Vertical eos in a child. What problems will the electrical axis of the heart tell you about?

Sinus rhythm. The voltage is satisfactory.

Normal position electrical axis of the heart

ECG 2. NORMAL POSITION OF THE ELECTRICAL AXIS OF THE HEART

Sinus arrhythmia of the heart EOS vertical

Discounts » History » Sinus arrhythmia of the heart EOS vertical

Sinus arrhythmia, causes of its occurrence and main symptoms. Diagnostic criteria. Sinus arrhythmia is a normal change in heart rate. The concept of cardiography unites different methods study of cardiac activity. Good afternoon. Please tell me. I did a cardiogram and heart ultrasound for my children. Cardiac arrhythmia can manifest itself in cases of dysfunction of the autonomic nervous system, A. What ECG signs are observed with sinus arrhythmia. Sinus arrhythmia happens. Okg cardiology Description. The right rhythm. Sinus waves p are of normal configuration (their amplitude varies).

Sinus arrhythmia of the heart
Sinus arrhythmia all questions and
Cardiography of the heart and blood vessels
Child's cardiogram result
Arrhythmia – medicine consultations

Now almost every ambulance team is equipped with a portable, lightweight and mobile one. Decoding the cardiogram in children and adults general principles, reading the results, example. When recording an ECG in twelve conventional leads, practically no signs are detected. Eos is short for electrical axis of the heart - this indicator. Thin people usually have a vertical position of the eos, while thick people and faces have a vertical position. Sinus arrhythmia is an abnormal sinus rhythm with periods.

Sinus arrhythmia is an abnormal heart rhythm that... The vertical position of the heart axis is sinus arrhythmia, do not be alarmed. Sinus arrhythmia (irregular sinus rhythm). This term means. Their average contraction frequency is 138 beats, the eos is vertical. Vertical electrical position of the heart (or vertical. Sinus arrhythmia can be respiratory (associated with phases.). I did an ultrasound of the heart after a cardiogram with sinus arrhythmia. Sinus arrhythmia, the position of the eospolus is vertical vagal. The electrical activity of the heart is recorded on the ECG, which changes. The normal position of the electrical axis of the heart is 3069o, vertical. Deviation of the electrical axis of the heart (EOS) to the left or right. The conclusion was written by sinus arrhythmia with tendinus. Symptoms of blood cancer after 40 years. And she sometimes points her finger to her chest in the area of the heart and says that she has. Hello. Sinus arrhythmia - one of the most. In the 4th stage, qt 0.28 in the 4th stage, sinus arrhythmia 111-150, vertical position of the eos. Deviation of the electrical axis of the heart (eos) to the right (angle a 90170). In most infants, the eos moves to a vertical position. On average up to 110120 beats, some children develop sinus arrhythmia.

Mild sinus arrhythmia (vertical position of the eos) is also not a diagnosis. What already. Sinus arrhythmia of the heart, the causes of which can be completely different, can be as follows. Conclusion - sinus rhythm sharply severe arrhythmia with heart rate from 103 to 150. Eos, Not complete blockade right bundle branch. Ultrasound of the heart at 2 years old. The conclusion is sinus arrhythmia, EOS vertical bradycardia. Eos is short for electrical axis of the heart - this indicator allows. Sinus arrhythmia is an abnormal sinus rhythm with periods.

Sinus rhythm with heart rate 71 eos vertical metabolic change in the myocardium. Eos (electrical axis of the heart), however, it will be correct. Reduced wave voltage, sinus tachycardia, diffuse changes in the myocardium. It was written that I have sinus arrhythmia (severe) vertical electrical position of the heart. Tell me, is this serious? An ECG records the electrical activity of the heart, which changes cyclically. Deviation of the electrical axis of the heart (EOS) to the left or right is possible with hypertrophy of the left or. Electrical position vertical. The conclusion was written as sinus arrhythmia with Qrst0.26 n e. The cardiac axis is not deviated. According to the ECG data, the conclusion is sinus arrhythmia, EOS vertical bradycardia. Violation. The following are typical for physiological cardiac hypertrophy in athletes. Sinus arrhythmia indicates a dysregulation of the sinus node and... Vertical eos is more often observed in football players and skiers. Symptoms of skin cancer on the hands Deviation of the eos to the left. 40 is blocked, sinus arrhythmia of the heart, they prescribed Concor and statins, will Concor lower the blood pressure. Hello. I’m 26 years old. Severe sinus arrhythmia on Holter is scary? Open. Sinus arrhythmia is common in healthy people. Found. Deviation of EOS to the left. The coronary artery is 40 blocked, sinus arrhythmia of the heart, they prescribed Concor and statins, will Concor lower the blood pressure. Yesterday we did an ultrasound of the heart, and the doctor diagnosed sinus tachycardia. Registered. Sinus tachycardia, moderate arrhythmia, Coraxan. Sinus tachycardia, vertical position of the eos and shortening of the interval. II degree - mild sinus arrhythmia, rhythm fluctuations within limits. The power of the heart is represented by the electrical axis of the heart (EOS). Eos is short for electrical axis of the heart - this indicator. Thin people usually have a vertical position of the eos, while thick people and faces have a vertical position. Sinus arrhythmia is an abnormal sinus rhythm with periods.

Posted: 10 Feb 2015

Process disruption

total 21,238 consultations

The electrocardiogram gives useful information for diagnosing diseases of cardio-vascular system in children. Decoding the results of the cardiogram allows you to obtain data on the state of the heart muscle, the frequency and rhythm of heart contractions.

ATTENTION! Before asking a question, we recommend that you read the contents of the “Frequently Asked Questions” section. There is a high probability that you will find the answer to your question there right now, without wasting time waiting for an answer from a consultant doctor.

Rimma asks.

Hello! My son is 4 years old. At the pediatrician's appointment, they listened to heart murmurs and did an ECG: sinus bradycardia with a heart rate of 88 per minute, vertical position of the EOS, incomplete blockade of the right bundle branch. They sent me for a consultation with a cardiologist. Please explain how serious this is? What does this even mean?

information about the consultant

As for the conclusion about your child’s condition, the best answer to this question is a pediatric cardiologist, who will be familiar not only with the description of the cardiogram, but also with the entire history of the child’s health, and will also examine him in person.

Projection of the average result vector QRS to the frontal plane is called average electrical axis of the heart (AQRS). Rotations of the heart around the conventional anteroposterior axis are accompanied by a deviation of the electrical axis of the heart in the frontal plane and a significant change in the configuration of the complex QRS in standard and reinforced unipolar limb leads.

