Pronounced axis deviation to the left. Sinus arrhythmia of the heart EOS vertical. Why is the normal conduction of electrical excitations of the heart so important?

The electrical axis of the heart (ECA) is a generally accepted concept among cardiologists and specialists in testing the functionality of the heart. She shows electrical processes flowing in the organ.

Cardiologists represent an organ in three dimensions, superimposing it on a coordinate axis, which is conventionally taken to be the chest. This makes it possible to set the tilt angle of the axis. The axis angle may be different.

For example, the EOS is deviated to the right. It can tilt to the left, and also take a horizontal or vertical position. Changes of a bioelectrical nature that accompany the next compression and expansion are reflected in the tilt of the vector.

Whenever cardiovascular pathologies electric axle hearts can change their position

The mechanism that transmits these impulses is muscle filament fibers. They begin to contract in the sinus node, receiving a signal from the nerve center of the brain.

Therefore, during examination they say: the heart muscle is normal, sinus rhythm is observed. The man is healthy.

The impulse oscillation, moving through the system, reaches the heart organ and causes it to contract. When deviations occur, the EOS changes its location.

The ventricle of the organ on the left is much larger in size than the section on the right. There the impulses are more powerful. Therefore, the axis deviates more in his direction.

Heart axis deviation

By transferring the projection of the heart muscle to an imaginary coordinate system, it is assumed that the axis has a deviation angle of 0 to + 90 degrees for healthy people. Thin and tall people (asthenic type) have an angle from +70 to +90 degrees.

Small people with a strong build (hypersthenic type) have an angle deviation from 0 to + 30 degrees. Clean look These types of people are rare in nature.

People with mixed type physiques have an EOS with a semi-vertical or semi-horizontal position. There are five EOS positions:

She's fine
Positioned horizontally
Placed in a semi-horizontal position
Vertical state
Semi-vertical position

All conditions are not diseases.

Pathological shift to the left

The electrical axis of the heart may deviate to the left during deep inspiration

No pathologies are observed, but the EOS may deviate to the left in the following situations:

When a man takes a deep breath
When the body is horizontal. The diaphragm experiences pressure from internal organs
At high aperture in little people

The EOS shifts to the right without the presence obvious pathologies in the following cases:

When the deep breath ends
When the human body takes a vertical position
In tall, thin people

These offsets from normal condition are not considered a disease. These are the prerequisites for the onset of destruction in the cardiac organ and conduction apparatus, indicating possible developing diseases:

Thickening of the walls.
Interruptions of the working valve of the ventricle on the left.
Impaired conduction of electrical signals of the left ventricle.

Beginning diseases:

congenital
Acquired heart defect
Ciliated
Infectious myocardial damage

Pathology in the right position

Based on an ECG, cardiologists can determine the nature of the disease by the position of the electrical axis of the heart

The heart organ is regulated by impulses sent by the brain via nerve fibers. They cause the muscles of the organ to periodically contract. Any violation nerve impulses leads to changes in organs.

The heart is no exception in this case. The EOS normally occupies a diagonal location - directed down and to the left. Based on these provisions, which are reflected in, specialists can determine the nature of the disease.

For each person, the location of the axis depends on the physique and personality.

How you can independently decipher the ECG results, see the following video:

When it tilts to the right, it is considered normal in newly born children. In adults, this is considered an indicator of serious illness.

For example, ventricular hypertrophy on the right. It may occur for the following reasons:

Diseases of the pulmonary system and bronchi: prolonged bronchial asthma.
Chronical bronchitis, obstructive bronchitis, emphysema.
with changes in the ventricular valve on the right.
The stronger the thickening of the walls of the right section, the greater the angle of inclination in this direction.

Axle roll to the right indicates diseases such as:

Myocardial circulatory disorders. Oxygen starvation. When obstruction in the coronary arteries increases sharply. There is a threat of myocardial infarction.
pulmonary artery, can be congenital or acquired. This is a decrease in lumen pulmonary vessel, when it is difficult for the blood flow to leave the heart on the right. Against this background, thickening of the walls and enlargement of the right side develops.
Atrial fibrillation. A disruption of electrical processes occurs in the atrium, which is accompanied by blockage or rupture of a cerebral vessel.
. The performance of the lungs is impaired, pathological changes occur, and difficulties arise in the functioning of the heart on the left. Therefore, another department is forced to work with double force, and this is the path to thickening the walls of the organ.
Defect or malformation of film tissue at the border of the atria. This is due to the existing hole in the septum between the atria, when blood is thrown from the left atrium to the right, which is excluded. Heart failure occurs and blood pressure in the arteries of the lung increases.
Stenosis mitral valve. This is a decrease in the internal diameter of the canal between the atrium on the left side and the heart. This interferes with the movement of blood flow and the rhythmic functioning of the heart organ fails. It is considered an acquired vice.
Pulmonary embolism. When thrombotic clots form in arterial vessels. They, moving along the bloodstream, block the lung artery and branches.
Primary pulmonary hypertension. Increased pressure in the artery of the lung for various reasons.
Poisoning with certain antidepressants.

