The heart is a complex organ that works in a certain rhythm. It is set by the sinus node in the right atrium, which is a generator of cardiac impulses; they move from top to bottom

It looks like this: the impulse first enters the right atrium, and after that it moves to the left. The impulse then follows along the atrioventricular orifice and passes to the cardiac ventricles. Therefore, the organ rhythmically contracts and relaxes, performing the main function of blood transmission.

Without going into medical terminology, the concept of “sinus rhythm” can be explained this way:

• There are cells in the human heart that create an impulse at a certain number of beats per minute.
• These cells are located in the sinus node, in the septum between the ventricles, called the atrioventricular node, and in the Purkinje fibers, which are the tissue of the ventricles of the heart.
• Sinus rhythm means that the impulse is generated by the sinus node (normally 50 beats per minute).
• If it is changed, a different heart node produces a different number of beats per minute.

The main examination in cardiology is electrocardiography. An ECG records the electrical fields generated during cardiac activity, giving a specialist the opportunity to assess the condition of the most important organ of the human body.
An electrocardiogram is used for various tests:

1. Determination of contraction frequency, extrasystoles - rapid contractions, arrhythmias - missed contractions.
2. Myocardial damage – infarction, ischemia.
3. Electrolyte metabolism disorders: magnesium, calcium, etc.
4. Cardiac conduction disorders - blockades.
5. Screening for ischemic heart disease.
6. Physical condition of the heart muscle.
7. Data on diseases outside the field of cardiology - pulmonary embolism, etc.
8. The cardiogram of the heart determines sinus rhythm, which is one of the main tasks of electrocardiographic research.

If you feel changes in cardiac activity, you should contact a cardiologist, who will give you a referral for electrocardiography before prescribing treatment.

If on the ECG the P waves have the same shape, the distance between P-P or R-R is the same, and the frequency of contractions does not exceed 60-80 beats per minute, the interval between beats is in the range from 0.12 to 0.22 seconds - this is the norm.

If the doctor sees that the distance between the P waves and their height are not the same, the sinus rhythm is weak. To determine the cause of weakness, the patient is prescribed a special diagnosis, which helps to identify the causes: either there is a pathology of the node, or there are problems in the autonomic system.

Remember: If the doctor wrote: “Sinus rhythm, vertical position of the heart,” this means that the heart is normal.

In this case, the vertical position is the normal position of the cardiac axis in the chest.

Sinus rhythm disorder

If violated, arrhythmias (impaired heart contraction functions) or blockades are possible, which occur when the transmission of cardiac impulses to the muscle is disrupted. If acceleration is detected, this may be a sign of tachycardia; if deceleration is observed, bradycardia is possible.
In cases of irregular rhythm, the body lacks oxygen. The patient feels the symptoms of this pathology: dizziness, fluctuating blood pressure, pain in the chest, difficulty breathing, etc.
When the rhythm exceeds 110 beats/min, tachycardia occurs. If a person is healthy, an acceleration of the heart rate can occur as a result of physical activity, excitement, or stress.

Important: If the rhythm is less than 50, as well as more than 90, the patient needs a cardiac examination.

Factors influencing its change:

• Congenital and acquired defects.
• Diseases of the myocardium with changes in structure and function - cardiomyopathy.
• Infectious lesions of the valves and other parts of the heart - infective endocarditis.
• Various overloads: in the emotional and psychological sphere, as well as physical.

Disorders in children

Despite the fact that this pathology can be observed in childhood, adolescence, and adulthood, in many cases it does not affect general well-being and is diagnosed during examination for the presence of other diseases.
In addition to general causes, disorders in children also have specific, age-related ones:

1. Congenital defects caused by the course of pregnancy and the birth process of the mother.
2. Neurological diseases.
3. Pathologies of the endocrine system.
4. Intolerance or overdose of certain pharmacological drugs.
5. Lack of selenium and magnesium in the body.

It is worth noting: arrhythmia is diagnosed in 25% of children, but this does not mean a disease. The incidence of arrhythmia increases in adolescence.

In children and adolescents, respiratory sinus arrhythmia, also called paradoxical pulsus, is often detected. This type of arrhythmia is characterized by an increase in heart rate during inhalation and a significant decrease during exhalation.
To normalize the condition, sometimes it is enough to regulate your daily routine and diet. But if the problem cannot be solved in this way, a detailed examination by a doctor who specializes in the diagnosis and treatment of cardiac diseases in children is necessary.

Disorders in pregnant women

Pregnancy is a period of restructuring of all systems of the female body. Special changes also occur in cardiovascular functions.
During pregnancy, sinus rhythm, as a rule, accelerates by 10 beats per minute, and 50% of subjects experience either arrhythmia or tachycardia. Doctors believe that such changes are a relapse of an existing pathology or a manifestation of the female body’s adaptation to the pregnancy process.
Due to the need for additional (increased) nutrition, the frequency of contractions of the heart muscle increases. Physiological changes that occur during these months may also be the cause. In the vast majority of cases, after childbirth the condition returns to normal.

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

The heart is the main organ that supplies all organs and tissues with blood; the degree of oxygenation and the function of the entire organism depend on its rhythmic and consistent work. To contract a muscle, a push is needed - an impulse emanating from special cells of the conduction 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 (SU)

The sinus node (SU) is located under the inner lining of the right atrium, it is well supplied with blood, receiving blood directly from the coronary arteries, and is 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 and have a spindle-shaped shape. Their contractile function is extremely weak, but their ability to form an electrical impulse is akin to nerve fibers. The main node is connected to the atrioventricular junction, to which it transmits signals for further excitation of the myocardium.

