/ 22.02.2018

Sinus rhythm horizontal position eos. Normal location of the EOS and reasons for its displacement

Additional Research

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

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

Treatment

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

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

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

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

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

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

In the direction of the axis, the doctor determines the bioelectrical changes that occur in the myocardium during contraction.

To determine the direction of the EOS, there is a coordinate system that is located throughout the chest.

With electrocardiography, the doctor can install the electrodes according to the coordinate system, and it will be clear where the axis angle is located, that is, the places where the electrical impulses are strongest.

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.

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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, pain in the chest, swelling of the limbs and face, suffocation and shortness of breath.

If cardiac symptoms occur, you should immediately undergo electrocardiography.

Determination of ECG signs

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 it S has great depth than the height R.

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. 24-hour Holter monitoring can also be performed.

Do you still think that it is impossible to get rid of HEART DISEASES!?

• Do you often experience discomfort in the heart area (pain, tingling, squeezing)?
• You may suddenly feel weak and tired...
• I constantly feel high blood pressure...
• There is nothing to say about shortness of breath after the slightest physical exertion...
• And you have been taking a bunch of medications for a long time, going on a diet and watching your weight...

But judging by the fact that you are reading these lines, victory is not on your side. That is why we recommend reading the story of Olga Markovich, who found an effective remedy for cardiovascular diseases.

In this issue I will briefly touch on these issues. From the next issues we will begin to study pathology.

Also, previous issues and materials for a more in-depth study of ECG can be found in the "" section.

1. What is the resulting vector?

Inextricably linked with the concept of the resulting vector of ventricular excitation in the frontal plane.

The resulting vector of ventricular excitation is the sum of three moment vectors of excitation: the interventricular septum, the apex and base of the heart.
This vector has a certain orientation in space, which we interpret in three planes: frontal, horizontal and sagittal. In each of them, the resulting vector has its own projection.

2. What is the electrical axis of the heart?

Electrical axis of the heart called the projection of the resulting vector of ventricular excitation in the frontal plane.

The electrical axis of the heart may deviate from its normal position either to the left or to the right. The exact deviation of the electrical axis of the heart is determined by the alpha (a) angle.

3. What is the alpha angle?

Let us mentally place the resulting vector of ventricular excitation inside Einthoven’s triangle. Corner, formed by the direction of the resulting vector and the I axis of the standard lead, and is required angle alpha.

The value of the alpha angle are found using special tables or diagrams, having previously determined on the electrocardiogram the algebraic sum of the teeth of the ventricular complex (Q + R + S) in standard leads I and III.

Find the algebraic sum of the teeth ventricular complex is quite simple: measure in millimeters the size of each wave of one ventricular QRS complex, taking into account that the Q and S waves have a minus sign (-), since they are below the isoelectric line, and the R wave has a plus sign (+). If any wave on the electrocardiogram is missing, then its value is equal to zero (0).

If the alpha angle is within 50-70°, talk about the normal position of the electrical axis of the heart (the electrical axis of the heart is not deviated), or a normogram. When the electrical axis of the heart deviates right angle alpha will be determined in within 70-90°. In everyday life, this position of the electrical axis of the heart is called a legal grammar.

If the alpha angle is greater than 90° (for example, 97°), it is considered that this ECG has block of the posterior branch of the left bundle branch.
By defining the alpha angle within 50-0° we speak of deviation of the electrical axis of the heart to the left, or levogram.
A change in the alpha angle within 0 - minus 30° indicates a sharp deviation of the electrical axis of the heart to the left or, in other words, about the sharp leftogram.
And finally, if the value of the alpha angle is less than minus 30° (for example, minus 45°), they speak of anterior branch blockade left bundle branch.

Determination of the deviation of the electrical axis of the heart by the alpha angle using tables and diagrams is carried out mainly by office doctors functional diagnostics, where the relevant tables and diagrams are always at hand.
However, it is possible to determine the deviation of the electrical axis of the heart without the necessary tables.

In this case, the deviation of the electrical axis is determined by analyzing the R and S waves in standard leads I and III. In this case, the concept of the algebraic sum of the teeth of the ventricular complex is replaced by the concept "defining tooth" QRS complex, visually comparing the R and S waves in absolute value. They speak of an “R-type ventricular complex,” meaning that in this ventricular complex the R wave is higher. On the contrary, in "S-type ventricular complex" The defining wave of the QRS complex is the S wave.

If on the electrocardiogram in the first standard lead the ventricular complex is represented by the R-type, and the QRS complex in the third standard lead has an S-type shape, then in this case the electrical the axis of the heart is deviated to the left (levogram). Schematically, this condition is written as RI-SIII.

On the contrary, if in standard lead I we have the S-type of the ventricular complex, and in lead III the R-type of the QRS complex, then the electrical axis of the heart deviated to the right (pravogram).
Simplified, this condition is written as SI-RIII.

The resulting vector of ventricular excitation is normally located in frontal plane like this that its direction coincides with the direction of axis II of the standard lead.

The figure shows that the amplitude of the R wave in standard lead II is greatest. In turn, the R wave in standard lead I exceeds the RIII wave. Under this condition of the ratio of R waves in various standard leads, we have normal position of the electrical axis of the heart(the electrical axis of the heart is not deviated). A short notation for this condition is RII>RI>RIII.

4. What is the electrical position of the heart?

Close in meaning to the electrical axis of the heart is the concept electrical position of the heart. Under the electrical position of the heart imply the direction of the resulting vector of ventricular excitation relative to axis I of the standard lead, taking it as if it were the horizon line.

Distinguish vertical position of the result vector relative to axis I of the standard lead, calling it the vertical electrical position of the heart, and the horizontal position of the vector is the horizontal electrical position of the heart.

There is also a basic (intermediate) electrical position of the heart, semi-horizontal and semi-vertical. The figure shows all the positions of the resulting vector and the corresponding electrical positions of the heart.

For these purposes, the ratio of the amplitude of the K waves of the ventricular complex in the unipolar leads aVL and aVF is analyzed, keeping in mind the features of the graphic display of the resulting vector with the recording electrode (Fig. 18-21).

Conclusions from this issue of the newsletter “Learning ECG step by step - it’s easy!”:

1. The electrical axis of the heart is the projection of the resulting vector in the frontal plane.

2. The electrical axis of the heart is capable of deviating from its normal position either to the right or to the left.

3. The deviation of the electrical axis of the heart can be determined by measuring the alpha angle.

A small reminder:

4. The deviation of the electrical axis of the heart can be determined visually.
RI-SШ levogram
RII > RI > RIII normogram
SI-RIII spelling

5. The electrical position of the heart is the position of the resulting vector of excitation of the ventricles in relation to axis I of the standard lead.

6. On the ECG, the electrical position of the heart is determined by the amplitude of the R wave, comparing it in leads aVL and aVF.

7. The following electrical positions of the heart are distinguished:

Conclusion.

You can find everything you need to study deciphering an ECG and determining the electrical axis of the heart in the section of the site: "". The section contains both clear articles and video tutorials.
If there are problems with understanding or deciphering, we are waiting for questions on the forum for free consultations with a doctor -.

Additional Information:

1. The concept of “inclination of the electrical axis of the heart”

In some cases, when visually determining the position of the electrical axis of the heart, a situation is observed when the axis deviates from its normal position to the left, but clear signs The levogram is not detected on the ECG. The electrical axis is, as it were, in a borderline position between the normogram and the levogram. In these cases, they talk about a tendency to levogramma. In a similar situation, deviations of the axis to the right indicate a tendency towards a right-hand grammar.

2. The concept of “uncertain electrical position of the heart”

In some cases, it is not possible to find on the electrocardiogram the conditions described for determining the electrical position of the heart. In this case, they speak of an uncertain position of the heart.

Many researchers believe that the practical significance of the electrical position of the heart is small. It is usually used for more accurate topical diagnosis pathological process, occurring in the myocardium, and to determine hypertrophy of the right or left ventricle.

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

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

ATTENTION! Information provided on the site website is for reference only. The site administration is not responsible for possible negative consequences if you take any medications or procedures without a doctor’s prescription!

