Physiological and pathological sinus rhythm of the heart. Regular and irregular sinus rhythm of the heart Sinus rhythm 79 beats per minute

The heart is an organ that works rhythmically. Normally, the sinus node sets the heart rhythm. 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 momentum moves from top to bottom. First enters the right atrium, then - to the left. The impulse then travels through the atrioventricular junction to the ventricles. As a result, the heart alternately contracts and relaxes, due 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, the distance P-P or R-R is the same, the frequency of contractions is 60-80 beats per minute. The heart is in order 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 another node of the heart is the pacemaker. Further, special diagnostics will help to establish what the reason is: in 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 in order.

If sinus rhythm is disturbed, then you may have heart blocks and arrhythmias. Any disturbance in the regularity, sequence and frequency of heart contractions is called an arrhythmia. Heart blocks occur when there is a violation in the transmission of impulses from the nerve centers to the heart muscle. With an accelerated rhythm, they speak of tachycardia, with a slow one - 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
Cardiomyopathy
Infective endocarditis
Overload, both physical and psychological and emotional.

These disorders can occur at any age. Quite common in children. Although in many cases, heart rhythm disturbance does not affect their well-being in any way and is detected by chance, it can cause more serious abnormalities (bradycardia, tachycardia, arrhythmias). Sinus rhythm in a child can be disturbed from birth, or maybe with growing up. Often such deviations occur in adolescence, this is due to an imbalance in the development of the body and internal organs. If the child faints, complains of pain in the heart, weakness, dizziness, you need to check the work of his heart. The main way is to make an electrocardiogram.

What are the causes of cardiac arrhythmias in children?

Congenital malformations associated with adverse pregnancy and childbirth
Diseases of the nervous system
Endocrine diseases
Intoxication (including overdose or individual intolerance to drugs)
Deficiency of trace elements, in particular magnesium and selenium

After examinations and finding out the reasons for the deviations, the cardiologist will suggest the necessary measures, sometimes it is enough to provide the child with a proper study and rest regimen, proper nutrition and the heart returns to normal. In case of serious problems, a more detailed examination and treatment is prescribed.

There are some peculiarities in the work of the heart in pregnant women. Sinus rhythm during pregnancy accelerates by an average of 10 beats per minute, and tachycardia and arrhythmia occur in half of pregnant women. This may be a relapse of an existing disease, or it may be the result of a woman's body getting used to pregnancy. The body needs additional nutrition, and the heart increases the frequency and strength of contractions. The physiological characteristics of the course of pregnancy can also cause the sinus rhythm of the heart to be disturbed.

If you feel any changes in the work of the heart, discomfort, increased fatigue, it is better not to postpone, but to go to the doctor, do an electrocardiogram and, if necessary, provide support to your heart.

Sinus rhythm of the heart refers to the indicators of its work. The correct rhythm is set by the main pacemaker, which is the sinus node. In the case of a conduction disturbance, such a phenomenon occurs, both with a corresponding change in both the rhythm itself and the quality of the work of the heart, which immediately affects the state of health.

The easiest way to assess the correct functioning of the heart is an ECG. It is for this procedure that the therapist sends if necessary. This is especially true for aged patients, with whom it is impossible to begin to deal with without printing a cardiogram.

It is from the printout of the ECG, according to the location of the teeth and the distance between them, that the specialist is able to assess the performance of the heart with a high probability.

The sinus rhythm of the heart is a constant contraction of all the walls of the cardiac muscle membrane due to incoming electrical impulses from the main pacemaker - the sinus node. In the absence of any pathologies, the heart rhythm is sinus.

For reference. The sinus node is the largest group of atypical cardiomyocytes - the cells responsible for the rhythmic heartbeat.

This formation is localized in the upper part of the right atrium, at the confluence of the superior and inferior vena cava. The sinus node constantly creates electrical shocks, they go through each layer of the muscular membrane, causing the ventricles of the heart to contract. This process ensures a healthy heartbeat.

The sinus rhythm of the heart is an ECG value that indicates the beating of the heart with the help of impulses from the sinus node. When this value corresponds to the norm, it can be argued that the sinus node is able to overcome the electrical impulses created by other clusters of atypical cardiomyocytes.

