Non-sinus rhythm on ecg. The value of sinus rhythm for deciphering an ecg. What could be the rhythm?

Normal norm The heart rate of an adult is considered to be 40-60 beats per minute. The indicator is influenced by many factors: field of activity, activity, stressful situations and rest frequency.

Each person should monitor the frequency so that in case of the slightest changes, they know about it and promptly seek qualified help. Often not only a person’s health, but also his life depends on this.

How is rhythm revealed?

Doctors and scientists, in close cooperation, managed to create a device that was unique for the beginning of the 20th century, which made it possible to record work and readings heart rate. It was a device that allowed an electrocardiogram (ECG) to be performed..

ECG analysis and interpretation allow doctors to obtain full information about the presence in the human body of diseases of the heart muscle and the entire conduction system.

The human heart is a pump, which, due to uninterrupted operation, ensures a cyclic supply of blood to organs and systems. The study of the electrocardiogram is based on obtaining data on normal rhythm cardiac activity, heart rate, and conductivity.

Heart machine or operating principle

The rhythm of heart contractions depends entirely on the impulses generated by the sinus node.

Heart rate can be affected by work thyroid gland and the autonomic nervous system. In the case of a reduction in beats, systole decreases, and diastole also shortens (responsible for the indicator of relaxation of the heart muscle).

The atria contract only after receiving an electrical impulse. By pumping blood to the ventricles, they relax. At this moment, the ventricles relax, which release the required volume of blood into the arteries. After this, all 4 chambers of the heart relax, and a new circle of blood circulation occurs.

An ECG can reveal different deviations in contractions: uncoordinated, chaotic, or with additional beats. This may indicate the development of a heart disease. The following factors may influence:

• hypoxia;
• ischemia, myocardial infarction;
• hereditary sinus node defects;
• , smoking;
• anemia;
• heart disease;
• arterial hypertension;
• stress or emotional tension;

What can be seen on a cardiogram

If the results of the procedure did not reveal any serious deviations, then you do not have to worry about your health. Sinus rhythm tends to differ significantly at rest and during deep sleep at night. When the heart rate decreases to less than 60 beats, a person experiences sinus .

During active physical activity The pulse rate increases to 100 beats per minute, and sometimes more. Sinus, stress or during severe emotional distress.

The presence of an irregular indicator on the ECG results should not be a cause for concern. Most likely, the patient was nervous before the diagnosis or had to go through some moments that affected the functioning of the heart.

Decoding the cardiogram

A doctor with relevant experience carries out the diagnosis and interprets the results. The transcript of the received tape includes:

• heart beats;
• Availability inflammatory processes in the heart muscle;
• thickening of the valves;
• imbalance or oxygen starvation.

The ECG must indicate the heart rate. It should be in the range of 60-90 beats in an adult. Latin language The interval of blows and teeth are indicated.

How is sinus rhythm calculated? There is a special formula for this:

From the number 220 we subtract the number of full years: 220-65 = 165 beats per minute should be the maximum standard.

During the day, many patients may experience rare deviations in the number of minute beats, which indicates the onset of sinus arrhythmia. This is within normal limits and should not cause concern..

Additional Information

Sinus rhythm of the heart can be detected by an ECG procedure. If the doctor does not indicate any additional information except for heart rate, the result can be considered satisfactory (good). During decoding of the analyzes other deviations may be detected:

• incomplete blockade of the right leg;
• diffuse disruption of the repolarization process;
• violation of intraventricular conduction;
• left ventricular hypertrophy.

Electrical impulses are conducted correctly and force the heart muscle to contract in the right amount.

Can! But they must be strictly combined with the appointments and prescriptions of your doctor. Could it be? Find out in this article. Any deviations from the norm should immediately be a reason for a visit to the doctor.

In children

The disorder has features compared to the manifestation of sinus rhythm in adults. Young patients undergo the same analysis of ECG results.

This allows for initial stage diagnose functional deviations from normal operation hearts, and also identify pathological disorders in a growing body. The process of maturation and growth itself has a significant impact on the occurrence of sinus heart rhythm in a child.

Conclusion

We have studied information about what sinus heart rhythm means, how it is determined and when you need to see a doctor. The main diagnostic tool for identifying abnormalities is the electrocardiogram procedure.