As shown in Fig. 4.10, the position of the electrical axis of the heart in the six-axis Bailey system is quantitatively expressed by the angle a, which is formed by the electrical axis of the heart and the positive half of the axis of the standard lead. The positive pole of the axis of this lead corresponds to the origin - 0 negative - ±380 The perpendicular drawn from the electrical center of the heart to the horizontal zero line coincides with the axis of lead aVF, the positive pole of which corresponds to +90°, and the negative pole corresponds to minus 90 e. The positive pole of axis II of the standard lead is located at an angle break +60 V, III standard lead - at an angle of +120%, lead aVL - at an angle -30°, and lead aVR - at an angle -150°, etc.

In a healthy person, the electrical axis of the heart is usually located in the sector from 0° to +90°, only occasionally going beyond these limits. Normally, the electrical axis of the heart approximately corresponds to the orientation of its anatomical axis. For example, the horizontal position of the electrical axis of the heart (angle a from 0° to 29°) is often found in healthy people with a hypersthenic body type, and the vertical position of the electrical axis is often found in people with a vertically located heart.

More significant turns of the electrical axis of the heart around the anteroposterior axis, both to the right (more than +9(G)) and to the left (less than 0°), are usually caused by pathological changes in the heart muscle - hypertrophy of the ventricular myocardium or disturbances of intraventricular conduction (see . below). However, it should be remembered that with moderate pathological changes in the heart, the position of the electrical axis of the heart may not differ in any way from that in healthy people, i.e. it can be horizontal, vertical or even normal.

Let's consider two methods for determining the position of the electrical axis of the heart.

Determination of angle a by graphical method. To accurately determine the position of the electrical axis of the heart using a graphical method, it is enough to calculate the algebraic sum of the amplitudes of the teeth of the complex QRS in any two leads from the limbs, the axes of which are located in the frontal plane. Typically, standard leads I and III are used for this purpose (Fig. 4.11). Positive or negative value of an algebraic sum

teeth QRS on an arbitrarily chosen scale is plotted on the positive or negative part of the axis of the corresponding lead in the six-axis Bailey coordinate system.

For example, on the ECG shown in Fig. 4.11, algebraic sum of the teeth of the complex QRS in standard lead I is + 12 mm (R== 12 mm, Q = 0 mm, S= Oh mm). This value is plotted on the positive part of the lead axis I. The sum of teeth in standard lead III is -12 mm (R= + 3 mm, S=- 15 mm); it is placed on the negative part of this lead.

These quantities (corresponding to the algebraic sum of ampli tud teeth) actually represent projections of the desired electrical axis of the heart on the axis I and III of standard leads. From the ends of these projections, perpendiculars to the axes of the leads are restored. The intersection point of the perpendiculars is connected to the center of the system. This line is the electrical axis of the heart (AQRS). IN in this case angle a is -30 degrees (sharp deviation to the left of the electrical axis of the heart).

Angle a can also be determined after calculating the algebraic sums of the amplitudes of the teeth of the complex QRSb two leads from the limbs various tables and diagrams given in electrocardiography manuals.

Visual determination of angle a. The graphical method described above for determining the position of the electrical axis of the heart, although it is the most accurate, in practice is rarely used in clinical electrocardiography. A simpler and more accessible method is the visual method for determining the position of the electrical axis of the heart, which allows you to quickly assess the angle a with an accuracy of ±10°. The method is based on two well-known principles.

1. Maximum positive or negative value the algebraic sum of the teeth of the complex QRS observed in that electrocardiographic lead, the axis of which approximately coincides with the location of the electrical field of the heart and is parallel to it.

2. Complex type R.S. where the algebraic sum of the teeth is zero (R = S or I = Q+ S), is recorded in the lead whose axis is perpendicular to the electrical axis of the heart.

For example, let’s try to determine the position of the electrical axis of the heart visual method according to the ECG shown in Fig. 4.12. Maximum algebraic sum of teeth of a complex QRS and the highest tooth R are observed in standard lead II, and the type complex RS(R*S)- in lead aVL. This indicates that the electrical axis of the heart is located at an angle a of about 60° (coinciding with axis II of the standard lead and perpendicular to the axis of lead aVL). This is also confirmed by the approximate equality of the amplitude of the teeth R in leads I and III, the axes of which in this case are located at some identical (!) angle to the electrical axis of the heart (R ] l > R t ~ R ul). Thus, the ECG shows a normal position of the electrical axis of the heart (angle a = 60°).

Let's consider another option for the normal position of the electrical axis of the heart (angle A= 45°), shown on rice. 4.13.a. In this case, the electrical axis of the heart is located between the axes of leads II and aVR. Maximum tooth R will be registered in the same way as in the previous example, in lead II, and

/?,>/?,> Rul*. In this case, the electrical axis is perpendicular to a hypothetical line, which seems to pass between the axes of standard lead III and lead aVL. Under certain assumptions, it can be considered that the axes of leads III and aVL are almost perpendicular to the electrical axis of the heart. Therefore, it is in these leads that the algebraic sum of the teeth approaches zero, and the complexes themselves QRS take the form R.S. where are the teeth/? w and i? aVL have a minimum amplitude, only slightly exceeding the amplitude of the corresponding teeth Sj n and S sVL .

At vertical position of the electrical axis of the heart (Fig. 4.13, b), when angle a is about +90°, the maximum algebraic sum of the teeth of the complex QRSn maximum positive wave R will be detected in lead aVF, the axis of which coincides with the direction of the electrical axis of the heart. Complex type R.S. Where R-S, is recorded in standard lead I, the axis of which is perpendicular to the direction of the electrical axis of the heart. The negative wave predominates in lead aVL S, and in lead III there is a positive wave R.

With an even more pronounced rotation of the electrical axis of the heart to the right, for example, if angle a is +120°, as shown in Fig. 4.13, in, maximum tooth R is recorded in standard lead III. A com is recorded in lead aVR.

plex QR, Where R= Q. Positive waves predominate in lead II and aVF R, and in leads I and aVL there are deep negative waves S.

On the contrary, when horizontal position of the electrical axis of the heart, (angle a from +30° to 0°) maximum tooth R will be fixed in standard lead I (Fig. 4.14, a), and the type complex RS- in lead aVF. A deepened wave is recorded in lead III S y and in lead aVL there is a high tooth R.R [ > R ll > R lli< S uy

With a significant deviation of the electrical axis of the heart to the left (angle a - -30), as shown in Fig. 4.14, b, maximum positive tooth R shifts to lead aVL, and the complex QRSuxcm RS - to lead II. High prong R is also recorded in lead I, and in leads III and aVF deep negative waves predominate S. R x > R li > R m .

So for practical definition in the future, we will use the visual method of determining the angle a. We suggest that you independently complete several tasks to determine the position of the electrical axis of the heart visually(see Fig. 4.16-4.19). In this case, it is advisable to use a pre-prepared diagram of a six-axis coordinate system (see Fig. 2.6), as well as the following algorithm.

