dr_hani
04-01-2003, 09:09 PM
*Normal sinus rhythm :
Normal sinus rhythm is the rhythm of a healthy normal heart, where the sinus node triggers the cardiac activation. This is easily diagnosed by noting that the three deflections, P-QRS-T, follow in this order and are differentiable. The sinus rhythm is normal if its frequency is between 60 and 100/min.<
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902ae.gif
All complexes normal, evenly spaced
Rate 60 - 100/min
*Sinus bradycardia :
A sinus rhythm of less than 60/min is called sinus bradycardia. This may be a consequence of increased vagal or parasympathetic tone.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902be.gif
All complexes normal, evenly spaced
Rate < 60 - 100/min
*Sinus tachycardia :
A sinus rhythm of higher than 100/min is called sinus tachycardia. It occurs most often as a physiological response to physical exercise or psychical stress, but may also result from congestive heart failure.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902ce.gif
All complexes normal, evenly spaced
Rate > 100/min
*Sinus arrhythmia :
If the sinus rhythm is irregular such that the longest PP- or RR-interval exceeds the shortest interval by 0.16 s, the situation is called sinus arrhythmia. This situation is very common in all age groups. This arrhythmia is so common in young people that it is not considered a heart disease. One origin for the sinus arrhythmia may be the vagus nerve which mediates respiration as well as heart rhythm. The nerve is active during respiration and, through its effect on the sinus node, causes an increase in heart rate during inspiration and a decrease during expiration. The effect is particularly pronounced in children.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902de.gif
All complexes normal, rhythm is irregular
Longest R-R interval exceeds shirtest > 0.16 s
*Wandering pacemaker :
The origin of the atrial contraction may also vary or wander. Consequently, the P-waves will vary in polarity, and the PQ-interval will also vary.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902ee.gif
Variation in P-wave contour, P-R and P-P interval
and therefore in R-R intervals
*Atrial flutter :
When the heart rate is sufficiently elevated so that the isoelectric interval between the end of T and beginning of P disappears, the arrhythmia is called atrial flutter. The origin is also believed to involve a reentrant atrial pathway. The frequency of these fluctuations is between 220 and 300/min. The AV-node and, thereafter, the ventricles are generally activated by every second or every third atrial impulse (2:1 or 3:1 heart block).
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902fe.gif
Rapid flutter waves, ventricular response irregular
Normal sinus rhythm is the rhythm of a healthy normal heart, where the sinus node triggers the cardiac activation. This is easily diagnosed by noting that the three deflections, P-QRS-T, follow in this order and are differentiable. The sinus rhythm is normal if its frequency is between 60 and 100/min.<
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902ae.gif
All complexes normal, evenly spaced
Rate 60 - 100/min
*Sinus bradycardia :
A sinus rhythm of less than 60/min is called sinus bradycardia. This may be a consequence of increased vagal or parasympathetic tone.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902be.gif
All complexes normal, evenly spaced
Rate < 60 - 100/min
*Sinus tachycardia :
A sinus rhythm of higher than 100/min is called sinus tachycardia. It occurs most often as a physiological response to physical exercise or psychical stress, but may also result from congestive heart failure.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902ce.gif
All complexes normal, evenly spaced
Rate > 100/min
*Sinus arrhythmia :
If the sinus rhythm is irregular such that the longest PP- or RR-interval exceeds the shortest interval by 0.16 s, the situation is called sinus arrhythmia. This situation is very common in all age groups. This arrhythmia is so common in young people that it is not considered a heart disease. One origin for the sinus arrhythmia may be the vagus nerve which mediates respiration as well as heart rhythm. The nerve is active during respiration and, through its effect on the sinus node, causes an increase in heart rate during inspiration and a decrease during expiration. The effect is particularly pronounced in children.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902de.gif
All complexes normal, rhythm is irregular
Longest R-R interval exceeds shirtest > 0.16 s
*Wandering pacemaker :
The origin of the atrial contraction may also vary or wander. Consequently, the P-waves will vary in polarity, and the PQ-interval will also vary.
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902ee.gif
Variation in P-wave contour, P-R and P-P interval
and therefore in R-R intervals
*Atrial flutter :
When the heart rate is sufficiently elevated so that the isoelectric interval between the end of T and beginning of P disappears, the arrhythmia is called atrial flutter. The origin is also believed to involve a reentrant atrial pathway. The frequency of these fluctuations is between 220 and 300/min. The AV-node and, thereafter, the ventricles are generally activated by every second or every third atrial impulse (2:1 or 3:1 heart block).
http://butler.cc.tut.fi/~malmivuo/bem/bembook/19/fi/1902fe.gif
Rapid flutter waves, ventricular response irregular