The electrical axis and the electrical position of the heart

The electrical axis of the heart is a concept that represents the electrical processes in this organ. The direction of EOS shows all the bioelectric changes in total that occur during the work of the heart muscle. During the removal of the electrocardiogram, each electrode fixes the bioelectric reaction in the strictly designated part of the myocardium.

Determine the position of the EOS

  • the speed and quality of the passage of the electrical signal through the structural units of the conducting system of the heart
  • myocardial contraction ability,
  • changes in internal organs that can affect the work of the heart, and in particular, on the conducting system.

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

It is considered normal when the EOS is in the range from 0 to 90 degrees, depending on the constitutional features. Most often, a normal EOS is between 30 and 70 degrees. Anatomically, it is directed down and to the left. The intermediate position is between 15 and 60 degrees. On the ECG, the positive teeth are higher in the second, aVL, aVF leads.

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

EOS can deviate both to the left and to the right. Taking into account the side of the deviation, possible causes and consequences are determined, depending on the primary disease. The deviation of the EOS to the left on the ECG is determined by the angle?. In this case, the indicator ranges from 0 to -90. Left axis displacement is a pathology and requires further examination.

The main cause of EOS bias is hypertrophy of the left heart, in particular left ventricular hypertrophy. This condition is not a separate pathology and occurs in many diseases of the cardiovascular system. Often, the deviation of the EOS to the left side is a sign of a prolonged increase in blood pressure, for example, with hypertension or secondary hypertension.

In this case, hypertrophy of the left heart develops compensatory, in response to increased pressure in the aorta. The higher the pressure in the aorta, the more force the left ventricle should push blood. Over time, myocardial mass increases, hypertrophy develops. On the ECG, this is manifested by a deviation of the EOS. Another disease in which there is a displacement of the EOS is cardiomyopathy.

Regardless of the cause, cardiomyopathy results in myocardial damage, which in some cases manifests itself in the form of hypertrophy. If axis deviation to the left is detected, other ECG indices must be evaluated. In the future, you may need to consult a cardiologist, the use of additional studies, such as echocardiography.

The consequences depend on the primary disease. In some cases, the deviation of the EOS is not accompanied by pathological changes and does not pose a life threat. Deviation to the right is pathological and may indicate myocardial damage. Such changes on the ECG occur mainly due to damage to the right heart.

The cause can be various myocardial diseases, heart defects and large vessels, pathology of the respiratory system. Often, an axis shift to the right occurs due to chronic diseases of the lung tissue. As a result of prolonged pulmonary hypertension, myocardial hypertrophy develops compensatory. The right sections of the heart grow, mainly the right ventricle.

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

If this symptom is detected on the ECG, an additional examination is required. Various instrumental and laboratory research methods are used to identify the cause. For this purpose, daily ECG monitoring and stress tests are prescribed – this will reveal if the changes in the electrocardiogram are functional or irreversible.

To determine the presence of damage to the heart or lungs, a panoramic radiography of the chest organs is prescribed. An x-ray shows an increase in heart size, signs of pulmonary hypertension. In addition, echocardiography is prescribed – a method that allows you to assess the condition of the heart and the degree of impaired function.

The forecast for detecting an axis deviation varies depending on the initial state. In some cases, the outcome is favorable: if other studies have not revealed a pathology, drug intervention is not required. If pathological signs of pulmonary hypertension, pulmonary embolism, arrhythmia, cardiomyopathy are revealed, treatment of the underlying disease is necessary.

  • Normal – depends on the structure of the body. The axis is marked in the range from zero to 90 degrees. Usually the correct axis is located between 30 and 70 degrees and is directed downward, with a deviation to the left.
  • Intermediate – the axis is located in the range from 15 to 60 degrees. The location is also explained by the addition of the patient. In addition to the full, dense, thin, there are other types of structure of the human figure. Therefore, the intermediate location is individual.
  • Horizontal – characteristic of well-fed, squat patients, with unfolded breasts and overweight. The axis is between 13 and -35 degrees.
  • Vertical – seen in tall, underweight patients with a hollow and underdeveloped chest. The axis runs in the range of 70 to 90 degrees.

    Left ventricular hypertrophy Deviation of the EOS at an angle from -15 to -30 is sometimes called a small deviation to the left, and if the angle is from -45 to -90, they indicate a significant deviation to the left. What are the main causes of this condition? Let’s consider them in more detail.

  • Variant of norm;
  • BPV of the left leg of the bundle of His;
  • Blockade of the left leg of the bundle of His;
  • Left ventricular hypertrophy;
  • Positional changes associated with the horizontal arrangement of the heart;
  • Some forms of ventricular tachycardia;
  • Malformations of endocardial pillows.

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

    • The axis of the heart is located at an angle from 91 to 180;
    • The deviation of the electrical axis at an angle of up to 120 is sometimes called a small deviation of it to the right, and if the angle is from 120 to 180 – a significant deviation of the right.
  • Variant of norm;
  • Hypertrophy of the right ventricle;
  • Blockade of the posterior-upper branching;
  • Pulmonary embolism;
  • Dextrocardia (right-sided location of the heart);
  • A variant of the norm with positional changes associated with a vertical arrangement of the heart due to emphysema, COPD, and other pulmonary pathologies.