Article publication date: 01/14/2017

Article updated date: 12/18/2018

From this article you will learn: what does sinus rhythm of the heart mean, what its deviations may be, learn to determine the signs of normal and pathological sinus rhythm using an ECG.

Sinus rhythm of the heart means regular cuts all parts of the myocardium due to exciting electrical impulses from the sinus node - the most important pacemaker in the heart. This means that the heart rate of every healthy person is sinus.

For a qualified test, during which the heart rhythm is first assessed, contact a cardiologist.

Concept and characteristics of sinus rhythm

The heart is the central organ of the circulatory system. It contracts automatically, independently, and while this happens, the body maintains vitality. Autonomous activity is possible thanks to clusters of special nerve cells in certain parts of the heart. The largest cluster is called the sinus node. It is located in upper section heart and regularly emits spontaneous strong electrical impulses, which, passing through all parts of the myocardium, cause its consistent contraction. This phenomenon underlies regular, normal heartbeats.

Sinus rhythm is an electrocardiogram (ECG) indicator that indicates that the heart is contracting due to impulses emanating from the sinus node. If this ECG indicator is normal, then this means that the main pacemaker is healthy and has sufficient strength to suppress other foci of spontaneous electrical activity (small and less active nodes that exist in the myocardium).

Description of the main characteristics of normal heartbeats:

1. Frequency ranges from 60 to 90/minute.
2. Regularity – each subsequent heartbeat occurs at regular intervals.
3. Sequence - each contraction passes in the same direction, sequentially capturing first the atria and then the ventricles, which is reflected by the sound characteristics of the first and second tones, as well as on the ECG.
4. Physiological variability - the ability to change the heart rate while maintaining regularity and consistency in response to external and internal influences (for example, stress, sleep, anxiety, pain, increased body temperature, etc.)

What violations may there be?

Even if the ECG shows signs of sinus rhythm, this does not mean that there cannot be any abnormalities in the body. It is possible that pulses occur in the main node, but do not correspond to normal characteristics. The most common violations are shown in the table.

Sinus rhythm disturbances can be both a variant of the norm and a signal of a serious pathology!

What does sinus rhythm look like on an ECG, normally and with abnormalities?

An electrocardiogram (ECG) is a reflection of the electrical activity of the heart, recorded on paper in the form of a graph. It is recorded from different parts of the body (limbs) and area. In order to determine sinus rhythm, standard leads are suitable (indicated by Roman numerals I, II, III - first, second, third).

You need to pay attention to the following elements of the ECG:

• P wave;
• P–Q interval;
• QRS complex;
• R–R intervals;
• R–R intervals;
• heart rate.

What does a recording of normal sinus rhythm look like?

P wave and P–Q interval

• Must always face up (positive P).
• Small in size compared to the largest R wave.
• Precedes each QRS complex.
• There should be a small but equal gap between each P and QRS - the P-Q interval (if it is not there, this may indicate a disease such as Wolff-Parkinson-White syndrome (WPW)).

QRS complexes and R–R–R intervals

• In all QRS complexes, the largest R waves should face upward.
• The distance between the R teeth (R-R-R intervals) should be the same.

R-R interval

The distance between adjacent P waves should be equal and the same as R-R.

What does sinus rhythm pathology look like on an ECG?

Sinus tachycardia

Sinus bradycardia

Sinus arrhythmia

When it contracts due to excitations from the sinus node, but irregularly, unrhythmically with:

• normal frequency;
• increased heart rate;
• slowing down the rhythm.

Sinus extrasystole

If the heart makes an unpredictable extraordinary contraction caused by an additional impulse from the main pacemaker, then on the ECG:

1. Sinus rhythm can be traced, but it is incorrect - another QRS complex appears prematurely.
2. The P wave should be present, but sometimes it may be absent.
3. The QRS complex appears unchanged.
4. After an extrasystole, the next complex is absent for a long time - this is called a compensatory pause, which is twice as long as the pause between normal complexes.

Sick sinus syndrome

ECG – informative method heart rate assessments. A final conclusion on an electrocardiogram can only be made by a specialist who knows not only the standard deviations from the norm, but also all their possible variants!

