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Sinus Bradycardia With Sinus Arrhythmia

What Tests Will Be Done To Diagnose This Condition

Sinus Bradycardia ECG/EKG Interpretation, Causes, Treatment, Nursing NCLEX Review Cardiac

While a physical exam alone is enough to diagnose sinus bradycardia, its only possible with a specific type of test called an electrocardiogram . Thats because analyzing your hearts electrical activity is the only way to know that your heart rhythm is otherwise normal.

EKGs analyze your hearts electrical activity through several sensors called electrodes, which stick to the skin of your chest. These electrodes then display the electrical power of your heartbeat as a wave on a paper printout or a screen. Healthcare providers look at the wave for signs that your hearts electrical system isnt working properly. If your heartbeat is slow but otherwise normal, thats all a doctor needs to diagnose sinus bradycardia.

But if you have symptoms of sinus bradycardia, its important to know why. To answer that question, several other types of tests are possible.

  • Electrolyte levels: These tests measure the levels of electrolytes in your blood, especially calcium and magnesium.
  • Thyroid hormone levels: Hypothyroidism can cause sinus bradycardia.
  • Troponin: Your heart muscles cells contain a specific type of troponin, a protein. Damage to those cells causes troponin to leak into your blood, indicating damage to your heart. Troponin is a key indicator that healthcare providers use to diagnose heart attacks.
  • Toxicology screen. This test looks for toxic substances in your blood. This test can identify drugs that can cause sinus bradycardia, as well as other heart-damaging substances.

Sinus Rhythm With 2nd Or 3rd Degree Av Blocks

Atria are depolarizated by sinus node, but some or all stimuli are not conducted to the ventricles.

In 2nd degree AV block not all sinus P waves are followed by QRS complexes because there is an intermittent failure of the AV conduction.

In complete AV block sinus P waves are dissociated from QRS complexes. No P waves are conducted to the ventricles because there is a complete block of the AV conduction.

It may be described as Sinus Rhythm with Second or Third degree AV Block.

Algorithm For Acute Management Of Bradycardia

  • Terminate or adjust any medications that cause or aggravate the bradycardia.
  • In case of acute bradycardia with circulatory compromise:
  • 12 ml of atropine 0.5 mg/ml is the first line therapy. It can be repeated if necessary.
  • If atropine is insufficient or require too frequent dosing, infusion isoproterenol should be given. An ampoule with 5 ml isoproterenol is mixed with 245 ml glucose with starting dose 0,01 g/kg/min. This is titrated up until adequate effect is achieved.
  • If atropine and isoproterenol fails, it might be necessary to perform transcutaneous pacing . Most modern defibrillators are equipped with ability to perform transcutaneous pacing. Transcutaneous pacing is only indicated until a permanent pacemaker can be implemented.
  • An alternative to transcutaneous pacing is temporary transvenous pacing, which is also indicated until a permanent pacemaker can be implemented.

Patients with bradycardia due to myocardial ischemia/infarction only demand treatment if cardiac output is compromised or if the bradycardia predisposes to more malign arrhythmias . Note, however, that bradycardias due to inferior wall ischemia/infarction is transient in most cases and rarely necessitate permanent pacemaker. Anterior wall infarctions, on the other hand, generally leave permanent bradycardia and thus demand permanent pacemaker. Learn more about conduction defects caused by ischemia and infarction.

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Risk Factors For Bradycardia

A key risk factor for bradycardia is age. Heart problems, which are often associated with bradycardia, are more common in older adults.

Risk factors related to heart disease

Bradycardia is often associated with damage to heart tissue from some type of heart disease.

Therefore, factors that increase your risk of heart disease can also increase the risk of bradycardia. Lifestyle changes or medical treatment might decrease the risk of heart disease associated with the following factors:

  • High blood pressure
  • Psychological stress or anxiety

Causes And Symptoms Of Sick Sinus Syndrome

ÙÙÙÙÙÙÙÙÙÙÙÙ . A. Sinus Bradycardia with PACS B.

