What is accelerated sinus rhythm of the heart. Sinus rhythm of the heart - what does it mean, the norm in adults and a child Permissible sinus rhythm on an ecg

What does it mean when the heart rhythm (cardiac) sinus was determined during the course of the study? And should this be considered normal?

Before answering this question, it is necessary to determine which study helps to determine the beat of the heart muscle, what are the reasons sinus arrhythmia, as well as what signs of deviation on the results of the cardiogram can be seen. And does it require any treatment? All these issues should be dealt with in stages, starting from the essence and ending with the tactics of therapy.

The concept of sinus rhythm

So what does sinus rhythm mean? To begin with, it should be noted that the heart muscle is the organ that works, adhering to a certain tact. The heart is a key organ of the circulatory system and can contract on its own. It is allowed to function autonomously by special nerve cells localized in separate parts of the organ.

Most large cluster such cells and received in medicine the name of the sinus node. This node is located in the upper part of the heart muscle and constantly sends spontaneous electrical impulses, which allows the muscle to contract. These contractions, or the so-called sinus rhythm of the heart, are the basis for a normal heartbeat.

At the very beginning of the 20th century, scientists created a device that makes it possible to record heartbeats, i.e. a specialist in the course of the study makes a cardiogram of the heart. If during such a study a normal indicator of sinus rhythm is detected, then this indicates that the main muscle is healthy and endowed with sufficient strength. Such results are evidence that there are no deviations in the work of the patient's organ.

Analysis of the rhythm of the heart gives the attending physician the opportunity to identify existing violations in the work main muscle human body.

Speaking about what sinus rhythm is, it should be noted that this definition refers to an electrocardiogram indicator, which indicates that the heart muscle is contracting to impulses that come from the sinus node.

In this case, the rhythm of the contractions of the heart is directly dependent on the shocks that the sinus node sends. However, if we consider the principle of the heart and the cardiac cycle, then after an electrical impulse arrives from the sinus node, atrial contraction occurs. These atria push blood into the ventricles of the heart, after which they relax. At the same time, there is a contraction of the ventricles and the release of blood volumes into the vessels. Only after that, all four chambers of the heart muscle relax. All these movements are repeated over and over again in the bloodstream.

Normal indicators and causes of deviations

According to experts, normal beat hearts can be described by the following characteristics:

• The frequency will vary from 60 to 90 beats per minute.
• The ECG should show regularity, i.e. between each subsequent beat must pass the same period of time. irregular rhythm hearts can be the sign of the most various diseases to be identified by the attending physician.
• On electrocardiography, a sequence should be visible, which means that each subsequent muscle contraction should be carried out in a similar direction to the previous one, which can be determined by the characteristics of the sound.
• Physiological variability, which implies the ability to change the frequency of the beat of the main muscle, but with the preservation of regularity and consistency.

Before we talk about the causes of heart rhythm deviations, it is necessary to understand what deviations can occur.

To begin with, it should be said that sinus rhythm disturbance can be both physiological and pathological in nature. There are three types of abnormal sinus heart rate:

1 Sinus tachycardia, when the rhythm of the heart muscle is characterized by an accelerated pace. The ECG decoding shows the value of the frequency of muscle contractions (HR) at a level of more than 120 for a minute. If there are severe deviations, then the heart rate is able to reach 200-220 beats in 60 seconds. At the same time, the patient's breathing quickens, he experiences a lack of air, a feeling of anxiety and palpitations in the area behind the sternum.

2 Sinus bradycardia of the heart, when there is a decrease in heart rate to a value below 60 beats per minute. At the same time, the decoding of the results of the study shows rare reductions. A patient with this diagnosis experiences a feeling of dizziness, fainting occurs quite often. The reason for the development of such a pathology, both in an adult and in a child, as a rule, is the defeat of the vagus nerve.

3Arrhythmia of the heart, in which heart contractions are irregular. Deciphering the results of the study shows an unstable heartbeat and increased heart rate, followed by a decrease, or vice versa.

Violation of the heart rhythm can also occur due to a weak sinus node. And deciphering the results of the cardiogram will definitely show this. In this case, a sick person experiences dizziness, headaches, fainting occurs, and a feeling of nausea occurs. Such patients are characterized by a changeable psycho-emotional state and irritability.

Speaking of the most probable reasons cardiac arrhythmias, both in adult patients and in children, it should be highlighted:

• Abuse of alcoholic beverages.
• All kinds of heart defects, which, as a rule, can be observed in a child. After all, this disease is congenital.
• Abuse of tobacco products.
• If sticks out mitral valve main muscle of the human body.
• Diseases of the thyroid gland.
• Acute or chronic dysfunction of the organ.
• Damage to areas of the heart that are infectious in nature.
• Pathologies of the nervous system.
• Different types of anemia.
• Emotional, psychological and physical stress.

Therapy for cardiac arrhythmias

According to experts, sinus arrhythmia should not be treated. Violation of the rhythm does not mean at all that there are any pathologies. After all, a violation in the rhythm of the heart is a very common syndrome that can be observed in both a child and an adult.

If a person stops smoking and drinking tobacco products, eliminates excessive physical and psychological stress, then he will have every chance to eliminate the likelihood of developing all kinds of deviations and bring the rhythm back to normal.

In this case, if sinus pathology is detected, the patient should consult a doctor who will be able to give appropriate recommendations and, if necessary, prescribe appropriate treatment. Most likely, such a sick person will not need drug therapy.

All treatment will consist in a proper diet, an established daily routine and the absence of stressful situations in life. In this case, vitamins will be very useful, which will support the work of the heart and improve the elasticity of the arteries. If we talk about such treatment, then today the pharmaceutical industry offers a wide selection of vitamin complexes for the indicated purposes.

However, the so-called treatment can be carried out if you include in the diet foods such as dried grapes, citrus fruits, cabbage, beets, blueberries and spinach. They contain great amount antioxidants that control free radicals, the excess of which can cause myocardial infarction.

Also, for the smooth functioning of the heart, the body needs vitamin D, a huge amount of which is present in chicken eggs, parsley, milk and salmon.

Thus, the sinus rhythm of the heart can be both in healthy people and in people with pathologies of the organ. It is very important in this situation to pass diagnostic studies and, if necessary, receive an appropriate course of therapy.

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Electrocardiography is a technique for recording and studying the electrical fields generated during the work of the heart. In turn, the ECG (electrocardiogram) is graphic representation the results of this survey. The familiar uneven line with characteristic teeth can appear on a computer display or be fixed on a long narrow paper tape in the form of a graph.

How is an electrocardiogram performed?. The patient is asked to lie down on a couch, after which electrodes are attached to certain areas of his body (arms, legs, chest). The standard procedure is to use 10 sensors (sometimes 8.12). During the recording of the ECG, the subject must remain still and remain calm, since any movement (even minimal tremor or trembling) can significantly affect the results. Of course, there are exceptions when a doctor asks a person to hold their breath for a while or perform a simple physical exercise. Such a stress test (or stress test) is necessary to track what changes occur in the heart during exercise. Registration of electrical potentials lasts 5-10 minutes, during which the cardiological impulses are converted into a wavy line printed on paper. This painless and easy-to-perform procedure is a very informative, but at the same time inexpensive and accessible method for studying cardiac activity.

On a note: immediately before the ECG recording procedure, it is forbidden to do physical exercises and do not recommend drinking cold water - the results after this may be erroneous.

What information does the doctor receive when analyzing the ECG:

• Determines the frequency and regularity of heart contractions (for example, extrasystoles (extraordinary contractions), or loss of individual contractions - arrhythmias).
• Notices acute or chronic myocardial injury (myocardial infarction, myocardial ischemia).
• Detects metabolic disorders of potassium, calcium, magnesium and other electrolytes.
• Detects violations of intracardiac conduction (various blockades).
• Gets an idea about physical condition heart (left ventricular hypertrophy).
• May infer non-cardiac disorders such as pulmonary embolism.
• Able to remotely diagnose acute cardiac pathology (myocardial infarction, myocardial ischemia) using a cardiophone.
• Can explore cognitive processes (in combination with other methods).