Algorithm for determining the position of the electrical axis of the heart in the frontal plane

1. Find one or two leads in which QRS approaches zero ( R S or R* Q+ L). The axis of this lead is almost perpendicular to the desired direction of the electrical axis of the heart.

2 Find one or two leads in which the algebraic sum of the teeth of the complex QRS has the maximum positive value. The axis of this lead approximately coincides with the direction of the electrical axis of the heart.

3. Adjust the two results. Determine angle a.

Usage example of this algorithm shown in Fig. 4.15. When analyzing the ECG in 6 limb leads shown in Fig. 4.15, the normal position is approximately determined

study of the electrical axis of the heart R H = A, > L,. The algebraic sum of the teeth of the complex (DO" is equal to zero in lead III (R= 5). Consequently, the electrical axis is presumably located at an angle a+30° to the horizontal, coinciding with the aVR axis. Algebraic sum of teeth QRS has a maximum value in leads I and II, with A, - Rxv This confirms the assumption made about the value of angle a (+30°), since identical projections on the lead axis (equal teeth R, and /?,) are possible only with this arrangement of the electrical axis of the heart.

Conclusion. Normal position of the electrical axis of the heart. Angle a - +30°.

Now, using the algorithm, independently determine the position of the electrical axis of the heart on the ECG shown in Fig. 4.16-4.19.

Check the correctness of your decision.

Standards of correct answers

Rice. 4.16, a. Analysis of the relationships between the teeth of the complex QRSw The presented ECG suggests that there is a normal position of the electrical axis of the heart (R il > R l > R m). Indeed, the sum of the teeth of the complex QRS equals zero in lead aVL (R ~ S). Consequently, the electrical axis of the heart is presumably located at an angle of +60° to the horizontal and coincides with axis II of the standard lead. Algebraic sum of teeth of the complex QRS has a maximum value in standard lead II. This confirms the assumption made about the value of the angle a+60". Conclusion. The normal position of the electrical axis of the heart is Angle a+60°.

Rice. 4.16, b. The ECG shows a deviation of the electrical axis of the heart to the left: high waves R registered in leads I and aVL, deep waves S- in leads III and aVF, with i ^> R II > i ^ II.

Algebraic sum of the amplitudes of the teeth of the complex QRS is equal to zero in standard lead II. Therefore, the electrical axis of the heart is perpendicular to the axis of lead II, i.e., located at an angle a = -30°. Maximum positive value of the sum of teeth QRS is detected in lead aVL, which confirms the assumption made. Conclusion. Deviation of the electrical axis of the heart to the left. Angle a- -30 e.

Rice. 4.17, a. The ECG shows a deviation of the electrical axis of the heart to the right: high waves Rm mVF and deep teeth 5, aVU and R in > R u > R l . Algebraic sum of the amplitudes of the teeth of the complex QRS equals zero in lead aVR. Electric axis the heart is located at an angle a+ 120 e and approximately coincides with axis III of the standard lead. This is confirmed by the fact that the maximum amplitude of the tooth R determined in lead Sh.

Conclusion, Deviation of the electrical axis of the heart to the right. Angle a= +120*.

Rice. 4.17, b. The ECG recorded high waves L w aVF and relatively deep waves L ", aVL, with ^ P >^ G > L^. The sum of the amplitudes of the waves QRS equal to zero in lead I. The electrical axis of the heart is located at an angle a = +90°, coinciding with the axis of lead aVR In lead aVF there is a maximum positive sum of wave amplitudes QRS which confirms this assumption. Conclusion. Vertical position of the electrical axis of the heart. Angle a - +90°.

Rice. 4.18, a. The ECG recorded high waves /?, hVL and deep waves L* H1 oVF, with /?,>/?,>/?,. In lead aVR, the algebraic sum of the teeth of the complex QRS equal to a bullet. The electrical axis of the heart most likely coincides with the negative half of the axis of standard lead III (the largest amplitude S U 1). Unlike an ECG, it depicts

Noah in Fig. 4.17, a, the electrical axis of the heart is not deviated to the right but

to the left, so angle a is approximately -60°. Conclusion. A sharp deviation of the electrical axis of the heart to the left. Angle a -60 e.

Rice. 4.18, 6. There is approximately a rotation of the heart axis to the left: high teeth I am aVL, deep serrations Sul aVF , and R J > R ll > R tll . There is no lead on the ECG in which the algebraic sum of the waves QRS is clearly equal to zero. However, the minimum algebraic sum of teeth QRS approaching zero, found in leads II and aVF , whose axes are located nearby, at an angle of 30* to each other. Moreover, the sum of the amplitudes of the teeth of the complex QRS in standard lead II it has a small positive value, and in lead aVF it has a small negative value. Consequently, a hypothetical line perpendicular to the electrical axis of the heart passes between the axes of leads II and aVF, and the electrical axis of the heart itself is accordingly located approximately at an angle a equal to - 15°, i.e., between the axes of leads I and aVL. Indeed, the maximum algebraic sum of teeth QRS found in leads I and aVL, which confirms the assumption made. Conclusion. Deviation of the electrical axis of the heart to the left. Angle a* - 15 e.

Rice. 4.19 A. There is approximately a rotation of the electrical axis of the heart to the left: high waves D, aVL, relatively deep waves S uv what does it have to do with R t > R n > R m . As in the previous example, it is impossible to identify a lead on the ECG in which the algebraic sum of the teeth QRS equal to zero. A hypothetical line perpendicular to the electrical axis of the heart probably runs between adjacent lead axes III and aVF , since the algebraic sum of the teeth QRS in these leads approaches zero, and the sum of the teeth in III lead indicates the predominance of the negative wave S, and in lead aVF - to the predominance of the wave R. Consequently, the electrical axis of the heart is most likely located at an angle a* +15°. Maximum positive algebraic sum of teeth QRS is detected in lead I, which confirms the assumption made. Conclusion. Horizontal position of the electrical axis of the heart. Angle a +15°.

Rice. 4.19, b. Approximately has a rotation of the electrical axis of the heart to the left: high teeth Rlt aVL, deep teeth 5 Ш, aVF, and R l > R ^> R Bl . In lead aVF, the algebraic sum of waves QRS equal to zero, i.e. the electrical axis is perpendicular to the axis of lead aVF. Therefore, we can assume that angle a is 0°. The maximum positive sum of waves is found in standard lead I, which confirms the assumption made. Conclusion. Horizontal position of the electrical axis of the heart. Angle ai 0°.

The electrical axis of the heart (EOS) is one of the main parameters of the electrocardiogram. This term is actively used both in cardiology and in functional diagnostics, reflecting the processes occurring in the most important organ human body.