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

    Changes in heart activity on an electrocardiogram are triggered by many factors.

    We consider each case in more detail.

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    Heart Disease

    The main reason for the left axis shift of the heart is left ventricular hypertrophy. Changes can provoke: ischemia (including heart attacks and post-infarction cardiosclerosis), aortic and mitral valve disease, cardiomyopathy, myocardial dystrophy and other diseases.

    Cardiogram changes are possible with atrial fibrillation, heart defects (acquired and congenital), blockade of the left bundle branch block.

    A slight deviation of the EOS on electrocardiography is often found in completely healthy people, for example, athletes, in thin and tall patients.

    The electric axis can shift to the left during deep exhalation, a high-standing diaphragm and when the body position changes (from vertical to horizontal), which is caused by squeezing the diaphragm by internal organs. Such shifts are considered quite normal.

    In children, EOS can vary according to age. For example, for newborns, a right-sided deviation is characteristic and this is not a pathology. In adolescence, the angle of EOS has stable indicators.

    Most often, in children, left-sided axis deviation (up to –90 °) is caused by congenital malformations, which can be complicated by concomitant cardiovascular anomalies. This is possible with open ductus arteriosus, in case of high loads on the left ventricle, which happens with mitral heart defects or aortic coarctation. Such a picture in a child is possible with a defect in the interventricular septum or with a high standing of the diaphragmatic dome.

    A shift of the axis to the left (from 0 to –20 °) is also possible due to a change in the position of the ventricles. Congenital heart disease with incomplete atrioventricular communication, as well as defects in the atrial septum, are also accompanied by a change in axis from –20 ° to –60 °.

    Pathological conditions in which there is a displacement of the cardiac axis to the left

    The deviation of the cardiac axis to the left with an increase in the left ventricle is understandable, because physiologically this chamber of the heart is already the most powerful in mass. And this means that the heart vector will “take” the left ventricle onto itself. And the more it grows in size and grows, the more it will “go left” EOS.

    This pathology occurs at high pressure or arterial hypertension, when the heart chambers, unable to withstand the increased pressure and load, begin to gain compensatory mass – to hypertrophy. Hypertrophy as one of the symptoms occurs in heart failure, atherosclerotic vascular changes, angina pectoris, cardiac asthma, cardiomyopathies.

    Blockade of the left leg

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

    The conduction system of the heart muscle is atypical muscle fibers that connect various parts of the organ and help it contract simultaneously. Its beginning is considered to be a sinus node located between the mouths of the vena cava, so healthy people have a sinus heart rhythm. When an impulse occurs in the sinus node, the myocardium contracts.

    The heart consists not only of typical muscle cells that are responsible for its contraction. The composition of the myocardium includes specific muscle fibers that are able to generate and propagate nerve impulses. Due to their presence, the heart can contract on its own. All these specific fibers are part of the conductive system – the cardiac complex, which provides excitability and autonomic activity of the myocardium.

    The cardiac conduction system (PSS) consists of 3 main formations that are interconnected and provide a coordinated contraction of all parts of the myocardium. Normally, an impulse occurs in the sinoatrial node – the initial formation of the PSS. Then the impulse wave propagates through the fibers and reaches the interatrial node.

    Further, nervous excitement spreads to the ventricles along the bundle of His and its legs. Thus, PSS ensures the spread of a nerve impulse to all parts of the heart muscle. Due to this, a coordinated heartbeat occurs. EOS is a projection of a vector that reflects all the electrical processes that occur in the myocardium.

    At the heart of the regulation of cardiovascular functions
    systems is tonic activity
    medulla neurons, activity
    which changes under the influence of afferents
    impulses from sensitive receptors
    systems – baro- and chemoreceptors.
    Vasomotor center oblong
    the brain undergoes stimulating
    influences from overlying departments
    CNS with a decrease in blood supply
    brain.

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

    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 impulse of electrical excitation passes to the atrioventricular node and further along the bundle of His. This bundle passes in the interventricular septum, where it is divided into the right, going 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 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 posterior branch is somewhat to the left of the anterior one. The myocardial conduction system is a powerful source of electrical impulses, which means that it primarily affects the heart in an electrical state that precedes cardiac contraction. In case of violations in this system, the electrical axis of the heart can significantly change its position, which will be discussed later.

    Axis directions and its offset

    Since the weight of the left ventricle of the heart muscle in fully healthy adults is greater than the right, all electrical processes occur more strongly there. Therefore, the axis of the heart is facing him.

  • Normal position. If you project the location of the heart on 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 of this indicator in different people.
  • Horizontal position (from 0 to 30 degrees). It is displayed on a cardiogram in stunted 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.
  • 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 hardly passes through the vessels. As a result, the left ventricle is working hard. Deviation to the left occurs with various blockages, lesions of the valve apparatus. With progressive heart failure, when the organ cannot fully perform its functions, the electrocardiogram also fixes the displacement of the axis to the left. All these diseases make the left ventricle work for wear, so its walls become thicker, the impulse along the myocardium goes 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. This may be cardiomyopathy, coronary disease, abnormalities in the structure of the heart muscle. The right deviation is also caused by problems with the respiratory system, such as lung obstruction, bronchial asthma.