To assess the quality of functioning of the cardiac conduction system and form an idea of ​​the structure of the myocardium, a fairly simple study is used - electrocardiography.

This technique helps in making a diagnosis in heart patients, is a screening procedure for identifying cardiac disorders, and is carried out before surgical interventions. Often the first phrase when decoding an ECG is sinus rhythm, what is it?

Nature of ECG

An electrocardiogram is a graphical representation electrical processes, occurring in the heart. Rhythmic contraction of the myocardium is associated with the emergence and passage of impulses along the autonomic nerve pathways this organ.

The hierarchy of structures of the conduction system of the heart is represented by the sinus and atrioventricular nodes (AV), the His bundle and Purkinje fibers. Each of these components is capable of generating pulses with a certain frequency.

The source of healthy automaticity is the sinoatrial node (SA or SU), which suppresses the activity of other units. In this case, sinus rhythm is recorded on the ECG. On the contrary, as a result of activation of heterotopic foci of impulses, arrhythmias develop.

ECG interpretation includes analysis of the resulting curve during the study. The film shows various teeth and spaces between them, which correspond to the propagation of the excitation wave through the heart.

Main components of a cardiogram:

What could the rhythm be?

ABOUT normal functioning The main source of automatism is the correct sinus rhythm, with a frequency of 60–90 impulses per minute.

It should be noted that the distance between adjacent P waves, as well as QRS complexes, should be the same. In addition, all components on the ECG must comply with their duration standards.

Changes in the intervals or widening of the beats, while maintaining the correct 1:1 relationship between the P waves and the ventricular beats, indicate abnormal sinus rhythm, the presence of blocks (slow conduction) or arrhythmia.

What is arrhythmia?

Arrhythmia literally means a lack of rhythm in the generated impulses. There is a physiological (respiratory) form and a pathological one, which can occur directly from the sinus node or during migration of the pacemaker (for example, atrial, from the AV junction).

Respiratory arrhythmia practically does not change the picture on the ECG. Its presence is distinguished by cyclic changes in the distance between the P waves associated with the act of “inhalation-exhalation”.

While recording an electrocardiogram, a functional diagnostician may ask the subject to stop breathing for a few seconds to verify the nature of the arrhythmia.

When exhalation is held, sinus rhythm is reflected at regular intervals on the ECG film.

Classification of arrhythmias

1)

a) physiological;

b) pathological.

2) Not sinus arrhythmia: atrial;

a) ventricular;

b) from the atrioventricular connection.

There are tachyarrhythmias, bradycardia (heart rhythm disturbances with increased or decreased heart rate), various blockades, extrasystoles.

The most common non-sinus arrhythmias

If with each recorded cycle changes in the P wave and the PQ interval are recorded on film, a gradual inversion (decrease followed by reaching a negative value) of the P wave is observed, such a cardiogram indicates the presence of pacemaker migration.

This phenomenon is the result of a change in the main source of impulses (SU) to the atrioventricular connection. Pacemaker migration can reach the level of ventricular structures, but this phenomenon is very rare.

Common disorders include junctional rhythm. In such a situation, the atrioventricular node takes on the leading role in generating impulses.

In this case, an altered P wave is recorded on the ECG (negative, biphasic), there are deviations from the interval reflecting conduction through the atria, the heart rate is 40–60 beats per minute.

A junctional rhythm is said to occur when there are 6 or more consecutive impulses from the AV junction.

A special category of rhythm disturbances is atrial fibrillation(atrial fibrillation). In this case, the separate P-P cycles And QRS complexes as a result of the separation of sinus impulses and ventricular activity.

IN critical cases The ECG records the rhythm of ventricular fibrillation and flutter. Typically, this type is diagnosed when resuscitation measures, requiring intensive care and defibrillation.

Extrasystoles

Episodes ectopic activity from various representatives of the conduction system can disrupt the harmonious picture of the ECG rhythm. Such impulses lead to an extraordinary contraction of the heart or a small part of it.

Extrasystole can be atrial, from the AV node, ventricular, manifested from one specific area or several at once. There are single and group (2, 3 or 4 extrasystoles).

