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Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
Normal Sinus Rhythem
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Normal Sinus Rhythem

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  • 1. ECG Rhythm Interpretation Module III Normal Sinus Rhythm
  • 2. Course Objectives
    • To recognize the normal rhythm of the heart - “Normal Sinus Rhythm.”
    • To recognize the 13 most common rhythm disturbances.
    • To recognize an acute myocardial infarction on a 12-lead ECG.
  • 3. Learning Modules
    • ECG Basics
    • How to Analyze a Rhythm
    • Normal Sinus Rhythm
    • Heart Arrhythmias
    • Diagnosing a Myocardial Infarction
    • Advanced 12-Lead Interpretation
  • 4. Normal Sinus Rhythm (NSR)
    • Etiology: the electrical impulse is formed in the SA node and conducted normally.
    • This is the normal rhythm of the heart; other rhythms that do not conduct via the typical pathway are called arrhythmias.
  • 5. NSR Parameters
    • Rate 60 - 100 bpm
    • Regularity regular
    • P waves normal
    • PR interval 0.12 - 0.20 s
    • QRS duration 0.04 - 0.12 s
    • Any deviation from above is sinus tachycardia, sinus bradycardia or an arrhythmia
  • 6. Arrhythmia Formation
    • Arrhythmias can arise from problems in the:
      • Sinus node
      • Atrial cells
      • AV junction
      • Ventricular cells
  • 7. SA Node Problems
    • The SA Node can:
    • fire too slow
    • fire too fast
    • Sinus Bradycardia
    • Sinus Tachycardia
    Sinus Tachycardia may be an appropriate response to stress.
  • 8. Atrial Cell Problems
    • Atrial cells can:
    • fire occasionally from a focus
    • fire continuously due to a looping re-entrant circuit
    • Premature Atrial Contractions (PACs)
    • Atrial Flutter
  • 9. Teaching Moment
    • A re-entrant pathway occurs when an impulse loops and results in self-perpetuating impulse formation.
  • 10. Atrial Cell Problems Atrial cells can also: • fire continuously from multiple foci or fire continuously due to multiple micro re-entrant “wavelets” Atrial Fibrillation Atrial Fibrillation
  • 11. Teaching Moment Multiple micro re-entrant “wavelets” refers to wandering small areas of activation which generate fine chaotic impulses. Colliding wavelets can, in turn, generate new foci of activation. Atrial tissue
  • 12. AV Junctional Problems
    • The AV junction can:
    • fire continuously due to a looping re-entrant circuit
    • block impulses coming from the SA Node
    • Paroxysmal Supraventricular Tachycardia
    • AV Junctional Blocks
  • 13. Ventricular Cell Problems
    • Ventricular cells can:
    • fire occasionally from 1 or more foci
    • fire continuously from multiple foci
    • fire continuously due to a looping re-entrant circuit
    • Premature Ventricular Contractions (PVCs)
    • Ventricular Fibrillation
    • Ventricular Tachycardia
  • 14. End of Module III Normal Sinus Rhythm Proceed to Module III Practice Quiz on WebCT

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