The sinus node is called the main pacemaker, because it is the one that provides the frequency of heart contractions that gives the organs adequate blood supply, therefore maintaining a regular sinus rhythm is extremely important for assessing the work of the heart in case of its damage.

The control system generates pulses of the highest frequency compared to other parts of the conduction system, and then transmits them further at high speed. The frequency of impulse formation by the sinus node is ranging from 60 to 90 per minute, which corresponds to the normal heart rate, when they occur due to the main pacemaker.

Electrocardiography is the main method that allows you to quickly and painlessly determine where the heart receives impulses, what their frequency and rhythm are. ECG has become firmly established in 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 heart rate 75” should not bother you, this is the norm, but if a specialist writes about non-sinus, increased heart rate (tachycardia) or slowdown (bradycardia), then It's time to go for further examination.

Rhythm from the sinus node (SU) – sinus rhythm – normal (left) and pathological non-sinus rhythms. The pulse origination points are indicated

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

Sinus rhythm is normal

Often, patients who find sinus rhythm in the ECG report begin to worry whether everything is in order, because the term is not known to everyone, which means it may indicate pathology. However, you can calm them down: sinus rhythm is the norm, which indicates the active functioning of the sinus node.

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

The impact of the vagus nerve and fibers of the sympathetic nervous system on the sinus node often causes a change in its function towards a higher or lower 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 normality and pathology, that is, with a heart rate of 58 beats per minute, it is too early to talk about bradycardia, as well as tachycardia if it exceeds indicator of 90. All these parameters must be assessed comprehensively, taking into account the general condition of the patient, the characteristics of his metabolism, type of activity, and even what he was doing immediately before the study.

Determining the source of rhythm when analyzing an ECG is a fundamental point, while the following are considered indicators of sinus rhythm:

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

At the conclusion of the ECG, the subject can find: “sinus rhythm with heart rate 85, normal position of the electrical axis.” We consider this conclusion to be the norm. Another option: “non-sinus rhythm with a frequency of 54, ectopic.” This result should be alarming, since serious myocardial pathology 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 sinus system - in the fibers of the ventricular muscle, atrioventricular node, etc. Impulse is possible from two places of the conduction system at once, in this case we are also talking about arrhythmia.

Correct conclusions about the regulation of heart rhythm can be made by studying long-term ECG recordings, since in the process of life, all healthy people change the frequency of their heartbeats: at night the pulse is one, during the day - another. However, even shorter periods of recording ECG signs demonstrate pulse unevenness associated with the characteristics of autonomic innervation and the functioning of the entire organism as a whole. Pulse assessment is helped by specially developed mathematical processing programs, statistical analysis - cardiointervalography, histography.

In order for the ECG result to be most accurate, all possible causes of changes in heart activity should be excluded. Smoking, quickly climbing stairs or running, or drinking a cup of strong coffee can change cardiac parameters. The rhythm, of course, will 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

Let us remember again that sinus rhythm corresponds to a frequency of 60–90 per minute. But what to do if the parameter goes beyond the established limits while maintaining its “sinus”? 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, during heavy physical labor, etc.;
3. After eating too much, drinking strong coffee or tea.

This physiological tachycardia is reflected in the ECG data:

• The length of the gap between the P waves and the RR interval decreases, the duration of which, with appropriate calculations, makes it possible to determine the exact heart rate figure;
• The P wave remains in its normal place - in front of the ventricular complex, which, in turn, has the correct configuration;
• According to calculations, the heart rate exceeds 90-100 per minute.

Tachycardia, with preserved sinus rhythm under physiological conditions, is aimed at providing blood to tissues that, for various reasons, begin 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 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 took place - 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 slowing down of its contractions (), which also does not always indicate pathology.

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

1. State of sleep;
2. Professional sports;
3. Individual constitutional characteristics;
4. Wearing clothes with a tight collar and a tightly tightened tie.

It is worth noting that bradycardia more often than an increase in heart rate indicates pathology, so close attention is usually paid to it. With organic lesions of the heart muscle, bradycardia, even if the “sinus” rhythm is maintained, can become a diagnosis requiring drug 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 such bradycardia is not recorded during routine mass studies, but it can be seen during 24-hour 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 particularly worried patients.

In addition, it has been noted that about 25% of young men have a slower pulse in the range of 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 when the pulse decreases to less than 60, but impulses in the heart continue to be generated by the main node. People with this condition may faint or 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 a lengthening of the intervals between the atrial waves and the complexes of 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 unless there are indications of other changes (ischemia, for example).

When should you worry?

Cardiography findings indicating pathological sinus tachycardia, bradycardia, or rhythm instability and irregularity should be a cause for concern.

With tachy- and bradyforms, the doctor quickly determines whether the pulse is more or less abnormal than normal, clarifies complaints and refers for additional examinations - ultrasound of the heart, Holter, blood tests for hormones, etc. Having found out the cause, you can begin 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 ms. This is almost always a sign of pathology, so the patient is not ignored and the cause of instability in the sinus node is found out.

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

An irregular sinus rhythm comes from the main pacemaker, but the frequency of the organ’s beats either increases or decreases, losing its constancy and regularity. In this case, they talk about sinus arrhythmia.

