearance is associated with disruption of the nervous and cardiovascular systems. In most cases, the resulting failure does not have a significant impact on health, but parents must take measures to prevent the occurrence of new seizures (paroxysms). They will have to take the baby to the doctor for an examination. The specialist will tell you what sinus arrhythmia is in children and, based on the results of the diagnosis, will conclude whether it is necessary to draw up a course of treatment, or it is enough to follow the rules of prevention.

Definition

Sinus (sinus) arrhythmia that occurs in a child is a consequence of a malfunction in the natural pacemaker (sinus node). It arises due to the influence of various external and internal factors (stress, overwork, pathologies, endocrine disruptions). A cardiologist treats irregular heartbeat.

Any parent can identify arrhythmia, knowing the pulse rate by age:

A deviation from the norm of more than 20 beats per minute (up or down) is already considered a violation of the heart rhythm. The baby cannot fully express his discomfort, so it is advisable to show the child to the doctor.

Expert opinion

Evgeny Olegovich Komarovsky is one of the best specialists in the field of pediatrics. In his opinion, mild forms of arrhythmia are characteristic of virtually all children. It is extremely difficult to meet a baby who has never suffered from this problem. Treatment is prescribed by a doctor, focusing on the patient's condition. If the case is not severe, then the specialist will seek to limit himself to lifestyle correction and folk remedies. Medicines and surgical intervention in the treatment regimen for children are used only as needed.

Types of failure

Sinus failure in the heart rhythm is divided into the following types according to the nature of the manifestation:

• tachycardia (rapid heartbeat);
• bradycardia (slow rhythm);
• extrasystole (extraordinary contraction).

The classification of the failure according to the severity will help to understand what the sinus form of arrhythmia of the heart in a child is:

• A mild form of palpitations is a consequence of the immaturity of the nervous system. It passes on its own and is not considered dangerous.
• A moderate form of failure occurs in children 5-6 years old. It has no special symptoms, therefore it is detected only with the help of an electrocardiogram (ECG).
• Severe sinus arrhythmia in a child occurs in flight. It is manifested by rather persistent paroxysms and bright clinical picture. Experts consider this species dangerous because of the likelihood of developing heart pathologies.

Non-dangerous forms of failure

Respiratory arrhythmia occurs in many children. It is characterized by an increase in heart rate on inspiration and a slowdown on exhalation. A similar reflex reaction is checked during electrocardiography by laying the patient on a couch, on top of which a cold oilcloth is laid. Because of its impact, the child instinctively holds his breath. In the presence of this form of arrhythmia, the heart rate will decrease slightly.

There is a respiratory type of failure in the rhythm of the heart due to the immaturity of the nervous system. The frequency of manifestations of seizures and their intensity depends on the age of the patient. This arrhythmia develops due to the influence of the following factors:

• postnatal (from birth to 1 week) encephalopathy;
• high level of pressure inside the skull;
• prematurity of the child;
• rickets, provoking excessive excitation of the nervous system;

• excess body weight causes tachyarrhythmia after physical exertion;
• phase of active growth (6-10 years).

The severity of the failure depends on the cause of its occurrence. Often, arrhythmia is provoked by the inability of the autonomic department to keep up with the active growth of the child. Over the years, this problem resolves itself.

The functional form is not as common as the respiratory form. It is not considered dangerous, and in most cases passes without the intervention of a doctor. Arrhythmia occurs for the following reasons:

• endocrine disruptions;
• weakened immune defense;
• immature nervous system.

More dangerous is a functional failure due to the following factors:

• diseases caused by infections (bacterial or viral);
• disrupted thyroid function.

Dangerous types of failure

The organic form of arrhythmia is considered the most severe. It is characterized by prolonged paroxysms or a constant flow. The sinus node continues to work, but due to a violation of the integrity of cardiomyocytes (heart cells) or failures in the conduction system, the heart rate (HR) jumps. An organic form develops under the influence of various diseases.

The incidence of dangerous forms of heart failure in children is 25-30% of the total. You can find the reasons for them in the list below:

• Hereditary predisposition is the main factor in the development of many pathologies. If mom or dad had diseases that provoke the occurrence of arrhythmias, then there is a possibility of their occurrence in a child.
• Pathologies caused by infections, combined with acute intoxication, fever and dehydration, have a negative effect on the heart muscle. The electrolyte balance and the composition of the interstitial fluid are disturbed, which causes failures in the conduction system.
• Vegetovascular dystonia is manifested by a violation of the function of constriction and expansion of blood vessels. The heart has to contract more often or more slowly, which leads to the development of arrhythmias and disruptions in hemodynamics (blood flow).
• Rheumatism affects the valvular apparatus, which can cause inflammatory diseases. It has a chronic course and develops due to angina. The disease is accompanied high temperature, intermittent joint pain and damage to the heart muscle.
• Inflammatory diseases of the myocardium (myocarditis, pericarditis, endocarditis), which are of a bacterial or viral nature, provoke the occurrence of various arrhythmias. Often a sinus type of failure occurs, but sometimes more dangerous forms develop (atrial fibrillation, blockade of the His bundle). The main pathological process is accompanied by pain in the chest area, high fever, swelling lower extremities, shortness of breath and liver dysfunction.
• Malformations often provoke the occurrence of a pronounced form of arrhythmia. They are eliminated only by surgery, if it is not possible to stop seizures with the help of medications.
• Tumors of the heart are extremely rare, but can cause heart rate failures. It is treated exclusively by surgery.