The position of the electrical axis of the heart shows the specialist what exactly is happening in the heart muscle every minute. This parameter is the sum of all bioelectrical changes observed in the organ. When taking an ECG, each electrode of the system registers excitation passing at a strictly defined point. If you transfer these values to a conventional three-dimensional coordinate system, you can understand how the electrical axis of the heart is located and calculate its angle relative to the organ itself.

How is an electrocardiogram taken?

ECG recording is performed in a special room, maximally shielded from various electrical interference. The patient sits comfortably on the couch with a pillow under his head. To take an ECG, electrodes are applied (4 on the limbs and 6 on the chest). An electrocardiogram is recorded when calm breathing. In this case, the frequency and regularity of heart contractions, the position of the electrical axis of the heart and some other parameters are recorded. This simple method allows you to determine whether there are abnormalities in the functioning of the organ, and, if necessary, refer the patient for a consultation with a cardiologist.

What influences the location of the EOS?

Before discussing the direction of the electrical axis, you should understand what the conduction system of the heart is. It is this structure that is responsible for the passage of impulses through the myocardium. The conduction system of the heart is atypical muscle fibers, connecting each other various areas organ. It begins with the sinus node, located between the mouths of the vena cava. Next, the impulse is transmitted to the atrioventricular node, located in the lower part of the right atrium. The next to take up the baton is the His bundle, which quickly diverges into two legs - left and right. In the ventricle, the branches of the His bundle immediately become Purkinje fibers, which penetrate the entire cardiac muscle.

An impulse entering the heart cannot escape the myocardial conduction system. This is a complex structure with fine settings, sensitively responding to the slightest changes in the body. In case of any disturbances in the conduction system, the electrical axis of the heart can change its position, which will be immediately recorded on the electrocardiogram.

EOS location options

As you know, the human heart consists of two atria and two ventricles. Two circles of blood circulation (large and small) ensure the normal functioning of all organs and systems. Normally, the mass of the myocardium of the left ventricle is slightly greater than that of the right. It turns out that all impulses passing through the left ventricle will be somewhat stronger, and the electrical axis of the heart will be oriented specifically towards it.

If you mentally transfer the position of the organ to a three-dimensional coordinate system, it will become clear that the EOS will be located at an angle from +30 to +70 degrees. Most often, these are the values recorded on the ECG. The electrical axis of the heart can also be located in the range from 0 to +90 degrees, and this, too, according to cardiologists, is the norm. Why do such differences exist?

Normal location of the electrical axis of the heart

There are three main provisions of the EOS. The range from +30 to +70° is considered normal. This option occurs in the vast majority of patients who visit a cardiologist. The vertical electrical axis of the heart is found in thin, asthenic people. In this case, the angle values will range from +70 to +90°. The horizontal electrical axis of the heart is found in short, tightly built patients. On their card, the doctor will mark the EOS angle from 0 to +30°. Each of these options is normal and does not require any correction.

Pathological location of the electrical axis of the heart

A condition in which the electrical axis of the heart is deviated is not a diagnosis in itself. However, such changes in the electrocardiogram may indicate various violations in the work itself important body. TO major changes The following diseases affect the functioning of the conduction system:

Cardiac ischemia;

Chronic heart failure;

Cardiomyopathies of various origins;

Congenital defects.

Knowing about these pathologies, the cardiologist will be able to notice the problem in time and refer the patient to hospital treatment. In some cases, when EOS deviation is registered, the patient requires emergency care in intensive care.

Deviation of the electrical axis of the heart to the left

Most often, such changes in the ECG are observed with enlargement of the left ventricle. This usually occurs with the progression of heart failure, when the organ simply cannot fully perform its function. It is possible that this condition may develop in arterial hypertension, which is accompanied by pathology of large vessels and increased blood viscosity. In all these conditions, the left ventricle is forced to work hard. Its walls thicken, leading to inevitable disruption of the impulse through the myocardium.

Deviation of the electrical axis of the heart to the left also occurs with narrowing of the aortic mouth. In this case, stenosis of the lumen of the valve located at the exit from the left ventricle occurs. This condition is accompanied by a disruption of normal blood flow. Part of it is retained in the cavity of the left ventricle, causing it to stretch and, as a result, thickening of its walls. All this causes a natural change in EOS as a result of improper conduction of the impulse through the myocardium.

Deviation of the electrical axis of the heart to the right

This condition clearly indicates right ventricular hypertrophy. Similar changes develop in some respiratory diseases (for example, bronchial asthma or chronic obstructive pulmonary disease). Some birth defects hearts can also cause enlargement of the right ventricle. First of all, it is worth noting pulmonary artery stenosis. In some situations, tricuspid valve insufficiency can also lead to a similar pathology.

Why is changing EOS dangerous?

Most often, deviations of the electrical axis of the heart are associated with hypertrophy of one or another ventricle. This condition is a sign of a long-standing chronic process and, as a rule, does not require emergency assistance cardiologist. The real danger is the change in the electrical axis due to His bundle block. In this case, the conduction of impulses through the myocardium is disrupted, which means there is a risk sudden stop cardiac activity. This situation requires urgent intervention cardiologist and treatment in a specialized hospital.

With the development of this pathology, the EOS can be deviated both to the left and to the right, depending on the localization of the process. The blockade may be caused by myocardial infarction, infectious lesion heart muscle, as well as taking certain medications. A regular electrocardiogram allows you to quickly make a diagnosis, which means it allows the doctor to prescribe treatment taking into account all important factors. IN severe cases It may be necessary to install a pacemaker (pacemaker), which will send impulses directly to the heart muscle and thereby provide normal work organ.

What to do if the EOS is changed?

First of all, it is worth considering that the deviation of the heart axis itself is not the basis for making a particular diagnosis. The position of the EOS can only give impetus to a more careful examination of the patient. For any changes in the electrocardiogram, you cannot do without consulting a cardiologist. An experienced doctor will be able to recognize normal and pathological conditions, and, if necessary, prescribe additional examination. This may be echocardioscopy for targeted study of the condition of the atria and ventricles, monitoring blood pressure and other techniques. In some cases, consultation with related specialists is required to decide on further management of the patient.

To summarize, several important points should be highlighted:

The normal EOS value is considered to be the range from +30 to +70°.

Horizontal (from 0 to +30°) and vertical (from +70 to +90°) positions of the heart axis are acceptable values and do not talk about the development of any pathology.

Deviations of the EOS to the left or to the right may indicate various disorders in the conduction system of the heart and require consultation with a specialist.

A change in EOS detected on a cardiogram cannot be made as a diagnosis, but is a reason to visit a cardiologist.

The heart is amazing organ, ensuring the functioning of all systems of the human body. Any changes that occur in it inevitably affect the functioning of the whole organism. Regular examinations by a therapist and an ECG will allow timely detection of serious illnesses and avoid the development of any complications in this area.

http://fb.ru

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, with its narrow end directed downwards, forward and to the left, and the electrical axis has a semi-vertical position, that is, it is also directed downwards and to the left, and when projected onto the coordinate system it can be in the range from +0 to +90 0.