Features of rhythm in children

Children are a very special part of people whose many parameters 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 babies of the first years and, especially newborns, have a pulse much faster than adults.

Sinus rhythm should be recorded in all children without exception, unless there is heart damage. Age-related tachycardia is associated with the small size of the heart, which must provide the growing body with the necessary amount of blood. The smaller the child, the faster his pulse, reaching 140-160 seconds per minute during the newborn period and gradually decreasing to the “adult” norm by the age of 8 years.

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

At the same time, when 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 related to breathing, which is often observed in childhood. It is also necessary to take into account the conditions for taking an ECG: if the baby is laid on a cold couch, he is scared or confused, then a reflexive holding of 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, 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, rhythm regulation improves, and disturbances may go away on their own.

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

Sports for a child with respiratory arrhythmia are not contraindicated, but only under the condition of constant dynamic monitoring and ECG registration. If the cause of unstable sinus rhythm turns out to be non-physiological, then the cardiologist will be forced to limit the child’s sports activities.

It is clear that parents are concerned about an important question: what to do if the sinus rhythm on the ECG is incorrect or an arrhythmia is recorded? First, you need to go to a cardiologist and give your child another cardiogram. If the physiological changes are proven, then observation and an ECG 2 times a year are sufficient.

If the instability of sinus rhythm does not fit within the normal range and is not caused by breathing or functional reasons, then the cardiologist will prescribe treatment in accordance with the true cause of the arrhythmia.

To assess the quality of functioning of the cardiac conduction system and form an idea of ​​the structure of the myocardium, a fairly simple study is used - electrocardiography.

This technique helps in making a diagnosis in heart patients, is a screening procedure for identifying cardiac disorders, and is carried out before surgical interventions. Often the first phrase when decoding an ECG is sinus rhythm, what is it?

Nature of ECG

An electrocardiogram is a graphical representation of the electrical processes occurring in the heart. The rhythmic contraction of the myocardium is associated with the emergence and passage of impulses along the autonomic nerve pathways of this organ.

The hierarchy of structures of the conduction system of the heart is represented by the sinus and atrioventricular nodes (AV), the His bundle and Purkinje fibers. Each of these components is capable of generating pulses with a certain frequency.

The source of healthy automaticity is the sinoatrial node (SA or SU), which suppresses the activity of other units. In this case, sinus rhythm is recorded on the ECG. On the contrary, as a result of activation of heterotopic foci of impulses, arrhythmias develop.

ECG interpretation includes analysis of the resulting curve during the study. The film reveals various teeth and spaces between them, which correspond to the propagation of an excitation wave through the heart.

Main components of a cardiogram:

What could the rhythm be?

The normal functioning of the main source of automatism is indicated by a correct sinus rhythm with a frequency of 60–90 impulses per minute.

It should be noted that the distance between adjacent P waves, as well as QRS complexes, should be the same. In addition, all components on the ECG must comply with their duration standards.

Changes in the intervals or widening of the beats, while maintaining the correct 1:1 relationship between the P waves and the ventricular beats, indicate abnormal sinus rhythm, the presence of blocks (slow conduction) or arrhythmia.

What is arrhythmia?

Arrhythmia literally means a lack of rhythm in the generated impulses. There is a physiological (respiratory) form and a pathological one, which can occur directly from the sinus node or during migration of the pacemaker (for example, atrial, from the AV junction).

Respiratory arrhythmia practically does not change the picture on the ECG. Its presence is distinguished by cyclic changes in the distance between the P waves associated with the act of “inhalation-exhalation”.

While recording an electrocardiogram, a functional diagnostician may ask the subject to stop breathing for a few seconds to verify the nature of the arrhythmia.

When exhalation is held, sinus rhythm is reflected at regular intervals on the ECG film.

Classification of arrhythmias

1)

a) physiological;

b) pathological.

2) Non-sinus arrhythmia: atrial;

a) ventricular;

b) from the atrioventricular connection.

There are tachyarrhythmias, bradycardia (heart rhythm disturbances with increased or decreased heart rate), various blockades, and extrasystoles.

The most common non-sinus arrhythmias

If with each recorded cycle changes in the P wave and the PQ interval are recorded on film, a gradual inversion (decrease followed by reaching a negative value) of the P wave is observed, such a cardiogram indicates the presence of pacemaker migration.

This phenomenon is the result of a change in the main source of impulses (SU) to the atrioventricular connection. Migration of the pacemaker can reach the level of ventricular structures, but this phenomenon is very rare.

Common disorders include junctional rhythm. In such a situation, the atrioventricular node takes on the leading role in generating impulses.

In this case, an altered P wave is recorded on the ECG (negative, biphasic), there are deviations from the interval reflecting conduction through the atria, the heart rate is 40–60 beats per minute.

A junctional rhythm is said to occur when there are 6 or more consecutive impulses from the AV junction.

A special category of rhythm disturbances is atrial fibrillation (atrial fibrillation). In this case, separate P-P cycles and QRS complexes are graphically displayed as a result of the decoupling of sinus impulses and ventricular activity.

In critical cases, the rhythm of ventricular fibrillation and flutter is recorded on the ECG. As a rule, this type is diagnosed during resuscitation, requiring intensive care and defibrillation.

Extrasystoles

Episodes of ectopic activity from various parts of the conduction system can disrupt the harmonious picture of the ECG rhythm. Such impulses lead to an extraordinary contraction of the heart or a small part of it.