Symptoms of pathologies

Sudden attacks choking may indicate a deviation of the EOS, which means the occurrence of cardiovascular pathology

You need to think seriously when the following symptoms occur:

Presence of headaches
Feeling of tightness in the chest
Availability
Swelling on the face
Seizures
Sudden attacks of suffocation
Labored breathing

Diagnosis of lesions of the cardiovascular system

If two or three symptoms are detected, it is necessary to undergo examination.

For this, the cardiologist prescribes special methods research to determine existing diseases:

for a detailed examination of the anatomy of the organ.
. These are special sensors and a recording device that are attached to the patient's body. He can lead a normal life for a certain period of time. Usually this is from 1 to 7 days. Sometimes the patient is asked to perform several physical exercise to determine the response of the heart muscle to stress.
Chest X-ray.
Taking a cardiogram under load.
Coronary angiography is a procedure to determine the condition of the coronary vessels.

Treatment

To support the heart when EOS deviation is detected, traditional therapy methods can be used

If EOS deviations are detected, existing diseases are identified and treatment is prescribed, depending on many factors of the body’s condition. After treatment, as a rule, the axis returns to its normal position.

Further treatment comes down to prevention and maintaining the body in a stable condition, preventing deterioration. When treating hypertrophy of both ventricles, verampil and are prescribed.

Not excluded surgery when the affected area of the organ is removed.

Additionally used folk recipes to restore and support the heart muscle:

Use a decoction of the following composition: take dried wild rosemary and wild rosemary, 2 parts each; 3 parts – motherwort herb; 1 part kidney tea, mix everything. Pour a heaping tablespoon of the mixture cold water in the volume of one and a half glasses, bring to a boil, let simmer for 5 minutes. Wrap the infusion and leave for 4 hours. Pass through cheesecloth. Drink half a glass of warm decoction strictly 20–30 minutes before meals three times a day.
Taking a teaspoon of cranberries with sugar after meals has a very beneficial effect.
Decoction of St. John's wort herb. Pour 100 g of dry grass into two liters cold water. Boil and keep on fire for 10 minutes. Remove, wrap and let sit for about an hour. Filter, dissolve 200 ml of honey. Store in glass containers. Take 3 tablespoons no more than three times before meals, half an hour before meals.
Garlic. Grind the garlic cloves using a blender, add honey in a 1:1 ratio. Leave for 7 days in a dark place, shaking constantly. Take a tablespoon half an hour before meals three times. Drink throughout the year, taking breaks of 7 days every 30 days. The tincture helps with hypertension, atherosclerosis and left ventricular hypertrophy.
If you have shortness of breath, nettle will help fresh. Wash and chop the young stems and leaves of the plant. Take 5 tablespoons of raw materials, mix in a glass jar with 5 tbsp. l. honey Place in a place away from light, shaking daily. After 14 days, heat the product for steam. When the medicine becomes liquid, strain through gauze and keep in a cool place. Take 1 tsp. 3 times a day before meals.

The human heart works non-stop and requires careful treatment. It is necessary to consult and conduct examinations constantly, undergo treatment and follow preventive measures. Then the heart and the whole body will work like a well-oiled mechanism.

For example, in Fig. 5-3 high teeth visible R in leads II, III, aVF, which is considered as a sign of the vertical position of the EOS (vertical average electrical axis QRS).

Rice. 5-3. The QRS angle is +90°.

In addition, the height of the teeth R is the same in leads II and III. In Fig. 5-3 teeth height R in three leads (II, III and aVF) is the same; in this case, the EOS is directed to the middle lead aVF (+90°). Therefore, a simple assessment of the electrocardiogram can assume that QRS directed between positive poles leads II and III to the positive pole aVF (+90°).

Method No. 2

In Fig. 5-3 the direction of the EOS can be calculated in another way. Remember that if the wave is perpendicular to the axis of any lead, it is recorded two-phase complex R.S. or QR(see section ""). And vice versa, if in any limb lead the complex QRS two-phase, average electrical axis of the complex QRS should be directed at an angle of 90° to this lead. Look again at Fig. 5-3. Do you see any biphasic complexes? It is obvious that in lead I there is a two-phase complex R.S., therefore, the EOS should be perpendicular to lead I.

Since lead I in the six-axis diagram corresponds to 0°, the electrical axis lies at right angles to 0° (angle QRS can be -90° or +90°). If the axis angle were -90°, the depolarization would be directed from the positive pole of lead aVF and the complex QRS would be in it negative. In Fig. 5-3 there is a positive complex in lead aVF QRS(high prong R), so the axis must have an angle of +90°.

