What is irregular sinus rhythm? Unstable sinus rhythm

An electrocardiogram is a diagnostic method that allows you to determine functional state the most important body human body- hearts. Most people have dealt with such a procedure at least once in their lives. But having received the ECG result in hand, not every person, except those who have medical education, will be able to understand the terminology used in cardiograms.

What is cardiography

The essence of cardiography is the study of electrical currents arising during the work of the heart muscle. The advantage of this method is its relative simplicity and accessibility. Strictly speaking, a cardiogram is the result of measuring the electrical parameters of the heart, displayed in the form of a time graph.

Creation of electrocardiography in its modern form associated with the name of the Dutch physiologist of the early 20th century, Willem Einthoven, who developed the basic ECG methods and terminology used by doctors to this day.

Thanks to the cardiogram, it is possible to obtain the following information about the heart muscle:

• Heart rate,
• Physical condition of the heart
• The presence of arrhythmias,
• The presence of acute or chronic myocardial damage,
• The presence of metabolic disorders in the heart muscle,
• Presence of electrical conductivity disturbances,
• Position electrical axis hearts.

Also, a cardiac electrocardiogram can be used to obtain information about certain vascular diseases not related to the heart.

An ECG is usually performed in the following cases:

• Feeling of abnormal heartbeat;
• Attacks of shortness of breath, sudden weakness, fainting;
• Heartache;
• Heart murmurs;
• Deterioration of the condition of patients with cardiovascular diseases;
• Passing medical examinations;
• Medical examination of people over 45 years of age;
• Examination before surgery.

• Pregnancy;
• Endocrine pathologies;
• Nervous diseases;
• Changes in blood counts, especially with an increase in cholesterol;
• Over 40 years of age (once a year).

Where can I get a cardiogram?

If you suspect that there is something wrong with your heart, you can contact a therapist or cardiologist so that he can give you a referral for an ECG. Also, for a fee, a cardiogram can be done in any clinic or hospital.

Methodology of the procedure

ECG recording is usually performed in supine position. To take a cardiogram, a stationary or portable device is used - an electrocardiograph. Stationary devices are installed in medical institutions, and portable ones are used by teams emergency care. The device receives information about electrical potentials on the surface of the skin. For this purpose, electrodes are used that are attached to the chest area and limbs.

These electrodes are called leads. There are usually 6 leads installed on the chest and limbs. Chest leads are designated V1-V6, the leads on the limbs are called basic (I, II, III) and reinforced (aVL, aVR, aVF). All leads give a slightly different picture of oscillations, but by summing up the information from all electrodes, you can find out the details of the functioning of the heart as a whole. Sometimes additional leads are used (D, A, I).

Typically, the cardiogram is displayed in the form of a graph on paper containing millimeter markings. Each electrode lead has its own schedule. The standard speed of the belt is 5 cm/s; other speeds may be used. The cardiogram displayed on the tape can also indicate the main parameters, normal indicators and a conclusion generated automatically. Data can also be recorded in memory and on electronic media.

After the procedure, the cardiogram is usually deciphered by an experienced cardiologist.

Holter monitoring

In addition to stationary devices, there are also portable devices for daily (Holter) monitoring. They are attached to the patient's body along with electrodes and record all information received during long period time (usually within 24 hours). This method gives much more full information about processes in the heart in comparison with a regular cardiogram. So, for example, when taking a cardiogram in inpatient conditions the patient should be at rest. Meanwhile, some deviations from the norm may appear during physical activity, sleep, etc. Holter monitoring provides information about such phenomena.

Other types of procedures

There are several other methods for carrying out the procedure. For example, this is monitoring with physical activity. Abnormalities are usually more pronounced on the stress ECG. The most common way to provide the body with the necessary physical activity is treadmill. This method is useful in cases where pathologies can only manifest themselves in the case of increased heart function, for example, if coronary artery disease is suspected.

During phonocardiography, not only the electrical potentials of the heart are recorded, but also the sounds that arise in the heart. The procedure is prescribed when it is necessary to clarify the occurrence of a heart murmur. This method often used when heart defects are suspected.

It is necessary that the patient remains calm during the procedure. A certain period of time must pass between physical activity and the procedure. It is also not recommended to undergo the procedure after eating, drinking alcohol, caffeinated drinks, or cigarettes.

Reasons that can affect the ECG:

• Times of Day,
• Electromagnetic background,
• Physical exercise,
• Eating,
• Electrode position.

Types of teeth

First we should talk a little about how the heart works. It has 4 chambers - two atria and two ventricles (left and right). The electrical impulse, due to which it contracts, is formed, as a rule, in the upper part of the myocardium - in the sinus pacemaker - the sinoatrial (sinus) node. The impulse spreads down the heart, first affecting the atria and causing them to contract, then passes through the atrioventricular nerve node and another nerve node, the bundle of His, and reaches the ventricles. The main burden of pumping blood is taken on by the ventricles, especially the left one, which is involved in the systemic circulation. This stage is called heart contraction or systole.