Sports and sinus arrhythmia

Parents send many children to sports sections, thanks to which the body is strengthened and its full development becomes possible. When detecting sinus arrhythmia, it is important to find out its nature in order to understand what physical activity is acceptable for a child:

• Non-hazardous types of failure are not a contraindication to playing sports. It is enough for parents to show the baby to a cardiologist and conduct an electrocardiographic study several times a year. The purpose of diagnosis is to monitor the development of arrhythmia. If it begins to turn into more dangerous varieties, then the process must be stopped in a timely manner.
• Dangerous forms of failure should be treated as soon as they occur. Permissible physical activity is determined by the attending physician, focusing on the causative factor and the condition of the baby.

In most cases, arrhythmia manifests itself when receiving physical activity due to hereditary predisposition. Children involved in sports professionally need to periodically consult a doctor and do an ECG every 3-4 months. If respiratory arrhythmia is detected, the child may be allowed to compete, but if its form is more severe, then the issue of stopping the athlete’s career and reducing the resulting physical activity will be decided.

Diagnosis and treatment

To draw up a full-fledged course of therapy, the child should be shown to a cardiologist. The doctor will conduct an examination and prescribe the necessary examinations. Chief among them is electrocardiography. Perform it in a standing and lying position, as well as with a load and during the day (daily monitoring).

An important indicator that is indicated on the electrocardiogram is the electrical axis of the heart (EOS). With its help, you can determine the location of the body and evaluate its size and performance. The position can be normal, horizontal, vertical or shifted to the side. This nuance is influenced by various factors:

• With hypertension, there is a shift to the left or a horizontal position.
• Congenital lung diseases cause the heart to move to the right.
• Thin people tend to have a vertical EOS, and full people have a horizontal one.

During the examination, it is important to identify the presence of a sharp change in the EOS, which may indicate the development of serious malfunctions in the body. Other diagnostic methods can be used to obtain more accurate data:

• rheoencephalography;
• ultrasound examination of the heart;
• x-ray of the thoracic and cervical spine.

Based on the results obtained, a treatment plan is drawn up. Functional and respiratory arrhythmias are not eliminated by medication. Doctors give advice on lifestyle changes. The main focus will be on the following points:

Moderate arrhythmia is stopped not only by lifestyle correction, but also by sedatives (Corvalol, tinctures of hawthorn, mint, glod) and tranquilizers (Oxazepam, Diazepam). Preparations and their dosages are selected exclusively by the attending physician.

The pronounced variety is eliminated by the correction of nutrition, rest and physical activity in combination with drug therapy. In advanced cases, as well as in the absence of the result of treatment with tablets, surgery is used.

To begin with, the specialist will have to stop the negative influence of the factor that causes arrhythmia. The following measures will help with this:

• elimination of the main pathological process;
• treatment of chronic infection;
• the abolition of medications that provoke a failure in the rhythm of the heart.

Supplement the treatment regimens with folk remedies and physiotherapy procedures. They are selected depending on the characteristics of the child's body and the presence of other pathologies.

Medical treatment

With sinus arrhythmia, the following drugs are prescribed to stabilize heart rate:

• Drugs with arrhythmic effects (Digoxin, Adenosine, Bretilium) dilate blood vessels and normalize heart rate.
• Tablets to improve metabolic processes ("Inosine", "Riboxin") protect the myocardium from oxygen starvation, thereby eliminating arrhythmia.
• Preparations based on magnesium and potassium ("Panangin", "Orokamag") normalize electrolyte balance, regulate blood pressure and stimulate neuromuscular transmission.

Surgery

If drug treatment did not help to eliminate severe arrhythmia, then the following types of minimally invasive surgical intervention are used:

• Radiofrequency ablation, the purpose of which is to cauterize the focus of an ectopic signal in the heart by passing a catheter through the femoral artery.
• Installation of an artificial pacemaker (pacemaker, defibrillator).

Physiotherapeutic procedures complement the treatment regimen well. Their list is given below:

• acupuncture;
• therapeutic baths
• laser or magnetic therapy.

ethnoscience

Facilities traditional medicine prepared from plants healing properties and have few contraindications. Before using them, you should consult your doctor to avoid undesirable consequences. The most popular recipes are:

• 300 g of dried apricots, 130 g of raisins and walnuts must be thoroughly ground and mixed with 150 ml of honey and lemon. Such a gruel helps cleanse the blood and improve the functioning of the heart muscle. Use it in an amount of 1 to 2 tbsp. l., depending on age (up to 3 years old, over four ml).
• The daily diet must be saturated with fruits. They can be cut into cereals, desserts and other dishes. Instead of a regular drink, it is recommended to drink fresh juice (apple, grape).
• Pour 30 g of dry lemon balm with a glass of boiling water and let it brew for half an hour. It is advisable to drink such a tea with a sedative effect for at least 2 weeks.

