Displacement of the heart axis what. Horizontal position eos what does it mean

The figure below shows the six-axis Bailey lead system, which shows the red vector electrical axis of the heart located horizontally (angle α=0..+30°). The dotted line marks the projections of the e.o.s. vector. on the lead axis. Explanations for the figure are given in the table below.

On the "Automatic detection of EOS" page, a specially developed script will help you determine the location of the EOS based on ECG data from any two different leads.

Signs of horizontal position of the electrical axis of the heart

Lead	Amplitude and shape of the tooth
Standard lead I	E.o.s. is maximally parallel to lead I of all standard leads, therefore the projection of the e.o.s. on the axis of this lead will be the greatest, therefore, the amplitude of the R wave in this lead will be the maximum of all standard leads: R I >R II >R III
Standard lead II	E.o.s. is located in relation to axis II of the standard lead at an angle of 30..60°, therefore the amplitude of the R wave in this lead will be intermediate: R I >R II >R III
Standard lead III	Projection e.o.s. on axis III of the standard lead is as close as possible to the perpendicular, but still somewhat different from it, therefore, a small predominant negative wave will be recorded in this lead (since the e.o.s. is projected onto the negative part of the lead): S III >R III
Enhanced lead aVR	The enhanced lead aVR is located towards the e.o.s. the most parallel of all reinforced leads, while the e.o.s. vector is projected onto the negative part of this lead, therefore, in lead aVR a negative wave of the maximum amplitude of all enhanced leads will be recorded, approximately equal to the amplitude of the R wave in standard lead I: S aVR ≈R I
Enhanced lead aVL	E.o.s. is located in the area of the bisector of the angle formed by the standard lead II (positive half) and the enhanced lead aVL (positive half), hence the projection of the e.o.s. on the axis of these leads will be approximately the same: R aVL ≈R II
Enhanced lead aVF	The axis of the heart is vaguely perpendicular to lead aVF and is projected onto the positive part of the axis of this lead, therefore a small predominant positive wave will be recorded in this lead: R aVF >S aVF

Signs of horizontal position of e.o.s. ( angle α=0°)

Lead	Amplitude and shape of the tooth
Standard lead I	E.O.S direction coincides with the location of axis I of the standard lead and is projected onto its positive part. Therefore, the positive R wave has the maximum amplitude among all limb leads: R I =max>R II >R III
Standard lead II	E.o.s. identically located in relation to standard leads II and III: at an angle of 60° and projected onto the positive half of lead II and the negative half of the axis of lead III: R I >R II >R III ; S III >R III
Standard lead III
Enhanced lead aVR	E.o.s. identically located in relation to the enhanced leads aVR and aVL: at an angle of 30° and is projected onto the negative half of lead aVR and the positive half of aVL: S aVR =R aVL
Enhanced lead aVL
Enhanced lead aVF	Projection e.o.s. on the axis of the enhanced lead aVF is equal to zero (since the e.o.s. vector is perpendicular to this lead) - the amplitude of the positive R wave is equal to the amplitude of the negative S wave: R aVF =S aVF

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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 of the 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.

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.

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, tall people of asthenic physique, and closer to the horizontal position in strong, stocky people 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 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”).

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 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 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 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

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.

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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 the sinus node (the main source of cardiac electrical potentials).

Left ventricular hypertrophy (LVH) is a thickening of the wall and/or increase in size 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 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.

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 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

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 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.

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.

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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.

To record an ECG, an indifferent electrode is obtained by combining together the electrodes from the left arm, right arm 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 arm and right arm, II - left leg and right arm, III - left leg and left arm.

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).

A grounding electrode is always placed on the right leg.

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 of the heart's electrical activity; 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. The most important segments are P-Q and S-T. For example, the 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. First, depolarization of the interventricular septum occurs 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 an increased risk of torsade de pointes. Negative U waves in the precordial leads are always a 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 incorrect 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 high P waves of normal duration in leads II, III, aVF are characteristic of hypertrophy of the right atrium, for example, with “cor pulmonale”.

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.