Daily ECG monitoring. This is a continuous recording of an electrocardiogram for 24 hours or more (48, 72 hours, sometimes up to 7 days). The method allows you to register an ECG not only in the supine position near the device, but also in normal conditions. Everyday life sick.

Abnormal ECG results may be a sign of:

• Arrhythmias
• Damage or changes to the heart muscle


• Changes in sodium or potassium levels in the blood
• congenital heart disease
• Cardiomyopathy
• Effusive pericarditis
• Myocarditis
• Heart attack: current or past
• Poor blood supply to the heart artery
• atrial fibrillation
• heart failure
• Multifocal atrial tachycardia
• Paroxysmal supraventricular tachycardia
• sick sinus syndrome
• Wolff-Parkinson-White Syndrome

The method is not omnipotent. It should be borne in mind that many heart diseases are difficult or impossible to detect using an ECG, since they do not produce serious changes in the overall cardiogram. For example, it is impossible to fix a sinoauricular blockade of the first degree, which means a prolongation of the time of impulse conduction from the sinoatrial node to the tissues surrounding the atrium. Nor can electrocardiography provide information about the presence or absence of an aneurysm. In the event that there is indeed an expansion of the aortic lumen, only indirect signs ailment: insufficiency aortic valve or thickening of the wall of the left ventricle of the heart. There are difficulties in diagnosing angina pectoris using the registration of electric fields. The role of ECG at rest in this situation is small, since in 60% of patients with chest pain no changes in the usual pattern are observed.

Interesting fact: In 1924 Nobel Prize in the field of Physiology and Medicine went to the Dutch physiologist Willem Einthoven for the discovery of the mechanism of the electrocardiogram.

A bit of terminology.

Most often, specialists record the results of electrocardiography using standard medical terms and abbreviations.

• heart rate- heart rate per minute. Norm: 60-90 strokes. A result of more than 91 beats is a sign of tachycardia, below 60 - bradycardia.
• EOS- electrical axis of the heart. The indicator allows you to roughly determine the location of the heart in the chest, to get an idea of ​​the shape and function of its various departments. Based on EOS, it is difficult to draw conclusions, since the position of the heart is determined not only by diseases, but also by age, gender, and body type of a person. Meanwhile, it is known that in hypertension, EOS deviation to the left or its horizontal location is common. In chronic lung diseases (chronic obstructive bronchitis, bronchial asthma), on the contrary, EOS deviation to the right is often found.
• Rhythm sinus regular- normal healthy heart rhythm
• The rhythm is non-sinus- a sign of heart disease
• Rhythm sinus irregular / sinus arrhythmia- is a symptom of the disease if it persists with holding the breath
• Leg block(left, right, left and right) bundle of His(RBBB, BLNG), complete or incomplete, indicates the presence of changes in the myocardium of the ventricles of the heart, which often accompany myocarditis, myocardial infarction, cardiosclerosis, heart defects, myocardial hypertrophy and arterial hypertension
• Left ventricular hypertrophy (LVH) has the most common causes of arterial hypertension, heart defects and hypertrophic cardiomyopathy.
• Right ventricular hypertrophy Among the causes are heart defects, chronic lung diseases (chronic obstructive bronchitis, bronchial asthma), cor pulmonale.
• cicatricial changes, scars are signs of a myocardial infarction once transferred.
• Cardiac changes- always a sign of coronary heart disease (CHD).
• Dystrophic changes indicate metabolic disorders in the myocardium, are characteristic of cardiomyopathy, anemia, endocrine diseases, diseases of the liver, kidneys, hormonal disorders, intoxication, inflammatory processes, heart injuries.

Normal ECGs:

• Children 1-12 months: typical heart rate fluctuation depending on the behavior of the child (increased with crying, anxiety), average heart rate- 138 beats per minute (60-150), the location of the EOS is vertical. Appearance of incomplete blockade of the right leg of a ventriculonector is allowed.
• Children aged 1-6 years: Normal, vertical, less often - horizontal position of the EOS, heart rate 95-128 per minute. There is a sinus respiratory arrhythmia.
• Children aged 7-15 years: Characterized by respiratory arrhythmia, heart rate 65-90 per minute. The position of the EOS is normal or vertical.
• Adults: Heart rate 60-90 beats per minute, regular sinus rhythm, electrical axis of the heart is located normally.

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ECG: sinus rhythm

ECG indication: sinus rhythm indicates that a person does not have any serious disturbances in the work of the heart.

If in the conclusion of the ECG of the heart the doctor wrote "sinus rhythm: irregular", then you should think about the presence of sinus bradycardia, characterized by a low heart rate.

However, these disorders have completely different causes, which include cardiomyopathy, infective endocarditis, as well as physical, psychological and emotional overload.

Factors that increase sinus rhythm (sympathomimetics, emotional and physical stress) eliminate respiratory arrhythmia.

Normosystole and supraventricular scallop retardation

Irregular sinus rhythm does not mean the presence of one of the listed diseases. Heart rhythm disturbance is a very common syndrome that manifests itself in humans. different ages. Almost constantly icy hands with a lilac tint. What examination data are available (indicating reference values): 1) ECG: sinus arrhythmia, normosystole.

In some cases, the cause of cardiac arrhythmias are congenital features of the conduction system of the heart. The causes of such tachycardia can be both extracardiac factors and the actual heart disease. In simple terms, an ECG is a dynamic recording of an electrical charge, thanks to which our heart works (that is, it contracts).

An ECG is a completely painless and safe study, it is performed for adults, children and even pregnant women.

Most of the ECG findings are described in special terms that are understandable to doctors, which after reading this article, the patient himself will be able to understand. Heart rate is not a disease or a diagnosis, but just an abbreviation for "heart rate", which refers to the number of contractions of the heart muscle per minute.

With an increase in heart rate above 91 beats / min, they speak of tachycardia; if the heart rate is 59 beats / min or less, this is a sign of bradycardia.

I did a cardiogram. What means? Before the doctor for a long time tell me. According to the decoding, it is written minus rhythm, normosystalia.

Referral to a cardiologist regional hospital does not give. At the daughter's a child is born with aortic correction, who underwent surgery at 10 days of age. Normal sinus rhythm is characterized by a frequency of 60-80 beats per minute, the right rhythm and a constant interval between beats - 0.12-0.22 seconds.

Sinus tachycardia[edit edit wiki text]

An accelerated sinus rhythm (more than 110 beats per minute) indicates that a person has sinus tachycardia.

Help to decipher the conclusion of the ECG

Sinus tachycardia may be temporary and appear after taking sympathomimetics, atropine, alcohol, and as a result of a rapid decrease in blood pressure.

Sinus rhythm can be disturbed both from birth and as a result of growing up. This disease is characterized by a violation of the rhythm, frequency and sequence of contractions of the heart.

If a person has an unstable sinus rhythm, then this indicates the presence of sinus arrhythmia. Sinus arrhythmia does not require special treatment. Atrial flutter - this type of arrhythmia is very similar to atrial fibrillation.

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How the cardiogram of the heart is deciphered: sinus rhythm and what the ECG results say

After performing the diagnosis, the cardiogram of the heart is deciphered, the sinus rhythm and other parameters are described according to all the rules.

A specialist (cardiologist) compares the result with the norm and makes a conclusion:

• The normal heart rate falls in the range of 60 to 90 beats per minute, in children under 6 years old up to 120, and in newborns up to 140.
• The state of excitation of the sinus node can be determined by the P wave, which is always in front of the QRS teeth.
• The PQ interval has the same duration (0.12-0.20 seconds) on the entire electrical cardiogram.
• The RR interval (the cycle of myocardial contraction until the next contraction begins) should also be the same throughout the entire cardiogram.

ECG results, interpretation, sinus rhythm may indicate a physiological arrhythmia caused by increased psycho-emotional or physical stress, as well as some external factors (a sharp change in weather conditions).

Functional bradycardia or tachycardia accompanied by both irregular sinus rhythm and changes in heart rate. If, when the listed causes are eliminated, cardiac activity does not return to normal, a pathological process can be suspected.