• A decoction of valerian is prepared from the roots of the plant. They must be cleaned and poured with boiling water in a ratio of 30 g per 250 ml. Then put on fire. Remove from stove after 10 minutes and let cool. Take a decoction with a pronounced sedative effect of 0.5 tbsp. l. It can also be added to the bathroom.
• Pour 30 g of rose hips with 1 cup of boiling water and add 20 ml of honey. Ready drink tones up well nervous system and improves heart function.
• Adding celery and greens to salads will saturate the body with useful substances, which will have a beneficial effect on the functioning of the heart and nervous system.

Preventive measures

Compliance with the rules of prevention will prevent attacks of arrhythmia and improve the overall well-being of the child. They can be found below:

• Make the right diet, saturating it with herbs, vegetables, fruits and berries. Cooking is recommended by steaming or by boiling. Eat small meals, but 5-6 times a day, avoiding overeating. Dinner should be no later than 3-4 hours before bedtime.
• It is better to forget about intense physical activity. The child needs more rest. Among sports, it is recommended to choose running or swimming, but initially you should limit yourself to morning exercises.

• Regardless of the season, the child should be outdoors more. It is recommended to reduce the amount of time at the computer and TV to a minimum.
• From stressful situations, the child should be completely protected. Any experiences and conflicts can aggravate his condition.
• When complications occur, side effects and other problems - you need to contact your doctor. Self-medication is strictly prohibited.

Forecast

Non-dangerous forms of arrhythmias pass virtually without the participation of a doctor and do not provoke the development of complications. Organic types of failure often lead to heart failure, asystole, atrial fibrillation and other dangerous consequences. Because of them, the child can become disabled or die. The prognosis will depend on the severity of the underlying pathological process and the effectiveness of the course of therapy. In advanced cases, surgical intervention is used.

The sinus form of arrhythmia occurs in every second baby. It rarely leads to complications and is virtually invisible. In most cases, a similar failure is detected using an ECG. If it was caused by pathologies of the heart or other organs, then the course of therapy will be aimed at eliminating them. The treatment regimen will include medications, physiotherapy and lifestyle changes. In the absence of a result, surgical intervention will be applied. Milder cases of arrhythmia are eliminated by reducing physical activity, avoiding stress and proper dietary intake.

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 cone-shaped shape, directed with its narrow end 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.

• Causes of deviations from the norm
• Symptoms
• Diagnostics
• Treatment

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 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 standing 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 impaired intracardiac blood flow, and, consequently, increased stress 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, 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:

1. 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.
2. 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.
3. 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.
4. Chest X-ray - with severe myocardial hypertrophy, an expansion of the cardiac shadow is characteristic.
5. 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 a phrase that the electrical axis of the heart is not in a normal position, this should alert him and prompt him to consult a doctor to find out the cause of such an ECG - a sign, even if there are no symptoms does not occur.

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

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

Each electrode, when taking an ECG, registers the bioelectrical excitation that occurs in a certain area of ​​the myocardium. 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 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 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. 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 pathological.

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

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 mouth of the aorta, in which the ejection of blood from the left ventricle is difficult, insufficiency of the 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.

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 additional examination. 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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1Theoretical foundations of the definition

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

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

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

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

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

1. We find QRS complexes in leads I and III;
2. We summarize the height of the teeth in the first lead;
3. Sum the height in the third lead;
   

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

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

3Why does a diagnostician need a pencil or when is it not necessary to look for the alpha angle?

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

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

4Why define this parameter?

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

1. Blockade of the anterior-upper branch of the left leg of the bundle of His;
2. Hypertrophy of the right ventricle. characteristic feature its magnification is the right axis deviation. But if there is a suspicion of left ventricular hypertrophy, the displacement of the axis of the heart is not necessary at all, and the determination of this parameter does not help much in its diagnosis;
3. Ventricular tachycardia. Some of its forms are characterized by a deviation of the EOS to the left or its indefinite position, in some cases there is a turn to the right;
4. Blockade of the posterior superior branch of the left leg of the bundle of His.

5What can be the EOS in the norm?

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

6 Norm in children

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

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

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

7 Reasons for EOS deviation to the left

The deviation of the EOS at an angle of -15 to -30 is sometimes called a slight deviation to the left, and if the angle is from -45 to -90, they speak of a significant deviation to the left. What are the main causes of this condition? Let's consider them in more detail.