    The situation is normal

    The electrical axis of the heart are those words that are first encountered in decoding an electrocardiogram. When they write that her position is normal, the patient is satisfied and happy. However, in the conclusions they often write about the horizontal, vertical axis, its deviations. In order not to feel in vain anxiety, it is worth having a concept about EOS: what it is and what threatens its position, which is different from normal.

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

    EOS is an indicator that is determined by decoding an electrocardiogram. If the deviation of this indicator is determined, then this indicates the presence of pathology. There are several options for the normal position of the EOS. The position is determined by the angle alpha. It is formed by the direction of the vector and the axis of the I lead.

    The angle alpha is determined by a special table. To do this, you need to determine 2 indicators – the sum of all QRS teeth in I and III leads. The horizontal position of the EOS is a normal variant. This option is often found in people with a hypersthenic constitution. The chest of such people is wide, has a lower height.

    Accordingly, the heart is located in the chest cavity more horizontally. This is a feature of the structure of the body and does not indicate the presence of pathological changes. You can determine the horizontal position by the angle alpha. With this option, its value will be in the range from 0 to 30. The vertical position of the EOS also applies to physiological variants.

    In this case, the alpha angle indicator ranges from 70 to 90. The vertical position of the heart is determined in people with asthenic body structure. Their chest is narrow, high, so the heart is located more vertically. This arrangement is not considered pathological, and does not pose a threat to health. The horizontal position is also an individual feature of a person.

    In the structure of the human body, borderline variants are rarely found, that is, a purely vertical or horizontal position. More often, intermediate options are identified, that is, semi-horizontal or semi-vertical. Such options are also physiological and do not indicate the presence of pathology. What is the angle? determined in the range from 30 to 70.

    Variants of the position of the EOSU of healthy people have the following descriptions of the EOS: normal, semi-vertical, vertical, semi-horizontal, horizontal. Normally, as a rule, the electric axis of the heart in people older than 40 years 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 individuals, the diaphragm is low, the EOS is rejected more often to the right, the heart is in a more vertical position. In obese people, hypersthenics, on the contrary, the heart lies more horizontally, a deviation to the left is observed. In normostenics, the heart occupies an intermediate position.

    In newborns and infants, a pronounced deviation of the EOS to the right on the electrocardiogram is observed, by the year in most children the EOS goes into a vertical position. This is explained physiologically: the right heart divisions somewhat prevail over the left both in mass and electrical activity, and changes in the position of the heart can also be observed – rotations around the axes.

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    By the age of two, many children still have a vertical axis, but in 30% it becomes normal. The transition to a 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, normal EOS prevails, the vertical, less often horizontal electric axis of the heart can be more common. Summarizing the foregoing, the norm in children is considered:

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

    The muscle mass of the left ventricle (LV) is comparable to the right. Therefore, the electrical processes that occur in LV are stronger, and the EOS vector will be directed in this direction. If you design the heart on a coordinate system, the left ventricle will be located in the range of 40 0 ​​70 0 (which is considered the normal orientation of the axis). However, the individual features of the structure of the heart and physique of each patient vary the position of the EOS within the range from 0 0 to 90 0.

    The electrical axis of the heart (EOS) is a term used in cardiology and functional diagnostics that reflects the electrical processes occurring in the heart. The direction of the electrical axis of the heart shows the total amount of bioelectric changes occurring in the heart muscle with each contraction. The heart is a three-dimensional organ, and in order to calculate the direction of EOS, cardiologists present the chest in the form of a coordinate system.

    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 a narrow end down, forward and left, and the electric 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 °.

    The ECG conclusion is considered normal, in which one of the following provisions of the axis of the heart is indicated: not deviated, has a semi-vertical, semi-horizontal, vertical or horizontal position. Closer to the vertical position, the axis is located in thin tall people of asthenic physique, and to the horizontal one – in strong stocky faces of hypersthenic physique.

    For example, in the conclusion of the ECG, the patient can see the phrase: “the sinus rhythm, the EOS is not deviated . ”, or “the axis of the heart is vertical”, this means that the heart is working correctly. In the case of heart diseases, the electrical axis of the heart along with the heart rhythm It is one of the first ECG – criteria that the doctor pays attention to, and when decoding the ECG by the attending physician, it is necessary to determine the direction of the electric axis.

