However, such patients have severe, dilated cardiomyopathy, and preexisting BBB or intraventricular conduction delays (wide QRS in sinus rhythm). However, when in doubt, treat the arrhythmia as if it was VT, as approximately 80 % of wide QRS complex tachycardias are of ventricular origin.30,31, Antonia Sambola An electrocardiogram (EKG) can tell your provider if you have sinus arrhythmia. An abnormally slow heart rate can cause symptoms, especially with exercise. When a WCT abruptly becomes a narrow complex tachycardia with acceleration of the heart rate, SVT (orthodromic atrioventricular reciprocating tachycardia using an accessory pathway on the same side as the blocked bundle branch) is confirmed (Coumels law). This rhythm has two postulated, possibly coexisting . Whenever possible, a 12-lead ECG should be obtained during WCT; obviously, this is not applicable to the hemodynamically unstable patient (such as presyncope, syncope, pulmonary edema, angina). Had an ECG taken and slightly worried. The following historical features (Table I) powerfully influence the final diagnosis. Table 1 summarizes the Brugada and Vereckei protocols. Normal Sinus Rhythm The default heart rhythm P wave is there and QRS follows each time and in a predictable manner . Her 12-lead ECG, shown in Figure 12, prompted a consultation for evaluation of nonsustained VT.. Lau EW, Pathamanathan RK, Ng GA, The Bayesian approach improves the electrocardiographic diagnosis of broad complex tachycardia, Pacing Clin Electrophysiol, 2000;23(10 Pt 1):151926. The Licensed Content is the property of and copyrighted by DSM. ( over 0.10 seconds) is caused by delayed conduction of the electrical stimulus from the upper chamber which causes a delay in contraction of the ventricles. There are 5 classic causes of wide complex tachycardia mechanisms: Brugada, P, Brugada, J, Mont, L. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Please login or register first to view this content. the algebraic sum of the voltage of the first 40 ms divided by the last 40 ms is less than or equal to one. 2008. pp. This is one SVT where the QRS complex morphology exactly mimics that of VT. The QRS complex in rhythm strip V1 shows an RR configuration, but with the second rabbit ear taller than the first; this favors SVT with aberrancy. 5. This is traditionally printed out on a 6-second strip. General approach to the ECG showing a WCT. Once again, the clinical scenario in which such a patient is encountered (such as history of antiarrhythmic drug use), along with other ECG findings (such as tall peaked T waves in hyperkalemia) will help make the correct diagnosis. clinically detectable variation of the first heart sound and examination of the jugular venous pressure were noted to be useful for the diagnosis of a ventricular origin of the arrhythmia.3. Because an accessory pathway inserts directly into ventricular myocardium, the resulting QRS complex during antidromic AVRT is generated by muscle-to-muscle spread propagating away from the ventricular insertion site, rather than via His-Purkinje spread, and therefore meets all the QRS complex morphology criteria for VT. I have the Kardia and have the advanced determination so it records 6 arrhythmias. There are multiple approaches and protocols, each having its own pros and cons. To reinforce the material we would like to offer of this protocol are 96.5 and 95.7 %, respectively, which is similar to the previous alghorithm published by this group.29 To reinforce the material we would like to offer two ECGs for review (see Figures 1 and 2). A. 2012 Aug. pp. R on T . . The interval from the pacing spike to the captured QRS complex progressively gets longer, before a pacing spike fails to capture altogether; this is consistent with Pacemaker Exit Wenckebach. This is one VT which meets every QRS morphology criterion for SVT with aberrancy. WCT tachycardia obtained from a 72-year-old man with a history of remote anteroseptal myocardial infarction and reduced ejection fraction. He had a history of paroxysmal atrial fibrillation. , Khairy P, Harris L, Landzberg MJ, et al., Implantable cardioverterdefibrillators in tetralogy of Fallot, Circulation, 2008;117:36370. Rules for each rhythm include paramters for measurements like rate, rhythm, PR interval length, and ratio of P waves to QRS complexes. Comparison with the baseline ECG is an important part of the process. Figure 1. Its usually a sign that your heart is healthy. He underwent electrophysiology study, where a wide complex tachycardia (right panel in Figure 6) was easily and reproducibly induced with programmed ventricular stimulation. - And More, Close more info about Differential Diagnosis of Wide QRS Complex Tachycardias. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. Alan Bagnall Of the conditions that cause slowing of action potential speed and wide QRS complexes, there is one condition that is more common, more dangerous, more recognizable, more rapidly life threatening, and more readily . A widened QRS interval. vol. Sinus Tachycardia. B. Heart, 2001;86;57985. Vereckei A, Duray G, Szenasi G et al., Application of a new algorithm in the differentiatial diagnosis of wide QRS complex tachycardia, Eur Heart J, 2007;28,589600. 4. The electrical signal to make the heartbeat starts . The width of the QRS complex, both with aberrancy and during VT, can vary from patient to patient. This is done by simply judging the QRS duration. There are errant pacing spikes (epicardial wires that were undersensing). The time between heartbeats can be different depending on whether youre breathing in or out. Figure 9: After starting intravenous amiodarone, this ECG was obtained. The frontal axis is pointing to the right shoulder, and favors VT. His ECG showed LBBB during sinus rhythm (left panel in Figure 6). Her rhythm strips from the ambulance are shown in Figure 5. , Once corrected, normal pacing with consistent myocardial capture was noted. Figure 6: A 65-year-old man with severe alcoholism presented with catastrophic syncope while seated at a bar stool resulting in a cervical spine fracture. Wide complex tachycardia due to bundle branch reentry. A special consideration is WCT due to anterograde conduction over an accessory pathway. Morady F, Baerman JM, DiCarlo LA Jr, et al., A prevalent misconception regarding wide-complex tachycardias, JAMA, 1985;254(19):27902. Key causes of a Wide QRS. Articles marked Open Access but not marked CC BY-NC are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Griffith MJ, Garratt CJ, Mounsey P, Camm AJ, Ventricular tachycardia as default diagnosis in broad complex tachycardia, Lancet, 1994;343(8894):3868. If an old EKG is available, the baseline wide QRS will be present. (Never blacked out) No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Its very common in young, healthy people. Leads V2 and V3, however, show swift down strokes (onset to nadir <70 ms), favoring SVT with LBBB aberrancy. Sometimes, these electrical impulses are sent out faster than this typical rhythm, causing sinus tachycardia. QRS complex duration of more than 140 ms; the presence of positive concordance in the precordial leads; the presence of a qR, R or RS complex or an RSR complex where R is taller than R and S passes through the baseline in V. QRS complex duration of more than 160 ms; the presence of negative concordance in the precordial leads; the absence of an RS complex in all precordial leads; an R to S wave interval of more than 100 ms in any of the precordial lead; the presence of atrio-ventricular dissociation; and, the presence of morphologic criteria for VT in leads V. the presence of atrio-ventricular dissociation; the presence of an initial R wave in lead aVR; a QRS morphology that is different from bundle branch block or fascicular block; and. For the most common type of sinus arrhythmia, the time between heartbeats can be slightly shorter or longer depending on whether youre breathing in or out. Broad complex tachycardia Part I, BMJ, 2002;324:71922. 2016. pp. I gave a Kardia and last night I upgraded the Kardia and my first reading was Sinus rhythm with wide QRS and I was concerned because my left side was hurting and I also had a cramp in my back . As expected, the P waves are of low amplitude in hyperkalemia. Broad complexes (QRS > 100 ms) may be either ventricular . The following observations can be made from the first ECG: The emergency medical services were summoned and IV amiodarone was administered. If the pacing artifact (spikes) are not large; especially true with bipolar pacing; they may be missed. High Grade Second Degree AV Block, All of the following are generally associated with a wide QRS complex EXCEPT: Select one: a. Jastrzebski, M, Sasaki, K, Kukla, P, Fijorek, K. The ventricular tachycardia score: a novel approach to electrocardiographic diagnosis of ventricular tachycardia. conduction of a supraventricular impulse from atrium to ventricle over an accessory pathway (bypass tract) so called pre-excited tachycardia. Danger: increase the risk of thromboemoblic events don't convert unless occurring less than 48 hrs, if don't know pt need to be