Sinus Node Rhythms and Arrhythmias: Difference between revisions

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==Normal heart rhythm: sinus rhythm==
==Normal heart rhythm: sinus rhythm==
[[Image:normalSR.jpg|thumb|Normal sinus rhythm with a positive P-wave in I, II and AVF, and a biphasic P-wave in V1.]]
The normal heart rhythm is ''sinus rhythm''. That means that the rhythm has its origin in the sinus node, the heart's fastest physiological impulse generator.
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With this knowledge it is quite simple to recognise normal sinus rhythm on the ECG.
With this knowledge it is quite simple to recognise normal sinus rhythm on the ECG.


;Criteria for normal sinus rhythm (see also [[Basics]]):
{| class="wikitable"
!Criteria for normal sinus rhythm (see also [[Basics]]):
|-
|
*A [[P wave morphology]] P wave (atrial contraction) precedes every QRS complex
*A [[P wave morphology]] P wave (atrial contraction) precedes every QRS complex
*The rhythm is regular, but varies slightly while breathing
*The rhythm is regular, but varies slightly while breathing
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*The P waves maximum height is 2.5 mm in II and/or III
*The P waves maximum height is 2.5 mm in II and/or III
*The P wave is positive in I and II, and biphasic in V1
*The P wave is positive in I and II, and biphasic in V1
|}


These last two definitions will be discussed in the topic [[P wave morphology]].
These last two definitions will be discussed in the topic [[P wave morphology]].

Revision as of 22:48, 7 February 2009

«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

Normal heart rhythm: sinus rhythm

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The sinus node (SA) is located in the upper part of the wall of the right atrium. When the sinus node generates an electrical impulse, 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.

With this knowledge it is quite simple to recognise 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 while breathing
  • The frequency ranges between 60 and 100 beats per minute
  • The P waves maximum height is 2.5 mm in II and/or III
  • The P wave is positive in I and II, and biphasic in V1

These last two definitions will be discussed in the topic P wave morphology. Heart rhythms which are not sinus rhythm are arrhythmias.

Sinus arrhythmias

Some variants of sinusrhythm 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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