After contraction of all parts of the heart, the time comes for their relaxation - diastole. The cycle then repeats again and again - this process is called heartbeat.

The condition of the heart, in which there are no changes in the propagation of impulses, is reflected on the ECG in the form of a straight horizontal line, called an isoline. The deviation of the graph from the isoline is called a spike.

One heartbeat on the ECG it contains six waves: P, Q, R, S, T, U. The waves can be directed both up and down. In the first case they are considered positive, in the second - negative. The Q and S waves are always positive, and the R wave is always negative.

The teeth reflect the different phases of heart contraction. P reflects the moment of contraction and relaxation of the atria, R – excitation of the ventricles, T – relaxation of the ventricles. Special designations are also used for segments (spaces between adjacent teeth) and intervals (sections of the graph that include segments and teeth), for example, PQ, QRST.

Correspondence between the stages of heart contraction and some elements of cardiograms:

• P – atrial contraction;
• PQ – horizontal line, the transition of the discharge from the atria through the atrioventricular node to the ventricles. The Q wave may be absent normally;
• QRS – ventricular complex, the element most often used in diagnostics;
• R – ventricular excitation;
• S – myocardial relaxation;
• T – ventricular relaxation;
• ST – horizontal line, myocardial recovery;
• U – may be absent normally. The reasons for the appearance of the prong are not clearly understood, but the prong is valuable for diagnosing certain diseases.

Below are some abnormal ECG findings and their possible explanations. This information, of course, does not negate the fact that it is more advisable to entrust the decoding to a professional cardiologist who better knows all the nuances of deviations from the norm and associated pathologies.

Main deviations from the norm and diagnosis

Table of cardiogram parameters in adults

Normal duration of cardiogram elements in children

The norms indicated in the table may also depend on age.

Rhythm of contractions

Violation of the rhythm of contractions is called. The irregularity of the rhythm during arrhythmia is measured as a percentage. An irregular rhythm is indicated by a deviation in the distance between similar teeth by more than 10%. Sinus arrhythmia, that is, arrhythmia combined with sinus rhythm, may be normal for adolescents and young adults, but in most cases it indicates the onset of a pathological process.

A type of arrhythmia is extrasystole. They say it in the case when extraordinary contractions are observed. Single extrasystoles (no more than 200 per day with Holter monitoring) can also be observed in healthy people. Frequent extrasystoles that appear on the cardiogram in the amount of several pieces may indicate ischemia, myocarditis, or heart defects.

Heart rate

This option is the simplest and most understandable. It determines the number of contractions in one minute. The number of contractions may be higher than normal (tachycardia) or lower than normal (bradycardia). Frequency rate heart rate in adults it can range from 60 to 80 beats. However, the norm in in this case The concept is relative, so bradycardia and tachycardia may not always be evidence of pathology. Bradycardia can occur during sleep or in trained people, and tachycardia can occur during stress, after exercise or at elevated temperatures.

Heart rate norms for children of different ages

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Heart Rate Types

There are several types of heart rhythm, depending on where the nerve impulse begins to spread, causing the heart to contract:

• Sinus,
• Atrial,
• Atrioventricular,
• Ventricular.

Normally, the rhythm is always sinus. In this case, sinus rhythm can be combined with both a heart rate above normal and a heart rate below normal. All other types of rhythms are evidence of problems with the heart muscle.

Atrial rhythm

Atrial rhythm also often appears on the cardiogram. Does it atrial rhythm normal or is this a type of pathology? In most cases, the atrial rhythm on the ECG is not normal. However, this is comparatively mild degree heart rhythm disturbances. It occurs when the sinus node is suppressed or disrupted. Possible reasons– ischemia, hypertension, sick sinus syndrome, endocrine disorders. However, isolated episodes of atrial contractions can also be observed in healthy people. This type The rhythm can take on both the character of bradycardia and the character of tachycardia.

Atrioventricular rhythm

Rhythm emanating from the atrioventricular node. With atrioventricular rhythm, the pulse rate usually drops to less than 60 beats per minute. Causes: weakness of the sinus node, atrioventricular block, taking certain medications. Atrioventricular rhythm, combined with tachycardia, can occur during heart surgery, rheumatism, and heart attack.

Ventricular rhythm

With ventricular rhythm, contractile impulses propagate from the ventricles. The contraction frequency drops to below 40 beats per minute. The most severe form of rhythm disturbance. Occurs when acute heart attack, heart defects, cardiosclerosis, insufficiency cardiac circulation, in a preagonal state.

Electrical axis of the heart

Another important parameter is the electrical axis of the heart. It is measured in degrees and reflects the direction of propagation of electrical impulses. Normally, it should be slightly inclined to the vertical and be 30-69º. At an angle of 0-30º the axis is said to be horizontal, and at an angle of 70-90º it is said to be vertical. Deviation of the axis in one direction or another may indicate a disease, for example, hypertension or intracardiac blockades.

What do the conclusions on cardiograms mean?