As a result of decoding the cardiogram of the heart, an abnormal sinus rhythm may indicate:

• diseases of the cardiovascular system of an inflammatory and / or infectious nature;
• organic changes in the myocardium;
• congenital and acquired anomalies of the heart valves;
• acute or chronic CHF;
• congenital anomaly of the atrioventricular node;
• endocrine pathologies, including thyrotoxicosis;
• vagus nerve damage;
• anemia or chronic hypoxia.

Nonspecific changes in the myocardium, confirmed by deciphering the cardiogram of the heart, sinus rhythm and its deviations may also indicate such bad habits like smoking, drug use and large doses of alcohol, as well as overdose of certain medications, therapeutic regular intake medicines such as cardiac glycosides.

The results of the ECG, interpretation, sinus rhythm and its display on the cardiogram will help not only to determine the presence of factors that lead to irregular heart fluctuations, but also to choose the appropriate treatment tactics.

The choice of therapy for cardiac arrhythmias depends on what causes they are caused, physiological or disease. If in the first case a change in regimen and a healthy lifestyle will help, then in the second case a thorough examination and treatment of the underlying disease is required.

In any case, without waiting for the results of the ECG decoding of the sinus rhythm, it is necessary to give up drugs, nicotine, alcohol abuse, coffee and tea, observe a normal sleep and rest regimen, play sports, and spend more time outdoors.

It is important to eat fully, not to abuse spices, chocolate, to provide the body with all the necessary nutrients. It is forbidden to self-prescribe medications, especially antiarrhythmic and sedatives.

The detection of severe sinus arrhythmia, which has developed against the background of pathology of the heart and blood vessels, requires careful analysis, a high-quality therapeutic complex, and, if necessary, surgical intervention.

The specifics of treatment depends on the type of pathological process and the severity of the symptoms.

Deciphering the cardiogram of the heart, sinus rhythm in most cases indicates the adaptive ability of the myocardium to living conditions and changes in the load on the body, but requires mandatory confirmation of the absence of ailments.

This is due to the fact that the blockade of the conduction system of the heart can be dangerous not only for health, but also for human life. Therefore, you should carefully look at all suspicious ECG results, decoding, sinus rhythm and carefully study elements and segments with deviations from the norm.

ECG with decoding Pulse in children is normal

Sinus rhythm is one of the most important indicators of the normal functioning of the heart, which indicates that the source of contractions comes from the main sinus node of the organ. This parameter is among the first in the conclusion of the ECG, and patients who have passed the study are eager to find out what it means and whether to worry.

The heart is the main organ that provides blood to all organs and tissues; the degree of oxygenation and the function of the whole organism depend on its rhythmic and consistent work. For muscle contraction, a push is needed - an impulse coming from special cells of the conducting system. The characteristics of the rhythm depend on where this signal comes from and what its frequency is.

the cardiac cycle is normal, the primary impulse comes from the sinus node (SN)

The sinus node (SN) is located under the inner shell of the right atrium, it is well supplied with blood, receiving blood directly from the coronary arteries, richly supplied with fibers of the autonomic nervous system, both parts of which influence it, contributing to both an increase and a decrease in the frequency of impulse generation.

The cells of the sinus node are grouped into bundles, they are smaller than ordinary cardiomyocytes, have a spindle shape. Their contractile function is extremely weak, but the ability to form an electrical impulse is akin to nerve fibers. The main node is associated with the atrioventricular junction, which transmits signals for further excitation of the myocardium.

The sinus node is called the main pacemaker, because it is it that provides the heart rate that gives the organs an adequate blood supply, so maintaining a regular sinus rhythm is extremely important for assessing the work of the heart in case of its lesions.

SU generates pulses of the highest frequency compared to other parts of the conducting system, and then transmits them from high speed Further. The frequency of the formation of impulses by the sinus node lies ranging from 60 to 90 per minute, which corresponds to the normal frequency heartbeat, when they occur at the expense of the main pacemaker.

Electrocardiography is the main method that allows you to quickly and painlessly determine where the heart receives impulses from, what is their frequency and rhythm. ECG has firmly entered the practice of therapists and cardiologists due to its accessibility, ease of implementation and high information content.

Having received the result of electrocardiography, everyone will look at the conclusion left there by the doctor. The first of the indicators will be the assessment of the rhythm - sinus, if it comes from the main node, or non-sinus, indicating its specific source (AV node, atrial tissue, etc.). So, for example, the result "sinus rhythm with a heart rate of 75" should not disturb, this is the norm, and if the specialist writes about non-sinus, increased heart rate (tachycardia) or slowdown (bradycardia), then It's time to go for an examination.

Rhythm from the sinus node (SN) - sinus rhythm - normal (left) and pathological non-sinus rhythms. The points of origin of the impulse are indicated

Also in the conclusion, the patient can find information about the position of the EOS ( electrical axis hearts). Normally, it can be both vertical and semi-vertical, and horizontal or semi-horizontal, depending on the individual characteristics of the person. EOS deviations to the left or right, in turn, usually indicate an organic pathology of the heart. More EOS and options for its position are described in.

Sinus rhythm is normal

Often, patients who found in custody ECG sinus rhythm, they begin to worry if everything is in order, because the term is not known to everyone, which means it can talk about pathology. However, they can be reassured: sinus rhythm is the norm, which indicates the active work of the sinus node.

On the other hand, even with the preserved activity of the main pacemaker, some deviations are possible, but they do not always serve as an indicator of pathology. Rhythm fluctuations occur under various physiological conditions not caused by pathological process in the myocardium.

The impact on the sinus node of the vagus nerve and the fibers of the sympathetic nervous system often causes a change in its function towards a greater or lesser frequency of formation of nerve signals. This is reflected in the heart rate, which is calculated on the same cardiogram.

Normally, the frequency of sinus rhythm lies in the range from 60 to 90 beats per minute, but experts note that there is no clear boundary for determining the norm and pathology, that is, with a heart rate of 58 beats per minute, it is too early to talk about bradycardia, as well as about tachycardia in excess indicator of 90. All these parameters should be assessed comprehensively with the obligatory consideration general condition the patient, the characteristics of his metabolism, the type of activity, and even what he was doing immediately before the study.

Determining the source of the rhythm in the analysis of the ECG is a fundamental point, while the indicators of sinus rhythm are:

• Definition of P waves before each ventricular complex;
• Constant configuration of atrial waves in the same lead;
• Constant value of the interval between the teeth P and Q (up to 200 ms);
• The P wave is always positive (upward) in the second standard lead and negative in aVR.

In the conclusion of the ECG, the subject can find: "sinus rhythm with a heart rate of 85, the normal position of the electrical axis." We consider this to be the norm. Another option: "the rhythm is non-sinus with a frequency of 54, ectopic." This result should alert, since a serious pathology of the myocardium is possible.

The characteristics listed above on the cardiogram indicate the presence of sinus rhythm, which means that the impulse goes from the main node down to the ventricles, which contract after the atria. In all other cases, the rhythm is considered non-sinus, and its source lies outside the SU - in the fibers of the ventricular muscle, the atrioventricular node, etc. Impulsation is possible from two places of the conduction system at once, in this case also we are talking about arrhythmias.

Correct conclusions about the regulation of the heart rhythm can be made by studying long-term ECG recordings, since in the process of life in all healthy people there is a change in the frequency of heartbeats: one pulse at night, another during the day. However, even shorter intervals of fixation of ECG signs demonstrate the irregularity of the pulse associated with the peculiarities of the autonomic innervation and the work of the whole organism as a whole. Pulse estimation is assisted by specially designed mathematical processing programs, statistical analysis- cardiointervalography, histography.

In order for the ECG result to be the most correct, all possible causes of changes in the activity of the heart should be excluded. Smoking, fast climbing stairs or running, a cup of strong coffee can change the parameters of cardiac activity. The rhythm will, of course, remain sinus if the node is working correctly, but at least tachycardia will be recorded. In this regard, before the study, you need to calm down, eliminate stress and anxiety, as well as physical activity - everything that directly or indirectly affects the result.

Sinus rhythm and tachycardia

Again, we recall that sinus rhythm corresponds to a frequency of 60 - 90 per minute. But what to do if the parameter goes beyond the set limits while maintaining its "sine"? It is known that such fluctuations do not always indicate pathology, so there is no need to panic prematurely.