    Deviation of the axis of the heart to the left more often develops with hypertrophy of the left ventricle 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 hypertrophy of the left ventricle. 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 (an increase in myocardial mass or expansion of the heart chambers) due to anemia, hormonal imbalance in the body, coronary heart disease, post-infarction cardiosclerosis, changes in the structure of the myocardium after myocarditis (an inflammatory process in the heart tissue);
    • long-existing arterial hypertension, especially with constantly high pressure figures;
    • heart defects of an acquired nature, in particular stenosis (narrowing) or insufficiency (incomplete closure) of the aortic valve, leading to disruption of the intracardiac blood flow, and, consequently, an increased load on the left ventricle;
    • congenital heart defects are often the cause of the deviation of the electrical axis to the left in the child;
    • violation of conduction along the left leg of the bundle of His is a complete or incomplete blockade leading to a violation of contractility of the left ventricle, while the axis is rejected, and the rhythm remains sinus;
    • atrial fibrillation, then the ECG is not only a deviation of the axis, but also the presence of a non-sinus rhythm.

    The horizontal position of the EOS – what kind of pathology is this, what threatens a person

    In the right ventricle, hypertrophic processes accompany the deviation of the EOS to the right. The right area of ​​the organ is responsible for the flow of blood to the lungs, where it is saturated with oxygen. Characterized by GVH for diseases of the respiratory system: pulmonary obstructive processes of a chronic type, asthma. If the disease lasts a long time, it provokes ventricular hypertrophic changes.

    The horizontal position of the EOS is between 15 and -30 degrees. It is characteristic for healthy people with a hypersthenic physique – a wide chest, short stature, and increased weight. The heart of such people “lies” on the diaphragm. On the ECG, the highest positive teeth are recorded in aVL, and the deepest negative ones in aVF.

    The deviation of the EOS to the left is its location in the range from 0 to -90 degrees. Up to – 30 degrees can still be considered a variant of the norm, but a more significant deviation indicates a serious pathology or 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 a deviation of the EOS to the left:

    • hypertrophy of the left ventricle of the heart – a companion and the consequence of prolonged arterial hypertension;
    • violation, conduction block on the left leg and fibers of the bundle of His;
    • left ventricular myocardial infarction;
    • heart defects and their consequences, changing the conduction system of the heart;
    • cardiomyopathy, which violates the contractility of the heart muscle;
    • myocarditis – inflammation also violates the contractility of muscle structures and conduction of nerve fibers;
    • cardiosclerosis;
    • myocardial dystrophy;
    • deposition of calcium 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 goes longer on the left side and the axis deviates to the left. On the ECG in the second and third leads, deep S waves are characteristic.

    Eos is rejected to the right if it is in the range from 90 to 180 degrees. Possible causes of this phenomenon:

    • violation of the conduct 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 result of which is a “pulmonary heart”, characterized by intense work of the right ventricle;
    • a combination of IHD with hypertension – depletes the heart muscle, leads to heart failure;
    • TELA – blocking blood flow in the branches of the pulmonary artery, of thrombotic origin, as a result, the blood supply to the lungs is impoverished, their vessels are spasmodic, 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;
    • pulmonary 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.

    The heart muscle is the main mechanism of the human body. EOS horizontal position – what is it? To confirm heart disease, various indicators of the work of the heart are considered. The horizontal position and other axis offsets indicate heart disease, vascular problems.

  • Variant of norm;
  • Variant of norm;

    Quite often, after passing the ECG, the subject can be put on a card with a record such as the vertical position of the EOS. The degree of correlation and physique (according to Chernorutsky) of a person are also indicated there. What does the position of the electric axis of the heart indicate and why did the doctors introduce this term into medical practice?

    What does the vertical position of the EOS mean and does it indicate that a person has any problems in the cardiovascular system? So, the electrical axis of the heart is a concept from the field of cardiology that describes the position of the heart. To describe it, use the line of the resulting vector on the front axis along the QRS.

    The angle itself in a healthy person is formed in a ratio from 0 to 90 degrees, possibly with a small deviation from the norm. All this indicates that there are no problems in the work of the cardiovascular system in humans. However, such a parameter as the physique of the subject is taken into account. Depending on this, for him, the normal position of the electrical axis of the heart can vary from vertical to horizontal.

    The first corresponds to those with an asthenic physique (predominantly thin). The gender of the person to the position of the EOS does not matter. That is, for both boys and girls, with a lean body structure, the normal position of the electric axis is vertical. If it is horizontal or with a huge deviation from the norm, this is considered a pathology.

    What is the principle used to determine the electrical axis of the heart? To describe the rhythm of his work. After all, contractions of the heart muscle in each individual person occur with a different rhythm. Thin people are faster than those with predominantly increased muscle mass, although here we are talking more about whether a person is engaged in sports or completely neglects his physical form.

    If during the ECG the vertical axis of the heart is indicated, and the doctor also makes a note on the card about the presence of a regular sinus rhythm, this indicates that, in principle, no problems with the work of the cardiovascular system were found. A person is conditionally considered healthy if the ECG did not show any pathologies and deviations in the research process.

    Sinus rhythm deviation is a complete destabilization of contractions of the heart muscle. This already carries a rather high risk for human health. A reasonable question arises, is it necessary for a healthy person to know his EOS? What will the knowledge of the angle of the electric axis of the heart give him and does it help in any way in the diagnosis of diseases of the cardiovascular system?