Normally, the S-T segment is 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)

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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.

As for individual characteristics, it is noted that in people who are tall and have 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 the ECG, signs of this are a 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. An ECG with stress and 24-hour Holter monitoring can also be performed.

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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.

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 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

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 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.

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Questions and answers on: ECG horizontal position EOS

2015-08-28 09:09:20

Marina asks:

Hello! I am 24 years old and have been involved in active sports before. The ECG results alarmed me, according to the ECG: 81 beats per minute; Horizontal position of EOS: 5 degrees; Changes in the myocardium in the anteroseptal region of the left ventricle (to differentiate metabolic disorders from coronary circulation disorders).

Answers Bugaev Mikhail Valentinovich:

Hello. I don’t think that at the age of 24 you can have coronary circulation disorders, unless it’s a congenital anomaly of the heart vessels. I don’t see anything wrong with the results described.

2015-04-15 10:07:16

Alexandra asks:

Good afternoon I'm pregnant, 33 weeks. I did an ECG. Here is the result.
The rhythm is ectopic lower atrial, regular, heart rate 78. Horizontal position of the EOS. 1st degree AV block. Signs of left ventricular hypertrophy. Slightly pronounced changes in the myocardium in the anteroseptal region, upper and lower walls of the left ventricle.
This is serious? Can I give birth myself and in a regular maternity hospital? Thank you for your reply.

Answers Bugaev Mikhail Valentinovich:

Hello. So far I don’t see anything that requires intervention. But I would also do an ultrasound of the heart and daily Holter ECG monitoring. Do you have any complaints? Are there any loss of consciousness or fainting states? What PQ interval did you intend?

2014-06-08 13:08:00

Asks Zharikova Victoria:

The patient is 51 years old, 14 years old, has type 2 diabetes, moderate severity in the decompensation stage. He stated that he had experienced deep emotional stress and provided an ECG cardiogram: sinus rhythm, heart rate 69 per minute, horizontal position of the EOS. Do you have heart problems - warning signs of a heart attack or stroke? Did emotional experience have an impact?

Answers Bugaev Mikhail Valentinovich:

Hello. Based on this “description” of the ECG, it is impossible to say anything about possible heart problems; everything described is normal. But that doesn't mean anything. The very fact of having diabetes is a risk factor for coronary artery disease and other vascular problems. You need to see a competent doctor.

2013-12-15 17:29:02

Aizhan asks:

Hello! On the ECG I was diagnosed with the following: sinus rhythm, GSS - 7561, horizontal position of the EOS. PQ 0.14 QRS 0.08 Q-T 0.34 R-R 0.80 Heart rate 7561 per 1 min. R>R>R
I II III
Transition zone V 3 Voltage is normal. What does this mean? What does this mean? I am 40 years old. Weight 52 kg. No thyroid diseases, normal sugar levels, chronic pyelonephritis since 1999. Thanks in advance.

2013-11-02 08:46:56

Natalya asks:

Good afternoon, I am 37 years old and have frequent pain in my heart. I did an ECG. Sinus tachycardia with a heart rate of 92 beats per minute. Horizontal position of the EOS. Insufficient growth of the R wave in V1-V4. There is no evidence of acute focal pathology.

2012-10-12 10:50:25

Oksana asks:

Hello, my husband had an ECG of the heart and this is the conclusion: sinus rhythm with heart rate 86/min, horizontal position of the EOS, focal changes on the posterior wall of the left ventricle! what does this mean, and can this affect his work? works as a fireman!!! Thanks for the answer

2011-07-17 00:03:44

Faith asks:

Good day! Our close male relative, 45 years old, recently had an ECG,
How can I determine if there is hyperkalemia using an ECG? Please determine whether it is or not,
Here is the result of the ECG
HERE is the result of the ECG,

Rhythm: sinus, regular;
HR-66;
EOS position: 11 horizontal (N+0-29 degrees)
PQ Duration: 154
QRS: 92
QT/QT corr: 448
T waves: + in 1.2,AVF.V2-V6;T1>T3 -N
Rhythm disturbance: not detected

NOTE: SV2+RV5=3.96
CONCLUSION: Sinus rhythm, regular. Horizontal position of the EOS. Signs of LV hypertrophy

Answers Bugaev Mikhail Valentinovich:

Hello. It is impossible to reliably determine the potassium content in the blood using an ECG (especially without seeing the film). You just need to go and take a blood test to determine your blood electrolyte levels. QT is a bit long.