Accelerated sinus rhythm of the heart (), which is not an indicator of pathology, is recorded when:

1. Emotional experiences, stress, fear;
2. Strong physical activity - in the gym, with heavy physical labor, etc .;
3. After eating too much, drinking strong coffee or tea.

Such physiological tachycardia reflected in the ECG data:

• The length of the gap between the P teeth, the RR interval decreases, the duration of which, with appropriate calculations, allows you to determine exact number heart rate;
• The P wave remains in its normal place - in front of the ventricular complex, which, in turn, has the correct configuration;
• The heart rate according to the results of calculations exceeds 90-100 per minute.

Tachycardia with a preserved sinus rhythm under physiological conditions is aimed at providing blood to the tissues, which, according to different reasons began to need it more - playing sports, jogging, for example. It cannot be considered a violation, and in a short period of time the heart itself restores the sinus rhythm to a normal frequency.

If, in the absence of any diseases, the subject encounters tachycardia with sinus rhythm on the cardiogram, you should immediately remember how the study was carried out - whether he was worried, whether he rushed headlong to the cardiography room, or maybe he smoked on the stairs of the clinic just before taking an ECG.

Sinus rhythm and bradycardia

The opposite of sinus tachycardia is the variant of the heart's work - slowing down its contractions (), which also does not always indicate pathology.

Physiological bradycardia with a decrease in the frequency of impulses from the sinus node less than 60 per minute can occur when:

1. sleep state;
2. Professional sports;
3. Individual constitutional features;
4. Wearing clothes with a tight collar, a tightly tightened tie.

It is worth noting that bradycardia more often than an increase in heart rate indicates pathology, so attention is usually paid to it. With organic lesions of the heart muscle, bradycardia, even if the "sinus" rhythm is preserved, can become a diagnosis requiring medical treatment.

During sleep, there is a significant decrease in heart rate - by about a third of the "daily norm", which is associated with the predominance of the tone of the vagus nerve, which suppresses the activity of the sinus node. ECG is more often recorded in awake subjects, so this bradycardia is not recorded in conventional mass studies, but it can be seen with daily monitoring. If in the conclusion of Holter monitoring there is an indication of a decrease in sinus rhythm during sleep, then it is likely that the indicator will fit into the norm, which the cardiologist will explain to especially worried patients.

In addition, it has been observed that about 25% of men young age have a rarer pulse within 50-60, and the rhythm is sinus and regular, there are no symptoms of trouble, that is, this is a variant of the norm. Professional athletes are also prone to bradycardia due to systematic physical activity.

Sinus bradycardia is a condition where the heart rate slows below 60, but impulses in the heart continue to be generated by the main node. People with this condition may faint, experience dizziness, often this anomaly accompanies vagotonia (a variant of vegetative-vascular dystonia). Sinus rhythm with bradycardia should be a reason to exclude serious changes in the myocardium or other organs.

Signs of sinus bradycardia on the ECG will be the lengthening of the gaps between the atrial teeth and complexes ventricular contractions, however, all indicators of the "sinus" rhythm are preserved - the P wave still precedes the QRS and has a constant size and shape.

Thus, sinus rhythm is a normal indicator on the ECG, indicating the preserved activity of the main pacemaker, and with normosystole, the rhythm is both sinus and normal frequency - between 60 and 90 beats. In this case, there should be no cause for concern, if there are no indications of other changes (ischemia, for example).

When should you worry?

Cause for concern should be the findings of cardiography, speaking of pathological sinus tachycardia, bradycardia, or with instability and irregularity of the rhythm.

With tachy- and bradyforms, the doctor quickly establishes the deviation of the pulse from the norm up or down, finds out complaints and sends for additional examinations - ultrasound of the heart, holter, blood tests for hormones, etc. Having found out the cause, you can start treatment.

Unstable sinus rhythm on the ECG is manifested by unequal intervals between the main teeth of the ventricular complexes, the fluctuations of which exceed - 150-160 msec. This is almost always a sign of pathology, so the patient is not left unattended and the cause of instability in the work of the sinus node is found out.

The fact that the heart beats with an irregular sinus rhythm will also be indicated by electrocardiography. Irregular contractions can be caused structural changes in the myocardium - scarring, inflammation, as well as heart defects, heart failure, general hypoxia, anemia, smoking, endocrine pathology, abuse of certain groups of drugs and many other reasons.

Irregular sinus rhythm comes from the main pacemaker, but the frequency of the organ beats at the same time either increases or decreases, losing its constancy and regularity. In this case, we speak of sinus arrhythmia.

Features of the rhythm in children

Children are a very special part of people who have many parameters that are very different from adults. So, any mother will tell you how often the heart of a newborn baby beats, but at the same time she will not worry, because it is known that in babies of the first years and, especially, newborns, the pulse is much more frequent than in adults.

Sinus rhythm should be recorded in all children, without exception, if we are not talking about heart damage. Age-related tachycardia is associated with small size heart, which should provide the growing body with the necessary amount of blood. How less baby- the more often his pulse, reaching 140-160 per minute during the neonatal period and gradually decreasing to the “adult” norm by 8 years of age.

The ECG in children captures the same signs of the sinus origin of the rhythm - P waves before contractions of the ventricles of the same size and shape, while tachycardia should fit into the age parameters. The lack of activity of the sinus node, when the cardiologist indicates the instability of the rhythm or ectopia of its driver, is a cause for serious concern for doctors and parents and the search for a cause, which most often becomes a congenital defect in childhood.

At the same time, reading the indication of sinus arrhythmia according to the ECG data, the mother should not immediately panic and faint. It is likely that sinus arrhythmia is associated with breathing, which is often observed in childhood. It is also necessary to take into account the conditions for taking an ECG: if the baby was laid on a cold couch, he was frightened or confused, then the reflex holding of the breath will increase the manifestations of respiratory arrhythmia, which does not indicate a serious illness.

However, sinus arrhythmia should not be considered normal until its physiological nature is clearly proven. Thus, the pathology of sinus rhythm is more often diagnosed in premature infants affected by intrauterine children, with increased intracranial pressure in newborns. It can be provoked by rickets, rapid growth,. As the nervous system matures, the regulation of the rhythm improves, and the disturbances can go away on their own.

One third of sinus arrhythmias in children is pathological and is caused by hereditary factors, infection with high fever, rheumatism, myocarditis, heart defects.

Sport with respiratory arrhythmia is not contraindicated for a child, but only under the condition of constant dynamic monitoring and ECG recording. If the cause of unstable sinus rhythm is not physiological, then the cardiologist will be forced to limit the child's sports activities.

Understandably, parents are concerned important question: what to do if the sinus rhythm is incorrect or an arrhythmia is recorded on the ECG? First, you need to go to the cardiologist and once again conduct a cardiogram for the child. If the physiological changes are proven, then observation and ECG 2 times a year are sufficient.

If the sinus rhythm instability is not within the normal range, is not caused by breathing, or functional reasons, then the cardiologist will prescribe treatment in accordance with the real reason arrhythmias.

When conducting and deciphering the ECG, an important indicator of cardiac activity is sinus rhythm. It is defined as the regular occurrence of impulses from the sinoatrial node of the cardiac pathways. Under the influence of certain factors, as a result of damage to the conductive fibers, a violation in the work of the heart can occur. This condition requires examination by a cardiologist and the appointment of appropriate treatment. Sinus heart rhythm deviations that occur during physiological processes pass on their own and do not require medical supervision.

Physiology of the pathways of the heart

The cardiac cycle of contractions normally begins with excitation of the sinoatrial (sinus) node located in the right atrium. As a result, there is a simultaneous contraction of both the right and left atrium. Further, nerve impulses along the bundles of Bachmann, Wenckebach and Torel are sent to the atrioventricular node and linger in it. This ensures consistent contraction of the atria and ventricles. From the atrioventricular node, impulses propagate along the bundle of His to the Purkinje fibers, causing contraction of the ventricles of the heart.

This is how one cycle of successive regular contractions of the atria and ventricles passes. The sinus rhythm of the heart in normal adults is 60-80 beats per minute. When exposed to damaging factors, deviations in the work of the sinus node occur, and heart rhythm disturbances occur.