Even healthy people Several episodes of ES are recorded per day. There are often cases when 24-hour ECG monitoring is necessary to establish a pathological extrasystole, as well as during paroxysms of atrial fibrillation.

Depending on the severity and number of episodes of extraordinary contractions, the doctor chooses the tactics for managing the patient.

Conduction disorders

Changes in the duration of intervals, waves and the ventricular complex mainly reflect blocking of impulses in the conduction system or confirm an increase in the myocardial walls.

There is also a syndrome of shortened PQ, associated with the presence of shortened paths to the AV junction and, accordingly, rapid conduction of biopotentials from the main source of automaticity to the ventricles. The presence of this condition increases the risk of arrhythmias.

Among the blockades there are:

• intraatrial;
• sinoatrial;
• several types of atrioventricular blocks;
• intraventricular (pedicles and branches of the His bundle).

As a rule, objective complaints are related to the presence sinus blockades and slowing of conduction from the AV node.

To simplify conductivity assessment, you can use the 0.1±0.02 rule. This means that any tooth, interval, or entire complex must not exceed the given duration in seconds. An increase above 0.12 indicates the presence of a blockade. LBBB and RBBB have characteristic M and W shapes in the precordial leads.

Example of a normal ECG description

The conclusion of an ideal cardiogram without pathology will indicate: sinus rhythm, correct, heart rate (from 60 to 90 in an adult), normal position electrical axis hearts.

Vertical and horizontal EOS are also variants of the norm (depending on the patient’s constitution) for asthenic people and hypersthenics, respectively.

Bundle branch blocks are often presented as an electrocardiographic finding and do not affect the health status of the patient.

When a doctor suspects diseases of the cardiovascular system or there is a high risk of their occurrence in a particular patient, he refers him to a special examination called an electrocardiogram. It can also be used to detect possible deterioration of already existing pathology. This procedure also shown before any surgery, even if it concerns other organs. So, the ECG results have certain indicators of cardiac activity.

Tact norm

An ECG indicates that there are no abnormalities in the functioning of the patient’s heart muscle. These are those oscillations in the process of which, impulses are first formed in a special node, and then disperse to their destinations, namely the ventricle and atrium. It is this process that causes the heart muscle to contract. In order for the cardiogram to correctly show the results, the person undergoing it should not experience anxiety or fear of anything, he must allow himself not to be nervous.

So what does sinus mean? ECG rhythm? When a cardiologist puts a corresponding mark on the cardiogram, he means that the elevation of P in the QRS complex is constant, the working pulse = 60-80 beats per minute, and P-P distances, R-R are identical. Thus, it becomes clear that in the analysis methodology great importance The driver of the heartbeat is localized in the sinus center. To do this, the following signs are checked:

• P armholes must precede each QRS complex;
• the size of the P protrusions should be the same in the same leads;
• does the segment PQ keep the same value;
• in the second lead, the P notch should be positive.

If the data ECG signs sinus rhythm is fully present, which means that excitation impulses are correctly distributed from top to bottom. If they are absent, the beat is assessed as non-sinus. This is evidence that its source is located in secondary sections - the atrium, ventricle or atrioventricular node.

What does ECG mean: sinus rhythm, vertical position? This means that the location of the central axis, as well as the stroke, correspond to the norm. Thus, the probable position is determined central authority V chest. In some cases, the “motor” can be located in planes: horizontal, semi-vertical and semi-horizontal. Moreover, the heart muscle can rotate forward or backward, left or right with respect to the transverse axis. But this is not evidence of any pathologies, but only speaks of some structural features of the human body.

Deviations

Not every person is in good health. Sometimes irregularities are noted during the diagnostic process. A negative ECG diagnosis of sinus rhythm may indicate blockades or arrhythmia. Heart block can be caused by non-standard transmission of impulses from the central part nervous system directly to the heart muscle. For example, the acceleration of the pulse indicates that with normal systematicity, as well as the sequence of muscle contraction, the oscillations are somewhat accelerated and even increased. As for the violation of tact, it is caused by any discrepancy in the sequence, systematicity and frequency of contractions.

