doktorekg.com
Dr. Mete ALPASLAN
Sinus Arrhythmia
Diagnostic criteria
P wave morphology is normal however PP intervals change more than 0.16 seconds (4 small squares).
Respiration affects the frequency of impulses originating from the sinus node: the heart rate increases during inspiration and decreases during expiration.
Since the impulses originate from the sinus node, P waves look like each other and are positive in leads I and II while negative in lead aVR.
Each P wave is followed by a QRS complex. Since PP intervals are not equal, the RR intervals also are not equal.
Sinus arrhythmia can be observed more frequently when sinus rate is slow.
Since it is affected by vagal tone, sinus arrhythmia cannot be observed in patients who have received atropin or who have undergone vagotomy (after heart transplantation, etc).
Causes
Respiratory sinus arrhythmia: inspiration inhibits vagal tone resulting in an increase in heart rate and expiration results in decreased heart rate.
Coronary artery disease.
Increased intracranial pressure.
Clinical significance
Especially more prevalent in children and adolescents.
Sinus arrhythmia has no clinical significance.
Reference
Curr Probl Cardiol 2004;29:357-432.
ECG 1. The ECG above belongs to a 30 years-old man with sinus arrhythmia.
His ECHOcardiography and treadmill exercise tests were normal.
P-P intervals are not equal in sinus arrhythmia.
Click here for a more detailed ECG
ECG 2. Sinus arrhythmia in a girl of 11 years old. P waves are identical.
Click here for a more detailed ECG
ECG 3. Sinus arrhythmia in an 18 years old male.
Click here for a more detailed ECG
ECG 4. Sinus arrhythmia detected during the Holter recording of an apparently healthy 22 years-old man.
Click here for a more detailed ECG
ECG 5. Sinus arrhythmia in an apparently healthy young girl.
Click here for a more detailed ECG
ECG 6. Respiratory sinus arrhythmia is seen in an apparently healthy 3 years-old girl.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 7. Respiratory sinus arrhythmia is seen in an apparently healthy 6 years-old girl.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 8a. The ECG above is from a 62 years-old woman with baseline drift, sinus arrhythmia and low amplitude P waves.
The diagnosis may be atrial fibrillation at first glance.
Click here for a more detailed ECG
ECG 8b. The ECG was recorded again. Sinus arrhythmia still persists but lesser baseline drift permits easy recognition
of P waves.
Click here for a more detailed ECG
ECG 8c. Re-recording of the ECG at a calibration of 20 mm/mV shows P waves more clearly.
Click here for a more detailed ECG
ECG 9. Respiratory sinus arrhythmia is seen in the above ECG of a 15 years-old male.
Daha detaylı EKG için buraya tıklayınız
ECG 10a. The ECG above is from a 21 years-old apparently healthy man with a normal ECHOcardiogram.
Marked sinus arrhythmia is seen.
Click here for a more detailed ECG
ECG 10b. The one channel ECG rhythm strip above belongs to the same patient.
Marked sinus arrhythmia and short-lasting baseline drift are seen.
Click here for a more detailed ECG
ECG 10c. The next minute, sinus arrhythmia is not seen.
Click here for a more detailed ECG
ECG 11. The ECG above belongs to an 18 years-old professional football player.
Sinus arrhythmia is seen. All P waves of a single lead are identical.
Click here for a more detailed ECG
ECG 12. The ECG above belongs to a 26 years-old man with sinus arrhythmia.
His ECHOcardiography and treadmill exercise tests were normal.
Click here for a more detailed ECG
ECG 13. Sinus arrhthmia. P-P intervals are not equal.
Click here for a more detailed ECG
ECG 14. Above is an ECG from a 65 years-old man with COPD.
Nonrespiratory sinus arrhythmia, P wave verticalization, low voltage and right axis deviation is seen.
Click here for a more detailed ECG
P wave morphology is normal however PP intervals change more than 0.16 seconds (4 small squares).
Respiration affects the frequency of impulses originating from the sinus node: the heart rate increases during inspiration and decreases during expiration.
Since the impulses originate from the sinus node, P waves look like each other and are positive in leads I and II while negative in lead aVR.
Each P wave is followed by a QRS complex. Since PP intervals are not equal, the RR intervals also are not equal.
Sinus arrhythmia can be observed more frequently when sinus rate is slow.
Since it is affected by vagal tone, sinus arrhythmia cannot be observed in patients who have received atropin or who have undergone vagotomy (after heart transplantation, etc).
Causes
Respiratory sinus arrhythmia: inspiration inhibits vagal tone resulting in an increase in heart rate and expiration results in decreased heart rate.
Coronary artery disease.
Increased intracranial pressure.
Clinical significance
Especially more prevalent in children and adolescents.
Sinus arrhythmia has no clinical significance.
Reference
Curr Probl Cardiol 2004;29:357-432.
ECG 1. The ECG above belongs to a 30 years-old man with sinus arrhythmia.
His ECHOcardiography and treadmill exercise tests were normal.
P-P intervals are not equal in sinus arrhythmia.
Click here for a more detailed ECG
ECG 2. Sinus arrhythmia in a girl of 11 years old. P waves are identical.
Click here for a more detailed ECG
ECG 3. Sinus arrhythmia in an 18 years old male.
Click here for a more detailed ECG
ECG 4. Sinus arrhythmia detected during the Holter recording of an apparently healthy 22 years-old man.
Click here for a more detailed ECG
ECG 5. Sinus arrhythmia in an apparently healthy young girl.
Click here for a more detailed ECG
ECG 6. Respiratory sinus arrhythmia is seen in an apparently healthy 3 years-old girl.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 7. Respiratory sinus arrhythmia is seen in an apparently healthy 6 years-old girl.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 8a. The ECG above is from a 62 years-old woman with baseline drift, sinus arrhythmia and low amplitude P waves.
The diagnosis may be atrial fibrillation at first glance.
Click here for a more detailed ECG
ECG 8b. The ECG was recorded again. Sinus arrhythmia still persists but lesser baseline drift permits easy recognition
of P waves.
Click here for a more detailed ECG
ECG 8c. Re-recording of the ECG at a calibration of 20 mm/mV shows P waves more clearly.
Click here for a more detailed ECG
ECG 9. Respiratory sinus arrhythmia is seen in the above ECG of a 15 years-old male.
Daha detaylı EKG için buraya tıklayınız
ECG 10a. The ECG above is from a 21 years-old apparently healthy man with a normal ECHOcardiogram.
Marked sinus arrhythmia is seen.
Click here for a more detailed ECG
ECG 10b. The one channel ECG rhythm strip above belongs to the same patient.
Marked sinus arrhythmia and short-lasting baseline drift are seen.
Click here for a more detailed ECG
ECG 10c. The next minute, sinus arrhythmia is not seen.
Click here for a more detailed ECG
ECG 11. The ECG above belongs to an 18 years-old professional football player.
Sinus arrhythmia is seen. All P waves of a single lead are identical.
Click here for a more detailed ECG
ECG 12. The ECG above belongs to a 26 years-old man with sinus arrhythmia.
His ECHOcardiography and treadmill exercise tests were normal.
Click here for a more detailed ECG
ECG 13. Sinus arrhthmia. P-P intervals are not equal.
Click here for a more detailed ECG
ECG 14. Above is an ECG from a 65 years-old man with COPD.
Nonrespiratory sinus arrhythmia, P wave verticalization, low voltage and right axis deviation is seen.
Click here for a more detailed ECG