As mentioned above, the incidence of sick sinus syndrome in young people is uncommon, but it can happen. For instance, heart surgery on the upper chambers can be one of the sick sinus syndrome causes for children. When it comes to the older population, although sick sinus syndrome causes are hard to define, we do know that genetics play a role. We also know coronary artery disease, high blood pressure, and aortic and mitral valve disease can occur along with the condition.

Sick sinus syndrome causes may also be linked to medications. Studies indicate medications such as calcium channel blockers or beta-blockers that are often used to treat high blood pressure, heart disease, as well as other conditions could contribute to the syndrome.

In the majority of cases, surgeons have found that natural pacemakers do not work properly due to age-related wear and tear to the heart muscle.

So how would you know if you have sick sinus syndrome? Well, that can be a little tricky. Sick sinus syndrome symptoms can be the same as many other disorders, but the bottom line is, if you experience any of the following, you should see a doctor.

  • Feeling your heart beat
  • Shortness of breath without being physical

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Electrocardiographic Relationship To Beat

Beat-to-Beat Pattern With Slowing Heart Rate

To understand the beat patterns identified in the dog the dynamic Poincaré plots were examined in conjunction with visualization of the electrocardiogram. Figure 9 illustrates this examination of four dogs during a stable sleep hour revealing the differing patterns of sinus arrhythmia and corresponding Poincaré plots. Note that during these stable sleep times with likely low sympathetic input, no short-short RR intervals along the line of identity are present . However, the bifurcation point is consistent and is identified in the dog when the heart rate slows after a sympathetic stimulation associated with excitement . The human heart rate slows linearly throughout the full range of beat intervals however, although the dog heart slows initially along the line of identity when the heart rate slows to a particular interval, a bifurcation develops. This interval was coined the bifurcation interval. An additional finding from the comparison of the Poincaré plots with the electrocardiogram is the cloud of longer intervals. The cloud associated with longlong intervals in many dogs formed a mass effect of intervals widely spread around the line of identity.

Bifurcation Interval/Zone

Table 3. Pairwise correlation of bifurcation interval measured during stable sleep hour in 50 dogs with heart rate, RR-interval, rate corrected SDNN, and age.

What Are The Symptoms Of An Arrhythmia

An arrhythmia may be silent and not cause any symptoms. A doctor can detect an irregular heartbeat during an examination by taking your pulse, listening to your heart or by performing diagnostic tests. If symptoms occur, they may include:

  • Palpitations: A feeling of skipped heartbeats, fluttering, flip-flops or feeling that the heart is running away
  • Pounding in the chest

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Sick Sinus Syndrome Role In Arrhythmia Sinus Bradycardia And Tachycardia

We are all familiar with the term heart disease however, some people who suffer from heart disease actually have what is referred to as sick sinus syndrome, sinus bradycardia or Tachycardia-bradycardia syndrome. Although rather rare in the younger population, sick sinus syndrome and related conditions are more common as we age.

Sick sinus syndrome, which is also called sinus node disease, is really the name for a group of heart rhythm dysfunctions. Essentially, if you have sick sinus, your hearts natural pacemaker doesnt work the way it is supposed to, so the rhythm of your heart is off. Many people know this as an arrhythmia problem.

Under normal conditions, your sinus node produces a steady pace of electrical impulses, but if you have sick sinus syndrome, you could have a heart rhythm that is too fast, too slow, pauses for long periods, or a heart rhythm that alternates between these problems. Some people with sick sinus syndrome end up needing a pacemaker to help keep their heart in a regular, steady rhythm.

Research shows that about one in 600 people with heart disease who are over the age of 65 suffer from sick sinus syndrome.

What Is An Ekg Interpretation

Rate and Rhythm | Sinus Bradycardia and Sinus Tachycardia

The electrocardiogram is a diagnostic tool that is routinely used to assess the electrical and muscular functions of the heart. While it is a relatively simple test to perform, the interpretation of the ECG tracing requires significant amounts of training. Numerous textbooks are devoted to the subject.