put . Wide complex tachycardia related to rapid ventricular pacing. In this article we try to summarize approaches which we consider optimal for the evaluation of patients with wide QRS complex tachycardias. Sinus arrhythmia is a kind of arrhythmia (abnormal heart rhythm). Fairley S, Sands A, Wilson C, Uncorrected tetralogy of Fallot: Adult presentation in the 61st year of life, Int J Cardiol, 2008;128(1);e9e11. When the sinoatrial node is blocked or suppressed, latent pacemakers become active to conduct rhythm secondary to enhanced activity and generate escape beats that can be atrial itself, junctional or ventricular. The QRS complex in lead V1 shows an Rr morphology (first rabbit ear is taller than the second), favoring VT (Table IV). Several arrhythmias can manifest as WCTs (Table 21-1); the most common is ventricular tachycardia (VT), which accounts for 80% of all cases of WCT. The burden of intramyocardial scar: as mentioned above, scar within the ventricles will affect the velocity of propagation through the myocardium and influence QRS complex width. 1988. pp. This collection of propagating structures is referred to as the His-Purkinje network.. When you breathe out, it slows down. Rhythms (From ECG Book) a. The sinus node is a group of cells in the heart that generates these impulses, causing the heart chambers to contract and relax to move blood through the body. A PJC is an early beat that originates in an ectopic pacemaker site in the atrioventricular (AV) junction, interrupting the regularity of the basic rhythm, which is usually a sinus rhythm. Ahmed Farah Furushima H, Chinushi M, Sugiura H, et al., Ventricular tachyarrhythmia associated with cardiac sarcoidosis: its mechanisms and outcome, Clin Cardiol, 2004;27(4):21722. - Clinical News 15. One approach to the interpretation of wide QRS complex tachycardias is to divide them into right bundle branch block morphology (QRS complex being predominantly positive in lead V1) and left bundle branch block morphology (QRS complex being predominantly negative in lead V1).20. QRS complex: 0.06 to 0.08 second (basic rhythm and PJC) Comment: ST segment depression is present. Medications included flecainide 100 mg twice daily (for 5 years) for paroxysmal atrial fibrillation, metoprolol XL 200 mg daily, and aspirin. A wide QRS is a delay beyond an internationally agreed time limit between the electrical conduction leaving the atria and that arriving at the ventricle. , It must be acknowledged that there are many clinical scenarios where different criteria will provide conflicting indications as to the etiology of a WCT. During VT, the width of the QRS complex is influenced by: As is true of all situations in medicine, the clinical context in which the wide complex tachycardia (WCT) occurs often provides important clues as to whether one is dealing with VT or SVT with aberrancy. QRS Width. Conclusion: Intermittent loss of pacing capture and aberrancy of intramyocardial conduction due to drug toxicity. Therefore, this tracing represents VT with 3:2 VA conduction (VA Wenckebach); this still counts as VA dissociation. The presence of atrioventricular dissociation strongly favors the diagnosis of VT. There is a suggestion of a P wave prior to every QRS complex, best seen in lead V1, favoring SVT. A Bayesian diagnostic algorithm, with assignment of different likehood ratios of different ECG criteria from historically published protocols used by Lau et al., was found to have very good diagnostic accuracy.28 However, this protocol did not incorporate certain important features, such as atrioventricular dissociation, as they could not be ascertained in all cases. Its actually a sign of good heart health. 101. Although not immediately apparent, the rhythm is now atrial flutter with 2:1 conduction. The ECG for a child or a pregnant woman can also feature a shorter interval of the P wave. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. The flutter waves are marked by arrows (). However, not every P wave results in a QRS complex the PR interval progressively lengthens, culminating in failure of AV conduction ("dropped QRS complexes"). She has missed her last two hemodialysis appointments. Sinus bradycardia occurs when your sinus rhythm is below 60 bpm. There are impressively tall, peaked T waves, best seen in lead V3, as expected in hyperkalemia. What determines the width of the QRS complex? There is (negative) precordial concordance, favoring VT. And you dont want to, because its a sign of a healthy heart. II. What Does Wide QRS Indicate? Application of irrigated