Interpretation of an ECG with a normal rhythm from the AV node

The result of electrocardiography will be reliable if the rules for performing the study are observed. It is carried out by a specially trained person. Below is a normal electrocardiogram in a healthy person:

The rhythm of the heart from the sinus node when deciphering the ECG has a number of signs:

• Conclusion on heart rate. In older people, it ranges from 60 to 80 per minute. For children under 5–6 years old, an increase in heart rate on the cardiogram up to 120 is characteristic. In newborns, the heart contracts normally at a frequency of 130–140 per minute;
• Prong R. It means that the sinus node has been excited. And always appears before the QRS complex;
• PQ interval. It is characterized by the same duration throughout the cardiogram. It is 0.12–0.20 seconds;
• R-R length. Р-Р - this interval means the process of excitation of the sinus node before the start of the next cycle of contractions. It is also the same throughout the ECG. Irregular intervals indicate pathology;
• All conclusions when deciphering the ECG are made by a cardiologist or therapist.

Causes of abnormal heart rhythms

Physiological rhythm disturbances occur as a result of neuro-emotional overstrain, physical activity, the impact of external factors. They cause both an irregular sinus rhythm and a heart rate disorder of the type or. elimination causal factors brings cardiac activity back to normal.

Pathological deviations of sinus rhythm can cause the following reasons:

• organic lesions of the heart muscle;
• inflammatory and infectious diseases of the cardiovascular system;
• anomalies in the development of the valvular apparatus of the heart;
• sharp and chronic insufficiency cardiac functions;
• congenital malformations in the area of ​​the AV node;
• bad habits (smoking);
• alcoholism and drug addiction;
• thyrotoxicosis and other endocrine disorders;
• taking medications - cardiac glycosides;
• drug overdose;
• diseases of the nervous system (pathology of the vagus nerve);
• lack of vitamins and microelements (potassium, calcium, selenium, magnesium);
• various types of anemia;
• chronic hypoxia.

What are the deviations of the sinus heart rate?

Irregular sinus rhythm can be physiological or pathological. They appear in 3 variants and differ from each other in the frequency of contractions, rhythm. These include:

1. . This deviation is characterized by a regular accelerated rhythm. Deciphering the ECG gives the following results: heart rate more than 120 per minute, shortening R-R interval. In severe violations of the heart rate can reach 200-220 contractions in one minute. The patient has rapid breathing, a feeling of lack of air, anxiety, a feeling of heartbeat behind the sternum.
2. sinus bradycardia. This is such a deviation at which there is a decrease in heart rate below 60 per minute. shows rare contractions, pronounced prolongation of the RR interval. The patient is dizzy, often fainting occurs. Most often, this pathology develops as a result of damage to the vagus nerve. If the sinus rhythm of the heart does not return to normal during the treatment, then a pacemaker is installed. With its help, the atrioventricular node is stimulated with the required frequency.
3. sinus arrhythmia. This condition is characterized by irregular heartbeats. This heart rate is unstable. With it, an increase in heart rate occurs, which is replaced by their decrease, and vice versa. According to the ECG, RR intervals of various duration are determined.

Pathology of the heart rhythm can also develop as a result of the weakness of the sinus node. This means that the sinoatrial node does not fully perform its functions. The patient has characteristic symptoms: dizzy, headaches, fainting, nausea appear. The psycho-emotional state becomes changeable, irritability is more often observed.

Weak sinoatrial node syndrome is more likely to cause irregular heartbeats. It can also cause cardiac asthma, pulmonary edema, angina pectoris, myocardial infarction and coronary heart disease.

Sinus rhythm of the heart - normally, this is the main conclusion on the cardiogram in healthy people. If you experience symptoms of disorders of the cardiovascular system, you should consult a doctor. Timely diagnosis and treatment of pathological changes reduce the risk of adverse outcomes.

Any electrocardiogram displays the work of the heart (its electrical potential during contractions and relaxations) in 12 curves recorded in 12 leads. These curves differ from each other, as they show the passage of an electrical impulse through different parts of the heart, for example, the first is the anterior surface of the heart, the third is the back. To record an ECG in 12 leads, special electrodes are attached to the patient's body in specific places and in a certain sequence.

How to decipher the cardiogram of the heart: general principles

The main elements of the electrocardiographic curve are:

ECG analysis

Having received an electrocardiogram in his hands, the doctor begins to evaluate it in the following sequence:

1. It determines whether the heart beats rhythmically, that is, whether the rhythm is correct. To do this, he measures the intervals between the R waves, they should be the same everywhere, if not, this is already the wrong rhythm.
2. Calculates the rate at which the heart beats (HR). This is easy to do, knowing the ECG recording speed and counting the number of millimeter cells between adjacent R waves. Normally, the heart rate should not go beyond 60-90 beats. in a minute.
3. According to specific features (mainly by the P wave), it determines the source of excitation in the heart. Normally, this is the sinus node, that is, in a healthy person, sinus rhythm is considered normal. Atrial, atrioventricular and ventricular rhythms indicate pathology.
4. Assesses the conduction of the heart by the duration of the teeth and segments. For each of them there are indicators of the norm.
5. Determines the electrical axis of the heart (EOS). Very thin people are more vertical position EOS, for full ones - more horizontal. With pathology, the axis shifts sharply to the right or left.
6. Analyzes teeth, segments and intervals in detail. The doctor writes down their duration on the cardiogram by hand in seconds (this is an incomprehensible set of Latin letters and numbers on the ECG). Modern electrocardiographs automatically analyze these indicators and immediately provide measurement results, which simplifies the work of the doctor.
7. Gives a conclusion. It necessarily indicates the correctness of the rhythm, the source of excitation, heart rate, characterizes the EOS, and also highlights specific pathological syndromes (rhythm disturbance, conduction disturbance, the presence of overload of individual parts of the heart and myocardial damage), if any.

Examples of electrocardiographic findings

In a healthy person, the ECG conclusion may look like this: sinus rhythm with a heart rate of 70 beats. in min. EOS in the normal position, no pathological changes were detected.

Also, for some people, sinus tachycardia (acceleration of heart rate) or bradycardia (slow heart rate) can be considered a normal option. In elderly people, quite often, the conclusion may indicate the presence of moderate diffuse or metabolic changes in the myocardium. These conditions are not critical and after receiving appropriate treatment and correction of the patient's nutrition, they mostly always disappear.

In addition, in conclusion, we can talk about a non-specific change in the ST-T interval. This means that the changes are not indicative and it is impossible to determine their cause only by the ECG. Another fairly common condition that can be diagnosed by a cardiogram is a violation of repolarization processes, that is, a violation of the recovery of the ventricular myocardium after excitation. This change can be caused by both severe heart disease and chronic infections, hormonal imbalances and other causes that the doctor will subsequently look for.

Prognostically unfavorable conclusions are considered, in which there is data on the presence of myocardial ischemia, hypertrophy of the heart, rhythm and conduction disturbances.

Deciphering the ECG in children

The whole principle of deciphering cardiograms is the same as in adults, but due to physiological and anatomical features baby heart there are differences in interpretation normal indicators. This applies primarily to heart rate, since up to 5 years in children it can exceed 100 beats. in a minute.

Also, sinus or respiratory arrhythmia (increased heart rate on inspiration and decrease on expiration) can be recorded in babies without any pathology. In addition, the characteristics of some teeth and intervals differ from those of adults. For example, a child may have an incomplete blockade of part of the conduction system of the heart - the right leg of the bundle of His. All these features are taken into account by pediatric cardiologists when they make a conclusion on the ECG.

Features of the ECG during pregnancy

The body of a pregnant woman goes through various processes adaptation to the new situation. Certain changes are also taking place cardiovascular system therefore, the ECG of expectant mothers may differ slightly from the results of a study of the heart of a healthy adult. First of all, in the later stages there is a slight horizontal deviation of the EOS, caused by a change in the relative placement of the internal organs and the growing uterus.

In addition, expectant mothers may have a slight sinus tachycardia and signs of overload of individual parts of the heart. These changes are associated with an increase in blood volume in the body and usually disappear after childbirth. However, their discovery cannot be left without detailed consideration and a more in-depth examination of the woman.

