ECG

CARDIAC RHYTHMS

a. Normal Sinus Rhythm (NSR). (1) Normal sinus rhythm originates in the SA node (pacemaker) and travels through the normal conduction pathways. It is not an arrhythmia (abnormality in the normal cardiac rhythm) or dysrhythmia (a disturbance in cardiac rhythm) because it is a normal pattern. See figure 1-12. (2) Normal sinus rhythm is analyzed in this manner: (a) When the R-R intervals and the P-P intervals are constant, the rhythm is considered regular. (b) The atrial and ventricular rates equal 60 to 100 heartbeats per minute with no added or lost P, QRS, or T waves. (c) The P wave has a uniform configuration with one P wave in front of every QRS. (d) The P-R interval is constant between 0.12 and 0.20 seconds. (e) The QRS complex measures less than 0.12 seconds.

Figure 1-12. Normal sinus rhythm. b. Sinus Bradycardia. The analysis of sinus bradycardia is given below and an example shown in figure 1-13. (1) The rhythm is regular with the R-R intervals constant and the P-P intervals constant. (2) The atrial and ventricular rates are less than 60 beats per minute. (3) The P wave is normal and upright with one P wave in front of every QRS complex. (4) The P-R interval is constant between 0.12 and 0.20 seconds. (5) The QRS complex measures less than 0.12 seconds. (6) A heart rate of less than 60 beats per minute may indicate good physical conditioning if the individual is young and healthy. (7) If the person is suffering from acute myocardial infarction (AM I), this heartbeat rate may indicate any one of the following: conduction system damage, increased parasympathetic tone, or possible toxic levels of certain cardiac drugs (digitalis, quinidine). If the heartbeat rate decreases to less than 50 beats per minute, the heart may not be able to pump enough fluid through the body's vital organs. Additionally, bradycardia leads to electrical instability in the ventricles, possibly resulting in ventricular arrhythmias. NOTE: Males normally have a slower heart rate than females. Cardiovascularly healthy people may normally have a slow (less than 60 beats per minute) heart rate which also normally slows during sleep and rest. A slow heart rate is significant only if it is associated with MI or cardiovascular compromise.

Figure 1-13. Sinus bradycardia. c. Sinus Tachycardia. The analysis of sinus tachycardia is given below and an example is shown in figure 1-14. (1) In sinus tachycardia, the rhythm is regular and the R-R and P-P intervals are constant. (2) Atrial and ventricular rates are equal to or greater than 100 beats per minute. (3) The P wave is normal and upright with one P wave in front of every QRS complex. (4) The P-R interval is constant between 0.12 and 0.20 seconds. (5) The QRS complex measures less than 0.12 seconds. (6) A variety of circumstances can cause sinus tachycardia including pain, fever, hypoxia, shock, congestive heart failure, and drugs such as epinephrine, atropine, and isoproterenol. The more rapid the heart rate, the harder the heart works. This can lead to further heart damage in AMI. Also, because there is insufficient time between contractions for the ventricles to fill completely with blood, the heart may not be able to pump fluid effectively when the heart rate is more than 120 to 140 beats per minute. Strenuous exercise such as jogging may cause this condition.

Figure 1-14. Sinus tachycardia.

Sinus Arrhythmia

Sinus arrhythmia is what can be defined as the anxious state of the slowing down of the heart while breathing out or during expiration and increasing of the heart beat while inhaling or during inspiration. This abnormality could prove to be dangerous and if remained uncured might as well lead to the death of the patient.

So if you ask. 'What is sinus arrhythmia?' then there are other things too associated with it. However, a sinus arrhythmia certainly does not mean that an individual is suffering from an unwarranted disease, especially no heart disease as such. Many arrhythmias, particularly arrhythmia is found to take place in people who do not have the least symptom or inkling of any heart disease. In most of the cases, even if an arrhythmia is found to exist alongside a heart disease, it is in all likely possibility that the patient will likely die of the heart disease than of the arrhythmia, particularly sinus arrhythmia. And a word of caution when you say,'What is sinus arrhythmia?', that sinus bradycardia is not the same as sinus arrhythmia. The symptoms of both the forms of heart-beat irregularities are divergent and the manifestations are different. Sinus arrhythmia affects the vagus nerve which is responsible for activating the nervous system-triggered parasympathetic input which regulates the heart beat. This systematic failure of the medulla oblongata results in the condition which is termed as sinus arrhythmia. To put it in simple words, the vagus nerve is left unstimulated resulting in the wrong signals to the heart and the subsequent decline in pitch of the heart rate. This is what is sinus arrhythmia. Sinus arrhythmia is the most common form of arrhythmia that occurs in middle-aged adults. With the advent of age, the conditions of arrhythmia increases. The symptoms exuded include dizziness or light-headedness, feeling of breathlessness. Patients are almost certain that their heart skipped a beat and a feeling of abnormal giddiness overcomes them. Such symptoms are commonplace and should not be confused with the exceptional cases that occur in the course of your lifetime. But if you see a pattern in the irregularities, then the situation demands immediate concern or attention. I hope you got your answer to these question, 'What is sinus arrhythmia?' Would you like to know how I treated my sinus headache in 4 days without any drugs? If yes then visit sinus treatment or sinus home remedy.