radiofrequency current to a site 8 mm below the apex of Koch's triangle was terminated . et al, Andre Briosa e Gala Goldberger, ZD, Rho, RW, Page, RL.. Approach to the diagnosis and initial management of the stable adult patient with a wide complex tachycardia. This causes a wide S-wave in V1V2 and broad and clumsy R-wave in V5V6. Complexes are complete: P wave, QRS complex (narrow), T wave 3. For left bundle branch block morphology the criteria include: for V12: an R wave of more than 30 ms duration, notching of the downstroke of the S wave, or duration from the onset of the QRS to the nadir of S wave of more than 70 ms; for lead V6: the presence of a QR or RS complex. AIVR is a wide QRS ventricular rhythm with rate of 40-120 bpm, often with variability during the episode. What causes a junctional rhythm in the sinus? Its normal to have respiratory sinus arrhythmia simply because youre breathing. In a small study by Garratt et al. It is atrial flutter with grouped beating. The "apparent" PR interval as seen in V 1 is shortening continuing regularity of the P waves and the QRS complexes, indicating dissociation (horizontal blue arrowheads). The precordial leads show negative complexes from V1 to V6so called negative concordance, favoring VT. Where views/opinions are expressed, they are those of the author(s) and not of Radcliffe Medical Media. Of course, such careful evaluation of the patient is only possible when the patient is hemodynamically stable during VT; any hemodynamic instability (such as presyncope, syncope, pulmonary edema, angina) should prompt urgent or emergent cardioversion. Unfortunately AV dissociation only . Such confusion is most often related to the occasional patient where aberrancy results in a particularly bizarre QRS complex morphology, raising the likelihood that the WCT might be VT. If the ambient sinus rate is rapid, the resulting ECG may show a WCT. A normal heartbeat is referred to as normal sinus rhythm (NSR). This could indicate a bundle branch block in which there is a delay in the passage of heart's electrical signals along the bottom of the heart. Aberrancy, ventricular tachycardia, supraventricular tachycardia, right-bundle branch block (RBBB), left-bundle branch block (LBBB), intraventricular conduction delay (IVCD), pre-excited tachycardia. Thus we recommend the following approach: evaluating the substrate for the arrhythmia, then evaluating the ECG for fusion beats, capture beats and atrioventricular dissociation. What condition do i have? Dual-chamber pacemakers may show rapid ventricular pacing as a result of tracking at the upper rate limit, or as a result of pacemaker-mediated tachycardia. The heart rate is 111 bpm, with a right inferior axis of about +140 and a narrow QRS. Because ventricular activation occurs over the RBB, the QRS complex during this VT exactly resembles the QRS complex during SVT with LBBB aberrancy. In most people, theres a slight variation of less than 0.16 seconds. The timing of engagement of the His-Purkinje network: at some point during propagation of the VT wave front, the His-Purkinje network is engaged, resulting in faster propagation; the earlier this occurs, the narrower the QRS complex. I. . A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/minute. Last reviewed by a Cleveland Clinic medical professional on 03/21/2022. It is characterised by the presence of correctly oriented P waves on the electrocardiogram (ECG). It also does not mean that you . If the patient then develops tachycardia in the background of this BBB (e.g. Impossible to say, your EKG must be interpreted by a cardiologist to differ supraventricular tachycardia with wide QRS from ventricular tachycardia. The ECG recorded during sinus rhythm . et al, Antonio Greco All QRS complexes are irregularly irregular. Note that as the WCT rate oscillates, the retrograde P waves follow the R-R intervals. Ventricular fibrillation. Tachycardias are broadly categorized based upon the width of the QRS complex on the electrocardiogram (ECG). I strongly suspect that the Kardia device will be reporting correctly. Vereckei, A, Duray, G, Szenasi, G. Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. Maron BJ, Estes NA 3rd, Maron MS, et al., Primary prevention of sudden death as a novel treatment strategy in hypertrophic cardiomyopathy, Circulation, 2003;107(23):28725. Europace.. vol. Each "lead" takes a different look at the heart. VA dissociation is best seen in rhythm leads II and V1. Wellens HJ, Br FW, Lie KI, The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex, Am J Med, 1978;64(1):2733. Such VTs may look very similar to SVT with aberrancy. 