1. Variant of the norm;
2. GSV of the left leg of the bundle of His;
3. Blockade of the left leg of the bundle of His;
4. Positional changes associated with the horizontal location of the heart;
5. Some forms of ventricular tachycardia;
6. Malformations of endocardial cushions.

8 Reasons for EOS deviation to the right

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

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

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

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

It should be noted that a sharp change in the electrical axis may alert the doctor. For example, if a patient has a normal or semi-vertical position of the EOS on previous cardiograms, and when taking an ECG at the moment, there is a pronounced horizontal direction of the EOS. Such drastic changes may indicate any disturbances in the functioning of the heart and require the earliest possible additional diagnostics and additional examination.

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Medical indicators

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

The patient is examined in a specialized room, which is shielded from various electrical interferences. The patient takes a supine position, a pillow is placed under the head. To take an ECG, electrodes are applied. The data is recorded during quiet breathing. At the same time, the device registers the frequency and regularity of heart contractions, including the position of the EOS and other parameters.

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

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

EOS shifts to the right in a healthy person with:

• the end of a deep breath;
• body features (asthenic).

The location of the EOS is determined by the mass of 2 parts of the ventricle. The definition of the indicator under consideration is carried out by 2 methods.

In the first case, the specialist detects a shift in the alpha angle. The value of the main indicator is calculated using a special table according to Died.

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

The electrical axis, shifted to the left, indicates the following problems:

• left ventricular hypertrophy;
• impaired functioning of the left ventricular valve;
• cardiac block.

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

Additional diagnostic methods

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

If the sinus rhythm is disturbed, EOS is rejected, 24-hour Holter ECG monitoring is performed. Data is recorded throughout the day. If the myocardial tissue is significantly hypertrophied, a chest x-ray is performed. With the help of angiography of the coronary arteries, the degree of damage to the vessels during the current ischemia is determined. Echocardioscopy allows you to determine the condition of the atria and ventricles of the heart.

Therapy of the phenomenon under consideration is aimed at eliminating the main disease. Some heart conditions are treated medical means. In addition, it is recommended to eat right and lead a healthy lifestyle.

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

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

Changes to the right

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

If necessary, the patient is prescribed additional diagnostics:

1. 1. Ultrasound - provides information about changes in the anatomy of the main organ.
2. 2. Chest x-ray - reveals myocardial hypertrophy.
3. 3. Daily ECG - performed with concomitant rhythm disturbance.
4. 4. ECG during exercise - helps to detect myocardial ischemia.
5. 5. CAG - is performed to diagnose the lesion of the coronary artery.

Axis deviation to the right can be triggered by the following pathologies:

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

Risk factors

Axis tilt to the right is a consequence of poisoning with a tricyclic antidepressant. The somatotropic effect of these drugs is observed due to the presence in them of substances that affect the conductive system of the heart. If the ECG diagnosed axis deviation in right side requires a deeper diagnosis of the patient.

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

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

If the value of the parameter under consideration in a newborn baby deviates from the norm to the right, there is no pathology.

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

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

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The range of position of the electrical axis is normal

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

In the case of heart 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.

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

How to determine the position of the electrical axis

Determination of 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 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 impaired intracardiac blood flow, and, consequently, increased stress 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.

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

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

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

The greater the degree of ventricular hypertrophy, the more 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.

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:

1. 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.
2. 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.
3. 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.
4. Chest X-ray - with severe myocardial hypertrophy, an expansion of the cardiac shadow is characteristic.
5. 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.

Aortic aneurysm diagnosis

What exactly does an ECG machine record?

Electrocardiograph fixes total electrical activity of the heart, or more precisely - the difference in electrical potentials (voltage) between 2 points.

Where in the heart there is a potential difference? Everything is simple. At rest, myocardial cells are negatively charged on the inside and positively charged on the outside, while a straight line (= isoline) is fixed on the ECG tape. When an electrical impulse (excitation) arises and propagates in the conduction system of the heart, the cell membranes pass from a state of rest to an excited state, changing the polarity to the opposite (the process is called depolarization). At the same time, the membrane becomes positive from the inside, and negative from the outside due to the opening of a number of ion channels and the mutual movement of K + and Na + ions (potassium and sodium) from the cell and into the cell. After depolarization, after a certain time, the cells go into a state of rest, restoring their original polarity (minus from the inside, plus from the outside), this process is called repolarization.

An electrical impulse sequentially propagates through the heart, causing depolarization of myocardial cells. During depolarization, part of the cell is positively charged from the inside, and part is negatively charged. Arises potential difference. When the entire cell is depolarized or repolarized, there is no potential difference. stages depolarization corresponds to contraction cells (myocardium), and stages repolarization - relaxation. The ECG records the total potential difference from all myocardial cells, or, as it is called, electromotive force of the heart(EMF of the heart). The EMF of the heart is a tricky but important thing, so let's get back to it a little lower.

Schematic arrangement of the EMF vector of the heart(in the center)
at one point in time.