    For a healthy person, there is no need to understand all such concepts. If his heart has never hurt, there is no increased or low blood pressure, then the position of the electric axis in any case will be considered normal for his body. You need to understand that the location of the heart for each individual person is individual.

    Why can the position of the heart in the chest area change? Because the heart muscle is not attached to any of the organs, not to mention the abdominal cavity. At its core, it is always in limbo and held in motion by the movement of the diaphragm, lungs, bronchi and the alimentary canal. In this case, blood vessels connect to the heart in the upper part, which again acts as an elastic support.

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

    And it should be understood that initially the concept of the electric axis did not mean exactly the position of the heart muscle, but the direction of action of the electromotive force of the heart at the time of contraction. However, this indicator also directly affects the position of the muscle itself, because squeezing the contents of the muscle is performed only in one direction (from the vein to the aorta and arteries).

    In the opposite direction, the electromotive force cannot be directed, since this already indicates the presence of atrophy of the sphincter and the heart valve. The electrical axis of the heart is diagnosed by the results of an ECG and a graph that looms when the heart muscle contracts. There are no diagnostic methods for checking the position of the heart.

    Semi-horizontal position of the electrical axis of the heart (? A = 30 °). A – the axis of the heart is perpendicular to the III lead: RIII = SIII; B – on an ECG (patient with chronic coronary heart disease): RI = RIIRIII and RIII = SIII, QRSIII split. Semi-horizontal position of the electrical axis of the heart (? A = 30 °). The electrical axis of the heart is clearly perpendicular to the III standard lead, since its direction coincides with the location of the axis of the lead aVR.

    The algebraic sum of teeth in lead III is 0, so RIII = SIII. The aVR lead axis divides the angle of the Einthoven triangle into 2 angles of 30 °. In this regard, with an accuracy of 30 °, the electrical axis of the heart is equally parallel to I and II standard leads. The axis of the heart is projected onto the positive parts of the axes of these leads.

    Its projection on the axis of these leads is the same. Therefore, RI = RII and RI = RIIRIII. Due to the fact that the location of the electrical axis of the heart coincides with the direction of the axis of the lead aVR and the electric axis is projected onto the negative part of the axis of this lead, the presence of deep Q or S in the lead aVR of large amplitude confirms the diagnosis.

    Thus, for the semi-horizontal position of the electrical axis of the heart with? A = 30 °, the following tooth ratio is characteristic: RI = RIIRIII; RIII = SIII. However, the equality of the R and S teeth in the III standard lead is of greatest importance for the diagnosis. The horizontal position of the electrical axis of the heart (? A = from 0 to 30 °).

    As was shown in the previous case, at? A = 30 °, the axis of the heart is equally parallel to I and II standard leads and clearly perpendicular to III lead. At? A 0 °, the electric axis is most parallel to the I standard lead, its projection onto the axis of this lead is greatest and exceeds the similar projection to the II axis of the standard lead.

    Therefore RIRII. The electrical axis of the heart is not clearly perpendicular to axis III of the standard lead and is projected onto the negative part of the axis of this lead, in connection with which RIII will be the smallest of the three standard leads, and the algebraic sum of the teeth in this lead will be negative, i.e. SIIIRIII. Therefore, RIRIIRIII and SIII RIII.

    The figure shows the projection of the electrical axis of the heart onto the axis of abduction aVF. As you know, the axis of this lead is perpendicular to axis I of the standard lead. The axis of the heart is projected onto the positive part of the axis of abduction aVF; therefore, the algebraic sum of the teeth in this assignment is positive and RaVFSaVF.

    Is treatment necessary?

    Sinus rhythm and vertical EOS position

    In the heart there are cells that create an impulse by a certain number of beats per minute. They are located in the atrioventricular and sinus nodes, in the Purkinje fibers entering the ventricular tissue. On the ECG, the sinus rhythm with vertical EOS means that the sinus node is directly responsible for generating such a pulse (50 is the norm).

    If the value is different, then the pulse is generated by another node issuing other numbers. A healthy heart sinus rhythm is normally normal, heart rate is different, depending on age. The rhythm frequency in newborns can range from 60 to 150 per minute. The rhythm frequency with adulthood slows down and approaches 6-7 years to adult values. In a healthy adult, this figure is from 60 to 80 per minute.

    For many years unsuccessfully fighting hypertension? Head of the Institute: “You will be amazed how easy it is to cure hypertension by taking it every day. The human heart is a kind of trigger for the productive work of the whole organism. Thanks to the pulses of this organ, which are issued in a regular mode, the blood has the ability to circulate throughout the body, saturating the body with vital substances.

    If the heart is normal, then the whole body works as productively as possible, but sometimes you still have to face certain health problems. If a person comes to the doctor for an examination and the specialist has suspicions that his heart is not all right, he sends the patient on an ECG. The sinus rhythm on the ECG is a very important indicator and clearly gives data on the real state of the human heart muscle.