Let's look at some terms that an ECG transcript may contain. They do not always indicate serious pathologies, however, in any case, they require contacting a doctor for advice, and sometimes - additional examinations.

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Atrioventricular block

Reflected on the graph as an increase in duration P-Q interval. Stage 1 disease is reflected in the form of a simple prolongation of the interval. Grade 2 is accompanied by deviation of QRS parameters (loss of this complex). At grade 3, there is no connection between P and the ventricular complex, which means that the ventricles and atria each work in their own rhythm. The syndrome in stages 1 and 2 is not life-threatening, but requires treatment, as it can progress to the extremely dangerous stage 3, in which there is a high risk of cardiac arrest.

Ectopic rhythm

Any heart rhythm that is not sinus. May indicate the presence of blockades, coronary disease heart or be a variant of the norm. It can also appear as a result of an overdose of glycosides, neurocirculatory dystonia, hypertension.

Sinus bradycardia or tachycardia

Sinus rhythm on the ECG, the frequency of which is below (bradycardia) or above (tachycardia) the normal limits. It can be either a variant of the norm or a symptom of certain pathologies. However, in the latter case this symptom will most likely not be the only one indicated in the transcript of the cardiogram.

Nonspecific ST-T changes

What it is? This entry indicates that the reason for the interval change is unclear and requires additional research. May indicate a violation metabolic processes in the body, for example, changes in the balance of potassium, magnesium, sodium ions or endocrine disorders.

Disorders associated with conduction within the ventricles

Typically associated with impaired conductivity inside nerve bundle Gisa. May affect the beam trunk or its legs. May lead to a delay in the contraction of one of the ventricles. Direct therapy for His bundle blockades is not carried out; only the disease that caused them is treated.

Incomplete right bundle branch block (RBBB)

Common ventricular conduction disorder. In most cases, however, it does not lead to the development of pathologies and is not their consequence. If the patient does not have problems with the cardiovascular system, then this symptom does not require treatment.

Complete right bundle branch block (RBBB)

This violation is more serious compared to incomplete blockade. May indicate myocardial damage. Usually occurs in older and older people; it is rarely found in children and adolescents. Possible symptoms– shortness of breath, dizziness, general weakness and fatigue.

Block of the anterior branch of the left bundle branch (ALBBB)

Occurs in patients with hypertension who have had a heart attack. May also indicate cardiomyopathies, cardiosclerosis, defect interatrial septum, insufficiency mitral valve. Has no characteristic symptoms. It is observed mainly in older people (over 55 years old).

Block of the posterior branch of the left bundle branch (B3VLBP)

How separate symptom is rare, usually combined with blockade right leg beam. May indicate a heart attack, cardiosclerosis, cardiomyopathy, or calcification of the conduction system. A blockade is indicated by a deviation in the electrical axis of the heart to the right.

Metabolic changes

Reflects nutritional disorders of the heart muscle. First of all, this concerns the balance of potassium, magnesium, sodium and. The syndrome is not an independent disease, but indicates other pathologies. Can be observed with ischemia, cardiomyopathy, hypertension, rheumatism, cardiosclerosis.

Low voltage ECG

Electrodes installed on the patient's body detect currents of a certain voltage. If the voltage parameters are below normal, then they speak of low voltage. This indicates insufficient external electrical activity of the heart and may be a consequence of pericarditis or a number of other diseases.

Paroxysmal tachycardia

A rare condition that differs from ordinary (sinus) tachycardia, first of all, in that with it there is a very high frequency heart rate – more than 130 beats/s. In addition, paroxysmal tachycardia is based on improper circulation of the electrical impulse in the heart.

Atrial fibrillation

At the core atrial fibrillation lies atrial fibrillation or flutter. Arrhythmia caused by atrial fibrillation can occur in the absence of heart pathologies, for example, with diabetes, intoxication, and smoking. Atrial flutter may be characteristic of cardiosclerosis, some types of ischemic disease, inflammatory processes myocardium.

Sinoatrial blockade

Difficulty in the exit of an impulse from the sinus (sinoatrial) node. This syndrome is a type of sick sinus syndrome. It is rare, mainly in older people. Possible causes are rheumatism, cardiosclerosis, calcinosis, severe hypertension. May lead to severe bradycardia, fainting, convulsions, and breathing problems.

Hypertrophic conditions of the myocardium

They indicate an overload of certain parts of the heart. The body feels this situation and responds to it by thickening the muscle walls of the corresponding section. In some cases, the causes of the condition may be hereditary.

Myocardial hypertrophy

General myocardial hypertrophy is a protective reaction, indicating excessive load on the heart. May lead to arrhythmia or heart failure. Sometimes it is a consequence of a heart attack. A type of disease is hypertrophic cardiomyopathy– a hereditary disease that leads to abnormal alignment of the heart fibers and carries the risk of sudden cardiac arrest.

Left ventricular hypertrophy

The most common symptom, which does not always indicate severe heart pathologies. May be typical for arterial hypertension, obesity, some heart defects. Sometimes it is observed in trained people, people engaged in heavy physical labor.