Deciphering the ECG, the norm of indicators

Deciphering the ECG - business knowledgeable doctor. With this method of functional diagnostics, the following is evaluated:

• heart rhythm - the state of the generators of electrical impulses and the state of the heart system that conducts these impulses
• the state of the heart muscle itself (myocardium). the presence or absence of its inflammation, damage, thickening, oxygen starvation, electrolyte imbalance

However, modern patients often have access to their medical documents, in particular, to the films of electrocardiography, on which medical conclusions are written. With their diversity, these records can bring to panic disorder even the most balanced, but ignorant person. Indeed, often the patient does not know for certain how dangerous for life and health what is written on the back of the ECG film by the hand of a functional diagnostician, and there are still a few days before an appointment with a therapist or cardiologist.

To reduce the intensity of passions, we immediately warn readers that with no serious diagnosis (myocardial infarction, acute rhythm disturbances), the functional diagnostician of the patient will not let the patient out of the office, but at least send him for a consultation with a specialist colleague right there. About the rest of the "secrets of the Open" in this article. In all unclear cases of pathological changes on the ECG, ECG control, daily monitoring (Holter), ECHO cardioscopy (ultrasound of the heart) and stress tests (treadmill, bicycle ergometry) are prescribed.

Numbers and Latin letters in ECG decoding

PQ- (0.12-0.2 s) - time of atrioventricular conduction. Most often, it lengthens against the background of AV blockade. Shortened in CLC and WPW syndromes.

P - (0.1s) height 0.25-2.5 mm describes atrial contractions. Can talk about their hypertrophy.

QRS - (0.06-0.1s) - ventricular complex

QT - (no more than 0.45 s) lengthens with oxygen starvation (myocardial ischemia, infarction) and the threat of rhythm disturbances.

RR - the distance between the apexes of the ventricular complexes reflects the regularity of heart contractions and makes it possible to calculate the heart rate.

The decoding of the ECG in children is shown in Fig. 3

Options for describing the heart rate

Sinus rhythm

This is the most common inscription found on the ECG. And, if nothing else is added and the frequency (HR) is indicated from 60 to 90 beats per minute (for example, heart rate 68`) - this is the most successful option, indicating that the heart works like a clock. This is the rhythm set by the sinus node (the main pacemaker that generates electrical impulses that cause the heart to contract). At the same time, sinus rhythm implies well-being, both in the state of this node, and the health of the conduction system of the heart. The absence of other records denies pathological changes heart muscle and means that the ECG is normal. In addition to sinus rhythm, it can be atrial, atrioventricular or ventricular, indicating that the rhythm is set by the cells in these parts of the heart and is considered pathological.

This is a variant of the norm in young people and children. This is a rhythm in which impulses exit the sinus node, but the intervals between heartbeats are different. This may be due to physiological changes(respiratory arrhythmia, when heart contractions slow down on exhalation). Approximately 30% of sinus arrhythmias require observation by a cardiologist, as they are threatened by the development of more serious rhythm disturbances. These are arrhythmias after rheumatic fever. Against the background of myocarditis or after it, against the background of infectious diseases, heart defects and in people with a history of arrhythmias.

These are rhythmic contractions of the heart with a frequency of less than 50 per minute. At healthy bradycardia happens, for example, in a dream. Also, bradycardia is often seen in professional athletes. Pathological bradycardia may indicate sick sinus syndrome. At the same time, bradycardia is more pronounced (heart rate from 45 to 35 beats per minute on average) and is observed at any time of the day. When bradycardia causes pauses in heart contractions of up to 3 seconds during the day and about 5 seconds at night, leads to disruptions in the supply of oxygen to tissues and manifests itself, for example, by fainting, an operation is indicated to install a heart pacemaker, which replaces the sinus node, imposing a normal rhythm of contractions on the heart.

Sinus tachycardia

Heart rate more than 90 per minute - is divided into physiological and pathological. In healthy people, sinus tachycardia is accompanied by physical and emotional stress, drinking coffee, sometimes strong tea or alcohol (especially energy drinks). It is short-lived and after an episode of tachycardia, the heart rate returns to normal in a short period of time after the cessation of the load. With pathological tachycardia, palpitations disturb the patient at rest. Its causes are temperature rises, infections, blood loss, dehydration, thyrotoxicosis, anemia, cardiomyopathy. Treat the underlying disease. sinus tachycardia stop only with a heart attack or acute coronary syndrome.

Extrasystole

These are rhythm disturbances, in which foci outside the sinus rhythm give extraordinary heart contractions, after which there is a pause doubled in length, called a compensatory one. In general, heartbeats are perceived by the patient as uneven, rapid or slow, sometimes chaotic. Most of all, failures in the heart rhythm are disturbing. May occur discomfort in the chest in the form of shocks, tingling, feelings of fear and emptiness in the abdomen.

Not all extrasystoles are dangerous to health. Most of them do not lead to significant circulatory disorders and do not threaten either life or health. They can be functional (against the background panic attacks, cardioneurosis, hormonal disruptions), organic (with IHD, heart defects, myocardial dystrophy or cardiopathy, myocarditis). They can also lead to intoxication and heart surgery. Depending on the place of occurrence, extrasystoles are divided into atrial, ventricular and antrioventricular (arising in a node on the border between the atria and ventricles).

• Single extrasystoles are most often rare (less than 5 per hour). They are usually functional and do not interfere with the normal blood supply.
• Paired extrasystoles of two accompany a certain number of normal contractions. Such a rhythm disturbance often indicates pathology and requires additional examination (Holter monitoring).
• Allorhythms - more complex types extrasystoles. If every second contraction is an extrasystole, it is bigymenia, if every third is trigynemia, and every fourth is quadrihymenia.

It is customary to divide ventricular extrasystoles into five classes (according to Laun). They are evaluated during daily ECG monitoring, since the indicators of a conventional ECG in a few minutes may not show anything.

• Class 1 - single rare extrasystoles with a frequency of up to 60 per hour, emanating from one focus (monotopic)
• 2 - frequent monotopic more than 5 per minute
• 3 - frequent polymorphic (of different shapes) polytopic (from different foci)
• 4a - paired, 4b - group (trigymenia), episodes of paroxysmal tachycardia
• 5 - early extrasystoles

The higher the class, the more serious the violations, although today even grades 3 and 4 do not always require medical treatment. In general, if there are less than 200 ventricular extrasystoles per day, they should be classified as functional and not worry about them. With more frequent, ECHO of the COP is indicated, sometimes - MRI of the heart. They do not treat extrasystole, but the disease that leads to it.

Paroxysmal tachycardia

In general, paroxysm is an attack. Paroxysmal acceleration of the rhythm can last from several minutes to several days. In this case, the intervals between heartbeats will be the same, and the rhythm will increase over 100 per minute (on average from 120 to 250). There are supraventricular and ventricular forms of tachycardia. The basis of this pathology is the abnormal circulation of an electrical impulse in the conduction system of the heart. Such a pathology is subject to treatment. From home remedies to eliminate an attack:

• breath holding
• increased forced cough
• face immersion in cold water

WPW syndrome

Wolff-Parkinson-White syndrome is a type of paroxysmal supraventricular tachycardia. Named after the names of the authors who described it. At the heart of the appearance of tachycardia is the presence between the atria and ventricles of an additional nerve bundle, through which a faster impulse passes than from the main pacemaker.

As a result, there is extraordinary reduction heart muscle. The syndrome requires conservative or surgical treatment(with ineffectiveness or intolerance of antiarrhythmic tablets, with episodes of atrial fibrillation, with concomitant heart defects).

CLC - Syndrome (Clerk-Levy-Christesco)

It is similar in mechanism to WPW and is characterized by an earlier excitation of the ventricles compared to the norm due to an additional bundle along which the nerve impulse travels. The congenital syndrome is manifested by attacks of rapid heartbeats.

Atrial fibrillation

It can be in the form of an attack or a permanent form. It manifests itself in the form of flutter or atrial fibrillation.

Atrial fibrillation

Atrial fibrillation

When flickering, the heart contracts completely irregularly (the intervals between contractions of the different duration). This is due to the fact that the rhythm is not set by the sinus node, but by other atrial cells.

It turns out a frequency of 350 to 700 beats per minute. There is simply no full-fledged atrial contraction, contracting muscle fibers do not provide effective filling of the ventricles with blood.

