ECG Level 2 Tutorial: Rhythm Diagnostic Criteria
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Tutorial: Rhythm Diagnostic Criteria
This module will list the basic rhythms, their diagnostic criteria, and their clinical significance .
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Tutorial: Rhythm Diagnostic Criteria Sinus Bradycardia
Lessons
42
Times Practiced
1284
Cases Completed
1h 24m
Total Time spent
1m 24s
Average Time
Progress
Accuracy
Efficiency
Accuracy
Efficiency
1 Normal Sinus Rhythm Normal Sinus Rhythm
Current lesson 2 Sinus Bradycardia Sinus Bradycardia
3 Sinus Tachycardia Sinus Tachycardia
4 Re-entry Re-entry
5 Atrial Fibrillation Atrial Fibrillation
6 Atrial Flutter Atrial Flutter
7 Heart Block - First degree Heart Block - First degree
8 Heart Block - Second degree Type 1 Heart Block - Second degree Type 1
9 Heart Block - Second degree Type 2 Heart Block - Second degree Type 2
10 Heart Block - Third degree Heart Block - Third degree
11 Junctional Rhythm Junctional Rhythm
12 SVT (supraventricular tachycardia) SVT (supraventricular tachycardia)
13 VT (Ventricular Tachycardia) VT (Ventricular Tachycardia)
14 Ventricular Fibrillation Ventricular Fibrillation
Sinus Bradycardia
Sinus Bradycardia
 


Diagnostic criteria: (boldfaced with * indicates an important feature)
  • * Rate: < 60
  • Rhythm: regular
  • P waves: normal
  • PR interval: normal (3-5 little squares)
  • QRS: narrow (< 3 little squares)
The definition of bradycardia is a HR less than 60 beats per minute (bpm).
 
Sinus bradycardia originates from the sinus node (which is why it is called "sinus"). It is caused by the SA node firing at a rate of less than 60 bpm. All other electrical conduction after the SA node is normal.

Electrophysiology:

The action potential of the sinus node looks like this:
action potential

The dotted line indicates the action potential threshold. The voltage inside the SA node cells increases during phase 4. If the slope of phase 4 is very shallow, then it will take a long time for the voltage to reach the action potential threshold. This will cause the frequency of "firing" to be reduced. If the slope is shallow enough, the frequency of firing will fall below 60 per minute and this will create sinus bradycardia.

Clinical Significance:

Rates less than 60 bpm are commonly found in healthy adults.  Healthy fit adults (especially athletes) often have a sinus bradycardia at rest or during sleeping. These do not need to be treated.
 
Rates that are inappropriately low can cause low cardiac output and hypotension and need to be treated. Treatment of sinus bradycardia can include:
  • atropine intravenous bolus
  • dopamine intravenous infusion
  • epinephrine intravenous infusion
  • artificial electronic pacemaker
Sinus bradycardia can be caused by:
  • healthy cardiovascular fitness level
  • negative chronotropes (drugs that slow down the sinus node such as beta blockers and calcium channel blockers)
  • toxins that increase parasympathetic tone: some insecticides (also called organophosphates)
  • myocardial ischemia
Examples:

sinus bradycardia

This example has some variation in the rhythm. Notice that the 5th, 6th, and 7th QRS's are a little closer together? This is called sinus arrhythmia and is normal and is caused by breathing. Breathing is normal, right?
sinus bradycardia

This example has really grossly shaped inverted T waves. Yuck.
sinus bradycardia

sinus bradycardia