Extrasystole can be atrial, from the AV node, ventricular, manifested from one specific area or several at once. There are single and group (2, 3 or 4 extrasystoles).

Even in healthy people, several episodes of SE are recorded per day. There are often cases when 24-hour ECG monitoring is necessary to establish a pathological extrasystole, as well as during paroxysms of atrial fibrillation.

Depending on the severity and number of episodes of extraordinary contractions, the doctor chooses the tactics for managing the patient.

Conduction disorders

Changes in the duration of intervals, waves and the ventricular complex mainly reflect blocking of impulses in the conduction system or confirm an increase in the myocardial walls.

There is also a syndrome of shortened PQ, associated with the presence of shortened paths to the AV junction and, accordingly, rapid conduction of biopotentials from the main source of automaticity to the ventricles. The presence of this condition increases the risk of arrhythmias.

Among the blockades there are:

• intraatrial;
• sinoatrial;
• several types of atrioventricular blocks;
• intraventricular (pedicles and branches of the His bundle).

As a rule, objective complaints are associated with the presence of sinus blockades and slowing of conduction from the AV node.

To simplify conductivity assessment, you can use the 0.1 ± 0.02 rule. This means that any tooth, interval, or entire complex must not exceed the given duration in seconds. An increase above 0.12 indicates the presence of a blockade. LBBB and RBBB have characteristic M and W shapes in the precordial leads.

Example of a normal ECG description

The conclusion of an ideal cardiogram without pathology will indicate: sinus rhythm, correct, heart rate (from 60 to 90 in an adult), normal position of the electrical axis of the heart.

Vertical and horizontal EOS are also variants of the norm (depending on the patient’s constitution) for asthenic people and hypersthenics, respectively.

Bundle branch blocks are often presented as an electrocardiographic finding and do not affect the patient's health.

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 because 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 posterior. To record a 12-lead ECG, special electrodes are attached to the patient’s body in specific places and in a certain sequence.

How to decipher a heart cardiogram: 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. Determines whether the heart contracts rhythmically, that is, whether the rhythm is correct. To do this, measures the intervals between the R waves; they must be the same everywhere; if not, this is already an incorrect rhythm.
2. Calculates the rate at which the heart contracts (HR). This can be done easily by 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. per minute.
3. Based on specific signs (mainly 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. Evaluates cardiac conductivity by the duration of waves and segments. Each of them has its own norm indicators.
5. Determines the electrical axis of the heart (EOS). Very thin people are characterized by a more vertical position of the EOS, while overweight people tend to have a more horizontal position. 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 doctor’s work.
7. Gives a conclusion. It necessarily indicates the correctness of the rhythm, the source of excitation, heart rate, characterizes the EOS, and also identifies specific pathological syndromes (rhythm disturbances, conduction disturbances, the presence of overload of certain parts of the heart and myocardial damage), if any.

Examples of electrocardiographic reports

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

Also, for some people, sinus tachycardia (heart rate acceleration) or bradycardia (heart rate slowdown) may be considered a normal variant. 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 correcting the patient’s diet, mostly always disappear.

In addition, the conclusion may indicate a nonspecific change in the ST-T interval. This means that the changes are not indicative and their cause cannot be determined by ECG alone. Another fairly common condition that can be diagnosed using 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 imbalance and other reasons that the doctor will subsequently look for.

Conclusions that contain data on the presence of myocardial ischemia, hypertrophy of the heart, rhythm and conduction disturbances are considered prognostically unfavorable.

Interpretation of ECG in children

The whole principle of deciphering cardiograms is the same as in adults, but due to the physiological and anatomical characteristics of the children's heart, there are differences in the interpretation of normal indicators. This primarily concerns heart rate, since in children under 5 years of age it can exceed 100 beats. per minute.

Also, children may experience sinus or respiratory arrhythmia (an increase in heart rate during inhalation and a decrease during exhalation) without any pathology. In addition, the characteristics of some waves 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 bundle branch. Pediatric cardiologists take all these features into account when making a conclusion based on the ECG.

Features of ECG during pregnancy

The body of a pregnant woman goes through various processes of adaptation to the new position. Certain changes also occur in the cardiovascular system, so 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 experience slight sinus tachycardia and signs of overload in certain parts of the heart. These changes are associated with an increase in blood volume in the body and, as a rule, disappear after childbirth. However, their detection cannot be left without a detailed examination and a more in-depth examination of the woman.

ECG interpretation, normal indicators

Decoding an ECG is the job of a knowledgeable doctor. This method of functional diagnostics evaluates:

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

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

To reduce the intensity of passions, we immediately warn readers that with not a single serious diagnosis (myocardial infarction, acute rhythm disturbances), a functional diagnostician will not let a patient leave the office, but, at a minimum, will send him for a consultation with a fellow specialist right there. About the rest of the “open secrets” in this article. In all unclear cases of pathological changes in the ECG, ECG monitoring, 24-hour monitoring (Holter), ECHO cardioscopy (ultrasound of the heart) and stress tests (treadmill, bicycle ergometry) are prescribed.

Numbers and Latin letters in ECG interpretation

PQ- (0.12-0.2 s) – atrioventricular conduction time. 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. May indicate 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 apices of the ventricular complexes reflects the regularity of heart contractions and makes it possible to calculate heart rate.