2010-06-08 14:39:38

Irina asks:

Good afternoon Please decipher the results of the ECG, I am 19 years old, height 163, weight 68. Sinus rhythm, horizontal position of the EOS, diffuse changes in the myocardium, pain expressed in the anteroseptal region of the left ventricle. Measurement results: HR 86 beats\min, QRS 94, QT\QTcB 388\464, PQ 164, P 110, RR\PP 698\685, P\QRS\T 70\5\40, QTD\QTcBD 78\93, Sokolov 1.9, NK 12

2009-09-02 15:29:19

Lolita Shemetova asks:

Hello! My husband is 55 years old. In August of this year, he was examined in the department of invasive cardiology and angiology of the N.A. Semashko Clinical Hospital in Simferopol, where he was given the CLINICAL DIAGNOSIS:
Myocardiofibrosis. Sick sinoantrial node syndrome. Transient SA blockade, stage II. Paroxysmal form of atrial fibrillation; group supraventricular extrasystole; unsustained atrial tachycardia. CH I st.

RELATED: Gastric ulcer, remission.

Laboratory results:
12
GENERAL BLOOD ANALYSIS: Er. - 4.0 x 10 /l; Hb - 131 g/l; CPU-0.98;
9 9
Leu - 7.3x10 /l; Platelets - 250x10 /l; ESR - 12mm/h; e - 2%, p - 1%, s - 60%, l - 29%, m - 8%, Hematocrit - 0.42.
BIOCHEMICAL BLOOD TEST: Glucose - 3.8 mm/l; Total bilirubin - 15.0 mm/l; straight - 5.0 mm/l; indirect - 10.0 mm/l; Urea - 5.7 mmol/l; Urea nitrogen - 2.6 mmol/l;
Sodium - 136 mmol/l; Potassium - 3.85 mmol/l; Creatinine - 0.10 mmol/l; AST - 0.61 mmol/l; ALT - 0.44 mmol/l; Cholesterol - 6.0 mmol/l.
COAGULOGRAM:
Prothrombin index - 100%, fibrinogen A - 2.2 g/l,
fibrinogen B - 0 g/l; recalcification time - 1 min.; fibrin - 10 mg; Thrombotest - VI stage; Time St. according to Lee-White - 8 min. 34 sec; Ethanol test - 0.

GENERAL URINE ANALYSIS: Color - yellow; Relative density - 1020; Reaction - sour; Protein - not detected; Glucose - negative; Epithelium - 0-1 in the field of vision, transition - 0-1 in the field of view; Leukocytes - units in p/zr; Red blood cells - 0--1 in p/z.

BLOOD GROUP: O (1) RH: positive.

RW dated 08/18/2009

ELECTROCARDIOGRAM dated August 17, 2009: Sinus rhythm. Horizontal position of the EOS. Group supraventricular extrasystole.

RG OGK No. 334 dated August 11, 2009: No focal or infiltrative shadows were identified. The roots are wide and dense. The heart is slightly enlarged due to the left ventricle, the aorta is elongated.

Heart ultrasound dated August 11, 2009: LA - 3.6 cm; LV EDR - 6.2 cm; LV ESD - 4.4 cm; LV ZS - 0.9 cm; IVS - 1.0 cm; Ejection fraction - 55%; RV - 3.6 cm.

Conclusion: Congenital compacted accessory chord in the LV cavity. Dilatation of the left ventricle, volume overload at the time of examination, eccentric hypertrophy of the left ventricle, myocardial factor is normal. Systolic and diastolic function were not changed. Septal fibrosis, fibrosis of the ring, walls of the non-expanded aortic root. Thrombus, non-classical anterior mitral and septal leaflet of the tricuspid valve, without obvious regurgitation. There is no pulmonary hypertension. The right sections are intact.