Leads on the ECG

As stated above, the electrocardiograph records the voltage (electrical potential difference) between 2 points, that is, in some abduction. In other words, the ECG machine captures on paper (screen) the value of the projection of the electromotive force of the heart (EMF of the heart) on any lead.

A standard ECG is recorded in 12 leads:

• 3 standard(I, II, III),
• 3 reinforced from limbs (aVR, aVL, aVF),
• and 6 chest(V1, V2, V3, V4, V5, V6).

1) Standard leads(proposed by Einthoven in 1913).
I - between the left hand and the right hand,
II - between the left leg and right hand,
III - between the left leg and left hand.

Protozoa(single-channel, i.e. recording no more than 1 lead at any time) the cardiograph has 5 electrodes: Red(applies to right hand) yellow (left hand), green(left leg), the black(right leg) and thoracic (suction cup). If you start from right hand and move in a circle, we can say that we got a traffic light. The black electrode means “ground” and is only needed for safety purposes for grounding so that a person is not shocked if the electrocardiograph is possible to break down.

Multichannel portable electrocardiograph.
All electrodes and suction cups differ in color and place of application.

2) Strengthened limb leads(proposed by Goldberger in 1942).
The same electrodes are used as for recording standard leads, but each of the electrodes in turn connects 2 limbs at once, and a combined Goldberger electrode is obtained. In practice, these leads are recorded by simply switching the handle on a single-channel cardiograph (i.e., the electrodes do not need to be rearranged).

aVR- enhanced lead from the right hand (short for augmented voltage right - enhanced potential on the right).
aVL- enhanced abduction from the left hand (left - left)
aVF- enhanced abduction from the left leg (foot - leg)

3) chest leads(proposed by Wilson in 1934) are recorded between the chest electrode and the combined electrode from all 3 limbs.
The points of location of the chest electrode are located sequentially along the anterior-lateral surface of the chest from the midline of the body to the left hand.

I do not specify in too much detail, because for non-specialists it is not necessary. The principle itself is important (see fig.).
V1 - in the IV intercostal space along the right edge of the sternum.
V2
V3
V4 - at the level of the apex of the heart.
V5
V6 - on the left mid-axillary line at the level of the apex of the heart.

Location of 6 chest electrodes when recording an ECG.

The 12 leads indicated are standard. If necessary, "write" and additional leads:

• by Nebu(between points on the surface of the chest),
• V7 - V9(continuation of chest leads to the left half of the back),
• V3R-V6R(mirror image of chest leads V3 - V6 on the right half of the chest).

Lead value

For reference: quantities are scalar and vector. Scalars haveonly magnitude (numerical value), for example: mass, temperature, volume. Vector quantities, or vectors, haveboth magnitude and direction ; for example: speed, force, electric field strength, etc. Vectors are indicated by an arrow above the Latin letter.

Why invented so many leads? EMF of the heart is vector heart emf in 3d world(length, width, height) taking into account time. On a flat ECG film, we can only see 2-dimensional values, so the cardiograph records the projection of the EMF of the heart on one of the planes in time.

Body planes used in anatomy.

Each lead records its own projection of the EMF of the heart. First 6 leads(3 standard and 3 reinforced from the limbs) reflect the EMF of the heart in the so-called frontal plane(see Fig.) and allow you to calculate the electrical axis of the heart with an accuracy of 30° (180° / 6 leads = 30°). The missing 6 leads to form a circle (360°) are obtained by continuing the existing lead axes through the center to the second half of the circle.

Mutual arrangement of standard and reinforced leads in the frontal plane.
But there is an error in the picture:
aVL and lead III are NOT in line.
Below are the correct drawings.

6 chest leads reflect the emf of the heart in the horizontal (transverse) plane(it divides the human body into upper and lower halves). This allows you to clarify the localization of the pathological focus (for example, myocardial infarction): the interventricular septum, the apex of the heart, the lateral sections of the left ventricle, etc.

When parsing an ECG, projections of the EMF vector of the heart are used, so this ECG analysis is called vector.

Note. The material below may seem very complex. This is fine. When studying the second part of the cycle, you will return to it, and it will become much clearer.

Electrical axis of the heart (EOS)

If draw a circle and draw lines through its center corresponding to the directions of three standard and three reinforced leads from the limbs, then we get 6-axis coordinate system. When recording an ECG in these 6 leads, 6 projections of the total EMF of the heart are recorded, which can be used to assess the location of the pathological focus and the electrical axis of the heart.

Formation of a 6-axis coordinate system.
Missing leads are replaced by extensions of existing ones.

Electrical axis of the heart- this is the projection of the total electrical vector of the ECG QRS complex (it reflects the excitation of the ventricles of the heart) onto the frontal plane. Quantitatively, the electrical axis of the heart is expressed angle α between the axis itself and the positive (right) half of the axis I of the standard lead, located horizontally.

It is clearly seen that the same EMF of the heart in projections
on different assignments gives various forms of curves.