2. nd. Idioventricular rhythm is a slow regular ventricular rhythm, typically with a rate of less than 50, absence of P waves, and a prolonged QRS interval. A sinus rhythm is any cardiac rhythm in which depolarisation of the cardiac muscle begins at the sinus node. It is a somewhat common misconception that patients with ventricular tachycardias are almost always hemodynamically unstable.2 The patients blood pressure cannot be used as a reliable sign for the differentiation of the origin of an arrhythmia. 28. Description 1. 2016 Apr. However, careful observation shows VA dissociation (best seen in lead V1) with slower P waves. Wide QRS Tachycardia: What every physician needs to know. The PR interval is the time interval between the P wave (atrial depolarization) to the beginning of the QRS segment (ventricular depolarization). Latest News Your top articles for Saturday, Continuing Medical Education (CME/CE) Courses. Answer (1 of 2): If, as you say, the heart rate is normal, then you have a bundle branch block that comes and goes, and the cause could be ischemia, that is a partly blocked vessel, or multiple vessels. If the QRS duration is prolonged (0.12 seconds), the arrhythmia is a wide complex tachycardia (WCT). The normal PR interval range is ~120 - 200 ms (0.12-0.20s), although it can fluctuate depending on your age and health. Kindwall, KE, Brown, J, Josephson, ME.. Electrocardiographic criteria for ventricular tachycardia in wide complex left-bundle branch block morphology tachycardias. Normal sinus rhythm typically results in a heart rate of 60 to 100 beats per minute. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. It is generally a benign arrhythmia and in the absence of structural heart disease and symptoms, generally no treatment is required. - Case Studies A complete QRS complex consists of a Q-, R- and S-wave. Circulation. Regularity of the rhythm: If the wide QRS tachycardia is sustained and monomorphic, then the rhythm is usually regular (i.e., RR intervals equal); an irregularly-irregular rhythm suggests atrial fibrillation with aberration or with WPW preexcitation. Wide QRS represents slow activation of the ventricles that does not use the rapid His-Purkinje system of the heart. Children with wide QRS complex tachycardia may present with hemodynamic instability, and if not urgently treated, serious morbidity or death may . And its normal. A wide QRS complex tachycardia in a patient older than 35 years is more likely to be VT.4 A known history of coronary artery disease, previous myocardial infarction or cardiomyopathy makes VT a probable diagnosis. This kind of arrhythmia is considered normal. vol. In EKG results, nonrespiratory sinus arrhythmia can look like respiratory sinus arrhythmia. 39. This can be seen during: The clinical situation that is commonly encountered is when the clinician is faced with an electrocardiogram (ECG) that shows a wide QRS complex tachycardia (WCT, QRS duration 120 ms, rate 100 bpm), and must decide whether the rhythm is of supraventricular origin with aberrant conduction (i.e., with bundle branch block), or whether it is of ventricular origin (i.e., VT). Wide Complex Tachycardia: Definition of Wide and Narrow. Sarabanda AV, Sosa E, Simes MV, et al., Ventricular tachycardia in Chagas' disease: a comparison of clinical, angiographic, electrophysiologic and myocardial perfusion disturbances between patients presenting with either sustained or nonsustained forms, Int J Cardiol, 2005;102(1):919. What is the reason for the wide QRS in this ECG?While analyzing wide QRS in sinus rhythm, one of my teachers used to put it simply like this: right bundle, l. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. A change in the QRS complex morphology or axis by more than 40, as well as a QRS axis of 90 to 180 suggests a ventricular origin of the arrhythmia.17,18 An entirely positive QRS complex in lead augmented ventor left (aVR) also supports the diagnosis of VT.17 When the sinus rhythm with wide QRS becomes narrow with a tachycardia, this indicates VT.19 The morphology of a tachycardia similar to that of premature ventricular contractions seen on prior ECGs increases the probability of a ventricular origin of the arrhythmia. Tetralogy of Fallot is a common cyanotic congenital lesion.6 Patients with both unrepaired and repaired conditions are at risk of having VT.7,8 Patients with a history of Duchenne muscular dystrophy, Becker muscular dystrophy, myotonic dystrophy, Friedreichs ataxia, and EmeryDreifuss muscular dystrophy are at increased risk of developing cardiomyopathies.9 Thus a diagnosis of VT should be considered in these patients presenting with wide complex tachycardias. 