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Sinus Rhythm Is Regular

In sinus rhythm the RR intervals are constant, or almost constant, but, how to determine if the rhythm is regular?

Sometimes it is easy to determine if the rhythm is regular, but in cases of doubt we can measure with a ruler or a compass.

A simple tip is to mark 3 QRS complexes on a blank sheet of paper and move the marks to the next QRS complexes, if they match, the R-R interval is constant and the rhythm is regular.

Minor variation in the P-P intervals is present in most subjects. When this variability is more accentuated, the term sinus arrhythmia is used 1.

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Sinus Rhythm With Other Disturbances

When we speak about normal sinus rhythm, the adjective ânormalâ refers only to heart rhythm, it does not mean that the complete EKG is normal.

For example, normal sinus rhythm can be described in the presence of bundle branch block or signs of acute myocardial infarct.

It is a different matter when an initial sinus rhythm is associated with other heart rhythm disturbance as AV blocks, conduction via accessory pathway or pacemaker pacing.

In these conditions, the diagnosis of sinus rhythm should be restricted to atrial rhythm only.

In these cases is possible to determine sinus rhythm because P waves fulfill the first three criteria described above, replacing R-R interval with P-P interval.

  • Heart rate between 60 and 100 bpm .
  • P-P interval must be constant .
  • Positive P wave in lead II and negative in lead aVR.

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What Causes A Low Heart Rate

Many things can bring on a slow heart rate.

A heart malfunction

The most common cause for bradycardia is a malfunction in the hearts natural pacemaker, the sinus node. It controls how quickly the top and bottom heart chambers pump blood through the body.

AV Block

Another cause of bradycardia is atrioventricular block , in which the top and bottom chambers dont communicate well and your heart rate drops as a result.

Its like having virtual electrical cables and wires inside the heart, Dr. Baez-Escudero says. These deteriorate as we age. Common medications used in older populations can also often make bradycardia more significant.


Age is the most common risk factor for developing bradycardia. The condition is most common among men and women over age 65.

Having certain illnesses or conditions

Illness or other conditions may also cause bradycardia. These include:

  • Heart attacks due to coronary artery disease.
  • A bacterial infection in the blood that attacks your heart.
  • Inflammation of your heart muscle.
  • Low thyroid function.
  • Too much potassium in your blood.
  • Certain medications, including beta blockers and antiarrhythmics.

Congenital heart defects, diabetes or long-standing high blood pressure all may make bradycardia more likely, says Dr. Baez-Escudero.

Next Steps And Considerations

Sinus Arrythmias

Most often, patients with a first-degree AV block do not experience hemodynamic instability and do not require treatment. This rhythm is largely considered benign. If medications contribute to the development of this rhythm, they can be modified or removed from the patients medication regimen under expert care and monitoring. As patients with a first-degree AV block advance in age, the likelihood of developing atrial fibrillation or more progressive AV blocks increases. Continued and regular monitoring under the care of an expert can help patients with a first-degree AV block identify potential worsening cardiac changes or complications throughout their lifespan.

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When Should I See My Healthcare Provider Or When Should I Seek Care

If you have sinus bradycardia without symptoms, you should still see a healthcare provider for an annual physical. These yearly visits are a key way to detect new problems before they become severe enough to cause symptoms.

If you have sinus bradycardia with symptoms, you should see your healthcare provider if your symptoms change noticeably or if your symptoms start to affect your daily life and routine.

When should I go to the hospital emergency room?

Because sinus bradycardia shares the following symptoms with other more serious heart conditions, you should go to the hospital if you experience:

  • Dizziness, feeling lightheaded or fainting .