Definition rules the positions of the EOS in the frontal plane are as follows: the electrical axis of the heart matches with that of the first 6 leads, in which highest positive teeth, And perpendicular to the lead in which the size of the positive teeth is equal to the size of the negative teeth. Two examples of determining the electrical axis of the heart are given at the end of the article.

Options for the position of the electrical axis of the heart:

• normal: 30° > α< 69°,
• vertical: 70° > α< 90°,
• horizontal: 0° > α < 29°,
• sharp right axis deviation: 91° > α< ±180°,
• sharp left axis deviation: 0° > α < −90°.

Options for the location of the electrical axis of the heart
in the frontal plane.

Fine electrical axis of the heart roughly corresponds to anatomical axis(for thin people it is directed more vertically from the average values, and for obese people it is more horizontally). For example, when hypertrophy(growth) of the right ventricle, the axis of the heart deviates to the right. At conduction disorders the electrical axis of the heart can deviate sharply to the left or right, which in itself is a diagnostic feature. For example, with complete blockade of the anterior branch of the left branch of the bundle of His, there is a sharp deviation of the electrical axis of the heart to the left (α ≤ −30°), the posterior branch to the right (α ≥ +120°).

Complete blockade of the anterior branch of the left leg of the bundle of His.
EOS sharply deviated to the left(α ≅− 30°), because the highest positive waves are seen in aVL, and the equality of the waves is noted in lead II, which is perpendicular to aVL.

Complete blockade of the posterior branch of the left leg of the bundle of His.
EOS sharply deviated to the right(α ≅ +120°), because the highest positive waves are seen in lead III, and the equality of the waves is noted in lead aVR, which is perpendicular to III.

Electrocardiogram reflects only electrical processes in the myocardium: depolarization (excitation) and repolarization (recovery) of myocardial cells.

Ratio ECG intervals from phases of the cardiac cycle(ventricular systole and diastole).

Normally, depolarization leads to contraction of the muscle cell, and repolarization leads to relaxation. To simplify further, I will sometimes use “contraction-relaxation” instead of “depolarization-repolarization”, although this is not entirely accurate: there is a concept “ electromechanical dissociation“, in which depolarization and repolarization of the myocardium do not lead to its visible contraction and relaxation. I wrote a little more about this phenomenon before.

Elements of a normal ECG

Before moving on to deciphering the ECG, you need to figure out what elements it consists of.

Waves and intervals on the ECG.
It is curious that abroad the P-Q interval is usually called P-R.

Every ECG is made up of teeth, segments And intervals.

TEETH are convexities and concavities on the electrocardiogram.
The following teeth are distinguished on the ECG:

• P(atrial contraction)
• Q, R, S(all 3 teeth characterize the contraction of the ventricles),
• T(ventricular relaxation)
• U(non-permanent tooth, rarely recorded).

SEGMENTS
A segment on an ECG is called straight line segment(isolines) between two adjacent teeth. The P-Q and S-T segments are of the greatest importance. For example, segment P-Q It is formed due to a delay in the conduction of excitation in the atrioventricular (AV-) node.

INTERVALS
The interval consists of tooth (complex of teeth) and segment. Thus, interval = tooth + segment. The most important are the P-Q and Q-T intervals.

Teeth, segments and intervals on the ECG.
Pay attention to large and small cells (about them below).

Waves of the QRS complex

Since the ventricular myocardium is more massive than the atrial myocardium and has not only walls, but also a massive interventricular septum, the spread of excitation in it is characterized by the appearance of a complex complex QRS on the ECG. How to pick out the teeth?

First of all, evaluate amplitude (dimensions) of individual teeth QRS complex. If the amplitude exceeds 5 mm, the prong denote capital (big) letter Q, R or S; if the amplitude is less than 5 mm, then lowercase (small): q, r or s.

The tooth R (r) is called any positive(upward) wave that is part of the QRS complex. If there are several teeth, subsequent teeth indicate strokes: R, R’, R”, etc. The negative (downward) wave of the QRS complex located before the R wave, denoted as Q (q), and after - as S(s). If there are no positive waves at all in the QRS complex, then the ventricular complex is designated as QS.

Variants of the QRS complex.

Normal tooth. Q reflects depolarization of the interventricular septum R- the bulk of the myocardium of the ventricles, tooth S- basal (i.e., near the atria) sections of the interventricular septum. The R wave V1, V2 reflects the excitation of the interventricular septum, and R V4, V5, V6 - the excitation of the muscles of the left and right ventricles. necrosis of areas of the myocardium (for example, with myocardial infarction) causes widening and deepening of the Q wave, so this wave is always paid close attention.

ECG analysis

General scheme ECG decoding

1. Checking the correctness of ECG registration.
2. Heart rate and conduction analysis:

• assessment of the regularity of heart contractions,
• counting the heart rate (HR),
• determination of the source of excitation,
• conductivity rating.

• analysis of the QRS complex,
• analysis of the RS-T segment,
• T wave analysis,
• analysis of the interval Q - T.