The interpretation of the ECG in children is presented in Fig. 3

Heart Rate Description Options

Sinus rhythm

This is the most common inscription found on an ECG. And, if nothing else is added and the frequency (heart rate) is indicated from 60 to 90 beats per minute (for example, heart rate 68`) - this is the best 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 in the heart muscle and means that the ECG is normal. In addition to sinus rhythm, there may be atrial, atrioventricular or ventricular rhythm, indicating that the rhythm is set by cells in these parts of the heart and is considered pathological.

This is a normal variant in young people and children. This is a rhythm in which impulses leave the sinus node, but the intervals between heart contractions are different. This may be due to physiological changes (respiratory arrhythmia, when heart contractions slow down during exhalation). Approximately 30% of sinus arrhythmias require observation by a cardiologist, as they are at risk of developing 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 persons with a family history of arrhythmias.

These are rhythmic contractions of the heart with a frequency of less than 50 per minute. In healthy people, bradycardia occurs, for example, during sleep. Bradycardia also often occurs in professional athletes. Pathological bradycardia may indicate sick sinus syndrome. In this case, 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 disturbances in the supply of oxygen to tissues and is manifested, for example, by fainting, an operation is indicated to install a cardiac 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 within a short period of time after stopping the load. With pathological tachycardia, heartbeats bother the patient at rest. Its causes are fever, infections, blood loss, dehydration, thyrotoxicosis, anemia, cardiomyopathy. The underlying disease is treated. Sinus tachycardia is stopped only in case of a heart attack or acute coronary syndrome.

Extarsystole

These are rhythm disturbances in which foci outside the sinus rhythm give extraordinary cardiac contractions, after which there is a pause of twice the length, called compensatory. In general, the patient perceives heartbeats as uneven, rapid or slow, and sometimes chaotic. The most worrying thing is the dips in heart rate. There may be unpleasant sensations in the chest in the form of tremors, tingling, feelings of fear and emptiness in the stomach.

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 of panic attacks, cardioneurosis, hormonal imbalances), organic (with ischemic heart disease, heart defects, myocardial dystrophy or cardiopathy, myocarditis). Intoxication and heart surgery can also lead to them. Depending on the place of occurrence, extrasystoles are divided into atrial, ventricular and anthrioventricular (arising in the node at 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 normal blood flow.
• Paired extrasystoles, two at a time, accompany a certain number of normal contractions. Such rhythm disturbances often indicate pathology and require further examination (Holter monitoring).
• Allorhythmias are more complex types of extrasystoles. If every second contraction is an extrasystole, this is bigymenia, if every third contraction is trigymenia, every fourth is quadrigymenia.

It is customary to divide ventricular extrasystoles into five classes (according to Lown). They are assessed during daily ECG monitoring, since the readings of a regular 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 classes 3 and 4 do not always require drug treatment. In general, if there are less than 200 ventricular extrasystoles per day, they should be classified as functional and not worry about them. For more frequent cases, ECHO CS is indicated, and sometimes cardiac MRI is indicated. It is not the extrasystole that is treated, but the disease that leads to it.

Paroxysmal tachycardia

In general, paroxysm is an attack. A paroxysmal increase in rhythm can last from several minutes to several days. In this case, the intervals between heart contractions 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. This pathology is based on abnormal circulation of electrical impulses in the conduction system of the heart. This pathology can be treated. Home remedies to relieve an attack:

• holding your breath
• increased forced cough
• immersing face in cold water

WPW syndrome

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

As a result, an extraordinary contraction of the heart muscle occurs. The syndrome requires conservative or surgical treatment (in case of ineffectiveness or intolerance of antiarrhythmic tablets, during episodes of atrial fibrillation, and with concomitant heart defects).

CLC – syndrome (Clerk-Levi-Christesco)

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

Atrial fibrillation

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

Atrial fibrillation

Atrial fibrillation

When flickering, the heart contracts completely irregularly (the intervals between contractions of very different durations). This is explained by the fact that the rhythm is not set by the sinus node, but by other cells of the atria.

The resulting frequency is from 350 to 700 beats per minute. There is simply no full contraction of the atria; contracting muscle fibers do not effectively fill the ventricles with blood.

As a result, the heart’s output of blood deteriorates 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 be either 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 beat of the heart.
• It develops as a series of completely irregular 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 agitation.
• Sometimes there is loss of consciousness.
• The attack ends with normalization of the rhythm and the urge to urinate, during which a large amount of urine is released.

To stop an attack, they use reflex methods, drugs in the form of tablets or injections, or resort to cardioversion (stimulating the heart with an electric 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 to patients and are felt only during 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 b'.
• Atrial fibrillation, normosystolic variant, heart rate 64 b'.

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

Atrial flutter

These are frequent (more than 200 per minute) regular contractions of the atria and equally regular, but less frequent contractions of the ventricles. In general, flutter is more common in the acute form and is better tolerated than flicker, since circulatory disorders are less pronounced. Fluttering develops when:

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

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

Conduction disorders

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

Sinoatrial blockade

When the exit of an impulse from the sinus node is difficult. In essence, this leads to sick sinus syndrome, slowing of 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 Samoilov-Wenckebach syndrome.

Atrioventricular block (AV block)

This is a delay of excitation in the atrioventricular node longer 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.

• In the first, the delay allows each atrial contraction to maintain an adequate number of ventricular contractions.
• The second degree leaves some of the atrial contractions without ventricular contractions. It is described, depending on the prolongation of the PQ interval and the loss of ventricular complexes, as Mobitz 1, 2 or 3.
• The third degree is also called complete transverse blockade. The atria and ventricles begin to contract without interconnection.