Right ventricular hypertrophy

More rare, but at the same time much more danger sign than left ventricular hypertrophy. Indicates insufficiency of pulmonary circulation, severe pulmonary diseases, valve defects or severe heart defects (tetralogy of Fallot, ventricular septal defect).

Left atrial hypertrophy

Reflected as a change in the P wave on the cardiogram. At this symptom the tooth has a double apex. Indicates mitral or aortic stenosis, hypertension, myocarditis, cardiomyopathies. Leads to chest pain, shortness of breath, increased fatigue, arrhythmias, and fainting.

Right atrial hypertrophy

Less common than left atrial hypertrophy. It can have many causes - pulmonary pathologies, chronic bronchitis, arterial embolism, tricuspid valve defects. Sometimes observed during pregnancy. May lead to circulatory problems, swelling, and shortness of breath.

Normocardia

Normocardia or normosystole means normal frequency heartbeats. However, the presence of normosystole in itself does not indicate that the ECG is normal and everything is in order with the heart, since it may not exclude other pathologies, such as arrhythmias, conduction disorders, etc.

Nonspecific T wave changes

This symptom is typical for approximately 1% of people. A similar conclusion is made if it cannot be unambiguously associated with any other disease. Thus, for nonspecific T wave changes, additional studies are necessary. The sign may be characteristic of hypertension, ischemia, anemia and some other diseases, and may also occur in healthy people.

Tachysystole

Also often called tachycardia. This common name a number of syndromes in which there is an increased frequency of contractions of various parts of the heart. There are ventricular, atrial, and supraventricular tachysystoles. Such types of arrhythmias as paroxysmal tachycardia, atrial fibrillation and flutter also belong to tachysystoles. In most cases, tachysystoles are a dangerous symptom and require serious treatment.

Heart ST depression

ST segment depression is common in high-frequency tachycardias. It often indicates a lack of oxygen supply to the heart muscle and may be characteristic of coronary atherosclerosis. At the same time, the appearance of depression is also observed in healthy people.

Borderline ECG

This conclusion often frightens some patients who have detected it on their cardiograms and are inclined to think that “borderline” means almost “deathbed.” In fact, such a conclusion is never given by a doctor, but is generated by a program that analyzes the parameters of the cardiogram on an automatic basis. Its meaning is that a number of parameters are outside the normal range, but it is impossible to unambiguously draw a conclusion about the presence of some kind of pathology. Thus, the cardiogram is on the border between normal and pathological. Therefore, when receiving such a conclusion, a doctor’s consultation is required, and perhaps everything is not so scary.

Pathological ECG

What it is? This is a cardiogram on which some serious deviations from the norm were clearly detected. These may be arrhythmias, conduction or nutritional disorders of the heart muscle. Pathological changes require immediate consultation with a cardiologist, who should indicate a treatment strategy.

Ischemic changes on the ECG

Coronary artery disease is caused by impaired circulation in the coronary vessels of the heart and can lead to such serious consequences as myocardial infarction. Therefore, identifying ischemic signs on the ECG is a very important task. Ischemia on early stage can be diagnosed by changes in the T wave (rising or falling). At a later stage, changes in the ST segment are observed, and at an acute stage, changes in the Q wave are observed.

Interpretation of ECG in children

In most cases, deciphering a cardiogram in children is not difficult. But the normal parameters and the nature of the disorders may differ compared to similar indicators in adults. Thus, children normally have much more rapid heartbeat. In addition, the sizes of the teeth, intervals and segments are slightly different.

• Sinus rhythm of the heart: features of anatomy and physiology
• Sinus rhythm disturbances: causes of the pathological condition
• What changes occur when the sinus rhythm of the heart is disturbed?

Quite often, patients who turn to cardiologists are faced with the concept of “sinus rhythm.” Few people know that this is not a diagnosis, but rather a statement that the human heart works normally and there are no pathological disorders on the part of the system that produces and conducts impulses that are the basis for heart contraction. If, for one reason or another, malfunctions occur in the operation of the apparatus that produces impulses, this leads to the person’s normal heart rhythm and coordination of work being disrupted. individual parts this organ. Such deviations from the norm become causes quite serious illnesses of cardio-vascular system. And if in order for muscle damage to cause certain diseases, pathological changes must be widespread and very serious, then in order for the physiological rhythm of the heart to be disturbed, a small focus of myocardial damage is sufficient.

Sinus rhythm of the heart: features of anatomy and physiology

Before we start talking about the sinus rhythm of the heart, I would like to dwell on some issues of the anatomy and physiology of the cardiovascular system. Without exception, all organs and systems of the human body are constantly in need of oxygen and other useful substances, which are delivered by the circulatory system. The human heart is a fairly simple but powerful pump that ensures constant blood circulation throughout the circulatory system.

The human heart is capable of making more than 100,000 beats per day and has a specific “pacemaker” called the sinus node and located in the right atrium. It is this node that generates impulses or electrical signals that first enter the atria, causing them to contract and push blood into the ventricles. After this, a certain pause occurs, allowing the ventricles of the heart to fill with blood, and then the impulse passes through the ventricle and blood, and is sent further through the circulatory system to all organs and tissues of the human body. This is how the heart constantly contracts at a certain frequency. Normal sinus rhythm is considered to be with a heart rate (heart rate) of 60 to 70 per minute.

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Sinus rhythm disturbances: causes of the pathological condition

There are conditions in which the pacemaker malfunctions, then the patient’s heart begins to beat either much faster than usual or much slower. What can cause this condition:

• lack of oxygen or hypoxia;
• anemia;
• strongly elevated arterial pressure(arterial hypertension);
• congenital anomalies anatomical structure sinus node;
• congenital heart defects;
• inflammatory diseases of the myocardium;
• cardiac ischemia;
• heart attack;
• physical fatigue;
• obesity of varying degrees;
• smoking and alcohol abuse;
• various disorders of the endocrine system;
• constant stress.

There are a number of age-related reasons for changes in the sinus rhythm of the heart. In children, its disorder often develops as a consequence of:

• congenital heart defects, which often occur against the background of an unfavorable course of pregnancy;
• pathologies of the nervous system;
• various endocrine disorders;
• intoxications of various origins, including individual intolerance to certain medicines or drug overdose;
• vitamin deficiency and deficiency of certain microelements (selenium, magnesium, etc.).

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What changes occur when the sinus rhythm of the heart is disturbed?

The sinus rhythm of the human heart is a variable value. In some situations (stress, emotional arousal, etc.) it may change slightly. Thus, the sinus rhythm in women bearing children is increased by about 10 beats per minute relative to normal. Also, rapid heartbeat can be observed in newborn children or older people, which is associated with hormonal features and other physiological reasons. This increase in sinus rhythm is considered a variant of the norm, that is, it is physiological and natural. This condition does not require intervention from cardiologists.

Another situation arises when the patient’s cardiogram shows no signs of sinus rhythm and significant deviations from the norm. In this case, additional diagnostic methods should be carried out, the cause of this condition should be sought and eliminated. Quite often in the practice of cardiologists there are cases when it is due to the fact that the sinus node ceases to perform its functions. This state is called "". This pathological condition has a number of very characteristic symptoms: severe headaches or dizziness, fast fatiguability, nausea, fainting states, emotional mobility, irritability, forgetfulness, etc. In addition, it can cause pathological changes such as:

• angina pectoris;
• cardiac asthma;
• pulmonary edema;
• myocardial infarction;
• cardiac ischemia.

Sinus rhythm disturbances lead to the development of the following pathological conditions:

1. . This is a condition when the patient's heart rate exceeds 120 beats per minute. Sometimes the heart rate reaches 220 beats. This condition can be either physiological or pathological. Physiological tachycardia can occur in a person at those moments in his life when he experiences strong emotions: stress, nervous tension, as well as heavy physical activity, etc. Pathological tachycardia is a consequence various diseases cardiovascular system, as a result of which blood circulation is disrupted both in the heart and in the body as a whole.
2. . A condition when the heart rate, on the contrary, sharply decreases and its indicator is less than 60 beats per minute. The cause of this condition in most cases is hypertension vagus nerve. At sinus bradycardia The patient may experience shortness of breath, severe dizziness, or even fainting. If the patient suffers from frequent fainting, then he is advised to have a pacemaker implanted, which allows him to regulate heart rate by artificially regulating the heart rhythm.
3. . This condition characterized by the fact that the time interval between heartbeats increases or decreases. This condition can be a consequence of various diseases of the cardiovascular system, neuroses or intoxication. It may also be the result of a change in blood composition, namely: a lack of potassium, calcium or magnesium. The lack of these elements leads to the fact that the heart muscle relaxes poorly and is in a permanent state of spasm. Similar pathological conditions not only lead to changes in heart rhythm, but can also cause the development of heart failure.

If heart rhythm disturbances are associated with natural causes, then no specific therapy is usually required. In other cases, if symptoms of sinus rhythm disturbance appear, you should immediately consult a cardiologist.

Only a doctor can prescribe adequate therapy, and self-medication can lead to irreversible consequences.

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 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 presence of 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.

In this way, the following deviations can be diagnosed:

1. – Heart rate/min is less than 60, sometimes an increase is recorded P-P 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 functionality thyroid gland, 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 found in parsley, chicken eggs, salmon, and 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:

The heart is an organ that works rhythmically. Normally, the heart rhythm is set by the sinus node. That is, the sinus rhythm of the heart is the normal heart rhythm. The sinus node is a natural impulse generator located in the right atrium. The impulse moves from top to bottom. First it enters the right atrium, then the left. The impulse then travels through the atrioventricular junction to the ventricles. As a result, the heart alternates between contracting and relaxing, thanks to which it performs its main function of pumping blood throughout the body.

What does sinus rhythm mean? This means that on the electrocardiogram the P waves are of a constant shape, distance R-R or R-R is the same, contraction frequency is 60-80 beats per minute. The heart is fine and works clearly and stably. If the rhythm is unstable, the height of the P waves and the distance between them are not the same on the cardiogram, then there is weakness of the sinus node or the pacemaker is another node of the heart. Further, special diagnostics will help determine what the reason is: the pathology of the sinus node itself or problems in its autonomic system. So, if the doctor, when deciphering your cardiogram, writes: “Sinus rhythm: normal,” then your heart is fine.

If your sinus rhythm is abnormal, you may have heart blocks and arrhythmias. Any disturbance in the regularity, consistency and frequency of heartbeats is called arrhythmia. Heart blocks occur when there is a disturbance in the transmission of impulses from the nerve centers to the heart muscle. With an accelerated rhythm, they speak of tachycardia, with a slow rhythm, bradycardia. A heart rate of less than 50 and more than 90 beats per minute is a signal that you need to see a doctor.

Common causes of sinus rhythm disturbance?

• Heart defects
• Cardiomyopathies
• Infective endocarditis
• Overload, both physical, psychological and emotional.

These disorders can occur at any age. Quite common in children. Although in many cases, heart rhythm disturbances do not affect their well-being in any way and are detected by chance, it can cause more serious abnormalities (bradycardia, tachycardia, arrhythmia). A child's sinus rhythm may be disrupted from birth, or perhaps as he grows up. Often such deviations occur in adolescence, this is due to an imbalance in the development of the body and internal organs. If a child faints, complains of pain in the heart area, weakness, dizziness, you need to check the functioning of his heart. The main way is to do an electrocardiogram.

Causes of heart rhythm disturbances in children?

• Congenital defects associated with unfavorable pregnancy and childbirth
• Nervous system diseases
• Endocrine diseases
• Intoxication (including overdose or individual intolerance to drugs)
• Deficiency of microelements, in particular magnesium and selenium

After examinations and finding out the causes of deviations, the cardiologist will suggest necessary measures, sometimes it is enough to provide the child with an appropriate regime of study and rest, proper nutrition and the heart returns to normal. For serious problems, more detailed examination and treatment are prescribed.

The functioning of the heart in pregnant women has its own peculiarities. Sinus rhythm during pregnancy accelerates by an average of 10 beats per minute, and tachycardia and arrhythmia occur in half of pregnant women. This could be a relapse existing disease, or may be the result of the process of a woman’s body getting used to pregnancy. The body needs additional nutrition, and the heart increases the frequency and force of contractions. Physiological features The course of pregnancy can also cause the sinus rhythm of the heart to be disturbed.

If you feel any changes in your heart function, discomfort, increased fatigue, it is better not to delay, but to go to see a doctor, have an electrocardiogram done and, if necessary, provide support to your heart.

An electrocardiograph (ECG) is a device for assessing the electrical activity of the heart muscle. In cardiology, it is most in demand, as it allows you to detect any changes in the heartbeat, organic lesions and electrolyte imbalances. Sinus rhythm when deciphering the cardiogram is detected in the absence pathological abnormalities. An experienced specialist evaluates the final results. To an ordinary person, Latin letters and curved lines will not say anything. Generally accepted standards and definitions will help you figure out the decoding yourself.

The sinus rhythm detected on the electrocardiogram is displayed by identical teeth at equal intervals of time and indicates proper operation hearts. The source of impulses is set by the natural pacemaker, the sinus (sinusoidal) node. It is localized in the angle of the right atrium and serves to generate signals that cause sections of the heart muscle to contract one by one.

A feature of the sinus node is its abundant blood supply. The number of impulses it sends is influenced by the divisions (sympathetic, parasympathetic) of the autonomic nervous system. If there is a malfunction in their balance, the rhythm is disturbed, which is manifested by an increase in heart rate (tachycardia) or slowdown (bradycardia).

Normally, the number of pulses generated should not exceed 60-80 per minute.

Maintaining sinus rhythm is important for stable circulation. Under the influence of external and internal factors, disruption of the regulation or conduction of impulses may occur, which will lead to disruptions in hemodynamics and dysfunction of internal organs. Against this background, the development of signal blockade or weakening of the sinusoidal node is possible. On the electrocardiogram, the resulting disorder is displayed as the presence of a focus of replacement (ectopic) impulses in a certain part of the heart muscle:

• atrioventricular node;
• atria;
• ventricles.

When the signal source is located anywhere other than the sinus node, we are talking about heart pathology. The patient will have to undergo a series of examinations ( daily monitoring ECG, stress tests, ultrasonography) to identify the causative factor of the disorder. Treatment will be aimed at eliminating it and restoring sinus rhythm.

Decoding the cardiogram of the heart: sinus rhythm

Panic when a “sinus rhythm” recording is detected is typical for people unfamiliar with medical terms. Usually the cardiologist prescribes a series of examinations, so you will be able to see him again only after receiving all the results. The patient can only wait patiently and familiarize himself with publicly available sources of information.