    In the concept of medical staff, the sinus rhythm of a cardiogram is the norm for the human body. If there are identical gaps between the teeth shown on the cardiogram, the height of these columns is also the same, then there are no deviations in the functioning of the main organ. Therefore, the sinus rhythm on the cardiogram is as follows:

    • graphic image of a person’s heartbeat;
    • a set of teeth of different lengths, between which different intervals, showing a specific rhythm of heart pulses;
    • a schematic representation of the work of the heart muscle;
    • an indicator of the presence or absence of deviations in the work of the heart and its individual valves.

    Normal sinus rhythm is present only when the heart rate is not less than 60 and not more than 80 beats per minute. It is such a rhythm that is considered normal for the human body. and on the cardiogram, it is displayed with teeth of the same size, located at the same distance from each other.

    It is clearly worth remembering that the results of a cardiogram can be one hundred percent accurate only if the person is completely calm. Stressful situations and nervous tension contribute to the fact that the heart muscle begins to emit pulses faster, which means that it will not be possible to get a reliable result about a person’s health status.

    Decoding of the results of the cardiogram is performed by doctors according to a special scheme. Medical professionals have a clear understanding of which marks on the cardiogram are normal and which are deviations. The ECG conclusion will be set only after calculating the results, which were displayed in a schematic form. When a doctor examines a patient’s cardiogram in order to correctly and accurately decipher it, he will pay special attention to a number of such indicators:

    • the height of the columns displaying the rhythm of heart pulses;
    • the distance between the teeth on the cardiogram;
    • how sharply the performance of the schematic image fluctuates;
    • what exactly is the distance between the columns representing the pulses.
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    A doctor who knows what each of these schematic marks means, carefully examines them and can clearly navigate what kind of diagnosis should be made. Cardiograms of children and adults are deciphered according to the same principle, but normal indicators for people of different age categories cannot be the same.

    Electrocardiogram readings can indicate clear signs of problems in the functioning of the heart muscles. Using this study, you can see if there is a weakness in the sinus node, and what kind of health problems it causes. Considering the indicators of the cardiogram of a particular patient, a medical specialist can decipher the presence of problems of the following nature:

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

    Sinus bradycardia is a frequent abnormality, especially when it comes to the health of the child. This diagnosis can be explained by many factors, among which physiological malformations or simply the factor of chronic fatigue may be hidden. Deviation of the EOS to the left also indicates that the work of the vital organ is not properly established.

    Having determined such deviations, the doctor will send the patient for an additional examination and ask him to take a number of necessary tests. If the vertical position of the EOS is observed, this means that the heart is in a normal position and is in place, there are no serious physiological deviations.

    This situation is an indicator of the norm, which is also indicated in the conclusion of the doctor who decoded the cardiogram. If there is a horizontal position of the EOS, then this cannot immediately be considered a pathological condition. Such axis indicators are observed in people who have short stature, but rather wide shoulders.

    If the axis deviates to the left or right, and this is very noticeable, then such indicators can talk about the pathological condition of the organ, an increase in the left or right ventricles. A displacement of the axis may indicate that damage to certain valves is present. If the axis shifts to the left, then the person most likely has heart failure. If a person suffers from ischemia, then the displacement of the axis occurs to the right. Such a deviation can also tell about abnormalities in the development of the heart muscle.

    On the ECG, the sinus rhythm is always and without fail compared with certain norm indicators. Only knowing these indicators completely, the doctor will be able to figure out the patient’s cardiogram and give the right conclusion. Normal factors for children and adults are completely different factors. If we consider the norm issues for different age categories, then they will be approximately as follows:

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

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

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

    • people regularly drink alcohol;
    • the patient smokes cigarettes for a fairly long time on a regular basis;
    • a person is regularly exposed to various kinds of stressful situations;
    • the patient often uses antiarrhythmic drugs;
    • a person has problems with the thyroid gland.

    Of course, an accelerated heart rate or too slow can speak of problems of a more serious nature. If the results of the cardiogram are not normal, then this may indicate acute heart failure, valve displacement, congenital heart defects. If the sinus rhythm is within the established norm, then the person should not worry, and the doctor will be able to make sure that his patient is healthy.

    The sine node regularly emits pulses that cause the heart muscles to contract properly and distribute the necessary signals throughout the body. If these impulses are given irregularly, which can be clearly detected by a cardiogram, then the doctor will have every reason to assume that the person has health problems. After studying the heart rate, the doctor will determine the exact cause of all the deviations and will be able to offer the patient competent treatment.

    The sinus rhythm, which is displayed on the ECG, clearly indicates whether there are abnormalities in the work of the heart and in which directions the problem is observed. Regularly undergoing such a study is necessary not only for adults, but also for children. The results of the performed cardiogram will help the person to receive the following information:

    • whether he has pathologies and diseases of an innate nature;
    • what pathologies in the body cause heart problems;
    • can a person’s way of life become a cause of disturbances in the functioning of the main organ;
    • whether the heart is in the correct position and whether its valves are working properly.

    The normal sinus rhythm on the ECG is displayed in the form of teeth of the same size and shape, while the distance between them is also the same. If any deviations from this norm are observed, then a person will have to be examined additionally. The sinus rhythm on the cardiogram should coincide with the framework of the established norm, and only in this case can a person be considered healthy.