Rice. 5-4. The QRS angle is -30°.

Method No. 3

Another example is in Fig. 5-4. At a quick glance, the average electrical axis of the complex QRS horizontal, since in leads I and aVL the complexes are positive, and in leads aVF, III and aVR they are predominantly negative. The exact electrical axis of the heart can be determined by lead II with a biphasic complex R.S.. Hence, the axis should be directed at right angles to lead II. It is located at an angle of +60° in a six-axis system, so the axis angle can be -30° or +150°. If it were +150°, in leads II, III, aVF complexes QRS would be positive. So the axis angle is -30°.

Method No. 4

The next example is in Fig. 5-5. Complex QRS positive in leads II, III and aVF, so the EOS is relatively vertical. Prongs R have equal heights in leads I and III - hence, the average electrical axis of the complex QRS should be located between these two leads at an angle of +60°.

Rice. 5-5. QRS angle +60°.

Method No. 5

According to Fig. 5-5 average electrical axis of the complex QRS can be calculated differently taking into account the two-phase complex R.S.-type in lead aVL. The axis should be perpendicular to lead aVL (-30°), i.e. at an angle of -120° or +60°. Obviously the axis angle is +60°. The EOS should be directed to lead II with a high tooth R.

Consider the example in Fig. 5-6.

Rice. 5-6. QRS angle -90°.

EOS is directed from leads II, III, aVF to leads aVR and aVL, where the complexes QRS positive. Because the teeth R have equal heights in leads aVR and aVL, the axis should be located exactly between these leads at an angle of -90°. In addition, in lead I - two-phase complex R.S. . In this case, the axis should be located perpendicular to lead I (0°), i.e. The axis angle can be -90° or +90°. Since the axis is directed from the positive pole of lead aVF to its negative pole, the axis angle should be -90°.

Look at fig. 5-7.

Rice. 5-7. QRS angle -60°.

Method number 6

Since in lead aVR there is a two-phase complex R.S.-type, EOS should be located perpendicular axis of this lead. The lead axis angle aVR is -150°, so the average electrical axis of the complex QRS in this case it should be -60° or +120°. It is clear that the axis angle is -60°, since in lead aVL the complex is positive, and in lead III it is negative. In Fig. 5-7 average electrical axis of the complex QRS you can also calculate from lead I, where the amplitude of the tooth R equal to the amplitude of the tooth S Lead II. The axis should be located between the positive pole of lead I (0°) and the negative pole of lead II (-120°); The axis angle is -60°.

These examples show basic rules for determining the average electrical axis of the complex QRS . However, such a definition may be approximate. An error of 10-15° is not significant clinical significance. Thus, it is possible to determine the electrical axis of the heart by the lead where the complex QRS close to biphasic, or in two leads, where the amplitudes of the waves R(or S) are approximately equal.

For example, if the amplitudes of the teeth R or S in two leads are only approximately equal, the average electrical axis of the complex QRS does not lie exactly between these leads. The axis is deviated towards the lead with a larger amplitude. In the same way, if there is a two-phase complex in the lead ( R.S. or QR) with teeth R And S(or teeth Q And R) of different amplitudes, the axis is not exactly perpendicular to this lead. If the tooth R more than a tooth S(or prong Q), the axis points are less than 90° from the lead. If the tooth R less than a tooth S or Q, the axis points are more than 90° away from this lead.

Rules for determining the average electrical axis of the complex QRS:

The average electrical axis of the complex QRS located in the middle between the axes of the two limb leads with high teeth R equal amplitude.
The average electrical axis of the complex QRS directed at an angle of 90° to any limb lead with a biphasic complex ( QR or R.S.) and to a lead that has relatively high teeth R.

The electrical axis of the heart (EOS) is a clinical parameter that is used in cardiology and is reflected on the electrocardiogram. Allows you to evaluate the electrical processes that move the heart muscle and are responsible for its correct functioning.

From the point of view of cardiologists, the chest is a three-dimensional coordinate system in which the heart is enclosed. Each contraction is accompanied by a number of bioelectrical changes, which determine the direction of the cardiac axis.

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

In a healthy state, the electrical axis shifts to the left under the following conditions:

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

Shift indicator to the right in the absence of pathology is observed in such situations:

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

The location of the electrical axis is determined by the fact that the mass of the left ventricle in normal conditions greater than the mass of the right half of the heart muscle. Due to this, electrical processes occur more intensely in it, so the vector is directed towards it.

Diagnosis using ECG

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

Alpha angle offset detection

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

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

The use of this determination method is suitable for those specialists who have the appropriate table at hand.