Normal electrocardiogram.

1) Checking the correctness of the ECG registration

At the beginning of each ECG tape there should be calibration signal- so-called control millivolt. To do this, at the beginning of the recording, a standard voltage of 1 millivolt is applied, which should display on the tape a deviation of 10 mm. Without a calibration signal, the ECG recording is considered incorrect. Normally, in at least one of the standard or augmented limb leads, the amplitude should exceed 5 mm, and in the chest leads - 8 mm. If the amplitude is lower, it is called reduced EKG voltage which occurs in some pathological conditions.

Reference millivolt on the ECG (at the beginning of the recording).

2) Heart rate and conduction analysis:

1. assessment of heart rate regularity

Rhythm regularity is assessed by R-R intervals. If the teeth are at an equal distance from each other, the rhythm is called regular, or correct. The variation in the duration of individual R-R intervals is allowed no more than ±10% from their average duration. If the rhythm is sinus, it is usually correct.

1. heart rate count(HR)

Large squares are printed on the ECG film, each of which includes 25 small squares (5 vertical x 5 horizontal). For a quick calculation of heart rate with the correct rhythm, the number of large squares between two adjacent R-R teeth is counted.

At 50 mm/s belt speed: HR = 600 / (number of large squares).
At 25 mm/s belt speed: HR = 300 / (number of large squares).

On the overlying ECG, the R-R interval is approximately 4.8 large cells, which at a speed of 25 mm/s gives300 / 4.8 = 62.5 bpm

At a speed of 25 mm/s each little cell is equal to 0.04s, and at a speed of 50 mm/s - 0.02 s. This is used to determine the duration of the teeth and intervals.

With an incorrect rhythm, they usually consider maximum and minimum heart rate according to the duration of the smallest and largest interval R-R respectively.

1. determination of the source of excitation

In other words, they are looking for where pacemaker which causes atrial and ventricular contractions. Sometimes this is one of the most difficult stages, because various disturbances of excitability and conduction can be very intricately combined, which can lead to misdiagnosis and incorrect treatment. To correctly determine the source of excitation on the ECG, you need to know well conduction system of the heart.

Sinus rhythm(this is a normal rhythm, and all other rhythms are pathological).
The source of excitation is in sinoatrial node. ECG signs:

• in standard lead II, the P waves are always positive and are in front of each QRS complex,
• P waves in the same lead have a constant identical shape.

P wave in sinus rhythm.

ATRIAL Rhythm. If the source of excitation is in the lower sections of the atria, then the excitation wave propagates to the atria from the bottom up (retrograde), therefore:

• in leads II and III, P waves are negative,
• There are P waves before each QRS complex.

P wave in atrial rhythm.

Rhythms from the AV junction. If the pacemaker is in the atrioventricular ( atrioventricular node) node, then the ventricles are excited as usual (from top to bottom), and the atria - retrograde (i.e., from bottom to top). At the same time on the ECG:

• P waves may be absent because they overlap normal complexes QRS,
• P waves may be negative, located after the QRS complex.

Rhythm from the AV junction, P wave overlapping the QRS complex.

Rhythm from the AV junction, the P wave is after the QRS complex.

The heart rate in the rhythm from the AV connection is less than sinus rhythm and is approximately 40-60 beats per minute.

Ventricular, or IDIOVENTRICULAR, rhythm(from lat. ventriculus [ventriculus] - ventricle). In this case, the source of rhythm is the conduction system of the ventricles. Excitation spreads through the ventricles in the wrong way and therefore more slowly. Features of idioventricular rhythm:

• the QRS complexes are dilated and deformed (look “scary”). Normally, the duration of the QRS complex is 0.06-0.10 s, therefore, with this rhythm, the QRS exceeds 0.12 s.
• there is no pattern between QRS complexes and P waves because the AV junction does not release impulses from the ventricles, and the atria can fire from the sinus node as normal.
• Heart rate less than 40 beats per minute.

Idioventricular rhythm. The P wave is not associated with the QRS complex.

1. conductivity assessment.
   To correctly account for conductivity, the write speed is taken into account.

To assess conductivity, measure:

• duration P wave(reflects the speed of the impulse through the atria), normally up to 0.1s.
• duration interval P - Q(reflects the speed of the impulse from the atria to the myocardium of the ventricles); interval P - Q = (wave P) + (segment P - Q). Fine 0.12-0.2s.
• duration QRS complex(reflects the spread of excitation through the ventricles). Fine 0.06-0.1s.
• internal deflection interval in leads V1 and V6. This is the time between the onset of the QRS complex and the R wave. Normally in V1 up to 0.03 s and in V6 to 0.05 s. It is mainly used to recognize bundle branch blocks and to determine the source of excitation in the ventricles in the case of ventricular extrasystole (extraordinary contraction of the heart).

Measurement of the interval of internal deviation.

3) Determination of the electrical axis of the heart.
In the first part of the cycle about the ECG, it was explained what electrical axis of the heart and how it is defined in the frontal plane.