HM ECG dated 08/17/2009: Sinus rhythm alternates with frequent episodes of flutter - atrial fibrillation and unstable atrial tachycardia. Frequent episodes of SA - stage II blockade with a maximum pause of 1900 msec.

CORONAROGRAPHY from 08/17/2009: Atherosclerosis of the coronary arteries. No hemodynamically significant lesions of the coronary arteries were detected.

Treatment was carried out: sotohexal, ipatone, magne I6, kymacef + physical solution, afobazole.

DISCHARGE CONDITION: Satisfactory. No complaints.
Blood pressure 120/80 mmHg.

RECOMMENDATIONS:
1. Observation by a cardiologist at the place of residence.
2. Sotohexal 40 mg 2 times a day.
3. Ipaton 0.25 g 2 times a day.
4. Magne B6 - 1 t 2 times a day.
5. Afobazole 1 t 3 times a day - 1 month.
6. Bilobil 1 caps 3 times a day - 1 month.
7. Vestibo 16 mg 3 times a day - 1 month.
8. Repeat Holter monitoring after 1.5 - 2 months
subsequent consultation in the department of invasive cardiology and
angiology.

Sorry for such an extensive description, I don’t know if it’s appropriate.

The clinic’s specialists recommended that we prepare for the fact that my husband would have to have a pacemaker installed.
I in no way question their recommendations, but I would like to hear the opinions of other specialists, how necessary is this and are there other methods of treatment for this diagnosis? And if you are going to install a pacemaker, which of the two-chamber models is better to give preference to in order to be able to lead a full-fledged lifestyle that does not exclude physical activity, active recreation, etc.
In Simferopol they offer pacemakers "Rhapsody" and "Symphony" made in France. But, they say, there are also more expensive models of pacemakers that are more multifunctional. What benefits do they provide?

I would be grateful and sincerely grateful for your answer.

Answers Selyuk Maryana Nikolaevna:

Good afternoon, Lolita
As for pacemakers, it is necessary, first of all, to decide whether it will be single-chamber or dual-chamber. Single-chamber pacemakers are a medical device that can affect and generate only one chamber of the heart (atrium or ventricle). Such pacemakers are the most simplified. The device can be frequency-controlled, in other words, it mechanically improves the frequency during physical exercise and without frequency regulation, that is, it continuously generates at the set frequency. Nowadays, single-chamber pacemakers are used in the generation of the right ventricle in chronic atrial fibrillation, and in addition in the generation of the right atrium in sick sinus syndrome (SSNS). For other indicators, a two-chamber pacemaker is used (often also used for SSSS syndrome).
There are a huge number of both single- and double-chamber ones. Sometimes they differ only in price. But this question will be better answered by the cardiac surgeon who is examining your husband specifically (it is necessary to take into account a number of absolutely specific parameters of both your husband and one should rely on the clinical experience of the cardiac surgeon with certain pacemakers and the ability to perform this or that operation). But, you should pay attention to the indicators that I have highlighted in bold. With such cholesterol, the disease progresses quite quickly... Low sugar levels are also not a good indicator. And the PTI indicator is high for your case. And the main thing - the phrase upon discharge - the condition is satisfactory, there are no complaints. So, all of the above stopped occurring (i.e., a cure occurred), or was the patient simply tired of complaining......?

The medical concept of “electrical axis of the heart” is used by cardiologists to reflect the electrical processes occurring in this organ. The location of the electrical axis must be calculated to determine the total component of the bioelectrical changes that occur in the muscle tissue of the heart during its contractile activity. The main organ is three-dimensional, and in order to correctly determine the direction of the EOS (which means the electrical axis of the heart), you need to imagine the human chest as a system with some coordinates that allow you to more accurately determine the angle of displacement - this is what cardiologists do.