An ECG conclusion is considered normal if it indicates any of the following positions of the heart axis: not deviated, semi-vertical, semi-horizontal, vertical or horizontal. The axis is closer to the vertical position in thin people tall people asthenic physique, and to the horizontal - in strong stocky persons of hypersthenic physique.

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 when interpreting the ECG, 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 non-sinus heart rate.

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 the normal functioning of the entire 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-term arterial hypertension, especially with constantly high blood pressure numbers;
acquired heart defects, in particular stenosis (narrowing) or insufficiency (incomplete closure) aortic valve, leading to disruption of intracardiac blood flow, and, consequently, increased load on 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 incomplete 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 there may be a sharp deviation of the axis.

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 cause of an ECG deviation of the heart axis to the left or right, a cardiologist or therapist may prescribe additional methods research:

Ultrasound of the heart is the most informative method that allows you to assess anatomical changes and identify ventricular hypertrophy, as well as determine the degree of their impairment 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) – performed to clarify the nature of the lesions coronary arteries with ischemic disease a.

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.

http://cardio-life.ru

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

Regular sinus rhythm - this phrase means an absolutely normal heart rhythm, which is generated in sinus node(the main source of cardiac electrical potentials).

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

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

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.

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. 6.1. P wave. Analysis of the P wave involves determining its amplitude, width (duration), shape, direction and degree of severity in various leads.

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

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

Methods for determining the position of the EOS.

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

An ECG is a completely painless and safe test; it is performed on adults, children and even pregnant women.

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

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

Thin people usually have a vertical position of the EOS, while thick people and obese people have a horizontal position. Respiratory arrhythmia is associated with the act of breathing, is normal and does not require treatment.

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

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

Block of the branches (left, right, left and right) of the His bundle (RBBB, LBBB), complete, incomplete, is a violation of the conduction of an impulse through the conduction system in the thickness of the ventricular myocardium.

The most common reasons hypertrophies are arterial hypertension, heart defects and hypertrophic cardiomyopathy. In some cases, next to the conclusion about the presence of hypertrophy, the doctor indicates “with overload” or “with signs of overload.”

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

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

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

When can the position of the EOS indicate heart disease?

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.

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. The conduction system of the heart consists of sections of the heart muscle consisting of so-called atypical muscle fibers.

Normal ECG readings

Myocardial contraction begins with the appearance of an electrical impulse in the sinus node (which is why the correct rhythm healthy heart called sinus). The 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.

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 position of the EOS itself is not a diagnosis.

These defects can be either congenital or acquired. The most common acquired heart defects are a consequence of rheumatic fever.

In this case, a consultation with a highly qualified sports doctor is necessary to decide on the possibility of continuing to play sports.

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

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

http://ladyretryka.ru

Before discussing the direction of the electrical axis, you should understand what the conduction system of the heart is. It is this structure that is responsible for the passage of impulses through the myocardium. The conduction system of the heart is atypical muscle fibers that connect different parts of the organ. It begins with the sinus node, located between the mouths of the vena cava. Next, the impulse is transmitted to the atrioventricular node, located in the lower part of the right atrium. The next to take up the baton is the His bundle, which quickly diverges into two legs - left and right. In the ventricle, the branches of the His bundle immediately become Purkinje fibers, which penetrate the entire cardiac muscle.

EOS location options

Cardiac ischemia;

Chronic heart failure;

Cardiomyopathies of various origins;

Congenital defects.

Why is changing EOS dangerous?

The normal EOS value is considered to be the range from +30 to +70°.

Horizontal (from 0 to +30°) and vertical (from +70 to +90°) positions of the heart axis are acceptable values and do not indicate the development of any pathology.

Deviations of the EOS to the left or to the right may indicate various disorders in the conduction system of the heart and require consultation with a specialist.

A change in EOS detected on a cardiogram cannot be made as a diagnosis, but is a reason to visit a cardiologist.

The heart is an amazing organ that ensures the functioning of all systems of the human body. Any changes that occur in it inevitably affect the functioning of the whole organism. Regular examinations by a therapist and an ECG will allow timely detection of serious diseases and avoid the development of any complications in this area.

☆

An ECG conclusion is considered normal if it indicates any of the following positions of the heart axis: not deviated, semi-vertical, semi-horizontal, vertical or horizontal. The axis is closer to the vertical position in thin, tall people of asthenic physique, and closer to the horizontal position in strong, stocky people of hypersthenic physique.

Electric axis position range is normal

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 functional diagnostics doctor who deciphers the ECG using special tables and diagrams using the angle α (“alpha”).

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

cardiomyopathy (increase in myocardial mass or expansion of the heart chambers), caused by anemia, hormonal imbalances in the body, coronary heart disease, post-infarction cardiosclerosis. changes in the structure of the myocardium after myocarditis (inflammatory process in cardiac tissue);
long-term 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 on 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 incomplete 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 there may be a sharp deviation of the axis.

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

diseases of the 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 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 of the lower extremities and face, shortness of breath, asthma attacks, etc.

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

Diagnostics

To determine the cause of an ECG deviation of the heart axis to the left or right, a cardiologist or therapist may prescribe additional research methods:

Ultrasound of the heart is the most informative method that allows you to 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 child for congenital heart pathology.
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

http://cardio-life.ru

☆

Regular sinus rhythm - this phrase means an absolutely normal heart rhythm, which is generated in the sinus node (the main source of cardiac electrical potentials).

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

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.

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

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

Methods for determining the position of the EOS.

To put it simply, an ECG is a dynamic recording of the electrical charge that makes our heart work (that is, contract). The designations of these graphs (they are also called leads) - I, II, III, aVR, aVL, aVF, V1-V6 - can be seen on the electrocardiogram.

An ECG is a completely painless and safe test; it is performed on adults, children and even pregnant women.

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

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

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

When can the position of the EOS indicate heart disease?

Normal ECG readings

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). 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.

These defects can be either congenital or acquired. The most common acquired heart defects are a consequence of rheumatic fever.

In this case, a consultation with a highly qualified sports doctor is necessary to decide on the possibility of continuing to play sports.

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

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

http://ladyretryka.ru

healthwill.ru

Department of Medical Cybernetics and Informatics RNRMU named after N.I. Pirogov

Work on the section Using the capabilities of a word processor to process and present medical information

The work was carried out by a student of group 243 Mikhailovskaya Ekaterina Aleksandrovna

MOSCOW 2014

General information about ECG

An ECG is a recording of the potential difference between two electrodes located on the surface of the body. The combination of two such electrodes is called an electrocardiographic lead, and an imaginary straight line connecting the two electrodes is called the axis of this lead. Leads can be bipolar or unipolar. In bipolar leads, the potential changes under both electrodes. In unipolar leads, the potential changes under one (active) electrode, but not under the second (indifferent) electrode.