    If the impulses from the heart to other systems diverge too quickly or slowly, then this does not bode well. So, doctors will have to further clarify the cause of the problem and deal with its complex treatment. If an uneven rhythm is observed on the cardiogram of a teenager, then this cannot be considered a pathological deviation, because such a condition can be associated with hormonal changes and physiological aging of the body.

    If the sinus rhythm is within normal limits, then you will not have to take additional tests and undergo repeated studies. Normal heart function, as well as pathological abnormalities, are always recorded by a cardiogram. The sinus rhythm on the ECG should be smooth and clear, without any broken lines, too long or short intervals.

    If the presented indicators are normal, then we can safely say that the person is completely healthy. Deviations in the cardiogram are the reason for doctors to perform additional studies and prescribe tests. Only after additional examinations can you understand the exact cause of the deviations and begin treatment.

    A general idea of ​​EOS – what it is

    It is known that the heart during its tireless work generates electrical impulses. They are born in a certain zone – in the sinus node, then normally the electrical excitation passes to the atria and ventricles, propagating through the conducting nerve bundle, called the bundle of His, through its branches and fibers.

    In total, this is expressed as an electric 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 teeth on the axis of the Einthoven triangle formed by standard ECG leads from the extremities:

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

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

    ECG electrical impulses, transcript

    Electrocardiography is an additional research method that reflects the electrical processes that occur in the myocardium. In addition to EOS, other indicators can be evaluated on the ECG. First of all, teeth, segments and intervals are evaluated on an electrocardiogram. It is important to know not only normal indicators, but also what they indicate, that is, their decoding.

  • Prong R. testifies to the state of the atria. The duration of the P wave is estimated, normally it is less than 0,1 s.
  • PQ interval Reflects the slowdown in the speed of the electrical impulse in the atrioventricular node. An important indicator is its duration, normally – no more than 0,2 s.
  • QRS complex. Reflects ventricular contraction. Not only the duration of the entire complex is evaluated, but also individual teeth. The duration of the complex should not exceed 0,1 s. An important element is the R wave – its duration and amplitude are estimated.
  • Segment ST. Reflects the phase of repolarization. Therefore, the indicator can be judged on the presence or absence of ischemia. Assess its location relative to the contour (higher or lower).

    In addition to the analysis of individual teeth and intervals, the decoding of the ECG also includes determining the source of excitation, the correctness and frequency of the rhythm, assessing conductivity and rhythm. EOS is an important indicator that is determined when decoding the electrocardiogram. An axis shift often indicates the presence of a pathology of the heart. But to differentiate diseases with the help of this indicator is impossible. To do this, use other, more specific, studies.

    EOS vertical position

    When verticalized, the electric axis is between 70 and 90 degrees. It is found in people with a narrow chest, tall and thin. Anatomically, the heart literally “hangs” in their chest. On the ECG, the highest positive teeth in are recorded in aVF. Deep negative – in aVL.

    In infants and newborns, a marked right deviation of the axis on the ECG is noted, by the year in almost all children the EOS becomes vertical. This is explained physiologically: in the heart, the right departments to some extent prevail over the left both in electrical activity and in mass, the position of the heart, that is, rotations around the axes, can also change. In many children, by the age of two years, the axis is still vertical, in 30% it becomes normal.

    In preschool and school age, the normal axis prevails, more often the vertical axis can occur, and the horizontal axis is less common.

    We examined what vertical EOS means.

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

    Are sinus arrhythmias and vertical EOS dangerous?

    EOS is shifted, which is determined on the cardiogram. Additional research and medical advice is required when the deviation leaves the normal limits set in the range 0 . 90˚.

    Factors and processes that affect the displacement of the heart axis are accompanied by clinically severe symptoms, and require additional additional examinations. Particular attention should be paid to factors when, with previously existing stable values ​​of axial deviation, an ECG change or a sinus rhythm defect suddenly appears. Such a symptom is one of the signs of blockade.

    Deviation of the axis itself does not need therapy, it refers to cardiological parameters that require first of all the establishment of the cause of the appearance. Only a cardiologist will determine if treatment is needed in each individual situation.

    Sinus arrhythmia is characterized by a change in the duration of the intervals between contractions of the heart, which occurs due to a disorder in the conduct or generation of electrical impulses in the myocardium. Heart rate can be within normal limits (60–90 beats per minute), as well as be disturbed. Arrhythmias have a different nature, causes and severity.

    With this problem, people turn to a therapist, but the treatment of the disease may be the responsibility of a cardiologist, neurologist, or even a psychotherapist.