The cardiac conduction system is a collection of sections of muscle tissue in the myocardium, which is an atypical type of fiber. These fibers have good innervation, which allows the organ to contract synchronously. The contractile activity of the heart begins in the sinus node; it is in this area that the electrical impulse originates. Therefore, doctors call the correct heart rate sinus.

Originating in the sinus node, the exciting signal is sent to the atrioventricular node, and then it travels along the His bundle. Such a bundle is located in the section that blocks the ventricles, where it is divided into two legs. The leg extending to the right leads to the right ventricle, and the other, rushing to the left, is divided into two branches - posterior and anterior. The anterior branch is accordingly located in the region of the anterior zones of the septum between the ventricles, in the anterolateral compartment of the wall of the left ventricle. The posterior branch of the left bundle branch is localized in two-thirds of the septal part separating the ventricles of the organ, the middle and lower, as well as the posterolateral and lower walls, located in the area of the left ventricle. Doctors say that the anterior branch is located slightly to the right of the posterior branch.

The conduction system is a powerful source that supplies electrical signals that cause the main part of the body to work normally, in the correct rhythm. Only doctors can calculate any violations in this area; they cannot do this on their own. Both an adult and a newborn baby can suffer from pathological processes of this nature in the cardiovascular system. If deviations occur in the conduction system of the organ, the axis of the heart may become confused. There are certain standards for the position of this indicator, according to which the doctor identifies the presence or absence of deviations.

Parameters in healthy people

How to determine the direction of the electrical axis of the heart? The weight of the muscle tissue of the left ventricle usually significantly exceeds that of the right ventricle. You can find out whether a given measurement is a horizontal or vertical vector using these standards. Since the mass of the organ is distributed unevenly, it means that electrical processes should occur more strongly in the left ventricle, and this shows that the EOS is directed specifically to this section.

Doctors project this data using a specially developed coordinate system, from which we can conclude that the electrical axis of the heart is in the region of +30 and also +70 degrees. However, every person, even a child, has individual body characteristics, its own anatomical characteristics. This shows that the slope of the EOS in healthy people can vary between 0-90 degrees. Based on such data, doctors have identified several areas of this indicator that are considered normal and do not interfere with the functioning of the organ.

What positions of the electrical axis exist:

semi-vertical electrical position of the heart;
vertically directed electrical position of the heart;
horizontal state of the EOS;
vertical placement of the electrical axis.

It should be noted that all five positions can occur in a person in good health. Finding the reason for such features is quite easy; human physiology explains everything.

Since the body structure of people is different, it is extremely rare to meet a pure hypersthenic or a very skinny individual; usually such types of structure are considered intermediate, and the direction of the heart axis can deviate from normal values (semi-vertical state or semi-horizontal position).

In what cases are we talking about pathology, the causes of violations

Sometimes the direction of the indicator can indicate the presence of a disease in the body. If, as a result of the diagnosis, deviations of the electrical axis of the heart to the left are detected, it means that the person has certain ailments, especially hypertrophic changes in the left ventricle. Often such a violation becomes a consequence of pathological processes, as a result of which the cavity of this section stretches and increases in size.

What diseases cause hypertrophy and a sharp tilt of the EOS to the left:

Ischemic damage to the main organ.
Arterial hypertension, especially with regular pressure surges to high tonometer values.
Cardiomyopathy. The disease is characterized by an increase in the weight of the muscle tissue of the heart and the expansion of all its cavities. This disease often appears after anemia, myocardial infarction, myocarditis or cardiosclerosis.
Chronic heart failure.
Disturbances in the aortic valve, its insufficiency or stenosis. A pathological process of this type can be acquired or congenital in nature. Such diseases cause disruption of blood flow in the cavities of the organ, which leads to overload of the left ventricle.
People involved in sports activities professionally also often exhibit these disorders.

In addition to hypertrophic changes, deviation of the heart axis sharply to the left may indicate problems with the conductive properties of the inner part of the ventricles, which usually arise with various blockades. What it is and what it threatens will be explained by the attending physician.

A blockade found in the left bundle branch is often diagnosed, which also refers to a pathology that shifts the EOS to the left.