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 can be detected only with an ECG, then the second is already characterized by sensations of periodic cardiac arrest, weakness, and fatigue. With complete blockades, brain symptoms (dizziness, spots 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.

Impaired conduction within the ventricles

In the ventricles, the electrical signal propagates to the muscle cells through such elements of the conduction system as the trunk of the His bundle, its legs (left and right) and 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 simultaneously covered by excitation, one of the ventricles is delayed, since the signal to it bypasses the blocked area.

In addition to the place of origin, a distinction is made between complete or incomplete blockade, as well as permanent and non-permanent blockade. The causes of intraventricular blocks are similar to other conduction disorders (ischemic heart disease, myocarditis and endocarditis, cardiomyopathies, heart defects, arterial hypertension, fibrosis, heart tumors). Also affected are the use of antiarthmic drugs, an increase in potassium in the blood plasma, acidosis, and oxygen starvation.

• The most common is blockade of the anterosuperior branch of the left bundle branch (ALBBB).
• In second place is right leg block (RBBB). This blockade is usually not accompanied by heart disease.
• Left bundle branch block is more typical for myocardial lesions. In this case, complete blockade (PBBB) is worse than incomplete blockade (LBBB). It sometimes has to be distinguished from WPW syndrome.
• Blockade of the posteroinferior branch of the left bundle branch can occur in individuals with a narrow and elongated or deformed chest. Among pathological conditions, it is more typical for overload of the right ventricle (with pulmonary embolism or heart defects).

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

• Bailey's syndrome is a two-bundle block (of the right bundle branch and the posterior branch of the left bundle branch).

Myocardial hypertrophy

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

• Left ventricular hypertrophy (LVH) is typical for arterial hypertension, cardiomyopathy, and a number of heart defects. But even normally, athletes, obese patients and people engaged in heavy physical labor may experience signs of LVH.
• Right ventricular hypertrophy is an undoubted sign of increased pressure in the pulmonary blood flow system. Chronic cor pulmonale, obstructive pulmonary diseases, cardiac defects (pulmonary stenosis, tetralogy of Fallot, ventricular septal defect) lead to RVH.
• Left atrial hypertrophy (LAH) – with mitral and aortic stenosis or insufficiency, hypertension, cardiomyopathy, after myocarditis.
• Right atrial hypertrophy (RAH) – with cor pulmonale, tricuspid valve defects, chest deformities, pulmonary pathologies and PE.
• Indirect signs of ventricular hypertrophy are 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 RVH.
• 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

Early ventricular repolarization syndrome

Most often, this is a variant of the norm, especially for athletes and people with congenital 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 does not provide clinical results and most often remains without consequences.

Moderate or severe diffuse changes in the myocardium

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

This is a sign of deterioration in myocardial nutrition without severe oxygen starvation, for example, in the event of an imbalance of electrolytes or against the background of dyshormonal conditions.

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

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

Advanced heart attack

It is usually described:

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

The whole variety of syndromes and specific changes on the ECG, 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 the ready-made conclusion of a functional diagnostician. It is much wiser, having the 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 ECG indicators of the heart?

An electrocardiographic study is the simplest, but very informative method of studying the functioning 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 the human body. Decoding 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 talks 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 a cardiogram of all 12 leads, electrodes are attached to the patient’s body. The specialist does this sequentially, installing them in specific places.

Principles of decoding

Each curve on the cardiogram graph has its own elements:

• Teeth, which are convexities directed downwards or upwards. All of them are designated in Latin capital letters. "P" shows the work of the heart's atria. “T” is the restorative capabilities of the myocardium.
• Segments represent the distance between several ascending or descending teeth located in the vicinity. Doctors are especially interested in the 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 element of the ECG shows a specific process that occurs directly in the heart. According to their width, height and other parameters, the doctor is able to correctly decipher the received data.

How are the results analyzed?

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

1. The correct rhythm is determined by the intervals between the “R” waves. They must be equal. Otherwise, we can conclude that the heart rhythm is incorrect.
2. Using an ECG you can determine your 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 signs. This will be revealed, among other things, by assessing the parameters of the “P” wave. The norm implies that the source is the sinus node. Therefore, a healthy person always has sinus rhythm. If a ventricular, atrial or any other rhythm is observed, this indicates the presence of pathology.
4. The specialist evaluates the conductivity of the heart. This happens based on the duration of each segment and tooth.
5. The electrical axis of the heart, if it shifts to the left or right quite sharply, may also indicate the presence of problems with the cardiovascular system.
6. Each tooth, interval and segment is analyzed individually and in detail. Modern ECG machines immediately automatically provide indicators of all measurements. This greatly simplifies the doctor’s work.
7. Finally, the specialist makes a conclusion. It indicates the decoding of the cardiogram. If any pathological syndromes were discovered, they must be indicated there.

Normal values ​​for adults

The norm of all indicators of the cardiogram is determined by analyzing the position of the teeth. But the heart rhythm 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, this will no longer be the norm, which should be within 60-80 pulsations per minute. If the sinus rhythm is more frequent, then the patient has tachycardia. On the contrary, a slow sinus rhythm indicates a disease called bradycardia.

P-QRS-T intervals will tell you about the passage of an impulse directly through all parts of the heart. 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, you 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 QT interval. The norm is 390-450 ms. If it is slightly longer, a diagnosis can be made: rheumatism, ischemia, atherosclerosis. If the interval is shortened, we can talk about hypercalcemia.