The ECG shows an irregular sinus rhythm to show how different the distances between the teeth are. IN to a greater extent this shows the level of weakness of the node. In order to identify possible pathology The rhythm is monitored by Holter monitoring, and a drug test is also performed. Thus, it is also determined whether the regulation has gone astray autonomic system source of rhythm.

ECG signs of sinus rhythm disturbance

A combination of electrocardiographic and clinical indicators, which indicate damage to the source of exposure, is SSSS (weakness syndrome). In order to know what normal looks like ECG conclusion. As already mentioned, it is characterized by positive and identically shaped P waves in one lead. Moreover, they must be located at the same distance from each other (from 0.12 to 0.20 s) and must be ahead of the QRS complex.

In this case, the heart rate within 60 seconds should not exceed 90 beats. To determine this indicator, the number 60 should be divided by R-R duration interval expressed in seconds. Another way: multiply the number of QRS complexes completed in 3 seconds (this corresponds to 15 cm of tape) by 20.

The ECG result, sinus rhythm, can show such deviations as:

• bradycardia – the main signs of sinus rhythm are preserved, but the heart rate/min is less than 60 beats, and the P-P interval may also increase to 0.21 s;
• tachycardia - the number of contractions of the heart muscle over the same period of time increases to 90 beats, although other signs of the rhythm are completely preserved. Quite often there is an oblique downward depression of the PQ segment, and the ST segment, on the contrary, is upward. Visually it resembles an anchor. If the heart rate is >150 beats/m, second-degree blockade may occur;
• arrhythmia – R-R intervals differ from each other by more than 0.15 s. This is mainly due to fluctuations in the number of beats at the time of inhalation and exhalation;
• rigid - this is evidenced by the excessive regularity of contractions, in which case R-R differs by less than 0.05 s. This may be primarily due to damage to the sinus node or, alternatively, a disorder of its neurovegetative regulation.

Causes of rhythm instability

The most common reasons for these deviations in performance are:

1. consumption of alcoholic beverages;
2. heart defects of a congenital or acquired nature;
3. smoking tobacco products;
4. long-term use antiarrhythmic drugs, as well as glycosides;
5. complete or partial protrusion of the mitral valve;
6. marked increase in thyroid hormone levels.

Those factors that increase the frequency of strokes can eliminate rhythmic deviations in the functioning of the respiratory organs.

Interesting! It is noteworthy that the ECG itself is a fairly simple and inexpensive research method, which a short time makes it possible to identify serious pathological changes. At the same time, the result of this procedure alone is not always enough to make an accurate diagnosis.

A heart rhythm that originates from the sinus node and not from other areas is called sinus. It is determined both in healthy people and in some patients suffering from heart disease.

Cardiac impulses appear in the sinus node, then disperse through the atria and ventricles, which causes muscular organ shrink.

Sinus rhythm of the heart on an ECG - what does it mean and how to determine it? There are cells in the heart that create impulse due to a certain number of beats per minute. They are located in the sinus and atrioventricular nodes, as well as in the Purkinje fibers, which make up the tissue of the cardiac ventricles.

Sinus rhythm on the electrocardiogram means that this the impulse is generated precisely by the sinus node(norm – 50). If the numbers are different, then the pulse is generated by another node, which produces a different value for the number of beats.

Normally, a healthy sinus rhythm of the heart is regular with varying heart rates depending on age.

In newborns, the rhythm frequency can be 60 - 150 per minute. With growing up, the rhythm frequency slows down and by 6-7 years it approaches adult levels. In healthy adults, the rate is 60–80 per 60 seconds.

Normal indicators in the cardiogram

What to pay attention to when performing electrocardiography:

1. The P wave on the electrocardiogram necessarily precedes the QRS complex.
2. The PQ distance corresponds to 0.12 seconds - 0.2 seconds.
3. The shape of the P wave is constant in each lead.
4. In an adult, the rhythm frequency corresponds to 60 – 80.
5. The P–P distance is similar to the R–R distance.
6. The P wave in a normal state should be positive in the second standard lead, negative in lead aVR. In all other leads (these are I, III, aVL, aVF), its shape may vary depending on the direction of its electrical axis. Typically, P waves are positive in both lead I and aVF.
7. In leads V1 and V2, the P wave will be 2-phase, sometimes it can be predominantly positive or predominantly negative. In leads V3 to V6, the wave is predominantly positive, although there may be exceptions depending on its electrical axis.
8. Normally, each P wave must be followed by a QRS complex and a T wave. The PQ interval in adults has a value of 0.12 seconds - 0.2 seconds.