The opposite condition also has its own reasons for its occurrence. Deviation of the electrical axis of the heart to the other side, the right, indicates hypertrophy of the right ventricle. There are certain diseases that provoke such a disorder.

What diseases lead to a tilt of the EOS to the right:

Pathological processes in the triscupid valve.
Stenosis and narrowing of the lumen of the pulmonary artery.
Pulmonary hypertension. This disorder often occurs against the background of other ailments, such as obstructive bronchitis, organ damage by emphysema, and bronchial asthma.

In addition, diseases that lead to a shift in the direction of the axis to the left can also cause the EOS to be tilted to the right.

Based on this, doctors conclude: a change in the electrical position of the heart is a consequence of ventricular hypertrophy. In itself, such a disorder is not considered a disease; it is a sign of another pathology.

First of all, it is necessary to note the position of the EOS during the mother's pregnancy. Pregnancy changes the direction of this indicator, as serious changes occur in the body. The rapidly enlarging uterus puts pressure on the diaphragm, which leads to a displacement of all internal organs and changes the position of the axis, as a result of which its direction can become semi-vertical, semi-horizontal or otherwise, depending on its initial state.

As for children, this indicator changes with age. In newborn babies, a significant deviation of the EOS to the right side is usually detected, which is absolutely normal. By adolescence, this angle is already established. Such changes are associated with a difference in the weight ratio and electrical activity of both ventricles of the organ, as well as with a change in the position of the heart in the chest area.

A teenager already has a certain angle of EOS, which normally remains throughout his life.

Symptoms

Changing the direction of the electrical axis cannot cause unpleasant sensations in humans. Disorders of well-being usually provoke hypertrophic damage to the myocardium if they are accompanied by severe hemodynamic disturbances, and also lead to the development of heart failure, which is very dangerous and requires treatment.

Symptoms:

pain in the head and chest area;
breathing problems, shortness of breath, suffocation;
swelling of the tissues of the lower, upper extremities and facial area;
weakness, lethargy;
arrhythmia, tachycardia;
disturbance of consciousness.

Determining the causes of such disorders is an important part of all therapy. The prognosis of the disease depends on the correctness of the diagnosis. If such symptoms occur, you should immediately consult a doctor, as cardiac problems are extremely dangerous.

Diagnosis and treatment

Typically, axis deviation is detected on an ECG (electrocardiogram). This method is not more often than others prescribed during a routine examination. The resulting vector and other characteristics of the organ make it possible to evaluate the activity of the heart and calculate deviations in its work. If such a disorder is detected on the cardiogram, the doctor will need to carry out several additional examinations.

Diagnostic methods:

Ultrasound of the organ is considered one of the most informative methods. With the help of such a study, it is possible to identify ventricular hypertrophy, disturbances in the structure of the heart and evaluate its contractile characteristics.
X-ray of the chest area, allowing you to see the presence of a shadow of the heart, which usually occurs with myocardial hypertrophy.
ECG in the form of daily monitoring. It is necessary to clarify the clinical picture in case of disorders related not only to the axis itself, but also to the origin of the rhythm not from the sinus node area, which indicates a disorder of the rhythmic data.
Coronary angiography or coronary angiography. It is used to study the characteristics of damage to the coronary arteries during organ ischemia.
An exercise ECG can detect myocardial ischemia, which is usually the cause of a shift in the direction of the EOS.

It is necessary to treat not a change in the electrical axis indicator, but the disease that caused the pathology. Using diagnostics, doctors accurately determine the factors that provoked such disorders.

Changing the angle of the electrical axis of the heart does not require therapy.

No class of medications will help in this case. The disease that led to such changes needs to be eliminated. Drugs are prescribed to patients only after an accurate diagnosis has been made. Depending on the nature of the lesions, medications are used. Sometimes it is advisable to undergo surgery.

In order to determine the functional abilities of the heart, it is necessary to conduct special examination methods. If it turns out that there are disturbances in the conduction system of the organ, there is no need to panic, you must follow all the doctor’s recommendations. Medicine today can eliminate almost any pathology, you just need to seek help in a timely manner.