4) Atrial P wave analysis.
Normal in leads I, II, aVF, V2 - V6 P wave always positive. In leads III, aVL, V1, the P wave can be positive or biphasic (part of the wave is positive, part is negative). In lead aVR, the P wave is always negative.

Normally, the duration of the P wave does not exceed 0.1s, and its amplitude is 1.5 - 2.5 mm.

Pathological deviations of the P wave:

• Pointed high P waves of normal duration in leads II, III, aVF are characteristic of right atrial hypertrophy, for example, when “ cor pulmonale”.
• A split with 2 peaks, an extended P wave in leads I, aVL, V5, V6 is typical for left atrial hypertrophy such as mitral valve disease.

P wave formation (P-pulmonale) with right atrial hypertrophy.

P wave formation (P-mitrale) with left atrial hypertrophy.

P-Q interval: fine 0.12-0.20s.
An increase in this interval occurs with impaired conduction of impulses through the atrioventricular node ( atrioventricular block, AV block).

AV block there are 3 degrees:

• I degree - the P-Q interval is increased, but each P wave has its own QRS complex ( no loss of complexes).
• II degree - QRS complexes partially fall out, i.e. Not all P waves have their own QRS complex.
• III degree - complete blockade of in the AV node. The atria and ventricles contract in their own rhythm, independently of each other. Those. an idioventricular rhythm occurs.

5) Analysis of the ventricular QRST complex:

1. analysis of the QRS complex.

The maximum duration of the ventricular complex is 0.07-0.09 s(up to 0.10 s). The duration increases with any blockade of the legs of the bundle of His.

Normally, the Q wave can be recorded in all standard and augmented limb leads, as well as in V4-V6. Q wave amplitude normally does not exceed 1/4 R wave height, and the duration is 0.03 s. Lead aVR normally has a deep and wide Q wave and even a QS complex.

The R wave, like Q, can be recorded in all standard and enhanced limb leads. From V1 to V4, the amplitude increases (while the r wave of V1 may be absent), and then decreases in V5 and V6.

The S wave can be of very different amplitudes, but usually no more than 20 mm. The S wave decreases from V1 to V4, and may even be absent in V5-V6. In lead V3 (or between V2 - V4) is usually recorded “ transition zone” (equality of the R and S waves).

1. analysis of the RS-T segment

The ST segment (RS-T) is the segment from the end of the QRS complex to the beginning of the T wave. The ST segment is especially carefully analyzed in CAD, as it reflects a lack of oxygen (ischemia) in the myocardium.

Fine S-T segment located in the limb leads on the isoline ( ± 0.5mm). In leads V1-V3, the S-T segment can be shifted upward (no more than 2 mm), and in V4-V6 - downward (no more than 0.5 mm).

The transition point of the QRS complex to the S-T segment is called the point j(from the word junction - connection). The degree of deviation of point j from the isoline is used, for example, to diagnose myocardial ischemia.

1. T wave analysis.

The T wave reflects the process of repolarization of the ventricular myocardium. In most leads where a high R is recorded, the T wave is also positive. Normally, the T wave is always positive in I, II, aVF, V2-V6, with T I> T III, and T V6> T V1. In aVR, the T wave is always negative.

1. analysis of the interval Q - T.

The Q-T interval is called electrical ventricular systole, because at this time all departments of the ventricles of the heart are excited. Sometimes after the T wave, a small U wave, which is formed due to a short-term increased excitability of the myocardium of the ventricles after their repolarization.

6) Electrocardiographic conclusion.
Should include:

1. Rhythm source (sinus or not).
2. Rhythm regularity (correct or not). Usually sinus rhythm is correct, although respiratory arrhythmia is possible.
3. The position of the electrical axis of the heart.
4. The presence of 4 syndromes:

• rhythm disorder
• conduction disorder
• hypertrophy and/or congestion of the ventricles and atria
• myocardial damage (ischemia, dystrophy, necrosis, scars)

Conclusion Examples(not quite complete, but real):

Sinus rhythm with heart rate 65. Normal position of the electrical axis of the heart. Pathology is not revealed.

Sinus tachycardia with a heart rate of 100. Single supragastric extrasystole.

The rhythm is sinus with a heart rate of 70 beats / min. Incomplete blockade right leg bundle of His. Moderate metabolic changes in the myocardium.

Examples of ECG for specific diseases of the cardiovascular system - next time.

ECG interference

In connection with frequent questions in the comments about the type of ECG, I will tell you about interference that can be on the electrocardiogram:

Three types of ECG interference(explanation below).

Interference on the ECG in the lexicon of health workers is called tip-off:
a) inductive currents: network pickup in the form of regular oscillations with a frequency of 50 Hz, corresponding to the frequency of the alternating electric current in the outlet.
b) " swimming» (drift) isolines due to poor contact of the electrode with the skin;
c) interference due to muscle trembling(Irregular frequent fluctuations are visible).