Sinus rhythm together with vertical position electrical axis of the heart(EOS) shows that these parameters are within normal limits. Vertical axis shows the projection of the position of the organ in the chest. Also, the position of the organ can be in semi-vertical, horizontal, semi-horizontal planes.

Rotations of the organ from the transverse axis can be determined, which only indicate the structural features of a particular organ.

When the ECG registers sinus rhythm, it means that the patient does not yet have problems with the heart. Very It is important not to worry or be nervous when undergoing the examination to avoid receiving false data.

You should not do the examination immediately after physical activity. or after the patient has climbed to the third to fifth floor on foot. You should also warn the patient that you should not smoke half an hour before the examination, so as not to get unreliable results.

Violations and criteria for their determination

If the description contains the phrase: sinus rhythm disturbances, then it is registered blockade or arrhythmia. An arrhythmia is any disruption in the rhythm sequence and its frequency.

Blockades can be caused if the transmission of excitation from nerve centers to the heart muscle. For example, rhythm acceleration shows that during a standard sequence of contractions, the heart rhythms are accelerated.

If the conclusion contains the phrase about unstable rhythm, then this is a manifestation of a small or Availability sinus bradycardia . Bradycardia has a detrimental effect on a person’s condition, since the organs do not receive the amount of oxygen required for normal activity.

Unpleasant symptoms of this disease may include dizziness, pressure changes, discomfort and even chest pain and shortness of breath.

If an accelerated sinus rhythm is recorded, then most likely this is a manifestation tachycardia. This diagnosis is made when the number of heart beats exceeds 110 beats.

Interpretation of results and diagnosis

To make a diagnosis of arrhythmia, you should compare the obtained indicators with the norm indicators. The heart rate for 1 minute should not be more than 90. To determine this indicator, you need to divide 60 (seconds) by the duration R-R gap(also in seconds) or multiply the number of QRS complexes in 3 seconds (a section of tape equal to 15 cm long) by 20.

This way you can diagnose following deviations:

1. – Heart rate/min is less than 60, sometimes fixed P-P increase interval up to 0.21 seconds.
2. Tachycardia– Heart rate increases to 90, although other signs of rhythm remain normal. Often there can be a downward depression of the PQ segment, and an upward depression of the ST segment. It may look like an anchor. If the heart rate rises above 150 beats per minute, stage 2 blockades occur.
3. Arrhythmia is an irregular and unstable sinus rhythm of the heart when R-R intervals differ by more than 0.15 seconds, which is due to changes in the number of beats per inhalation and exhalation. Often found in children.
4. Rigid rhythm– excessive regularity of contractions. R-R differs by less than 0.05 sec. This may occur due to a defect in the sinus node or a violation of its neurovegetative regulation.

Reasons for deviations

The most common causes of rhythm disturbances are:

• excessive alcohol abuse;
• smoking;
• long-term use of glycosides and antiarrhythmic drugs;
• bulging of the mitral valve;
• pathologies of thyroid function, including thyrotoxicosis;
• heart failure;
• infectious lesions of the valves and other parts of the heart - his disease is quite specific);
• overload: emotional, psychological and physical.

Additional Research

If the doctor, when examining the results, sees that the length of the area between the P waves, as well as their height, are unequal, it means sinus rhythm is weak.

To determine the cause, the patient may be recommended to undergo additional diagnostics: the pathology of the node itself or problems of the nodal autonomic system may be identified.

Additional examination is prescribed when the rhythm is lower than 50 and stronger than 90.

For the smooth functioning of the heart and the body vitamin D needed, which is contained in parsley, chicken eggs, salmon, milk.

If you plan your diet correctly and adhere to a daily routine, you can achieve long and uninterrupted functioning of the heart muscle and not worry about it until you are very old.

Finally, we invite you to watch a video with questions and answers about heart rhythm disturbances: