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Sinus Rhythms

Sinus Rhythms. Chapter 13. Normal Sinus Rhythm. Autonomic Nervous System Sympathetic nerves Parasympathetic nerves (vagus nerve). Sympathetic Stimulation. Increase in HR Palpitations pounding normal, premature beats, or ectopic (non-sinus) beats,. Tachycardia.

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Sinus Rhythms

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  1. Sinus Rhythms • Chapter 13

  2. Normal Sinus Rhythm • Autonomic Nervous System • Sympathetic nerves • Parasympathetic nerves (vagus nerve)

  3. Sympathetic Stimulation • Increase in HR • Palpitations • pounding • normal, premature beats, or ectopic (non-sinus) beats,

  4. Tachycardia • HR exceeding 100 beats/min • Increase SNS and/or decrease in PNS • Elderly individuals rarely show HR greater than 140-150 bpm • HR above this range usually indicate non-sinus tachycardia (e.g. atrial fibrillation or a paroxysmal supraventricular tachycardia)

  5. Sinus Tachycardia • • P Wave - Visible before each QRS complex • • P-R Interval - Normal • • QRS Duration - Normal • • Rhythm - Regular • • Rate - More than 100 beats per minute

  6. Tachycardia • Each QRS complex is preceded by a P wave • With a very fast rate, the P wave may merge with the preceding T wave

  7. Tachycardia • Anxiety, exertion, pain, • Drugs: increase SNS or decrease vagal tone • Fever • Congestive heart failure • Pulmonary embolism • Acute MI • Hyperthyrodism • Pheochromocytoma • Blood loss • Alcohol intoxication

  8. Sinus Bradycardia • Heart rate less than 60 bpm

  9. Sinus Bradycardia • P Wave - Visible before each QRS complex • P-R Interval - Normal • QRS Duration - Normal • Rhythm - Regular • Rate - less than 60 beats per minute • Usually benign and often caused by patients on beta blockers

  10. Sinus Bradycardia • Normal variant • Drugs: decrease SNS or increase vagal tone • Hypothyroidism • Hyperkalemia • Sick sinus syndrome (Fig 13-5) • Sleep apnea • Carotid sinus hypersensitivity syndrome • Vasovagal reactions

  11. Sinus Bradycardia • Symptoms • Moderate sinus bradycardia produces no symptoms • If HR is very slow, lightheadedness and syncope

  12. Sinus Arrhythmia • Beat to beat variation in HR • Younger, healthy individuals • Common cause: respiration • Respiratory sinus arrhythmia

  13. Sinus Pauses/Sinus Arrest • SA fails to stimulate the atria • Sinus pause or sinus arrest (Fig. 13-5)

  14. Escape Beats • Escape beat (Fig. 13-6) • Atria, AV node or ventricles

  15. Sinus Pauses/Sinus Arrest • Causes of sinus pause or arrest • hypoxemia • Ischemia or MI • Hyperkalemia • Drug toxicity • Vagal hyperreactivity • Sick sinus syndrome (Fig 13-5)

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