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

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

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

Normal indicators in the cardiogram

What to pay attention to when performing electrocardiography:

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

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

When the ECG registers sinus rhythm, it means that the patient does not yet have problems with the heart. It is very important not to worry or be nervous when undergoing the examination, so as not to receive false data.

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

Violations and criteria for their determination

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

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

If the conclusion contains a phrase about an unstable rhythm, this means a manifestation of a low heart rate or the presence of sinus bradycardia. Bradycardia has a detrimental effect on a person’s condition, since the organs do not receive the amount of oxygen required for normal activity.

If an accelerated sinus rhythm is recorded, then most likely this is a manifestation of tachycardia. This diagnosis is made when the number of heart beats exceeds 110 beats.

Interpretation of results and diagnosis

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

In this way, the following deviations can be diagnosed:

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

Reasons for deviations

The most common causes of rhythm disturbances are:

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

Additional Research

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

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

Then Holter monitoring is prescribed or a drug test is performed, which makes it possible to find out whether there is a pathology of the node itself or whether the regulation of the autonomic system of the node is disrupted.

For more details about weak node syndrome, watch the video conference:

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

Holter monitoring is a regular electrocardiogram that is performed throughout the day. Due to the duration of this examination, specialists can study the condition of the heart at different degrees of stress. When conducting a regular ECG, the patient lies on the couch, and when conducting Holter monitoring, it is possible to study the state of the body during physical activity.

Treatment tactics

Sinus arrhythmia does not require special treatment. An incorrect rhythm does not mean that you have any of the listed diseases. Heart rhythm disturbances are a common syndrome characteristic of any age.

A proper diet, daily routine, and lack of stress can greatly help to avoid heart problems. It would be useful to take vitamins to maintain heart function and improve the elasticity of blood vessels. In pharmacies you can find a large number of complex vitamins containing all the necessary components and specialized vitamins to maintain the functioning of the heart muscle.

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

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

If you plan your diet correctly and adhere to a daily routine, you can achieve long and uninterrupted functioning of the heart muscle and not worry about it until you are very old.

Finally, we invite you to watch a video with questions and answers about heart rhythm disturbances:

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

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

• in whose family cases of similar diseases have already been recorded;
• working in stressful conditions;
• leading a sedentary lifestyle.

Of course, stress and sitting at a computer for a long time does not always mean that the patient will have an irregular sinus rhythm or other disorders, it only places him at risk.

Read more about what heart rhythm is, what its normal rate is, the dangers of its disturbances, and what diseases it can signal later in the article.

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

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

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

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

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

Read more about how a heart cardiogram is deciphered, read further in the article.

ECG interpretation: general rules

What a sinus rhythm of one nature or another means, only a doctor can judge. However, he is guided by the norms of indicators - for adults and children they are somewhat different. This article discusses the adult electrocardiogram.

On the latter there are several areas that represent signs of sinus rhythm:

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

This all indicates relatively normal heart function. It is necessary to pay attention to the fact that the heart rate on the ECG of an adult should be within 60-85 beats in 60 seconds. For children under 12 years of age this figure is different. You can see it in the table below.

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

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

In fact, the deviation of the EOS to the left or right is uncritical. The axis of the heart can be in the position:

• vertical;
• horizontal;
• semi-vertical;
• the opposite.

However, a certain reversal of the heart can signal problems. If the axis is deviated to the left, this may indicate left ventricular hypertrophy, arterial hypertension, heart block or conduction disturbances within the ventricles. If the position of the electrical axis of the heart is deviated to the right, left ventricular hypertrophy or blockade may also occur. An altered position of the electrical axis of the heart is considered normal, but upon first detection it is recommended to undergo a thorough examination.

Some interesting patterns:

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

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

What does a disturbance in sinus rhythm on a cardiogram indicate?

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

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

The following abnormalities in heart contractions are distinguished:

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

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

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

What affects heart contractions?

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

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

Often the situation normalizes when a person finds himself in a calm environment. More than half of heart rate problems go away after stress relief. As a percentage, this figure is 62%. It is important to understand that due to busy work, most patients feel discomfort. Regardless of the reasons, if available obvious signs violations, it is recommended to visit a doctor.