What is characteristic of a normal heartbeat:

The heart rate is numerically equal to 60 to 90;
Heartbeats are generated after an equal amount of time;
The consistency of the beat is unchanged - at first the atria contract, then the ventricles. This characteristic can be traced by the characteristic sound of the first and second tones, in addition - with an ECG;
In a normal state, the heartbeat can undergo changes with a different state of a person - physical activity, pain, and others.

For reference. At the conclusion of the doctor “sinus rhythm frequency<60…90>, you can be calm for the functioning of the heart, since this condition is the norm.

What are sinus rhythm disorders?

The conclusion of the ECG may have various errors. Even if the electrocardiogram shows features of the sinus rhythm of the heart, a person may develop pathological processes. It happens that despite the fact that electrical impulses are produced in the sinus node, the rhythmic heart pulsation does not meet the norm.

What pathologies of sinus rhythm are most common:

An increased number of heartbeats may indicate that the patient has sinus tachycardia;
Conversely, a reduced number of heart beats may signal the development of sinus bradycardia;
Irregularity of heart contractions, in other words, arrhythmia, is characterized by the same frequency of beats that do not occur regularly. The specialist may also suspect that the patient has unexpected impulses in the intervals between normal heart beats. Another pathology that irregular beats may indicate is sick sinus syndrome. This pathology is characterized by a stable rare heartbeat, moments of “stopping” of cardiac activity, and in addition, the alternate occurrence of an accelerated and slow rhythm;
The disturbed regularity of the sinus rhythm indicates the absence of response reflexes in the muscular membrane of the heart to stimuli from the environment.

Read also related

Dull pain in the region of the heart

Sinus rhythm with heart rate - normal

In addition to establishing the nature of the heart pulsation and the leading pacemaker, heart rate is always determined on the ECG. As a rule, the device for taking an electrocardiogram copes with this task on its own.

However, his conclusion is far from being true in all cases. It is much better when the attending doctor is engaged in counting the heart rate.

Important. Normal values of sinus rhythm will be the number of heart beats in the range from 60 to 90 per minute. However, it must be remembered that not in all cases a shift in value in one direction or another can signal a disease.

For example, the number of heart beats can increase with excitement during the study, internal experiences, a cigarette smoked before the examination, physical activity before electrocardiography.

On the other hand, people who are actively involved in sports often show a decrease in the number of heartbeats, and the blood flow has normal characteristics. In this case, no deviation from the norm is observed.

What is sinus rhythm irregular

Sinus rhythm can be regular or irregular. In irregular sinus rhythm, the heart rate may increase or decrease. In this case, the number of heart beats is normal, but the intervals between them are not equal. This condition is called arrhythmia. It has a physiological or conditionally pathological character.

Attention. Physiological arrhythmia is closely related to the act of breathing. When a person inhales, the heart rate increases, while exhaling it decreases. This condition is typical for children.

Conditionally pathological arrhythmia can be expressed as tachycardia and bradycardia. The causes of this condition can be heart pathologies, as well as diseases of the nervous system, infections, adherence to a strict diet, etc.

What does sinus rhythm look like on an ECG in normal and pathological conditions?

The conclusion of an ECG is called an electrocardiogram. It allows you to fix the rhythmic contractions of the heart on paper in the form of a special graph. ECG captures information from the limbs of a person and the heart zone. The sinus rhythm of the heart is determined using standard leads, which are denoted by Roman numerals I, II, III.

Doctors analyze the following components of an electrocardiogram:

P wave
distance P-Q;
QRS complex;
distance between teeth P;
distance between teeth R;
the number of heart beats.

What does a normal sinus rhythm recording look like?

P wave and P-Q interval

The P wave is normally directed upwards - positive;
Relative to the R wave, which has the largest size, it is small;
Appears before each QRS complex;
Between the P wave and the QRS complex, there is normally a small distance (P-Q interval), while it is equal between these elements throughout the entire graph.

QRS complexes and R-R-R intervals

The largest wave - R in each QRS complex is directed upward;
The distances between all R waves are normally necessarily equal - this is an indicator of the regularity of heart beats.

P-P interval

As in the previous case, the same distance is the norm between the P waves.

What does sinus rhythm pathology look like on an ECG?

Heart rhythm disorders not only bring discomfort to a person, but can also be a harbinger of a serious heart disease.

Sinus tachycardia

If the patient has sinus tachycardia, the following features are distinguished on the electrocardiogram:

Heart rate exceeds the normal threshold in the direction of excess and is more than 90 beats per minute;
The regularity of the sinus rhythm is preserved, the P wave always appears before the QRS complex;
Ventricular complex (QRS) without abnormalities;
Reducing the gap between the P waves;
Increased or reduced height of the T wave;
EOS (electrical axis of the heart) can be directed to the left, and to the right, and up.

Sinus node - This is a group of cells located in the right atrium, which have the ability to produce impulses, to transmit these impulses to other myocardial cells.

Normally, an impulse occurs in the sinus node of the right atrium, covers both atria, then through the atrioventricular node, which is the center of automatism of the second order, the impulse is transmitted to the ventricles and covers them with excitation.

This is how the contraction of the heart occurs: first the atria, and then the ventricles. If, after conducting an ECG, the doctor made the conclusion “sinus, regular rhythm”, then this means that your heart is contracting normally, there are no pathological abnormalities in the conduction system. This means that the impulse that causes your heart to contract occurs where it is needed, namely in the sinus node of the right atrium.

1 ECG and sinus rhythm

The simplest and most accessible method for determining the heart rhythm is an ECG. This method allows you to determine the frequency and regularity of heart contractions, assess the nature of the rhythm and its source, diagnose acute or chronic damage to the myocardium. Conducting an ECG is mandatory for routine examination and medical examination. Any doctor and medical worker with a secondary medical education should be able to encrypt a cardiogram.

On the electrocardiogram, there is a P wave, which is responsible for the work of the atria, and there is a complex of QRS teeth, this complex shows the work of the ventricles. Since the atria normally contract first, then the ventricles, the P wave must always precede the QRS complex.

So, ECG signs of sinus rhythm:

Permanent shape of the P wave (duration 0.1 s, height 2-2.5 mm),
The same distance between the teeth P-P or R-R,
The P wave always precedes the QRS complex
The distance from the P wave to the next Q wave is the same and equal to 0.12-0.2 s,
Heart rate from 60 to 90 beats per minute.

If these criteria are met on the ECG, this means that the heart rhythm is normal.

2 What should a patient know before an ECG?

In order for the electrocardiogram data to be as accurate as possible, there are certain rules that the patient must follow before conducting this study. Firstly, try not to be nervous, do not drink alcohol, coffee, strong tea, do not smoke before the procedure, as the heart rate will increase, tachycardia will develop and the ECG data will not be correct. No need to overeat and do physical labor. If you follow all the above rules, then an ECG recording will allow you to accurately diagnose the work of your heart and determine its rhythm and frequency of contractions.

3 Heart rate in children

Heartbeat in newborn babies and toddlers is much more frequent than in an adult. If you put your hand on the chest of a small child, you can hear how often and loudly a tiny heart beats. The younger the child, the faster his heart beats. For example, the norm for a newborn baby is a heart rate of up to 140 beats per minute, and when feeding, screaming, it can reach 180 beats per minute.

This is due to the fact that the metabolism is more intense in babies and the fact that the heart is less affected by the vagus nerve, which slows down the heartbeat. By the age of two, the heart rate averages 120-125 per minute, by six - 100-105, and already at ten or twelve years, the heart rate in a child will correspond to an adult.

These physiological features, characteristic of childhood, should be taken into account by the parent, and do not panic if, when deciphering the cardiogram, the doctor writes a three-digit number, determining the heart rate for your child. Perhaps a rapid heartbeat is normal for his age. And if the intervals between heartbeats are the same, the P wave accompanies each set of ventricular contractions - this means sinus rhythm, and in this case there is no cause for concern.

4 When is sinus rhythm abnormal?

The sinoatrial node can produce impulses both with the same, constant frequency, and with periods of gradual increase and decrease. If the sinus rhythm is characterized by such periods of acceleration-decrease, we are talking about an abnormal sinus rhythm or arrhythmia. There are two forms of sinus arrhythmia: respiratory (cyclic) and not associated with breathing (non-cyclic).

Respiratory or cyclic arrhythmia is characterized by the fact that the heart rate increases on inhalation and slows down on exhalation, there is a clear connection with breathing. This condition occurs due to high activity of the vagus nerve. Respiratory arrhythmia is characteristic of young people, athletes, patients with neurocirculatory dystonia, neuroses, as well as adolescents during puberty.

ECG signs of respiratory arrhythmia:

Signs of sinus rhythm (P wave of normal shape and size, always precedes the QRS complex),
Increased heart rate on inspiration and decrease on expiration
The duration of R-R is not the same, but the runs are within 0.15 s.

A characteristic feature and diagnostic criterion is the following moment: respiratory arrhythmia disappears on the ECG when holding the breath, increases under the action of drugs of the group of b-blockers and disappears under the action of atropine. Sinus arrhythmia not associated with breathing is observed in the elderly, with various cardiac pathologies (cardiomyopathies, coronary artery disease, myocarditis).

If respiratory arrhythmia has a favorable prognosis and is a physiological feature, then non-cyclic arrhythmia has a more serious prognostic value and may mean certain disorders in the work of the heart.

ECG signs of non-cyclic arrhythmia:

Signs of sinus rhythm (P wave of normal shape and size, always precedes the QRS complex)
There is no connection of sinus arrhythmia with respiration,
Sinus arrhythmia persists when holding the breath,
The duration of R-R is not the same, the run-up is more than 0.15 s.

From the foregoing, we can conclude that sinus rhythm is a normal rhythm of heart contraction, but sinus rhythm does not exclude possible disturbances in the work of the heart. It is important that the rhythm is not just sinus, but also correct. Correct sinus rhythm means that your heart is beating regularly and rhythmically.

Sinus rhythm is the normal rhythm of the heart that is generated by the sinoatrial node. Normal heart rate per minute ranges from 60 to 90 beats. The sinus rhythm is considered correct, in which each complex on the cardiogram is at an equidistant distance from the other. If the distance between beats exceeds 10% of the average, the rhythm is called irregular.

Signs of sinus rhythm are positive P waves in lead II and negative P waves in avR. Each atrial wave is followed by a ventricular complex. These are the main signs of sinus rhythm.

Regular sinus rhythm indicates normal heart function.

Violation of sinus rhythm can be observed in healthy adults as a reaction to emotional experiences. However, more often rhythm changes indicate the following conditions:

acquired heart defects;
cardiomyopathy;
myocarditis;
alcoholic heart disease;
thyrotoxicosis.

Overdose of antiarrhythmic drugs or other drugs.

There are situations when, in addition to regular heartbeats, extraordinary impulses of the heart occur. They are called extrasystoles. Quite often, extrasystoles are attributed to violations of the normal rhythm and its regularity. However, in a small amount, extrasystoles can also occur in normal healthy people. The number of supraventricular extrasystoles normally depends on the age of the person.

Irregular sinus rhythm of the heart can be observed in the form of attacks of paroxysmal supraventricular tachycardia in pregnant women. Typically, such attacks are rare and disturb the woman only with palpitations. Hemodynamics does not change. However, in rare cases, such an attack can mean the development of significant disorders in the work of the heart. Therefore, any change in rhythm in a pregnant woman should be carefully diagnosed.

Clinical picture

The main complaint in violation of the rhythm in most cases is a feeling of palpitations. In addition, a person may be concerned about:

excessive sweating;
flushes of heat;
dizziness;
weakness.

Irregular sinus rhythm can be detected using a conventional ECG or Holter monitoring. The results of the study can be evaluated either by a cardiologist or a doctor of functional diagnostics.

In childhood

Irregular sinus rhythm in a child can also be both a manifestation of the norm and pathology.

Normally, instability of the sinus rhythm of the heart can occur with excessive emotional excitement. In adolescent children, such a change in rhythm often occurs as a manifestation of respiratory arrhythmia. Diagnosing it is quite simple - during the ECG procedure, after recording a standard cardiogram, the child is asked to hold his breath. If at the same time the rhythm returns to normal, doctors talk about the development of respiratory arrhythmia. If, after holding the breath, the rhythm does not become normal, additional studies are necessary.

In young children, unstable sinus rhythm may be one of the manifestations of congenital heart defects. In older children, changes in sinus rhythm may be the first manifestation of acquired heart defects, cardiomyopathies, and myocarditis. To exclude these conditions, it is necessary to conduct a thorough diagnosis.

Any violation of the rhythm requires a full diagnosis to determine the cause of its development. In order to make a diagnosis of physiological arrhythmia, it is necessary to exclude pathological factors.

An electrocardiogram is ordered to a patient when the doctor suspects the development of a disease related to the cardiovascular system. With the help of such an examination, many factors can be identified: worsening of a previously detected pathology, the manifestation of new symptoms.