What do the teeth mean?

When interpreting an ECG, it is imperative to monitor the height of all teeth. It may indicate the presence of serious heart pathologies:

• 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 myocardial pathology;
• The S wave is an indicator of excitation of those partitions that are located in the basal layers of the ventricles. The norm in this case is 20 mm in height. If there are deviations, this indicates coronary artery disease.
• The R wave in the ECG indicates the activity of the walls of all ventricles of the heart. It is recorded in all ECG curves. If there is no activity somewhere, then it makes sense to suspect ventricular hypertrophy.
• The T wave appears in lines I and II, as directed upward. 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 risk 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 children under 3 years old is about 110 pulsations per minute, and at the age of 3-5 years – 100 beats. This figure is already lower in adolescents - 60-90 pulsations.
2. The normal QRS reading is 0.6-0.1 s.
3. The P wave should normally not be longer than 0.1 s.
4. The electrical axis of the heart in children should remain without any changes.
5. The rhythm is sinus only.
6. On an ECG, the Q-T interval e may exceed 0.4 s, and the P-Q interval should be 0.2 s.

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

Why are the indicators different?

Often patients are faced with a situation where their ECG readings are different. What is this connected with? To get the most accurate results, there are many factors to consider:

1. Distortions when recording a cardiogram may be due to technical problems. For example, if the results are not correctly merged. And many Roman numerals look the same whether upside down or right 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 heavy breakfast, it is advisable to even give it up completely. You will have to stop drinking liquids, including coffee and tea. After all, they stimulate the heart rate. Accordingly, the final indicators are distorted. It's best to shower first, but you don't need to apply any body products. Finally, you need to relax as much as possible during the procedure.
3. Incorrect placement of the electrodes cannot be ruled out.

The best way to check your heart is with an electrocardiograph. He will help you carry out the procedure as correctly and accurately as possible. And to confirm the diagnosis indicated by the ECG results, the doctor will always prescribe additional tests.

The human heart is a kind of trigger for the productive work of the whole organism. Thanks to the impulses of this organ, which are issued on a regular basis, blood is able to circulate throughout the body, saturating the body with vital substances. If the heart is normal, then the whole body works as productively as possible, but sometimes you still have to face certain health problems.

If a person comes for an examination to a doctor and the specialist suspects that something is wrong with his heart, he will send the patient for an ECG. Sinus rhythm on an ECG is a very important indicator and clearly provides data on the real state of the human heart muscle. What exactly can be determined by looking at the cardiogram is worth considering in more detail.

What is sinus rhythm

In the understanding of medical workers, the sinus rhythm of the cardiogram is the norm for the human body. If there are equal spaces between the teeth shown on the cardiogram, and the height of these columns is also the same, then there are no deviations in the functioning of the main organ.

This means that sinus rhythm on the cardiogram is as follows:

• graphical representation of human pulse fluctuations;
• a set of teeth of different lengths, between which there are different intervals, showing the specific rhythm of heart impulses;
• schematic representation of the work of the heart muscle;
• an indicator of the presence or absence of abnormalities in the functioning of the heart and its individual valves.

Normal sinus rhythm is only present when the heart rate is at least 60 and no more than 80 beats per minute. This is the rhythm that is considered normal for the human body. and on the cardiogram it is displayed as teeth of the same size, located at the same distance from each other.

If the sinus rhythm of the heart cardiogram deviates from the norm, the medical specialist will prescribe a number of additional studies to the patient, including tests

It is clearly worth remembering that the results of a cardiogram can be one hundred percent accurate only if the person is completely calm. Stressful situations and nervous tension contribute to the fact that the heart muscle begins to emit impulses faster, which means that it will definitely not be possible to obtain a reliable result about the state of a person’s health.

What criteria are used to decipher the ECG result?

It is performed by doctors according to a special scheme. Medical specialists have a clear understanding of which marks on the cardiogram are normal and which are abnormal. The ECG conclusion will be issued only after calculating the results, which were displayed in schematic form. A doctor, when examining a patient’s cardiogram in order to correctly and accurately decipher it, will pay special attention to a number of such indicators:

• the height of the bars displaying the rhythm of heart impulses;
• the distance between the teeth on the cardiogram;
• how sharply the indicators of the schematic image fluctuate;
• what specific distance is observed between the bars displaying the pulses.

A doctor who knows what each of these schematic marks means carefully studies them and can clearly determine what kind of diagnosis needs to be made. Cardiograms of children and adults are deciphered according to the same principle, but normal indicators for people of different age categories cannot be the same.

What sinus rhythm problems can be seen on an ECG?

Electrocardiogram readings can indicate clear signs of problems in the functioning of the heart muscles. With the help of this study, you can notice whether there is weakness of the sinus node, and what kind of health problems this causes. By looking at the cardiogram readings of a particular patient, a medical specialist can decipher the presence of problems of the following nature:

• sinus tachycardia on the ECG, indicating an excess of the contraction rhythm, which is considered normal;
• sinus arrhythmia on the ECG, indicating that the interval between contractions of the heart muscles is too long;
• sinus bradycardia on the ECG, indicating that the heart beats less than 60 times in one minute;
• the presence of too small an interval between the teeth of the cardiogram, which means disturbances in the functioning of the sinus node.