14. Vaugham Williams Class I and Class III antiarrhythmic medications, multiple medications that prolong the QT, and digoxin at toxic levels may cause VT. A careful review of the electrocardiogram (ECG) may provide clues to the origin of a wide QRS complex tachycardia. The QRS complex down stroke is slurred in aVR, favoring VT. For management, see "Management of Wide Complex Tachycardia". Zareba W, Cygankiewicz I, Long QT syndrome and short QT syndrome, Prog Cardiovasc Dis, 2008;51(3):26478. Citation: An abnormally slow heartbeat is called bradycardia, while an abnormally fast heartbeat is called tachycardia. Vereckei, A, Duray, G, Szenasi, G. New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Its main differential diagnosis includes slow ventricular tachycardia, complete heart block, junctional rhythm with aberrancy, supraventricular tachycardia with aberrancy, and slow antidromic atrioventricular reentry tachycardia. 2007. pp. Study with Quizlet and memorize flashcards containing terms like Normal Sinus Rhythm, Sinus Arrest, Sinus arrhythmia and more. Interestingly enough, no statistically significant difference in sensitivity and specificity was found between the Brugada, Griffith and Bayesian algorithm approaches.25. The sensitivity and specificity of this protocol are 96.5 and 95.7 %, respectively, which is similar to the previous alghorithm published by this group.29. Its rare for people to have symptoms of sinus arrhythmia. Wide complex tachycardias with right bundle branch block morphologies are more likely to be of ventricular origin in the presence of the following criteria: Left bundle branch block morphology tachycardias are more likely to be VT if they have the following features: In addition to these criteria, the presence of an R wave of more than 30 ms duration, notching of the downstroke of the S wave, or duration from the onset of the QRS to the nadir of the S wave in leads V1 or V2 of greater than 60 ms and any Q wave in lead V6 favors the ventricular origin of an arrhythmia.23 A protocol for the differentiation of a regular, wide QRS complex tachycardia was published by Brugada et al.24 It consisted of four diagnostic criteria: The presence of any of these criteria supports the diagnosis of VT. Morphologic criteria for right bundle branch block for lead V1 are: the presence of monophasic R wave, QR or RS morphology; for lead V6: Larger S wave than R wave, or the presence of QS or QR complexes. Milena Leo The ECG in Figure 2 was obtained upon presentation. In between, there is a WCT with a relatively narrow QRS complex with an RBBB-like pattern. Is pain in chest , dizziness, headaches and ability to feel heart beat 24/7 normal? Known history of pacemaker implantation and comparison to prior ECGs usually provide the correct diagnosis. 1-ranked heart program in the United States. A Junctional rhythm can happen either due to the sinus node slowing down or the AV node speeding up. Updated. If your QRS complex is longer than 0.12 seconds, it is considered wide. Normal Sinus Rhythm . In 2007, Vereckei et al. The normal QRS complex during sinus rhythm is narrow (<120 ms) because of rapid, nearly simultaneous spread of the depolarizing wave front to virtually all parts of the ventricular endocardium, and then radial spread from endocardium to epicardium. Steinman RT, Herra C, Scuger CD, et al., Wide complex tachycardia in the conscious adult: ventricular tachycardia is the most common cause, JAMA, 1989;261:10136. Aberrancy implies the patient has an EKG with baseline wide QRS (from a bundle branch block (BBB)). , Conclusion: Atrial flutter with 2:1 AV conduction with preexisting RBBB and LPFB. The R-wave may be notched at the apex. While it may seem odd to call an abnormal heart rhythm a sign of a healthy heart, this is actually the case with sinus arrhythmia. Figure 5: An 88-year-old female with a dual-chamber pacemaker presented after three syncopal episodes within 24 hours. , Why can't a junctional rhythm be suppressed? A sinus rhythm result only applies to that particular recording and doesn't mean your heart beats with a consistent pattern all the time. Normal sinus rhythm is defined as the rhythm of a . vol. Sinus tachycardia is when your body sends out electrical signals to make your heart beat faster. Broad complex tachycardia Part II, BMJ, 2002;324:7769.

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