Visual definition

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

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

Establishing diagnosis

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

an increase in the size of the left ventricle -;
malfunction of the left ventricular valves, which causes the ventricle to be overloaded with blood volume;
cardiac blockades, for example, this looks appropriate, which you can learn about from another article);
disturbances in electrical conductivity inside the left ventricle.

All of these factors lead to the fact that the left ventricle does not work correctly, and the conduction of impulses through the myocardium is impaired. As a result, the electrical axis deviates to the left.

Diseases that are accompanied by levogram

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

heart (CHD);
cardiopathy of various origins;
chronic heart failure (CHF) of the left ventricular type;
hearts;
myocardium;
myocardium.

In addition to diseases, blockage of the conduction system of the heart can result from taking certain medications.

Additional Research

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

Bicycle ergometry(electrocardiogram while walking on a treadmill or on an exercise bike). Test to detect ischemia of the heart muscle.
Ultrasound. Using ultrasound, the degree of ventricular hypertrophy and disturbances in their contractile function are assessed.
. The cardiogram is taken within 24 hours. Prescribed in cases of rhythm disturbance, which is accompanied by deviation of the EOS.
X-ray examination chest. With significant hypertrophy of myocardial tissue, an increase in the cardiac shadow in the image is observed.
Angiography coronary arteries(KAG). Allows you to determine the degree of damage to the coronary arteries with diagnosed ischemic disease.
Echocardioscopy. Allows targeted determination of the condition of the patient’s ventricles and atria.

Treatment

Deviation of the electrical axis of the heart to the left from normal position is not a disease in itself. This is a sign determined using instrumental research, which allows you to identify disturbances in the functioning of the heart muscle.

The doctor makes a final diagnosis only after additional research. Treatment tactics are aimed at eliminating the underlying disease.

Ischemia, heart failure and some cardiopathy are treated with medications. Additional diet and healthy image life leads to normalization of the patient's condition.

IN severe cases surgery required, for example, with congenital or acquired heart defects. At severe violation conduction system may require transplantation of a pacemaker, which will send signals directly to the myocardium and cause it to contract.

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

Detection of a displacement of the electrical axis of the heart is not a cause for concern. But If this symptom is detected, you should immediately consult a doctor for further examination. and identifying the cause of this condition. Annual planned electrocardiography allows for timely detection of cardiac dysfunction and immediate initiation of therapy.

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 magnitude 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 the EOS, cardiologists represent the chest as a coordinate system.

When taking an ECG, each electrode records bioelectrical excitation occurring in a certain area of the myocardium. If you project the electrodes onto a conventional coordinate system, you can also calculate the angle of the electrical axis, which will be located where the electrical processes are strongest.

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

The conduction system of the heart consists of sections of the heart muscle consisting of 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 healthy heart called sinus). From the sinus node, the electrical impulse travels to the atrioventricular node and further along the His bundle. This bundle passes through the interventricular septum, where it divides into the right, heading towards the right ventricle, and the left legs. Left leg The bundle of His is divided into two branches, anterior and posterior. The anterior branch is located in the anterior sections interventricular septum, in the anterolateral wall of the left ventricle. The posterior branch of the left bundle branch is located in the middle and lower third of the interventricular septum, the posterolateral and inferior wall of the left ventricle. We can say that the posterior branch is located slightly to the left of the anterior one.

The myocardial conduction system 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. If there are disturbances in this system, the electrical axis of the heart can significantly change its position, which will be discussed below.

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

The mass of the 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 overall stronger, and EOS will be directed specifically at it. If we project the position of the heart on the coordinate system, the left ventricle will be in the area +30 + 70 degrees. This will be the normal position of the axis. However, depending on 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 heart axis occurs in tall, skinny people– asthenics.
Horizontal position of the EOS It 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 they are intermediate body types, therefore the electrical axis can have an intermediate value (semi-horizontal and semi-vertical).

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

So, in conclusion, the ECG is absolutely healthy person it can be said: “EOS is 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 diagnosing diseases.

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

When can the position of the EOS indicate heart disease?

The position of the EOS itself is not a diagnosis. However There are a number of diseases in which there is a displacement of the heart axis. Significant changes in the position of the EOS result from:

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

EOS deviations to the left

Thus, deviation of the electrical axis of the heart to the left may indicate left ventricular hypertrophy (LVH), i.e. an increase in size, which is also not an independent disease, but may indicate an overload of the left ventricle. This condition often occurs during 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 mass of the ventricular muscles increases, which leads to its hypertrophy. Ischemic disease, chronic heart failure, and cardiomyopathies also cause left ventricular hypertrophy.

In addition, LVH develops when the valve apparatus of the left ventricle is damaged. This condition is caused by stenosis of the aortic mouth, in which the ejection of blood from the left ventricle is difficult, insufficiency aortic valve, when some of the blood returns to the left ventricle, overloading it with volume.