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Ecg
The Normal Electrocardiogram Characteristics of the Normal Electrocardiogram P wave: electrical potentials generated when the atria depolarize before atrial contraction begins QRS complex: potentials generated when the ventricles depolarize before contraction (as the depolarization wave spreads through the ventricles) T wave: potentials generated as the ventricles recover from the state of depolarization Depolarization Waves Versus Repolarization Waves
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During depolarization, the normal negative potential inside the fiber reverses and becomes slightly

positive inside and negative outside.

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Depolarization wave: results from spread of depolarization along the muscle fiber membrane. Repolarization wave: results from spread of repolarization along the muscle fiber membrane Relation of the Monophasic Action Potential of Ventricular Muscle to the QRS and T Waves in the

Standard Electrocardiogram No potential is recorded in the electrocardiogram when the ventricular muscle is either completely polarized or completely depolarized. Only when the muscle is partly polarized/depolarized does current flow from one part of the ventricles to another part Relationship of Atrial and Ventricular Contraction to the Waves of the Electrocardiogram
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Before contraction of muscle can occur, depolarization must spread through the muscle to initiate the

chemical processes of contraction

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The P wave occurs at the beginning of contraction of the atria and the QRS complex of waves occurs at

the beginning of contraction of the ventricles.

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The ventricles remain contracted until after repolarization has occurred (the end of the T wave) The atrial repolarization wave is usually obscured by the much larger QRS complex. Voltage and Time Calibration of the Electrocardiogram

Normal Voltages in the Electrocardiogram PQ or PR interval

The time between the beginning of the P wave and the beginning of the QRS complex is the interval between the beginning of electrical excitation of the atria and the beginning of excitation of the ventricles.

QT interval Contraction of the ventricle lasts almost from the beginning of the Q wave to the end of the T wave

Rate of Heartbeat as Determined from the Electrocardiogram Heart rate is the reciprocal of the time interval between two successive heart beats.

Methods for Recording Electrocardiograms Pen Recorder Flow of Current Around the Heart During the Cardiac Cycle Recording Electrical Potentials from a Partially Depolarized Mass of Syncytial Cardiac Muscle Flow of Electrical Currents in the Chest Around the Heart
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When one portion of the ventricles depolarizes and therefore becomes electronegative with respect to the remainder, electrical current flows from the depolarized area to the polarized area in large circuitous routes.
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The average current flow occurs with negativity toward the base of the heart and with positivity toward

the apex.
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Immediately before depolarization has completed its course through the ventricles, the average direction of current flow reverses for about 0.01 second, flowing from the ventricular apex toward the base, because the last part of the heart to become depolarized is the outer walls of the ventricles near the base. Electrocardiographic Leads Three Bipolar Limb Leads
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Lead: combination of two wires and their electrodes to make a complete circuit between the body and the

electrocardiograph.
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Lead I Negative terminal of the electrocardiograph is connected to the R arm and the positive terminal to the L arm.

Lead II Negative terminal of the electrocardiograph is connected to the R arm and the positive terminal to

the L leg.
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Lead III Negative terminal of the electrocardiograph is connected to the L arm and the positive terminal to the L leg.

Einthoven s Triangle Einthoven s Law

If the electrical potentials of any two of the three bipolar limb electrocardiographic leads are known at any given instant, the third one an be determined mathematically by simply summing the first two. The sum of the voltages in leads I and III equals the voltage in lead II.
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Normal Electrocardiograms Recorded from the Three Standard Limb Leads Abnormalities of cardiac muscle contraction or cardiac impulse conduction do change the

patterns of the electrocardiograms markedly in some leads yet may not affect other leads. Chest Leads (Precordial Leads)
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Each chest lead records mainly the electrical potential of the cardiac musculature immediately beneath the electrode. (relatively minute abnormalities in the ventricles can cause marked changes in the electrocardiograms recorded from individual chest leads) Augmented Unipolar Limb Leads

Pulmonary wedge pressure

The pulmonary capillary wedge pressure or PCWP (also called the pulmonary wedge pressure or PWP, or pulmonary artery occlusion pressure or PAOP) is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch.[1] Physiologically, distinctions can be drawn among pulmonary venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and left atrial pressure, but not all of these can be measured in a clinical context.[2]

Clinical significance
Because of the large compliance of the pulmonary circulation, it provides an indirect measure of the left atrial pressure.[5] For example, it is considered the gold standard for determining the cause of acute pulmonary edema; this is likely to be present at a PCWP of >20mmHg. It has also been used to diagnose severity of left ventricular failure and mitral stenosis[6] Calculating PCWP is also important in diagnosis of acute respiratory distress syndrome (ARDS). Physiological pressure: 612 mm Hg.[7]

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Normal pressure range (in mmHg) 3 8

Central venous pressure