The procedure is mandatory prescribed before each surgical operation, regardless of the damaged organs and the alleged disease. The results of the electrocardiogram have certain marks of the normal activity of the heart muscle. Cardiogram of the heart, sinus rhythm, what is it?

Norm indicators

The sinus ECG rhythm indicates the absence of any abnormalities in the work of the heart muscle in the patient's body. These are certain fluctuations, upon the appearance of which, electronic impulses are first formed in the sinus node, and only then diverge at the final points - in the ventricular and precardiac departments of the organ. In general, this whole process makes the human heart beat, saturating the limbs with blood.

The correct result is displayed in the cardiogram if the patient who has been scheduled for the examination does not need to worry and be nervous about any issues. He should not be afraid, it is better to relax and not think about anything.

What does sinus rhythm mean? When a cardiologist puts a certain mark on the cardiogram, he shows that the P peak in the whole QRS complex is constant, the main beat interval is 65-85 beats per 60 seconds, and the shown P-P, R-R distances are similar. As a result, it becomes clear that in the examination methodology, great importance is given to the localization of the driver's rhythm in the sinus center. For a reliable analysis, the following factors are checked:

The P points must go before the QRS complexes;
The values of P openings must be identical to each other and located in similar divisions;
In the 2nd opening, the point P must be in the positive spectrum.

When all these ECG signs of a sinus beat are found in full, this means that the excitatory impulses are correctly distributed in order from top to bottom. If they were not detected, the rhythm cannot be assessed as sinus.

This fact will indicate that the source is located in the departments of the second order: the ventricles, the atrium, or the atrioventricular node.

Deciphering the cardiogram - the vertical position of the ECG rhythm. It means that the central axis and stroke move according to the accepted norm. As a result, this method determines the closest position of the heart muscle in the patient's chest.

In special cases, the organ is in planes - horizontal and semi-horizontal, as well as half vertical. It is worth noting that the heart can move in different directions relative to the axis: forward and backward, to the sides. This fact is not proof of the development of pathology, it only indicates the individual structural features of the patient's body.

Deviations from the norm

Unfortunately, not everyone is in good health. Often, the diagnosis reveals various deviations and disorders. A negative ECG indicator usually indicates blockades in the heart or arrhythmias.

Blockade is usually caused by abnormal, unusual transmission of electrical impulses from the CNS (central nervous system) to the heart muscle itself. For example, an overestimated number of pulse beats indicates that with the usual systematics, as well as the standard sequence of organ compression, the oscillations are slightly accelerated and increased.

If it speaks of deviations in the measure, then, usually, it is caused by any differences between the sequence, frequency and regularity of beats. The size of the differences between the distances of the points on the ECG reflects the irregularity of the sinus rhythm. As a rule, this indicates a weak node.

To detect the development of pathology of the heart rhythm, a Holter examination is prescribed, and a drug test is also performed. This method is used to find out how stable, whether the regulation of the autonomic system has gone astray.

Signs of sinus rhythm disturbances on the ECG

Weakness Syndrome (SSSS) is damage to the causative agent of impulses, which can be detected using electrocardiographic examination and clinical methods.

It is important to know what the normal ECG examination looks like in order to diagnose the presence of an arrhythmia in a patient.

It has already been indicated above that the P waves located in the positive zone and similar in size are characteristic of the disease. They should also be at the same distance from each other (about 0.1 to 0.2 seconds), be sure to be in front of the QRS indicator.

The main thing is that at the same time the frequency of strokes of the heart muscle within one minute does not exceed 90-100 contractions. To calculate the desired mark, you must divide 60 by the length of the R-R armhole, displayed in a second scale.

Another method is to multiply the QRS count obtained over a 3 second interval (about 15 centimeters on tape) by 20. An ECG examination of sinus rhythm can show the following abnormalities:

Causes of heart rate jumps

To The most well-known causes of heart failure include:

Excessive alcohol consumption;
Heart muscle disorders - defects, acquired or congenital;
tobacco smoking;
Long-term use of antiarrhythmic drugs, glucosides;
Protrusion of the mitral valve, which is full or partial;
Bright heart failure;
A strong surge in the production of thyroid hormones.

Some factors that affect the increase in heart rate can eliminate rhythm deviations in the work of the respiratory system.