These defects can be either congenital or acquired. The most common acquired heart defects are a consequence of rheumatic fever. Left ventricular hypertrophy is found in professional athletes. In this case, a consultation with a highly qualified sports doctor is necessary to decide on the possibility of continuing to play sports.

Also, the EOS can be deviated to the left in cases of intraventricular conduction disorders and various heart blocks. Deviation el. the axis of the heart to the left, together with a number of other ECG signs, is one of the indicators of blockade of the anterior branch of the left bundle branch.

EOS deviations to the right

A 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 causes hypertrophy. Pulmonary stenosis and tricuspid valve insufficiency lead to right ventricular hypertrophy. As in the case of the left ventricle, RVH is caused by coronary disease heart disease, chronic heart failure and cardiomyopathies. Deviation of the EOS to the right occurs with complete blockade of the posterior branch of the left bundle branch.

What to do if EOS displacement 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 diagnosing a particular disease. When the heart axis is deviated beyond the limits normal values(from 0 to +90 degrees), consultation with a cardiologist and a number of studies are required.

But still the main reason for EOS displacement is myocardial hypertrophy. The diagnosis of hypertrophy of a particular part of the heart can be made based on ultrasound results. Any disease leading to a displacement of the heart axis is accompanied by a number of clinical signs and demands additional examination. The situation should be alarming when, with a pre-existing position of the EOS, its sharp deviation on the ECG occurs. In this case, the deviation most likely indicates the occurrence of a blockade.

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

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1Theoretical basis of definition

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

Let's consider another concept necessary to determine the position of the EOS - the alpha angle (2 Practical principles for determining

In front of you is a captured cardiogram. So let's get started practical definition position of the heart axis. We look carefully at the QRS complex in the leads:

With a normal axis, the R wave in the second lead is larger than the R wave in the first lead, and the R wave in the first lead is larger than the R wave in the third: R II>RI>RIII;
The deviation of the EOS to the left on the cardiogram looks like this: the largest R wave is in the first lead, a little smaller in the second, and the smallest in the third: R I>RII>RIII;
A rotation of the EOS to the right or a shift of the heart axis to the right on the cardiogram appears as the largest R in the third lead, somewhat smaller in the second, the smallest in the first: R III>RII>RI.

But it is not always easy to visually 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. Here's how they do it:

We find QRS complexes in leads I and III;
We sum up the height of the teeth in the first lead;
Let's sum up the height in the third lead;

Important point! It should be remembered when summing that if a tooth is directed downward from the isoline, its height in mm will be with a “-” sign, if upward – with a “+” sign
We substitute the found two sums into a special table, find the place where the data intersects, which corresponds to a certain radius with degrees of the alpha angle. Knowing the norms of the alpha angle, it is easy to determine the position of the EOS.

3Why do I use a pencil to diagnose or when I don’t need to look for the alpha angle?

There is another method, the simplest and most beloved by students, of determining the position of the EOS using a pencil. It is not effective in all cases, but sometimes it simplifies the determination of the cardiac axis, makes it possible to determine whether it is normal or whether there is a displacement. So, with the non-writing part, we apply the pencil to the corner of the cardiogram 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 the non-writing part of the pencil is in the upper right corner, but the pointed tip of the writing part is in the lower left, then this position indicates the normal position of the heart axis. If the pencil is located almost horizontally, it can be assumed 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 deviated to the right.

4Why determine this parameter?

Questions related to electric axle 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 is of little help in diagnosing most heart diseases, of which there are more than a hundred. Decoding the direction of the axis turns out to be really useful for diagnosing 4 main conditions:

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

5What is the normal EOS?

In healthy people there are following descriptions EOS: normal, semi-vertical, vertical, semi-horizontal, horizontal. Normally, as a rule, the electrical axis of the heart in persons over 40 years of age is located at an angle of -30 to +90, in persons under 40 years of age - from 0 to +105. U healthy children The axis can deflect up to +110. For most healthy people, the indicator ranges from +30 to +75. In thin, asthenic individuals, 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, and there is a deviation to the left. In normosthenics, the heart occupies an intermediate position.

6Normal in children

In newborns and infants, there is a pronounced deviation of the EOS to the right on the electrocardiogram; by the age of one year, in most children, the EOS moves to a vertical position. This is explained physiologically: the right parts of the heart are somewhat more dominant than the left ones both in mass and in electrical activity, and changes in the position of the heart can also be observed - rotations around its axes. By the age of two, many children still have 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, during which the fit of the left ventricle to the chest decreases. In preschool children and schoolchildren, normal EOS prevails; the vertical electrical axis of the heart may be more common, and less often the horizontal electrical axis of the heart. Summarizing the above, the norm in children is considered to be:

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

7 Reasons for EOS deviation to the left

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

Variant of the norm;
GSV of the left bundle branch;
Left bundle branch block;
Positional changes associated with the horizontal position of the heart;
Some forms of ventricular tachycardia;
Malformations of endocardial cushions.

