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Please read the [[Introduction|introduction to the 7+2 step plan]] first. | Please read the [[Introduction|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 | 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. | ||
<flashow>http://nl.ecgpedia.org/images/0/09/Normal_SR.swf|align=right|height=300px|width=300px</flashow> | <flashow>http://nl.ecgpedia.org/images/0/09/Normal_SR.swf|align=right|height=300px|width=300px</flashow> | ||
With this knowledge it is quite simple to | With this knowledge it is quite simple to recognize normal sinus rhythm on the ECG. | ||
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*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 | *The rhythm is regular, but varies slightly during respirations | ||
*The rate ranges between 60 and 100 beats per minute | *The rate ranges between 60 and 100 beats per minute | ||
*The P waves maximum height | *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 | *The P wave is positive in I and II, and biphasic in V1 | ||
|} | |} | ||
As you see, | 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 | If the rhythm is not sinus, the '''[[arrhythmias|arrhytmias algorithm]]''' should be followed. | ||
==Sinus arrhythmias== | ==Sinus arrhythmias== | ||
Some variants of | Some variants of sinus rhythm exist: | ||
*[[Asystole]] | *[[Asystole]] | ||
*[[Sinustachycardia|Sinustachycardia (>100 beats per minute)]] | *[[Sinustachycardia|Sinustachycardia (>100 beats per minute)]] |
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