In fact, sinus rhythm is the generally accepted norm, therefore, there is no point in worrying. Deviations are possible only in heart rate (HR). It is affected by various physiological factors, the influence of the vagus nerve and autonomic failures. The number of heart beats per minute may become higher or lower than normal for age, despite sending signals from the natural pacemaker.

A diagnosis of “tachycardia” or “bradycardia” of sinus type is made only after a comprehensive assessment of all the nuances. The doctor will pay attention to the patient’s condition and ask about the actions performed immediately before the study. If the decrease or increase in heart rate is minor and is associated with exposure external factors, then the procedure will be repeated a little later or on another day.

Identification of the natural pacemaker during electrocardiography occurs according to generally accepted criteria:

• the presence of a positive P wave in the second lead;
• there is an equal interval between the P and Q waves, not exceeding 0.2 seconds;
• negative P wave in lead aVR.

If the transcript indicates that the patient has sinus rhythm and a normal position of the electrical axis of the heart (EOS), then they are afraid of nothing. The rhythm is set by its natural driver, that is, it comes from the sinus node into the atria, and then into the atrioventricular node and ventricles, causing alternate contractions.

Acceptable standards

Whether the cardiogram readings are normal can be determined by the position of the teeth. Heart rhythm is assessed by the interval between teeth R-R. They are the highest and should normally be the same. Slight deviation acceptable, but not more than 10%. Otherwise, we are talking about a slowdown or increase in heart rate.

The following criteria are typical for a healthy adult:

• the P-Q interval varies within 0.12-0.2 seconds;
• Heart rate is 60-80 beats per minute;
• the distance between the Q and S teeth remains in the range from 0.06 to 0.1 sec;
• the P wave is 0.1 sec;
• The Q-T interval varies from 0.4 to 0.45 seconds.

In children, the indicators are slightly different from adults, which is due to the characteristics of the child’s body:

• QRS interval does not exceed 0.1 second;
• Heart rate varies depending on age;
• the distance between the Q and T teeth is no more than 0.4 seconds;
• P-Q interval 0.2 sec.
• the P wave does not exceed 0.1 sec.

In adults, as in children, in the absence of pathologies, there should be a normal position of the electrical axis of the heart and sinus rhythm. You can see the permissible frequency of reductions by age in the table:

Reasons for deviation from the norm

Heart rate varies depending on the time of day, psycho-emotional state and other external and internal factors. To obtain reliable data, you will need to take into account many nuances:

Equally important is careful preparation for the procedure:

If you were unable to follow all the rules, then upon arrival at the diagnostic room you should tell the specialist about it. He will take this nuance into account and, if necessary, schedule an examination for another day.

A general list of factors that can affect the frequency and rhythm of the heart rhythm is as follows:

• mental disorders;
• overwork (psycho-emotional, physical);
• developmental defects (congenital, acquired);
• taking medications with antiarrhythmic effect;
• disruption of the valve apparatus (insufficiency, prolapse);
• dysfunction of the endocrine glands;
• advanced stage of heart failure;
• pathological changes in the myocardium;
• inflammatory heart diseases.

The use of medications, especially for stabilizing blood pressure (“Mexarithma”, “Amidarone”) and improving metabolic processes (“Metonate”, “Adenosine”), must be reported before the procedure. Many heart medications can slightly distort the results.

Features of deciphering an electrocardiogram

Based on the electrocardiogram, the cardiologist will be able to assess the electrical potential of the heart muscle during systole (contraction) and diastole (relaxation). Displays data in 12 curves. Each of them demonstrates the passage of an impulse through a specific part of the heart. Waveforms are recorded on 12 leads:

• 6 leads on the arms and legs designed to assess vibrations in the frontal plane.
• 6 leads in the chest area for recording potentials in the horizontal plane.

Each curve has its own elements:

• Teeth by appearance resemble convexities directed up and down. They are designated by Latin letters.
• Segments are the distance between several teeth located nearby.
• An interval is a gap consisting of several teeth or segments.

General principles of decoding

Electrocardiogram evaluation is complex process. The doctor carries it out step by step so as not to miss the slightest changes:

To better understand the information, it is advisable to familiarize yourself with various options expert opinions:

• A healthy person is characterized by sinus rhythm, 60-80 heartbeats per minute, EOS in normal position and absence of pathologies.
• With an increased or decreased heart rate, sinus tachycardia or bradycardia is indicated in conclusion. The patient will be advised to undergo several more examinations or repeat the procedure on another day if the result was influenced by external factors.
• In elderly patients and people who do not healthy image life, often reveal pathological changes in the myocardium of a diffuse or metabolic nature.
• A record of the presence of nonspecific changes in the ST-T interval indicates the need for additional examinations. To figure out the real reason Only using electrocardiography in this case is not possible.
• The detected repolarization disorder indicates incomplete recovery of the ventricles after contraction. Usually affect the process various pathologies and hormonal imbalances. To detect them, several more examinations will be required.

For the most part, the conclusions are positive. Changes can be overcome with lifestyle changes and medications. An unfavorable prognosis is usually when coronary artery disease, proliferation (hypertrophy) of the chambers of the heart muscle, arrhythmia and failures in the conduction of impulses are detected.