8 Reasons for deviation of the EOS to the right

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

The heart axis is located at an angle from +91 to +180;
A deviation of the electrical 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.

Most common reasons deviations of the EOS to the right can become:

Variant of the norm;
Right ventricular hypertrophy;
Blockade of the posterosuperior branching;
Pulmonary embolism;
Dextrocardia (right-sided location of the heart);
A normal variant for positional changes associated with the vertical position of the heart due to emphysema, COPD, and other pulmonary pathologies.

It should be noted that the doctor may be alerted by a sharp change in the electrical axis. For example, if the patient has a normal or semi-vertical position of the EOS on previous cardiograms, and when taking an ECG on this moment— pronounced horizontal direction of the EOS. Such sudden changes may indicate any disturbances in the functioning of the heart and require prompt additional diagnosis and further examination.

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Medical indicators

Using the electrical axis of the heart, cardiologists evaluate the electrical processes that move the heart muscles. The direction of EOS depends on different 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 noise. The patient takes a supine position with a pillow placed under his head. To take an ECG, electrodes are applied. Data is recorded when calm breathing. At the same time, the device records the frequency and regularity of heartbeats, including the position of the EOS and other parameters.

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

deep exhalation;
changing body position;
body features (hypersthenic).

The EOS shifts to the right in a healthy person when:

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

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

In the first case, the specialist identifies a displacement in the alpha angle. The value of the main indicator is calculated using a special table according to Diede.

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

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

left ventricular hypertrophy;
impaired functioning of the left ventricular valve;
cardiac blockade.

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

Additional diagnostic techniques

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

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

Therapy for the phenomenon under consideration is aimed at eliminating the underlying disease. Some heart pathologies are treated medical supplies. Additionally, it is recommended to eat right and lead a healthy lifestyle.

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

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

Changes to the right

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

If necessary, the patient is prescribed additional diagnostics:

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

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

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

Risk factors

Axial tilt to the right is a consequence of tricyclic antidepressant poisoning. The somatotropic effect of these drugs is observed due to the presence of substances in them that affect the conduction system of the heart. If the ECG diagnosed an axis deviation in right side, a more in-depth diagnosis of the patient is required.

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

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

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

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

But a deviation of the axis to the right in a baby may be associated with a blockade of the LBP. Therefore, when identifying the issue in question diagnostic symptom held full examination little patient.

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Electric axis position range is normal

For example, in the conclusion of an ECG, the patient may see the following phrase: “sinus rhythm, EOS is not deviated...”, or “the axis of the heart is in a vertical position,” this means that the heart is working correctly.

In the case of heart disease, 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 in case of ECG decoding The attending physician must determine the direction of the electrical axis.

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

How to determine the position of the electrical axis

Determination of the position of the heart axis 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, then there is a levogram, or deviation of the axis to the left. If there is more in III than in I, then it is a legal grammar. Normally, the R wave is higher in lead II.

Reasons for deviations from the norm

Axial deviation to the right or left is not considered an independent disease, but it can indicate diseases that lead to disruption of the heart.

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

Deviation of the heart axis to the left can 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 normal operation with all my heart. Hypertrophy can be caused by the following diseases:

cardiomyopathy (increase in myocardial mass or dilation of the heart chambers) caused by anemia, disorders hormonal levels in the body, coronary heart disease, post-infarction cardiosclerosis, changes in myocardial structure after myocarditis ( inflammatory process in cardiac tissue);
long-standing arterial hypertension, especially with constantly high blood pressure numbers;
acquired heart defects, in particular stenosis (narrowing) or insufficiency (incomplete closure) of the aortic valve, leading to disruption of intracardiac blood flow, and, consequently, increased load to the left ventricle;
congenital heart defects often cause a deviation of the electrical axis to the left in a child;
conduction disturbance along the left bundle branch - complete or not complete blockade, leading to impaired contractility of the left ventricle, while the axis is deviated, 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 heart axis to the right is a normal variant when conducting an ECG in a newborn child, and in this case a sharp deviation of the axis may occur.

In adults, such a deviation is usually a sign of right ventricular hypertrophy, which develops in the following diseases:

diseases bronchopulmonary system– long-term bronchial asthma, severe obstructive bronchitis, emphysema, leading to increased blood pressure in the pulmonary capillaries and increasing the load on the right ventricle;
heart defects with damage to the tricuspid (three-leaf) valve and the valve of the pulmonary artery, which arises from the right ventricle.

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

Symptoms

The electrical axis of the heart itself does not cause any symptoms in the patient. Impaired health appears in the patient if myocardial hypertrophy leads to severe hemodynamic disturbances and heart failure.

The disease is characterized by pain in the heart area

Signs of diseases accompanied by deviation of the heart axis to the left or right include headaches, pain in the heart area, swelling lower limbs and on the face, shortness of breath, asthma attacks, etc.

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

Diagnostics

To determine the reason for deviation according to ECG axis heart left or right, a cardiologist or therapist can prescribe additional methods research:

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

Treatment

Direct deviation of the electrical axis does not require treatment, since it is not a disease, but a criterion by which it can be assumed that the patient has one or another cardiac pathology. If, after further examination, some disease is identified, it is necessary to begin treatment as soon as possible.

In conclusion, it should be noted that if the patient sees in the ECG conclusion 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 sign, even if there are no symptoms does not arise.

cardio-life.ru Children's pulse is normal

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

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

The influence of the anatomical position of the heart on the electrical axis of the QRS complex

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

Effect of direction of ventricular depolarization

Can be confirmed in case of incomplete blockade of the anterior branch of the left ventricle, when the propagation of impulses along the upper left parts of the left ventricle is disrupted and the average electrical axis of the complex QRS deviated to the left (see section “Impaired intraventricular conduction”). On the contrary, with pancreatic hypertrophy it is deviated to the right.

How to recognize EOS deviation to the right and left

Axis deviation to the right

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

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

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 impulse travels to the atrioventricular node and further along the His bundle. This bundle passes through the interventricular septum, where it divides into the right, heading towards the right ventricle, and the left legs. The left bundle branch is divided into two branches, anterior and posterior. The anterior branch is located in the anterior sections of the interventricular septum, in the anterolateral wall of the left ventricle. The posterior branch of the left bundle branch is located in the middle and lower third of the interventricular septum, the posterolateral and inferior wall of the left ventricle. We can say that the posterior branch is located slightly to the left of the anterior one.

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 overall stronger, and EOS will be directed specifically at it. If we project the position of the heart on the coordinate system, the left ventricle will be in the area +30 + 70 degrees. This will be the normal position of the axis. However, depending on individual anatomical features and body type 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 heart axis is found in tall, thin people - asthenics.
Horizontal position of the EOS It is more common in short, stocky people with a wide chest - hypersthenics, and its value ranges from 0 to + 30 degrees.

All five position options (normal, horizontal, semi-horizontal, vertical and semi-vertical) occur 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, 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 diagnosing diseases.

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

When can the position of the EOS indicate heart disease?

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

EOS deviations to the left

Thus, deviation of the electrical axis of the heart to the left may indicate left ventricular hypertrophy (LVH), i.e. an 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 mass of the ventricular muscles increases, which leads to its hypertrophy. Ischemic disease, chronic heart failure, and cardiomyopathies also cause left ventricular hypertrophy.

In addition, LVH develops when the valve apparatus of the left ventricle is damaged. This condition is caused by stenosis of the aortic mouth, in which the ejection of blood from the left ventricle is difficult, and aortic valve insufficiency, when part of the blood returns to the left ventricle, overloading it with volume.

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 over a long period of time cause hypertrophy. Pulmonary stenosis and tricuspid valve insufficiency lead to right ventricular hypertrophy. As in the case of the left ventricle, RVH is caused by coronary heart disease, chronic heart failure and cardiomyopathies. Deviation of the EOS to the right occurs with complete blockade of the posterior branch of the left bundle branch.

What to do if EOS displacement 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 diagnosing a particular disease. If the deviation of the heart axis is outside the normal range (from 0 to +90 degrees), consultation with a cardiologist and a series of studies are necessary.

But still the main reason for EOS displacement is myocardial hypertrophy. The diagnosis of hypertrophy of a particular part of the heart can be made based on ultrasound results. Any disease that leads to a displacement of the heart axis is accompanied by a number of clinical signs and requires additional examination. The situation should be alarming when, with a pre-existing position of the EOS, its sharp deviation on the ECG occurs. In this case, the deviation most likely indicates the occurrence of a blockade.

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Normal values and causes of violation

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

In a healthy state, the electrical axis shifts to the left under the following conditions:

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

Shift indicator to the right in the absence of pathology is observed in such situations:

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

Diagnosis using ECG

Alpha angle offset detection

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

Visual definition

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

Establishing diagnosis

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

an increase in the size of the left ventricle - hypertrophy (LVH);
malfunction of the left ventricular valves, which causes the ventricle to be overloaded with blood volume;
cardiac blockades, for example, blockade of the left bundle branch (on the ECG this looks like this, which you can learn about from another article);
disturbances in electrical conductivity inside the left ventricle.

Diseases that are accompanied by levogram

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

coronary heart disease (CHD);
cardiopathy of various origins;
chronic heart failure (CHF) of the left ventricular type;
congenital heart defects;
myocardial infarction;
infectious damage to the myocardium.