As a result, the release of blood by the heart worsens and organs and tissues suffer from oxygen starvation. Another name for atrial fibrillation is atrial fibrillation. Not all atrial contractions reach the ventricles of the heart, so the heart rate (and pulse) will either be below normal (bradysystole with a frequency of less than 60), or normal (normosystole from 60 to 90), or above normal (tachysystole more than 90 beats per minute). ).

An attack of atrial fibrillation is difficult to miss.

• It usually starts with a strong heartbeat.
• It develops as a series of absolutely non-rhythmic heartbeats with a high or normal frequency.
• The condition is accompanied by weakness, sweating, dizziness.
• The fear of death is very pronounced.
• There may be shortness of breath, general arousal.
• Sometimes there is a loss of consciousness.
• The attack ends with the normalization of the rhythm and the urge to urinate, in which the a large number of urine.

To stop an attack, use reflex ways, drugs in the form of tablets or injections, or resort to cardioversion (stimulation of the heart with an electrical defibrillator). If an attack of atrial fibrillation is not eliminated within two days, the risks of thrombotic complications (pulmonary embolism, stroke) increase.

With a constant form of heartbeat flicker (when the rhythm is not restored either against the background of drugs or against the background of electrical stimulation of the heart), they become a more familiar companion of patients and are felt only with tachysystole (rapid irregular heartbeats). The main task when detecting signs of tachysystole of a permanent form of atrial fibrillation on the ECG is to slow down the rhythm to normosystole without trying to make it rhythmic.

Examples of recordings on ECG films:

• atrial fibrillation, tachysystolic variant, heart rate 160 in '.
• Atrial fibrillation, normosystolic variant, heart rate 64 in '.

Atrial fibrillation can develop in the program of coronary heart disease, against the background of thyrotoxicosis, organic heart defects, diabetes mellitus, sick sinus syndrome, intoxication (most often with alcohol).

atrial flutter

These are frequent (more than 200 per minute) regular atrial contractions and the same regular, but more rare ventricular contractions. In general, flutter is more common in acute form and is better tolerated than flicker, since circulatory disorders are less pronounced. Trembling develops when:

• organic heart disease (cardiomyopathies, heart failure)
• after heart surgery
• on the background of obstructive pulmonary disease
• it almost never occurs in healthy people.

Clinically, flutter is manifested by rapid rhythmic heartbeat and pulse, swelling of the jugular veins, shortness of breath, sweating and weakness.

Conduction disorders

Normally, having formed in the sinus node, electrical excitation goes through the conduction system, experiencing a physiological delay of a fraction of a second in the atrioventricular node. On its way, the impulse stimulates the atria and ventricles, which pump blood, to contract. If in some part of the conduction system the impulse lingers longer than the prescribed time, then the excitation to the underlying sections will come later, which means that the normal pumping work of the heart muscle will be disrupted. Conduction disorders are called blockades. They can occur as functional disorders, but are more often the result of drug or alcohol intoxication and organic heart disease. Depending on the level at which they arise, there are several types of them.

Sinoatrial blockade

When the exit of the impulse from the sinus node is difficult. In fact, this leads to a syndrome of weakness of the sinus node, a decrease in contractions to severe bradycardia, impaired blood supply to the periphery, shortness of breath, weakness, dizziness and loss of consciousness. The second degree of this blockade is called the Samoilov-Wenckebach syndrome.

Atrioventricular block (AV block)

This is a delay in excitation in the atrioventricular node of more than the prescribed 0.09 seconds. There are three degrees of this type of blockade. The higher the degree, the less often the ventricles contract, the more severe the circulatory disorders.

• At the first delay allows each atrial contraction to maintain an adequate number of ventricular contractions.
• The second degree leaves part of the atrial contractions without ventricular contractions. It is described in terms of PQ prolongation and ventricular beat prolapse as Mobitz 1, 2, or 3.
• The third degree is also called a complete transverse block. The atria and ventricles begin to contract without interrelation.

In this case, the ventricles do not stop, because they obey the pacemakers from the underlying parts of the heart. If the first degree of blockade may not manifest itself in any way and be detected only with an ECG, then the second is already characterized by sensations of periodic cardiac arrest, weakness, fatigue. With complete blockades, cerebral symptoms (dizziness, flies in the eyes) are added to the manifestations. Morgagni-Adams-Stokes attacks may develop (when the ventricles escape from all pacemakers) with loss of consciousness and even convulsions.

Conduction disturbance within the ventricles

in the ventricles to muscle cells the electrical signal propagates through such elements of the conducting system as the trunk of the bundle of His, its legs (left and right) and the branches of the legs. Blockades can occur at any of these levels, which is also reflected in the ECG. In this case, instead of being covered by excitation at the same time, one of the ventricles is delayed, since the signal to it goes around the blocked area.

In addition to the place of origin, a complete or incomplete blockade is distinguished, as well as permanent and non-permanent. The causes of intraventricular blockades are similar to other conduction disorders (IHD, myo- and endocarditis, cardiomyopathies, heart defects, arterial hypertension, fibrosis, heart tumors). Also, the intake of antiarthmic drugs, an increase in potassium in the blood plasma, acidosis, and oxygen starvation also affect.

• The most common is the blockade of the anteroposterior branch of the left leg of the bundle of His (BPVLNPG).
• In second place is the blockade of the right leg (RBNB). This blockade is usually not accompanied by heart disease.
• Blockade of the left leg of the His bundle is more typical for myocardial lesions. At the same time, complete blockade (PBBBB) is worse than incomplete blockade (NBLBBB). It sometimes has to be distinguished from the WPW syndrome.
• The blockade of the posterior inferior branch of the left leg of the bundle of His can be in persons with a narrow and elongated or deformed chest. From pathological conditions it is more typical for overloads of the right ventricle (with PE or heart defects).

The clinic of blockades at the levels of the bundle of His is not expressed. The picture of the main cardiac pathology comes first.

• Bailey's syndrome - two-beam blockade (of the right leg and posterior branch of the left leg of the bundle of His).

Myocardial hypertrophy

With chronic overloads (pressure, volume), the heart muscle in some areas begins to thicken, and the heart chambers stretch. On the ECG, such changes are usually described as hypertrophy.

• Left ventricular hypertrophy (LVH) is typical of arterial hypertension, cardiomyopathy, a number of heart defects. But even in normal athletes, obese patients and people engaged in heavy physical labor, there may be signs of LVH.
• Right ventricular hypertrophy is an undoubted sign of increased pressure in the pulmonary circulation system. Chronic cor pulmonale, obstructive pulmonary disease, cardiac defects (pulmonary stenosis, Fallot's tetralogy, ventricular septal defect) lead to HPZh.
• Left atrial hypertrophy (HLH) - with mitral and aortic stenosis or insufficiency, hypertension, cardiomyopathy, after myocarditis.
• Right atrial hypertrophy (HAP) - with cor pulmonale, tricuspid valve defects, deformities chest, pulmonary pathologies and pulmonary embolism.
• Indirect signs of ventricular hypertrophy are the deviation of the electrical axis of the heart (EOC) to the right or left. The left type of EOS is its deviation to the left, that is, LVH, the right type is LVH.
• Systolic overload is also evidence of hypertrophy of the heart. Less commonly, this is evidence of ischemia (in the presence of angina pain).

Changes in myocardial contractility and nutrition

Syndrome of early repolarization of the ventricles

More often all-option norms, especially for athletes and persons with congenitally high body weight. Sometimes associated with myocardial hypertrophy. Refers to the peculiarities of the passage of electrolytes (potassium) through the membranes of cardiocytes and the characteristics of the proteins from which the membranes are built. It is considered a risk factor for sudden cardiac arrest, but it does not give a clinic and most often remains without consequences.

Moderate or severe diffuse changes in the myocardium

This is evidence of myocardial malnutrition as a result of dystrophy, inflammation (myocarditis) or cardiosclerosis. Also, reversible diffuse changes accompany disturbances in the water and electrolyte balance (with vomiting or diarrhea), taking medications (diuretics), and heavy physical exertion.