Causes of deviations in sinus rhythm

Abnormal sinus rhythm appears under the influence of pathologies or physiological factors. The forms of failure differ depending on the frequency and rhythm of contractions:

Despite the correct source of signals, the problem that has arisen must be dealt with. If no action is taken, a more severe form of arrhythmia may develop and dangerous symptoms of hemodynamic disturbances may appear.

Sinus tachycardia

The sinus form of tachycardia can be pathological or physiological. In the first case, it occurs due to other diseases, and in the second, after stress and overwork. The electrocardiogram usually reveals an increased frequency of contractions from 100 to 220 per minute and a short P-P interval.

For an attack sinus tachycardia The following symptoms are typical:

• feeling of heartbeat;
• lack of air;
• general weakness;
• dizziness;
• sleep disturbance;
• chest pain;
• noise in ears.

Attacks of sinus bradycardia, like tachycardia, occur as a symptom of other diseases or as a reaction to physiological factors. They are characterized by a decrease in heart rate to 60 beats per minute or less. The electrocardiogram shows a noticeable increase in the distance between the P-P waves.

In addition to a slow heartbeat, during an attack of bradycardia the following symptoms appear:

• dizziness;
• fainting state;
• pain in the heart area;
• pale skin;
• tinnitus;
• fast fatiguability.

Sinus arrhythmia

The sinus variety of arrhythmia usually results in an irregular rhythm. The heart rate can increase or decrease sharply under the influence of various stimuli. The length of the P-P interval varies.

An attack of sinus arrhythmia is characterized by the following symptoms:

Features of ECG interpretation in children

Electrocardiography is performed in children in the same way as in adults. Problems can only arise with hyperactive kids. They must first be reassured and the importance of the procedure explained. The results obtained differ only in heart rate. During active growth, the heart has to work harder to supply all tissues of the body in full. As the child develops, the heartbeat gradually returns to normal.

Signs of sinus rhythm in children are similar to adults. The increase in heart rate must be within the acceptable age limit. If a focus of ectopic impulses is detected, then we can talk about congenital defect heart development. It can only be completely removed through surgery.

Cases of mild sinus arrhythmia are most often associated with respiratory system. During inhalation, the heart rate increases and stabilizes as you exhale. Such failures are typical for children and go away over time. At conducting an ECG respiratory arrhythmia must be taken into account, since a cold couch, fear and other factors provoke its aggravation.

The sinus form of arrhythmia can be provoked by more dangerous causes:

Due to the voiced pathological processes, the likelihood of developing complications that can lead to fatal outcome and disability. Among less serious reasons Active growth, rickets and vegetative-vascular dystonia can be distinguished. In most cases, they go away on their own. It is enough for parents to give their child vitamin complexes and diversify his diet.

Decoding the electrocardiogram during pregnancy

During pregnancy, significant changes occur in a woman’s body that affect the results of electrocardiography:

• An increase in circulating blood volume contributes to the development of tachycardia and the manifestation of signs of overload in certain parts of the heart muscle.
• The growing uterus provokes displacement of internal organs, which is manifested by a change in the location of the electrical axis of the heart.
• Hormonal surges affect all systems in the body, especially the nervous and cardiovascular systems. A woman experiences attacks of tachycardia after any physical exertion. Heart rate usually increases by no more than 10-20 beats per minute from normal.

The changes that occur go away on their own after the birth of the child, but in some cases they develop into a full-fledged pathological process. To prevent it, it is necessary to be observed by a doctor throughout the entire pregnancy.

The meaning of letters and numbers on an electrocardiogram

The definitions of the Latin letters that label the teeth will help you understand what is being said in the electrocardiogram:

• The PQ interval shows how long it takes for an electrical impulse to travel through the heart muscle (from the atria to the ventricles). In the absence of irritating factors, the length does not exceed 0.2 seconds. Based on this indicator, the doctor will evaluate general state conductor system. If there is a lengthening of the distance between the P and Q waves, then the problem may be the development of heart block.
• Along the space between the teeth R-R doctor determines the regularity of contractions and counts them.
• The QRS complex helps you see how the signal is conducted through the ventricles.
• The segment between the S and T waves shows the moment the excitation wave passes through the ventricles. Its permissible length is 0.1-0.2 seconds. The segment is located on an isoline. If it is slightly displaced, then certain pathological processes can be suspected:
  • higher by 1 mm or more – myocardial infarction;
  • lower by 0.5 or more – ischemic disease;
  • saddle-shaped segment – ​​pericarditis.

It will not be easy for an ordinary person to decipher an electrocardiogram. First, you will have to familiarize yourself with the definition of the Latin symbols that indicate the teeth, and the features of the intervals between them. Then you need to study the types of heart rhythm and generally accepted heart rate norms. Finally, it is advisable to review the options for expert opinions and general principles transcripts. Based on the information studied, even a person far from medicine will be able to understand the cardiogram.