In addition to diseases, blockage of the conduction system of the heart can result from taking certain medications.

Additional Research

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

Bicycle ergometry(electrocardiogram while walking on a treadmill or on an exercise bike). Test to detect ischemia of the heart muscle.
Ultrasound. Using ultrasound, the degree of ventricular hypertrophy and disturbances in their contractile function are assessed.
24-hour Holter ECG monitoring. The cardiogram is taken within 24 hours. Prescribed in cases of rhythm disturbance, which is accompanied by deviation of the EOS.
X-ray examination chest. With significant hypertrophy of myocardial tissue, an increase in the cardiac shadow in the image is observed.
Coronary artery angiography (CAG). Allows you to determine the degree of damage to the coronary arteries with diagnosed ischemic disease.
Echocardioscopy. Allows targeted determination of the condition of the patient’s ventricles and atria.

Treatment

Deviation of the electrical axis of the heart to the left from the normal position is not in itself a disease. This is a sign determined using instrumental research, which allows us to identify disturbances in the functioning of the heart muscle.

Ischemia, heart failure and some cardiopathy are treated with medications. Additional maintaining a diet and healthy lifestyle leads to normalization of the patient's condition.

In severe cases, surgery is required, for example, with congenital or acquired heart defects. In case of severe disruption of the conduction system, it may be necessary to transplant a pacemaker, which will send signals directly to the myocardium and cause its contraction.

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

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Axis location

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

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

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

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

The doctor may make the following conclusion:

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

All these conclusions are the norm.

Concerning individual characteristics, then they note that in people tall and a thin build, the EOS is in a semi-vertical position, and in people who are shorter and have a stocky build, the EOS is in a semi-horizontal position.

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

Reasons for rejection

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

In this condition, the cavity stretches and increases in size. Sometimes this occurs due to overload, but it can also be a consequence of a disease.

Diseases that cause hypertrophy are:

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

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

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

This pathology can be caused by the following diseases:

As well as diseases characteristic of LV hypertrophy:

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

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

We can conclude that the main cause of pathological displacement to the left or right is ventricular hypertrophy.

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

It is important to carry out timely identification of these indications and diseases.

Deviation of the heart axis does not cause any symptoms; symptoms manifest themselves from hypertrophy, which disrupts the hemodynamics of the heart. The main symptoms are headaches, chest pain, swelling of the limbs and face, suffocation and shortness of breath.

If cardiac symptoms occur, you should immediately undergo electrocardiography.

Determination of ECG signs

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

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

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

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

With blockade of the anterior branch of the left leg of His, the values will be from -300 or more. On ECG signs These are the late R wave (lead aVR). Leads V1 and V2 may have a small r wave. In this case, the QRS complex is not expanded, and the amplitude of its waves is not changed.

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

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

Determination of these diseases begins with an ECG, and then methods such as echocardiography, radiography, and coronary angiography are prescribed. ECG can also be performed with stress and daily monitoring according to Holter.

Pronounced axis deviation to the left. Sinus arrhythmia of the heart EOS vertical. Why is the normal conduction of electrical excitations of the heart so important?

Heart axis deviation

Pathological shift to the left

Pathology in the right position

Symptoms of pathologies

Diagnosis of lesions of the cardiovascular system

Treatment

Method No. 2

Method No. 3

Method No. 4

Method No. 5

Method number 6

Diagnosis using ECG

Alpha angle offset detection

Visual definition

Establishing diagnosis

Diseases that are accompanied by levogram

Additional Research

Treatment

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

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

When can the position of the EOS indicate heart disease?

EOS deviations to the left

EOS deviations to the right

What to do if EOS displacement is found on the cardiogram?

1Theoretical basis of definition

3Why do I use a pencil to diagnose or when I don’t need to look for the alpha angle?

4Why determine this parameter?

5What is the normal EOS?

6Normal in children

7 Reasons for EOS deviation to the left

8 Reasons for deviation of the EOS to the right

Medical indicators

Additional diagnostic techniques

Changes to the right

Risk factors

Electric axis position range is normal

How to determine the position of the electrical axis

Reasons for deviations from the norm

Symptoms

Diagnostics

Treatment

The influence of the anatomical position of the heart on the electrical axis of the QRS complex

Effect of direction of ventricular depolarization

How to recognize EOS deviation to the right and left

Axis deviation to the right

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

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

When can the position of the EOS indicate heart disease?

EOS deviations to the left

EOS deviations to the right

What to do if EOS displacement is found on the cardiogram?

Normal values ​​and causes of violation

Diagnosis using ECG

Alpha angle offset detection

Visual definition

Establishing diagnosis

Diseases that are accompanied by levogram

Additional Research

Treatment

Axis location

Reasons for rejection

Determination of ECG signs

Normal values and causes of violation