For ECG registration an indifferent electrode is obtained by combining together the electrodes from the left hand, right hand and left leg; This is the so-called zero electrode (combined electrode, central terminal).

ECG leads.

Typically 12 leads are used. They are combined into two groups:

six limb leads (their axes lie in the frontal plane)

six chest leads (axis - in the horizontal plane).

Limb leads.

The limb leads are divided into three bipolar (standard leads I, II and III) and three unipolar (enhanced leads aVR, aVL and aVF).

In standard leads, electrodes are applied as follows: I - left hand and right hand, II - left leg and right hand, III - left leg and left hand.

In amplified leads, the active electrode is placed: for lead aVR - on the right hand (R - right), for lead aVL - on the left hand (L - left), for lead aVF - on the left leg (F - foot). The letter “V” in the names of these leads means that they measure the potential values (Foliage) under the active electrode, the letter “a” means that this potential is enhanced (Augmented).

Strengthening is achieved by excluding from the null electrode the electrode that is applied to the limb under study (for example, in lead aVF, the null electrode is the combined electrode from the right hand and left hand).

On right leg A grounding electrode is always applied.

Chest leads.

To obtain unipolar chest leads, electrodes are installed at the following points:

The indifferent electrode is the usual zero electrode.

The ECG in each lead is a projection of the total vector onto the axis of this lead. Thus, different leads allow us to look at the electrical processes in the heart from different angles. The twelve ECG leads together create a three-dimensional picture electrical activity hearts; in addition to them, additional leads are sometimes used. Thus, to diagnose right ventricular infarction, right chest leads V3R, V4R and others are used. Esophageal leads allow us to detect changes in the electrical activity of the atria that are not visible on a conventional ECG.

For telemetric ECG monitoring, one is usually used, and for Holter monitoring, two modified leads are usually used.

Lead meaning

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

Body planes used in anatomy.

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

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

Electrical axis of the heart (EOS)

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

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

The rules for determining the position of the EOS in the frontal plane are as follows: the electrical axis of the heart coincides with the one of the first 6 leads in which the highest positive teeth are recorded, and is perpendicular to the lead in which the size of the positive teeth is equal to the size of the negative teeth. Two examples of determining the electrical axis of the heart are given at the end of the article.

Variants of the position of the electrical axis of the heart:

normal: 30° > α< 69°,

vertical: 70° > α< 90°,

horizontal: 0° > α< 29°,

sharp axis deviation to the right: 91° > α< ±180°,

sharp axis deviation to the left: 0° > α< −90°.

Normally, the electrical axis of the heart approximately corresponds to its anatomical axis (in thin people it is directed more vertically from the average values, and in obese people it is more horizontal). For example, with hypertrophy (growth) of the right ventricle, the heart axis deviates to the right. In case of conduction disturbances, the electrical axis of the heart may deviate sharply to the left or right, which in itself is a diagnostic sign. For example, with a complete block of the anterior branch of the left bundle branch, a sharp deviation of the electrical axis of the heart to the left (α ≤ −30°) is observed, and a sharp deviation of the posterior branch to the right (α ≥ +120°).

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

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

Waves in ECG

Any ECG consists of waves, segments and intervals.

Waves are convex and concave areas on an electrocardiogram. The following waves are distinguished on the ECG:

P (atrial contraction),

Q, R, S (all 3 teeth characterize ventricular contraction),

T (ventricular relaxation),

U (non-permanent wave, rarely recorded).

A segment on an ECG is a segment of a straight line (isoline) between two adjacent teeth. Highest value have segments P-Q and S-T. For example, P-Q segment is formed due to a delay in the conduction of excitation in the atrioventricular (AV) node.

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

P-Wines

Normally, the excitation wave propagates from the sinus node through the myocardium of the right and then the left atrium, and the total vector of atrial depolarization is directed predominantly down and to the left. Because it faces the positive pole of lead II and the negative pole of lead aVR, the P wave is normally positive in lead II and negative in lead aVR.

With retrograde excitation of the atria (inferior atrial or AV nodal rhythm), the opposite picture is observed.

QRS-Complex

Normally, the excitation wave quickly spreads through the ventricles. This process can be divided into two phases, each of which is characterized by a certain predominant direction of the total vector. Depolarization occurs first interventricular septum from left to right (vector 1), and then - depolarization of the left and right ventricles (vector 2). Since the depolarization wave covers the thick left ventricle for a longer time than the thin right ventricle, vector 2 is directed to the left and backward. In the right chest leads, this two-phase process is reflected by a small positive wave (septal r wave) and a deep S wave, and in the left chest leads (for example, in V6) - by a small negative wave (septal q wave) and a large R wave. In leads V2-V5, the amplitude of the R wave gradually increases, the S- wave decreases. The lead in which the amplitudes of the R and S waves are approximately equal (usually V3 or V4) is called the transition zone.

In healthy people, the shape of the QRS complex in the limb leads varies significantly depending on the position of the electrical axis of the heart (the predominant, or more precisely, the time-averaged direction of the total vector of ventricular depolarization in the frontal plane). The normal position of the electrical axis of the heart is from -30* to +100*; in all other cases, they speak of axis deviation to the left or right.

Deviation of the electrical axis of the heart to the left can be a normal variant, but is more often caused by left ventricular hypertrophy, blockade of the anterior branch of the left bundle branch, and inferior myocardial infarction.

Deviation of the electrical axis of the heart to the right also occurs normally (especially in children and young people), with right ventricular hypertrophy, infarction of the lateral wall of the left ventricle, dextrocardia, left-sided pneumothorax, and blockade of the posterior branch of the left bundle branch.

A false impression of electrical axis deviation can occur if the electrodes are applied incorrectly.

T-waves

Normally, the T wave is directed in the same direction as the QRS complex (concordant with the QRS complex). This means that the predominant direction of the ventricular repolarization vector is the same as the vector of their depolarization. Considering that depolarization and repolarization are opposite electrical processes, the unidirectionality of the T wave of the QRS complex can only be explained by the fact that repolarization moves in the direction opposite to the depolarization wave (that is, from the epicardial endocardium and from the apex to the base of the heart).

U-Prongs

The U wave is normally a small rounded wave (less than or equal to 0.1 mV) that follows the Ti wave and has the same direction. An increase in U wave amplitude is most often caused by drugs (quinidine, procainamide, disopyramide) and hypokalemia.

Tall U waves indicate increased risk pirouette tachycardia. Negative U waves in precordial leads - always pathological sign; it may serve as the first manifestation of myocardial ischemia.

