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 Tachycardia
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
2 Sinus Bradycardia Sinus Bradycardia
Current lesson 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 Tachycardia
Sinus Tachycardia
 

 


Diagnostic criteria: (boldfaced with * indicates an important feature)
  • * Rate: > 100
  • Rhythm: regular
  • P waves: normal
  • PR interval: normal (3-5 little squares)
  • QRS: narrow (less than 3 little squares)
 
The definition of tachycardia is a heart rate greater than 100 beats per minute (bpm).
 
Sinus tachycardia originates from the sinus node (which is why it is called "sinus"). It is caused by the SA node firing at a rate of greater than 100 bpm. All other electrical conduction after the SA node is normal.

Electrophysiology:

The action potential of the sinus node looks like this:


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 steep, then it will take a short time for the voltage to reach the action potential threshold. This will cause the frequency of "firing" to be increased. If the slope is steep enough, the frequency of firing will exceed 100 per minute and this will create sinus tachycardia.

Clinical Significance:

Rates greater than 100 bpm are commonly found in children and adults. In fact, if you got off your lazy butt right now and ran up and down a couple flights of stairs, you will most likely experience sinus tachycardia.  

Sinus tachycardia is a good thing if:
  • it is physiological: you are exercising and you need increased cardiac output to your very attractive ripped muscles that you are checking out in the mirror after your workout
  • it is compensatory: you are bleeding and hypovolemic and need a compensatory increased rate to maintain a bare minimum cardiac output to stay alive.
  • it is compensatory: you are anemic and need increased cardiac output to deliver an appropriate amount of oxygen to your tissues
Sinus tachycardia that is physiological or compensatory should not be treated because it is providing benefit.


Sinus tachycardia is a bad thing if:
  • it is driven by a pathological process such as an over active thyroid gland (hyperthyroidism)
  • you have coronary artery disease and will experience myocardial ischemia at high(er) heart rates
Sinus tachycardia can be treated by:
  • treating the underlying cause of the tachycardia (treat hyperthyroidism or anemia for example)
  • give a negative chronotrope: beta blocker or calcium channel blocker

Examples:

At high heart rates like this one, the P wave and T wave can be hard to differentiate.
sinus tachycardia

This one has a rate of 105, so "just barely" tachycardia.
sinus tachycardia

sinus tachycardia

sinus tachycardia