Sinus rhythm

2 Cardiac conduction system and

pathway

QRS
Complex

ST
Segment

PR

Segment

PR Interval

The cardiac conduction system is a pathway that consists

of specialized cells, known as myocytes (cardiac cells),
which create the natural electrical impulse that informs
the heart when it needs to pump. The location within the
conduction system that gives rise to electrical impulses is
known as the pacemaker. The initial impulse originates in
the sinoatrial (SA) node, or sinus node, which is located
in the upper right atrium of the heart. The SA node is
designated as the primary pacemaker of the heart. From
the SA node, the electrical impulse spreads through interatrial tracts that spread the electrical impulse through
the right and left atria and therefore cause atrial depolarization. As a result, a P-wave is observed. After the
atria depolarize, the electrical impulse spreads through
the internodal tracts and reach the atrioventricular node
(AV node). The AV node has its own pacing rhythm that
serves as a back up pacemaker in case the SA node fails to
initiate an electrical impulse. Consequently, the AV node
slows down the electrical impulse to allow the atria to
project their blood into the ventricles. From the AV node,
the impulse travels through the bundle of His, which bifurcate into the left and right bundle branches. From the
branches, the impulse travels through the Purkinje bers
and allows the electrical impulse to end in the ventricles to
initiate ventricular depolarization. Consequently, a QRS
complex is observed.

Q
S
QT Interval

Schematic representation of normal sinus rhythm showing standard waves, segments, and intervals

In medicine, sinus rhythm is the normal beating of the

heart, as measured by an electrocardiogram (ECG). Normal sinus rhythm indicates that the sinoatrial node is ring at a constant rate and pacing the heart. It has certain
generic features that serve as hallmarks for comparison
with normal ECGs.

3 Sinus rhythm on ECG

1

Sinus rhythm, commonly referred to as normal sinus

rhythm, is designated as the normal rhythm of the heart.
Several requirements must be met for an electrocardiogram to be classied as normal sinus rhythm. Criteria for
a normal sinus rhythm include:

ECG structure

Main article: Electrocardiography

1. A heart rate of 60100 beats per minute.

There are typically six distinct peaks (identied by the

letters P, Q, R, S, T, and U) in a single beat of the
heart in sinus rhythm, and they occur in a specic order,
over specic periods of time, with specic relative sizes.
While there is a signicant range within which variations
in rhythm are considered normal, anything that deviates
from sinus rhythm by more than a certain amount may be
indicative of heart disease.

2. RegularityRegular
3. The SA node pacing the heart. Therefore, a P
wave must be present, round, upright, and before every QRS complex in a ratio of 1:1.
4. PR interval is between .12 second and .20 second.

See also Heart rate variability.

5. QRS complex width should be less than .12 second.

1

External links
Normal Sinus Rhythm. Archived from the original on 15 December 2012.

EXTERNAL LINKS

Text and image sources, contributors, and licenses

5.1

Text

Sinus rhythm Source: http://en.wikipedia.org/wiki/Sinus%20rhythm?oldid=635247662 Contributors: Daniel Mahu, Michael Hardy, Darrell Greenwood, Angela, Kylet, Robbot, Superm401, Centrx, DocWatson42, Rchandra, G3pro, Rubik-wuerfel, Mdf, Arcadian, Wouterstomp, MoraSique, TaintedMustard, Cburnett, Ceyockey, GregAsche, Tedder, Gareth E Kegg, Scoo, Bleakcomb, Beanyk, Benandorsqueaks, Agateller, NCurse, CrookedAsterisk, Thumperward, Furby100, MrDolomite, Pascal.Tesson, Bluenokkad, Escarbot, Atom
cz, Spiral5800, OKBot, Dexenerator, Fenwayguy, Mnokel, Fyrwoman49, Dawynn, Ptbotgourou, Beeswaxcandle, Jmarchn, LilHelpa,
Dithridge, Jpcallan, RibotBOT, PigFlu Oink, DrilBot, ZroBot, ClueBot NG, Gautehuus, Reza luke, Nealj0528, BattyBot, Yamaha5,
YiFeiBot, Salubrious Toxin, FionaSky, Zoopsia and Anonymous: 31

5.2

Images

File:Ambox_important.svg Source: http://upload.wikimedia.org/wikipedia/commons/b/b4/Ambox_important.svg License: Public domain Contributors: Own work, based o of Image:Ambox scales.svg Original artist: Dsmurat (talk contribs)
File:Edit-clear.svg Source: http://upload.wikimedia.org/wikipedia/en/f/f2/Edit-clear.svg License: Public domain Contributors: The
Tango! Desktop Project. Original artist:
The people from the Tango! project. And according to the meta-data in the le, specically: Andreas Nilsson, and Jakub Steiner (although
minimally).
File:Question_book-new.svg Source: http://upload.wikimedia.org/wikipedia/en/9/99/Question_book-new.svg License: Cc-by-sa-3.0
Contributors:
Created from scratch in Adobe Illustrator. Based on Image:Question book.png created by User:Equazcion Original artist:
Tkgd2007
File:SinusRhythmLabels.svg Source: http://upload.wikimedia.org/wikipedia/commons/9/9e/SinusRhythmLabels.svg License: Public
domain Contributors: en:Image:SinusRhythmLabels.png Original artist: Created by Agateller (Anthony Atkielski), converted to svg by
atom.

5.3

Content license

Creative Commons Attribution-Share Alike 3.0