A note from Cleveland Clinic

Sinus bradycardia is a condition you may not even know you have, and for most people, it doesnt cause any symptoms. When it does cause symptoms, your healthcare provider can help you find out why its happening and if its a cause for concern. Fortunately, for people who do need treatment, this condition is often very treatable, and it shouldnt have a big impact on your daily life overall.

Hour Heart Rate Variability

Heart Rate Variability Boxer, Non-boxer, and Human

Table 1C shows the difference between groups of 24-h time domain heart rate corrected indices. All groups were different from each other however, the values in humans were markedly lower than in all dogs.

Heart Rate Variability and Age

Supplementary Table 1 shows the relationship of age to heart rate and each of the 24-h time domain indices of heart rate variability. Higher heart rate was associated with advancing age in the non-boxers. However, this group of dogs had a wider age range with numerous geriatric animals when compared to the boxers. In this population of humans relationship to age was not identified. However, time domain parameters were significantly related to age in humans. No relationship of age to time domain parameters were found in the dogs.

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What Are The Symptoms Of Sinus Bradycardia

For most people, sinus bradycardia doesnt cause any symptoms. This is especially true for people whore very physically active and have sinus bradycardia because their hearts are more efficient.

For others, symptoms of sinus bradycardia may include:

  • Irritability, agitation or other personality changes.

What Is A Sinus Arrhythmia

Sinus Bradycardia ECG –

Despite its name, a sinus arrhythmia has nothing to do with a common sinus infection. It is a disorder of the heart rate or heart rhythm.

A sinus arrhythmia means that the heart beats too fast or too slow, or irregularly.

Most often a sinus arrhythmia is temporary and nothing to worry aboutlike the accelerated heartbeat you feel when you had an extra shot of espressoor slower heartbeat when youre sleeping.

Other times an arrhythmia could point to an underlying condition. And although its rare, a sinus arrhythmia could become an urgent medical matter.

Heres what you should know about sinus arrhythmias and how they might affect your heart.

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How To Take Care Of Myself Or Manage Symptoms

Because sinus bradycardia requires an EKG to diagnose, its not something you should assume you have based on symptoms alone. The best course of action is to see your healthcare provider if you have sinus bradycardia symptoms. They can diagnose this condition and determine if its severe enough to need treatment.

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Can Sinus Arrhythmia Cause Chest Pain

No. Respiratory sinus arrhythmia doesnt cause chest pain.

A note from Cleveland Clinic

You might be concerned when your healthcare provider notices an abnormal heart rhythm in your routine EKG. But respiratory sinus arrhythmia is not a cause for worry. The time between heartbeats can be different depending on whether youre breathing in or out. So this abnormal rhythm is actually a sign of a heart thats working right.

Last reviewed by a Cleveland Clinic medical professional on 03/21/2022.


When To Contact A Doctor

Sinus bradycardia, junctional rhythm, and low

If a baby has a low pulse, a parent or caregiver should take them to the emergency room.

Adults and children who have a low pulse and experience symptoms such as chest pain, fainting, or exercise intolerance should also go to the hospital.

A person should contact a doctor about bradycardia when they:

  • experience an unexplained change in heart rate that lasts for several days
  • have bradycardia and other heart health risk factors, such as diabetes or smoking
  • have heart disease and bradycardia
  • experience bradycardia and other symptoms, such as fainting spells
  • experience episodes of bradycardia and tachycardia, which is a rapid heartbeat

If a person is concerned about their slow heart rate, they should also consult a doctor.

A doctor may not always need to treat a slow heart rate. However, when a slow heart rate causes serious health problems, it is essential that a person receives treatment.

The treatment an individual receives for their bradycardia

a pacemaker. This is a device that is implanted under a persons skin and connected to their heart. The pacemaker then sends impulses to the heart that cause it to beat regularly.

Depending on the cause, a doctor might also recommend:

  • changing heart medications
  • taking medication to treat thyroid or other metabolic disorders
  • making lifestyle changes, such as eating a low fat diet, getting more exercise, or quitting smoking
  • monitoring heart rate or blood pressure frequently

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