Sinus rhythm counterclockwise transposition refers to the patient should appear in the electrocardiogram V5, V6 leads of the graph but appeared in the V1, V2 leads, and at the same time from the heart of the long axis of the apical direction of the observation similar to the heart has occurred counterclockwise rotation. Sinus rhythm counterclockwise rotation is mostly seen in the left heart hypertrophy, clinically common cardiomyopathy, coronary artery disease, hypertension, heart failure, aortic valve stenosis, valvular disease, etc., may lead to the patient’s left heart hypertrophy or enlargement, thus showing the heart counterclockwise rotation. Secondly, part of the non-diseased population may also show sinus rhythm counterclockwise transposition, such as obese people, especially abdominal obesity, due to the abdominal fat is more, easy to lead to the diaphragm is elevated, so that the heart position is relatively high, belongs to the body type related to the electrocardiogram normal variant. Therefore, sinus rhythm reverse clockwise transposition may belong to the normal phenomenon, may also belong to the abnormal phenomenon, need to be analyzed according to the patient’s specific situation, if necessary, follow the doctor’s instructions to take corresponding treatment measures.