    The situation itself cannot serve as a basis for making a specific diagnosis, only indicating the presence of electrical disturbances. No cardiologist will convince you of the presence of pathology only by EOS. To establish the fact of the disease, it is necessary to support the conclusion of the examination with the correct clinical survey and additional diagnostic measures. A number of factors influence the position of the EOS

    • congenital heart defects;
    • secondary changes in the anatomical relationships between the right and left parts of the heart;
    • abnormal location of organs in the chest cavity (dextrocardia, vicar emphysema after lobectomy);
    • chest deformity (kyphosis, scoliosis, keeled or funnel-shaped curvature);
    • disruptions in the conduction system of the organ (especially in the bundles of Giss), which cause disturbances in the heartbeat;
    • cardiomyopathies of various origins;
    • long history of hypertensive and coronary heart disease (CHD);
    • chronic heart failure;
    • respiratory diseases with obstructive component (COPD, bronchial asthma, emphysema);
    • decompensated liver failure (ascites, flatulence).
  • Hypertrophy of the left half of the heart. Angle? directly proportional to the degree of LV mass growth. Pathology develops with idiopathic cardiomyopathy, arterial hypertension, excessive stress (“sports heart”), coronary heart disease, cardiosclerosis.
  • Myocardial infarction (with necrosis on the back wall).
  • Pathology of intracardiac conduction. Most often this is a blockade of the left leg or anteroposterior branch of the bundle of Giss.
  • Ventricular tachycardia.
  • Valvular heart defects.
  • Myocarditis.
  • Failures in the conduction of a nerve impulse along the fibers of the bundle of His.
  • Pulmonary stenosis (when pressure in the right ventricle rises).
  • Right myocardial infarction.
  • Cardiorespiratory diseases that formed a “pulmonary heart” (in this case, the LV functions poorly and overload of the right ventricle occurs).
  • Thromboembolism of the branches of the pulmonary artery (due to blockage, gas exchange in the lungs is disturbed, blood vessels of the pulmonary circulation are narrowed and pancreatic overload occurs).
  • Mitral valve stenosis (after rheumatic fever). The fusion of the valves between themselves prevents the full expulsion of blood from the left atrium, which causes pulmonary hypertension and overloads the pancreas.

    A sharp deviation of the EOS to the right is observed when the angle? = 120 0. It is worth remembering that not one of the above diseases can be diagnosed based solely on the provisions of the EOS. This parameter is only an auxiliary criterion in identifying any pathological process.

    Deviation of the axis is often not a sign of an acute condition. But if a sharp violation of the EOS with a value of more than 90 0 is registered, then this may indicate a sudden disorder of conduction in the myocardium and threaten cardiac arrest. Such patients require immediate specialized medical care in order to find the cause of such a sharp change in current direction. The following sources of information were used to prepare the material.

    So, a 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 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. Coronary heart disease, chronic heart failure, cardiomyopathies also cause left ventricular hypertrophy.

    hypertrophic changes in the left ventricular myocardium is the most common cause of left EOS deviation. In addition, LVH develops when the valve apparatus of the left ventricle is affected. This condition leads to stenosis of the aortic orifice, in which the ejection of blood from the left ventricle is difficult, aortic valve insufficiency, when part of the blood returns to the left ventricle, overloading it with volume.

    These defects can be both congenital and acquired. The most frequently 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 resolve the issue of the possibility of continuing to exercise.

    A shift in the electrical axis of the heart to the right may indicate hypertrophy of the right ventricle (PCG). 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 prolonged course cause hypertrophy.

    Hypertrophy of the right ventricle leads to pulmonary stenosis and tricuspid valve insufficiency. As with the left ventricle, PCa is caused by coronary heart disease, chronic heart failure, and cardiomyopathy. The deviation of the EOS to the right occurs with complete blockade of the posterior branch of the left leg of the bundle of His.

    Vertical EOS in a child

    Sodium. Concentration decrease
    Na ions in the extracellular fluid
    reduces the voltage of the ECG teeth.

    Potassium. Changes in ion concentration
    K in plasma cause more severe
    ECG disorders.

     Hyperkalemia is extremely dangerous
    and can be fatal.
    The increase in the content of K ions in
    plasma is reflected in occurrence on
    ECG of a high T wave as manifestations
    repolarization disorders. Higher
    K ion level paralyzes
    atria and increases duration
    QRS complex. Myocardial fibers lose
    excitability and the heart stops
    in diastole.

     Hypokalemia prolongs
    interval P – Q (R), the depth of the Q wave, inverts
    tooth T.

    Calcium. Increase concentration
    extracellular Ca2 increases
    myocardial contractility. Hypocalcemia
    increases the duration of the interval
    Q – T.

    In babies, the position of the EOS changes with growth and development In babies up to 12 months, the direction of the axis to the right is noted on the electrocardiogram. In a year, the EOS changes in children, it becomes vertically located. This is explained by growth processes: the right heart exceeds the left in strength, activity and mass.

    Changes in the location of the heart muscle are noticeable. By 2-3 years of age, the axis in 60% of children is vertical, in the rest it changes to normal. This is due to growth, enlargement of the left ventricle and a heart turn. In preschool children and older children, the normal position of the EOS dominates. Correct is the location of the axis in children:

    • Babies up to 12 months – EOS is from 90 – 170 degrees
    • Children 1-3 years old – vertical direction
    • Schoolchildren and adolescents – in 60% of children note normal EOS
  • Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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