This is a sign of deterioration in myocardial nutrition without pronounced oxygen starvation, for example, in violation of the balance of electrolytes or against the background of dyshormonal conditions.

Acute ischemia, ischemic changes, T wave changes, ST depression, low T

This describes the reversible changes associated with oxygen starvation of the myocardium (ischemia). It could be like stable angina and unstable, acute coronary syndrome. In addition to the presence of the changes themselves, their location is also described (for example, subendocardial ischemia). Distinctive feature such changes are reversible. In any case, such changes require comparison of this ECG with old films, and if a heart attack is suspected, rapid troponin tests for myocardial damage or coronary angiography should be performed. Depending on the variant of coronary heart disease, anti-ischemic treatment is selected.

Developed heart attack

It is usually described as:

• by stages. acute (up to 3 days), acute (up to 3 weeks), subacute (up to 3 months), cicatricial (lifelong after a heart attack)
• by volume. transmural (large focal), subendocardial (small focal)
• according to the location of the infarction. are anterior and anterior-septal, basal, lateral, inferior (posterior diaphragmatic), circular apical, posterior basal and right ventricular.

All the variety of syndromes and specific ECG changes, the difference in indicators for adults and children, the abundance of reasons leading to the same type of ECG changes do not allow a non-specialist to interpret even a ready-made conclusion of a functional diagnostician. It is much more reasonable, having an ECG result in hand, to visit a cardiologist in a timely manner and receive competent recommendations for further diagnosis or treatment of your problem, significantly reducing the risks of emergency cardiac conditions.

How to decipher the ECG of the heart?

An electrocardiographic study is the simplest, but very informative method for studying the work of a patient's heart. The result of this procedure is an ECG. Incomprehensible lines on a piece of paper contain a lot of information about the state and functioning of the main organ in human body. Deciphering ECG indicators is quite simple. The main thing is to know some of the secrets and features of this procedure, as well as the norms of all indicators.

Exactly 12 curves are recorded on the ECG. Each of them tells about the work of each specific part of the heart. So, the first curve is the anterior surface of the heart muscle, and the third line is its posterior surface. To record the cardiogram of all 12 leads, electrodes are attached to the patient's body. The specialist does this sequentially, installing them in specific places.

Decryption principles

Each curve on the cardiogram graph has its own elements:

• Teeth, which are bulges directed down or up. All of them are denoted by Latin capital letters. "P" shows the work of the heart atria. "T" is the restorative capacity of the myocardium.
• Segments are the distance between several ascending or descending teeth in the neighborhood. Doctors are especially interested in indicators of such segments as ST, as well as PQ.
• An interval is a gap that includes both a segment and a tooth.

Each specific ECG element shows a certain process that occurs directly in the heart. According to their width, height and other parameters, the doctor has the ability to correctly decipher the data received.

How are the results analyzed?

As soon as the specialist receives the electrocardiogram in his hands, its decoding begins. This is done in a certain strict sequence:

1. The correct rhythm is determined by the intervals between the "R"-teeth. They must be equal. Otherwise, it can be concluded that the heart rhythm is incorrect.
2. With the help of an ECG, you can determine the heart rate. To do this, you need to know the speed at which the indicators were recorded. Additionally, you will also need to count the number of cells between the two R waves. The norm is from 60 to 90 beats per minute.
3. The source of excitation in the heart muscle is determined by a number of specific features. This will be told, among other things, by the evaluation of the parameters of the “P” wave. The norm implies that the source is the sinus node. Therefore, a healthy person always has a sinus rhythm. If there is a ventricular, atrial or any other rhythm, then this indicates the presence of pathology.
4. The specialist evaluates the conduction of the heart. This happens according to the duration of each segment and tooth.
5. The electrical axis of the heart, if it shifts to the left or right sharply enough, may also indicate problems with the cardiovascular system.
6. Each tooth, interval and segment is analyzed individually and in detail. Modern ECG devices immediately automatically issue indicators of all measurements. This greatly simplifies the work of the doctor.
7. Finally, the specialist makes a conclusion. It indicates the decoding of the cardiogram. If any pathological syndromes were found, they must be indicated there.

Normal indicators of adults

The norm of all indicators of the cardiogram is determined by analyzing the position of the teeth. But the rhythm of the heart is always measured by the distance between the highest teeth "R" - "R". Normally they should be equal. The maximum difference can be no more than 10%. Otherwise, it will no longer be the norm, which should be within 60-80 pulsations per minute. If sinus rhythm is more frequent, then the patient has tachycardia. On the contrary, a slow sinus rhythm indicates a disease called bradycardia.

The P-QRS-T intervals will tell you about the passage of the impulse directly through all the cardiac departments. The norm is an indicator from 120 to 200 ms. On the graph, it looks like 3-5 squares.

By measuring the width from the Q wave to the S wave, one can get an idea of ​​the excitation of the ventricles of the heart. If this is the norm, then the width will be 60-100 ms.

The duration of ventricular contraction can be determined by measuring the Q-T interval. The norm is 390-450 ms. If it is somewhat longer, a diagnosis can be made: rheumatism, ischemia, atherosclerosis. If the interval is shortened, we can talk about hypercalcemia.

What do teeth mean?

IN without fail when deciphering the ECG, you need to follow the height of all the teeth. It can indicate the presence of serious pathologies of the heart:

• The Q wave is an indicator of excitation of the left cardiac septum. The norm is a quarter of the length of the R wave. If it is exceeded, there is a possibility of necrotic pathology of the myocardium;
• The S wave is an indicator of the excitation of those partitions that are in the basal layers of the ventricles. The norm in this case is 20 mm in height. If there are deviations, then this indicates coronary disease.
• The R wave in the ECG tells about the activity of the walls of all the ventricles of the heart. It is fixed in all ECG curves. If there is no activity somewhere, then it makes sense to suspect ventricular hypertrophy.
• The T wave appears in the I and II lines, as directed upwards. But in the VR curve it is always negative. When the T wave on the ECG is too high and sharp, the doctor suspects hyperkalemia. If it is long and flat, then there is a possibility of developing hypokalemia.

Normal pediatric electrocardiogram readings

In childhood, the norm of ECG indicators may differ slightly from the characteristics of an adult:

1. The heart rate of babies under 3 years old is about 110 pulsations per minute, and at the age of 3-5 years - 100 beats. This indicator in adolescents is already lower - 60-90 pulsations.
2. The norm of QRS readings is 0.6-0.1 s.
3. The P wave should normally not be higher than 0.1 s.
4. The electrical axis of the heart in children should remain unchanged.
5. The rhythm is only sinus.
6. On the ECG, the Q-T interval e can exceed 0.4 s, and P-Q should be 0.2 s.

Sinus heart rate in the decoding of the cardiogram is expressed as a function of heart rate on respiration. This means that the heart muscle is contracting normally. In this case, the pulsation is 60-80 beats per minute.

Why are the scores different?

Often, patients are faced with a situation where their ECG readings are different. What is it connected with? To get the most accurate results many factors must be taken into account:

1. Distortions in recording an ECG may be due to technical problems. For example, with incorrect gluing of results. And many Roman numerals look the same both upside down and upside down. It happens that the graph is cut incorrectly or the first or last tooth is lost.
2. Preliminary preparation for the procedure is important. On the day of the ECG, you should not have a hearty breakfast, it is even advisable to completely refuse it. You will have to stop drinking liquids, including coffee and tea. After all, they stimulate the heart rate. As a result, the results are skewed. It is best to take a shower beforehand, but you do not need to apply any body products. Finally, during the procedure you need to relax as much as possible.
3. The incorrect position of the electrodes cannot be ruled out.

It is best to check your heart on an electrocardiograph. He will help to carry out the procedure as accurately and accurately as possible. And in order to confirm the diagnosis indicated by the results of the ECG, the doctor will always prescribe additional studies.

The heart is an organ that works rhythmically. Normally, the sinus node sets the heart rate. 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 of a constant shape, R-R distance 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 is the reason: in the pathology of the sinus node itself or problems in it. vegetative 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 disturbance in the transmission of impulses from 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 necessary measures sometimes it is enough to provide the child with a proper regime of study and rest, proper nutrition and the heart returns to normal. At 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. It could be a relapse an existing disease, and 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.