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

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

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

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

Often problems with heart rhythm are eliminated by organizing correct mode work and rest, normalization of nutrition, elimination of stress.

It's best to prevent problems from occurring, so it's important to:

• do not overload yourself with physical exercise;
• if possible, do not deviate from the correct lifestyle;
• take heart-strengthening medications (after consulting your doctor).

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

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

• oranges;
• raisin;
• blueberries;
• beets;
• cabbage;
• spinach.

These products strengthen cardiovascular system, reduce the risk of rhythm interruptions. A properly selected diet will also reduce the likelihood of myocardial infarction, which is especially important for older people.

When should you visit a cardiologist?

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

In any case, the ECG, which should only be interpreted by a doctor, is considered the basis for recognizing the cause of the disease. Each number from the electrocardiogram has a specific meaning. A cardiologist will help you figure out what they mean.

Note! It should be remembered that some symptoms manifest differently in children. Therefore, the Union of Pediatricians of Russia has its own regulations regarding the treatment of such diseases in children.

Sinus rhythm disturbance: summary

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

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

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

Even if there are no complaints, you should not neglect visiting a cardiologist. Some diseases occur hidden, without causing inconvenience to the patient until a certain time.

Electrical axis of the heart - those words that appear first when deciphering an electrocardiogram. When they write that her position is normal, the patient is satisfied and happy. However, in conclusions they often write about the horizontal, vertical axis, and its deviations. In order not to experience unnecessary anxiety, it is worth having an understanding of EOS: what it is, and what the dangers are if its position is different from the normal one.

General idea of ​​EOS - what is it

It is known that the heart, during its tireless work, generates electrical impulses. They originate in a certain area - in the sinus node, then normally the electrical excitation passes to the atria and ventricles, spreading along the conducting nerve bundle, called the bundle of His, along its branches and fibers. In total, this is expressed as an electric vector, which has a direction. EOS is the projection of this vector onto the anterior vertical plane.

Doctors calculate the position of the EOS by plotting the amplitudes of the ECG waves on the axis of the Einthoven triangle formed by standard ECG leads from the limbs:

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

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

The normal position of the EOS - what is it?

Determine the position of the EOS

• speed and quality of passage of the electrical signal through the structural divisions of the conduction system of the heart,
• the ability of the myocardium to contract,
• changes internal organs, which can affect the functioning of the heart, and in particular the conduction system.

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

It is considered normal when the EOS is located in the range from 0 to +90 degrees, depending on constitutional features. Most often, normal EOS is located between +30 and +70 degrees. Anatomically, it is directed down and to the left.

The intermediate position is between +15 and +60 degrees.

On the ECG, positive waves are higher in the second, aVL, aVF leads.

• R2>R1>R3 (R2=R1+R3),
• R3>S3,
• R aVL=S aVL.

Vertical position of the EOS

When verticalized, the electrical axis is located between +70 and +90 degrees.

It occurs in people with a narrow chest, tall and thin. Anatomically, the heart literally “hangs” in their chest.

On the ECG, the highest positive waves are recorded in aVF. Deep negative – in aVL.

• R2=R3>R1;
• R1=S1;
• R aVF>R2,3.

Horizontal position of the EOS

The horizontal position of the EOS is between +15 and -30 degrees.

Characteristic for healthy people those with a hypersthenic physique - wide chest, short stature, increased weight. The heart of such people “lies” on the diaphragm.

On the ECG, the highest positive waves are recorded in aVL, and the deepest negative ones in aVF.

• R1>R2>R3;
• R aVF=S aVF
• R2>S2;
• S3=R3.

Deviation of the electrical axis of the heart to the left - what does it mean?

The deviation of the EOS to the left is its location in the range from 0 to -90 degrees. Up to -30 degrees can still be considered a variant of the norm, but a more significant deviation indicates a serious pathology or a significant change in the location of the heart. for example, during pregnancy. Also observed with maximally deep exhalation.