An ECG can easily determine the presence of sinus tachycardia, arrhythmia or bradycardia

Sinus bradycardia is a common abnormality, especially when it comes to the health of a child. This diagnosis can be explained by many factors, among which may be physiological defects or simply a factor of chronic fatigue.

Deviation of the EOS to the left also indicates that the functioning of a vital organ is not working properly. Having identified such deviations, the doctor will send the patient for additional examination and ask him to undergo a number of necessary tests.

If a vertical position of the EOS is observed, this means that the heart has a normal location and is in its place, there are no serious physiological abnormalities. This situation is an indicator of the norm, which is also indicated in the conclusion of the doctor who deciphered the cardiogram.

If a horizontal position of the EOS is observed, then this cannot immediately be considered a pathological condition. Such axis indicators are observed in people who are short in stature but have fairly broad shoulders. If the axis deviates to the left or right, and this is very noticeable, then such indicators may indicate a pathological condition of the organ, an enlargement of the left or right ventricles. A misalignment of the axis may indicate that certain valves are affected. If the axis shifts to the left, then the person most likely has heart failure. If a person suffers from ischemia, then the axis shifts to the right side. Such a deviation may also indicate abnormalities in the development of the heart muscle.

What can we say about normal indicators?

On an ECG, sinus rhythm is always and without fail compared with certain normal values. Only knowing these indicators completely will the doctor be able to understand the patient’s cardiogram and give the correct conclusion.

Normal indicators for children and adults are completely different factors. If we consider the norms for different age categories, they will be something like this:

• in children from birth to the first year of life, the direction of the axis is vertical, the heart beats with a heart rate of 60 to 150 beats per minute;
• children from one year to six years have a mainly vertical axis, but it can also be horizontal, without indicating deviations from the norm. Heart rate from 95 to 128;
• children from seven years of age and adolescents should have a normal or vertical axis position on the cardiogram, the heart should contract from 65 to 90 beats per minute;
• adults should have a normal axis direction on the cardiogram, the heart contracts at a frequency of 60 to 90 times per minute.

Normal heart rate in children is higher than in adults

The above indicators fall under the category of the established norm, but if they are slightly different, this does not always become a sign of the presence of some serious pathologies in the body.

Why ECG readings may deviate from the norm

Irregular heart rhythm can be provoked not only by serious pathological abnormalities, but also by factors more familiar to a person’s daily life.

If the result of the electrocardiogram does not always correspond to the norm, this means that this state of the body could be provoked by the following factors:

• the person regularly drinks alcoholic beverages;
• the patient has been smoking cigarettes on a regular basis for quite a long time;
• a person is regularly exposed to various types of stressful situations;
• the patient often uses antiarrhythmic drugs;
• a person has problems with the functioning of the thyroid gland.

Of course, an accelerated heart rate or too slow may indicate problems of a more serious nature. If the results of the cardiogram are not normal, this may indicate acute heart failure, valve displacement, or congenital heart defects.

If the sinus rhythm is within the established norm, then the person should not worry, and the doctor will be able to make sure that his patient is healthy.

The sinus node regularly emits impulses that cause the heart muscles to contract correctly and carry the necessary signals throughout the body. If these impulses are given irregularly, which can be clearly recorded by a cardiogram, then the doctor will have every reason to assume that the person has health problems. After studying the heart rate, the doctor will determine the exact cause of all deviations and will be able to offer the patient competent treatment.

Why should a person undergo an ECG test?

The sinus rhythm, which is displayed on the ECG, clearly indicates whether there are deviations in the functioning of the heart and in which directions the problem is observed. Not only adults, but also children need to undergo such research regularly. The results of a completed cardiogram will help a person obtain the following information:

• does he have any congenital pathologies or diseases;
• What pathologies in the body cause heart problems;
• could a person’s way of life become the cause of disturbances in the functioning of the main organ;
• whether the heart is in the correct position and whether its valves are working correctly.

Normal sinus rhythm on an ECG is displayed as waves of the same size and shape, and the distance between them is also the same. If any deviations from this norm are observed, then the person will have to be further examined.

Any irregularities in the cardiogram sheet can also be observed due to the fact that at the time of the procedure the person was very agitated. If the patient does notice something like this, then he should calm down and go through the procedure again in order to definitely get a reliable result.

The sinus rhythm on the cardiogram must coincide with the established norm, and only in this case can a person be considered healthy. If impulses from the heart to other systems diverge too quickly or slowly, then this does not bode well. This means that doctors will have to further clarify the cause of the problem and engage in comprehensive treatment. If an uneven rhythm is observed on a teenager’s cardiogram, then this cannot be considered a pathological deviation, because such a condition may be associated with hormonal changes and the physiological maturation of the body.

Doing a cardiogram regularly and checking the rhythm of impulses is necessary for those who already have heart problems or work in certain fields

If the sinus rhythm is within normal limits, then you will not have to undergo additional tests or repeat studies. Normal heart function, as well as pathological abnormalities, are always recorded by a cardiogram.

The sinus rhythm on the ECG should be smooth and clear, without any intermittent lines or too long or short intervals. If the presented indicators are normal, then we can safely say that the person is completely healthy. Deviations in the cardiogram are a reason for doctors to perform additional studies and prescribe tests. Only after additional examinations can we understand the exact cause of the deviations and begin treatment. A normal sinus rhythm is reflected by a clear and evenly spaced cardiogram. Additional attention will have to be paid to the location of the axis, regarding the parameters of which medical standards have also been established.