ECG analysis

General scheme of ECG decoding

№ actions	Purpose of action	Action plan
	Checking the correctness of ECG registration.	Checking the fixation of the electrodes, checking the contacts, checking the operation of the device.
	Heart rate and conduction analysis	Assessing heart rate regularity
		Heart rate (HR) counting
		Excitation Source Determination
		Conductivity assessment
	Determination of the electrical axis of the heart	Construction of the electrical axis of the heart, determination of its angles, evaluation of the obtained values
	Atrial P wave and P-Q interval analysis	Analysis of the length, boundaries of teeth, interval and segments, evaluation of the obtained values
	Ventricular QRST analysis	QRS complex analysis
		Analysis of the RS - T segment
		T wave analysis
		Q-T interval analysis
	Electrocardiographic report	Establishing diagnosis

ECG interpretation

Checking the correct ECG registration

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

Heart rate and conduction analysis:

assessment of heart rate regularity

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

heart rate counting (HR)

The ECG film has large squares printed on it, each of which contains 25 small squares (5 vertical x 5 horizontal). To quickly calculate heart rate with the correct rhythm, count the number of large squares between two adjacent R-R waves.

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

On the overlying ECG, the R-R interval is approximately 4.8 large cells, which at a speed of 25 mm/s gives 300 / 4.8 = 62.5 beats/min.

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

If the rhythm is abnormal, the maximum and minimum heart rate is usually calculated according to the duration of the shortest and longest R-R interval, respectively.

determination of the excitation source

In other words, they are looking for where the pacemaker is located, which causes contractions of the atria and ventricles. Sometimes this is one of the most difficult stages, because various disorders of excitability and conduction can be very confusingly combined, which can lead to incorrect diagnosis and improper treatment. To correctly determine the source of excitation on an ECG, you need to have a good knowledge of the conduction system of the heart.

Determination of the electrical axis of the heart.

In the first part of the ECG series, it was explained what the electrical axis of the heart is and how it is determined in the frontal plane.

Atrial P wave analysis.

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

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

Pathological deviations of the P wave:

Pointed tall P waves normal duration in leads II, III, aVF are characteristic of hypertrophy of the right atrium, for example, with “pulmonary heart”.

Split with 2 apexes, widened P wave in leads I, aVL, V5, V6 is characteristic of left atrium hypertrophy, for example, with mitral valve defects.

P-Q interval: normal 0.12-0.20 s.

An increase in this interval occurs when the conduction of impulses through the atrioventricular node is impaired (atrioventricular block, AV block).

There are 3 degrees of AV block:

I degree - the P-Q interval is increased, but each P wave corresponds to its own QRS complex (there is no loss of complexes).

II degree - QRS complexes partially fall out, i.e. Not all P waves have their own QRS complex.

III degree - complete blockade of conduction in the AV node. The atria and ventricles contract at their own rhythm, independently of each other. Those. idioventricular rhythm occurs.

Analysis of the ventricular QRST complex:

analysis of the QRS complex.

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

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

The R wave, like the Q wave, can be recorded in all standard and enhanced limb leads. From V1 to V4, the amplitude increases (while the rV1 wave may be absent), and then decreases in V5 and V6.

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

RS-T segment analysis

The S-T segment (RS-T) is a segment from the end of the QRS complex to the beginning of the T wave. The S-T segment is especially carefully analyzed in case of coronary artery disease, since it reflects the lack of oxygen (ischemia) in the myocardium.

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

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

T wave analysis.

The T wave reflects the process of repolarization of the ventricular myocardium. In most leads where a high R is recorded, the T wave is also positive. Normally, the T wave is always positive in I, II, aVF, V2-V6, with TI > TIII, and TV6 > TV1. In aVR the T wave is always negative.

Q-T interval analysis.

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

Electrocardiographic report.

Should include:

Source of rhythm (sinus or not).

Regularity of rhythm (correct or not). Usually sinus rhythm is normal, although respiratory arrhythmia is possible.

Position of the electrical axis of the heart.

Presence of 4 syndromes:

rhythm disturbance
conduction disturbance
hypertrophy and/or overload of the ventricles and atria
myocardial damage (ischemia, dystrophy, necrosis, scars)

studfiles.net

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.

As for individual characteristics, it is noted that 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.

dlyaserdca.ru

How is an electrocardiogram taken?

ECG recording is performed in a special room, maximally shielded from various electrical interference. The patient sits comfortably on the couch with a pillow under his head. To take an ECG, electrodes are applied (4 on the limbs and 6 on the chest). An electrocardiogram is recorded during quiet breathing. In this case, the frequency and regularity of heart contractions, the position of the electrical axis of the heart and some other parameters are recorded. This simple method allows you to determine whether there are abnormalities in the functioning of the organ, and, if necessary, refer the patient for a consultation with a cardiologist.

What influences the location of the EOS?

Before discussing the direction of the electrical axis, you should understand what the conduction system of the heart is. It is this structure that is responsible for the passage of impulses through the myocardium. The conduction system of the heart is atypical muscle fibers that connect different parts of the organ. It begins with the sinus node, located between the mouths of the vena cava. Next, the impulse is transmitted to the atrioventricular node, located in the lower part of the right atrium. The next to take the baton is the His bundle, which quickly diverges into two legs - left and right. In the ventricle, the branches of the His bundle immediately become Purkinje fibers, which penetrate the entire cardiac muscle.

EOS location options

Normal location of the electrical axis of the heart

Pathological location of the electrical axis of the heart

A condition in which the electrical axis of the heart is deviated is not a diagnosis in itself. However, such changes in the electrocardiogram may indicate various disorders in the functioning of the most important organ. The following diseases lead to serious changes in the functioning of the conduction system:

Cardiac ischemia;

Chronic heart failure;

Cardiomyopathies of various origins;

Congenital defects.

Knowing about these pathologies, the cardiologist will be able to notice the problem in time and refer the patient for inpatient treatment. In some cases, when EOS deviation is registered, the patient requires emergency care in intensive care.

Deviation of the electrical axis of the heart to the left

Deviation of the electrical axis of the heart to the right

This condition clearly indicates right ventricular hypertrophy. Similar changes develop in certain respiratory diseases (for example, bronchial asthma or chronic obstructive pulmonary disease). Some congenital heart defects can also cause the right ventricle to become enlarged. First of all, it is worth noting pulmonary artery stenosis. In some situations, tricuspid valve insufficiency can also lead to a similar pathology.

Why is changing EOS dangerous?

Most often, deviations of the electrical axis of the heart are associated with hypertrophy of one or another ventricle. This condition is a sign of a long-standing chronic process and, as a rule, does not require emergency care from a cardiologist. The real danger is the change in the electrical axis due to His bundle block. In this case, the conduction of impulses through the myocardium is disrupted, which means there is a risk of sudden cardiac arrest. This situation requires urgent intervention by a cardiologist and treatment in a specialized hospital.

With the development of this pathology, the EOS can be deviated both to the left and to the right, depending on the localization of the process. The blockade can be caused by myocardial infarction, infection of the heart muscle, as well as taking certain medications. A regular electrocardiogram allows you to quickly make a diagnosis, which means it allows the doctor to prescribe treatment taking into account all important factors. In severe cases, it may be necessary to install a pacemaker (pacemaker), which will send impulses directly to the heart muscle and thereby ensure normal functioning of the organ.

What to do if the EOS is changed?

First of all, it is worth considering that the deviation of the heart axis itself is not the basis for making a particular diagnosis. The position of the EOS can only give impetus to a more careful examination of the patient. For any changes in the electrocardiogram, you cannot do without consulting a cardiologist. An experienced doctor will be able to recognize normal and pathological conditions and, if necessary, prescribe additional examinations. This may include echocardioscopy for targeted study of the condition of the atria and ventricles, blood pressure monitoring and other techniques. In some cases, consultation with related specialists is required to decide on further management of the patient.

To summarize, several important points should be highlighted:

The normal EOS value is considered to be the range from +30 to +70°.

Horizontal (from 0 to +30°) and vertical (from +70 to +90°) positions of the heart axis are acceptable values and do not indicate the development of any pathology.

Deviations of the EOS to the left or to the right may indicate various disorders in the conduction system of the heart and require consultation with a specialist.

A change in EOS detected on a cardiogram cannot be made as a diagnosis, but is a reason to visit a cardiologist.

Let's figure out what this conclusion means, and whether it's worth sounding the alarm if your cardiogram shows a shift in the cardiac electrical axis.

1 Cardiac axis and ECG

The human heart has the ability to contract. Electrical impulses sequentially cover the chambers of the heart, originating in the atrial sinus node. If you imagine the course of these impulses in the form of directed vectors, you will notice that they have a similar direction. By summing the directions of the vectors, one main vector can be obtained. This will be the electrical axis of the heart (EOS).

Functional diagnostic doctors often determine EOS from a cardiogram visually, but it is more accurate to do this using special tables. If you look carefully at the QRS complex in leads I, II, III on the ECG, you can see that R II>RI>RIII, this means that the EOS on the cardiogram is normal.

If it is difficult for a doctor to visually determine the axis of the heart, he determines the alpha angle and calculates the EOS using special tables. Without delving into the course of measurements, we note that for a normal EOS angle alpha (RII>RIII), then the doctor’s conclusion will be as follows: deviation of the electrical axis of the heart to the left. EOS deviation is confirmed when the alpha angle is in the range from 00 to -900.

2 When does the heart axis “go to the left”?

The conclusions of a functional diagnostics doctor about the deviation of the cardiac axis to the left are not an independent diagnosis. But they always give reason to wonder why the heart axis “went to the left.” A slight shift of the EOS to -190, as well as its semi-vertical position, in some cases is not considered a pathology. This position of the axis can be observed in healthy, tall, thin people, in athletes with a trained heart, in children with an asthenic physique, and with a high position of the diaphragm dome.

If the cardiac axis is significantly deviated to the left, then this pathological condition indicates problems with the heart; the cause of such a displacement must be established. After all this symptom sometimes it can be the first “bell” in case of pathology of the heart and blood vessels. According to some data, a deviation of the electrical axis of the heart to the left up to -29-300 is sometimes called a slight deviation, and if the angle is from -450 to -900 they speak of a sharp deviation.

3 Pathological causes of EOS shift to the left

As mentioned above, a slight deviation of the EOS to the left can be considered by doctors as a variant of the norm, if, after a more thorough examination, the doctor did not identify any diseases in the patient and the patient’s health is good. If the EOS is significantly deviated to the left, or the patient has health problems due to minor ECG changes, the following should be suspected: pathological conditions, in which a shift to the left of the cardiac axis occurs most often:

4 Left ventricular hypertrophy

The deviation of the cardiac axis to the left with an enlargement of the left ventricle is quite understandable, because physiologically this chamber of the heart is already the most powerful in terms of mass. This means that the vector of the heart will “take over” the left ventricle. And the more it increases in size and grows, the more the EOS will “move to the left.” This pathology occurs with high blood pressure or arterial hypertension, when the chambers of the heart cannot withstand high blood pressure and loads, they begin to compensatory gain weight - hypertrophy. Hypertrophy as one of the symptoms occurs in heart failure, atherosclerotic vascular changes, angina pectoris, cardiac asthma, and cardiomyopathies.

5 Conduction disorders

Disturbances in the conduction system will lead to changes in the cardiac vector and deviation of the cardiac axis. This is most often observed with blockade of the left bundle branch, or with blockade of its anterior superior branch. There are other ECG signs due to which this variety arrhythmias can be diagnosed. Holter ECG monitoring will also help in establishing the diagnosis.

6 Special forms of ventricular tachycardia

Some forms of ventricular tachycardia may also be the reason why EOS values are far from normal.

7 Heart defects

Heart defects, the ECG symptom of which can be the axis of the heart moving to the left, by their nature can be either congenital or acquired. Defects of any etiology, accompanied by overload of the left heart chambers, will be characterized by this ECG symptomatology.

Based on the reasons described above for EOS deviation, we can conclude that a shift to the left of the cardiac axis is not such a harmless ECG sign. It may indicate the presence in the patient’s body of sufficient serious problems. But at the same time, don't panic! At feeling good patient, stable ECG for several years, in the absence of supporting data on pathological change heart and blood vessels after a thorough examination, a slight deviation of the cardiac axis to the left may be a variant of the norm! But the conclusion that this is the norm can be made by a doctor after a thorough examination of the patient, and in the absence of data on the pathology of the cardiovascular system. What examinations should a doctor prescribe when diagnosing a patient with a shift to the left of the heart axis?

8 A set of examinations to clarify the diagnosis

It should be understood that deviation to the left of the EOS is not a diagnosis, but an ECG sign, which can be either a variant of the norm or a symptom of numerous diseases. Only a doctor can make a conclusion about what information this symptom carries, after carrying out a set of diagnostic procedures.

9 Is it necessary to treat an axle tilted to the left?

As the only isolated ECG sign - no. If this symptom is one of the others in the presence of a disease in the human body, the disease certainly needs to be treated. Treatment tactics depend directly on the disease that caused changes in the direction of the cardiac axis. In case of hypertension, which has led to enlargement of the left ventricle, adequate selection is necessary antihypertensive drugs. For arrhythmias - antiarrhythmic drugs, or, if indicated, implantation of an artificial pacemaker. For diagnosed heart defects - surgical treatment according to indications.