Pathological conditions accompanied by deviation of the EOS to the left:

• hypertrophy of the left ventricle of the heart is a companion and consequence of prolonged arterial hypertension;
• violation, blockade of conduction along the left leg and fibers of the His bundle;
• left ventricular myocardial infarction;
• heart defects and their consequences that change the conduction system of the heart;
• cardiomyopathy, which impairs the contractility of the heart muscle;
• myocarditis - inflammation also impairs the contractility of muscle structures and the conduction of nerve fibers;
• cardiosclerosis;
• myocardial dystrophy;
• calcium deposits in the heart muscle, preventing it from contracting normally and disrupting innervation.

These and similar diseases and conditions lead to an increase in the cavity or mass of the left ventricle. As a result, the excitation vector takes longer on the left side and the axis deviates to the left.

The ECG in the second and third leads is characterized by deep S waves.

• R1>R2>R2;
• R2>S2;
• S3>R3;
• S aVF>R aVF.

Deviation of the electrical axis of the heart to the right - what does it mean?

Eos is deviated to the right if it is in the range from +90 to +180 degrees.

Possible reasons for this phenomenon:

• violation of the conduction of electrical excitation along the fibers of the His bundle, its right branch;
• myocardial infarction in the right ventricle;
• overload of the right ventricle due to narrowing of the pulmonary artery;
• chronic pulmonary pathology, the consequence of which is “ cor pulmonale", characterized by intense work of the right ventricle;
• the combination of coronary artery disease with hypertension - depletes the heart muscle, leading to heart failure;
• PE - blocking of blood flow in the branches of the pulmonary artery, of thrombotic origin, as a result the blood supply to the lungs is depleted, their vessels spasm, which leads to a load on the right side of the heart;
• mitral heart disease valve stenosis causing congestion in the lungs, which causes pulmonary hypertension and increased work of the right ventricle;
• dextrocardia;
• emphysema – moves the diaphragm down.

On the ECG, a deep S wave is noted in the first lead, while in the second and third it is small or absent.

• R3>R2>R1,
• S1>R1.

It should be understood that a change in the position of the heart axis is not a diagnosis, but only signs of conditions and diseases, and only an experienced specialist should understand the reasons.

A heart rhythm that originates from the sinus node and not from other areas is called sinus. It is determined both in healthy people and in some patients suffering from heart disease.

Cardiac impulses appear in the sinus node, then disperse through the atria and ventricles, which causes the muscular organ to contract.

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

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

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

In newborns, the rhythm frequency can be 60 - 150 per minute. With growing up, the rhythm frequency slows down and by 6-7 years it approaches adult levels. In healthy adults, the rate is 60–80 per 60 seconds.

Normal indicators in the cardiogram

What to pay attention to when performing electrocardiography:

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

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

Rotations of the organ from the transverse axis can be determined, which only indicate the structural features of a particular organ.

When the ECG registers sinus rhythm, it means that the patient does not yet have problems with the heart. Very It is important not to worry or be nervous when undergoing the examination to avoid receiving false data.

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

Violations and criteria for their determination

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

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

If a phrase about an unstable rhythm appears in the conclusion, this means that this is a manifestation of a small or presence of sinus bradycardia. Bradycardia has a detrimental effect on a person’s condition, since the organs do not receive the amount of oxygen required for normal activity.

Unpleasant symptoms of this disease can be dizziness, pressure changes, discomfort and even chest pain and shortness of breath.

If an accelerated sinus rhythm is recorded, then most likely this is a manifestation tachycardia. This diagnosis is made when the number of heart beats exceeds 110 beats.

Interpretation of results and diagnosis

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

In this way, the following deviations can be diagnosed:

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

Reasons for deviations

The most common causes of rhythm disturbances are:

• excessive alcohol abuse;
• smoking;
• long-term use of glycosides and antiarrhythmic drugs;
• bulging of the mitral valve;
• pathologies of thyroid function, including thyrotoxicosis;
• heart failure;
• infectious lesions of the valves and other parts of the heart - his disease is quite specific);
• overload: emotional, psychological and physical.

Additional Research

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

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

Additional examination is prescribed when the rhythm is lower than 50 and stronger than 90.

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

If you plan your diet correctly and adhere to a daily routine, you can achieve long and uninterrupted functioning of the heart muscle and not worry about it until you are very old.

Finally, we invite you to watch a video with questions and answers about heart rhythm disturbances: