Sinus Node Rhythms and Arrhythmias: Difference between revisions

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[[Image:geleidingssysteem.jpg|thumb|Het geleidingssysteem zorgt voor de verspreiding van het electrisch signaal door het hart. Het normale hartritme begint in de sinusknoop en gaat dan via de AV (atrio-ventriculaire) knoop naar de bundel van His, waarna het zich splitst via de linker en rechter bundeltak.]]
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This part is about the normal ECG. The normal heart rhythm is sinal rhythm. That means that the rhythm has its origin in the sinal node, the heart's fastest physiological impulse generator.
|previouspage=Basics
|previousname=Basics
|nextpage=Rate
|nextname=Step 2: Heart Rate
}}
{{authors|
|mainauthor= [[user:Drj|J.S.S.G. de Jong]]
|moderator= [[user: Vdbilt|I.A.C. van der Bilt]]
|supervisor=
}}
Please read the [[Introduction|introduction to the 7+2 step plan]] first.


The sinus node (SA) is located in the upper part of the wall of the right atrium. When the sinus node generates an electrical signal, first the cells of the right atrium depolarise, then the cells of the left atrium, the AV (atrioventricular) node follows and at last the ventricles are stimulated via the His bundle.
The sinus node (SA) is located in the roof of the right atrium. It is the fastest physiological pacemaker. When the sinus node generates an electrical impulse, the surrounding cells of the right atrium depolarize. Then the cells of the left atrium, the AV (atrioventricular)node, follow, and at last the ventricles are stimulated via the His bundle.


With this knowledge it is quite simple to recognise sinus rhythm on the ECG.
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With this knowledge it is quite simple to recognize normal sinus rhythm on the ECG.
===The properties of normal sinus rhythm (see also [[Basics]]):===
 
[[Image:QRSverklaring.jpg|thumb| Bij normaal sinusritme volgt na iedere atriale contractie (p-top) volgt een ventriculaire contractie (QRS complex).]]
{| class="wikitable"
[[Image:normalSR.jpg|thumb|Normaal sinusritme met een positieve P-top in I,II en AVF én een bifasische p-top in V1.]]
!Criteria for normal sinus rhythm (see also [[Basics]]):
*Een p top (boezemcontractie) gaat vooraf aan het QRS complex
|-
*Op iedere p top volgt een QRS complex
|
*Het ritme is regelmatig, maar varieert licht met de ademhaling
*A [[P wave morphology]] P wave (atrial contraction) precedes every QRS complex
*De frequentie ligt tussen de 60 en 100 / minuut.
*The rhythm is regular, but varies slightly during respirations
*De maximale hoogte van de p top is 2,5 mm in II en / of III
*The rate ranges between 60 and 100 beats per minute
*De p top is positief in I en II, en bifasisch in V1
*The P waves maximum height at 2.5 mm in II and/or III
*The P wave is positive in I and II, and biphasic in V1
|}
 
As you can see, knowledge of [[Rate|heart rate]] and [[P wave morphology]] are necessary to determine the rhythm. We have put Rhythm as step 1 as it is of great importance. Arrhythmias include the most life-threatening ECG abnormalities. In most settings, however, the rhythm will be sinus.


If the rhythm is not sinus, the '''[[Arrhythmias|Arrhythmias algorithm]]''' should be followed.


Deze laatste twee definities komen aan bod in het hoofdstukje [[p top morfologie]].
==Sinus arrhythmias==
Some variants of sinus rhythm exist:
*[[Asystole]]
*[[Sinustachycardia|Sinustachycardia (>100 beats per minute)]]
*[[Sinusbradycardia|Sinusbradycardia (<60 beats per minute)]]
*[[Sinusarrest|Sinus arrest or pause]]
*[[Sino-atrial_exit_block|Sino-atrial exit block]]
*[[Sick Sinus Syndrome]]
*[[Sinus Arrhythmia]]


Hartritmes die geen sinusritme zijn komen aan bod in het hoofdstuk [[ritmestoornissen]].
Arrhythmias are discussed in the [[Arrhythmias]] chapter.


If the heart rate exceeds 100 bpm, the [[Arrhythmias#Tachyarrhythmias|tachcyardia flow chart]] should be followed.
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[[Image:Normaal ecg.jpg|thumb| Een voorbeeld van een normaal ECG]]
==Examples==
<gallery>
Image:Normaal ecg.jpg|An example of normal sinus rhythm.
Image:Nsr.jpg|Another example of normal sinus rhythm.
</gallery>
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Latest revision as of 21:10, 14 January 2021

«Basics Step 2: Heart Rate»


Author(s) J.S.S.G. de Jong
Moderator I.A.C. van der Bilt
Supervisor
some notes about authorship

Please read the introduction to the 7+2 step plan first.

The sinus node (SA) is located in the roof of the right atrium. It is the fastest physiological pacemaker. When the sinus node generates an electrical impulse, the surrounding cells of the right atrium depolarize. Then the cells of the left atrium, the AV (atrioventricular)node, follow, and at last the ventricles are stimulated via the His bundle.

With this knowledge it is quite simple to recognize normal sinus rhythm on the ECG.

Criteria for normal sinus rhythm (see also Basics):
  • A P wave morphology P wave (atrial contraction) precedes every QRS complex
  • The rhythm is regular, but varies slightly during respirations
  • The rate ranges between 60 and 100 beats per minute
  • The P waves maximum height at 2.5 mm in II and/or III
  • The P wave is positive in I and II, and biphasic in V1

As you can see, knowledge of heart rate and P wave morphology are necessary to determine the rhythm. We have put Rhythm as step 1 as it is of great importance. Arrhythmias include the most life-threatening ECG abnormalities. In most settings, however, the rhythm will be sinus.

If the rhythm is not sinus, the Arrhythmias algorithm should be followed.

Sinus arrhythmias

Some variants of sinus rhythm exist:

Arrhythmias are discussed in the Arrhythmias chapter.

If the heart rate exceeds 100 bpm, the tachcyardia flow chart should be followed.

Examples

  • An example of normal sinus rhythm.

    An example of normal sinus rhythm.

  • Another example of normal sinus rhythm.

    Another example of normal sinus rhythm.


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