Dysrhythmias Originating in the SA Node

Sinus Bradycardia Sinus Tachycardia Sinus Dysrhythmia Sinus Arrest

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sinus Bradycardia
Rate
Rhythm Pacemaker Site P Waves PRI

Less than 60
Regular SA node Upright and normal Normal

QRS

Normal

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sinus Bradycardia
Etiology
Increased parasympathetic (vagal) tone, intrinsic disease of the SA node, drug effects May be a normal finding in healthy, well-conditioned persons

Clinical Significance
Decreased cardiac output, hypotension, angina, or CNS symptoms In healthy, well-conditioned person, may have no significance

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sinus Bradycardia
Treatment
Treat if hypotension or ventricular irritability is present Prepare for transcutaneous pacing
Atropine may be considered if delay in pacing

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Bradycardia Algorithm

Click here to view the Bradycardia Algorithm.

Reproduced with permission from 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Care, Circulation 2005, Volume 112, IV-68. 2005 American Heart Association.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sinus Tachycardia
Rate
Rhythm Pacemaker Site P Waves PRI QRS

Greater than 100

Regular SA node Upright and normal Normal Normal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sinus Tachycardia
Etiology
Results from an increased rate of SA node discharge Potential causes include exercise, fever, anxiety, hypovolemia, anemia, pump failure, increased sympathetic tone, hypoxia, or hypothyroidism

Clinical Significance
Decreased cardiac output for rates >140 Very rapid rates can precipitate ischemia or infarct

Treatment
Treatment is directed at the underlying cause

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sinus Dysrhythmia
Rate Rhythm Pacemaker Site P Waves PRI 60100 Irregular SA node Upright and normal Normal

QRS

Normal

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sinus Dysrhythmia
Etiology
Often a normal finding, sometimes related to the respiratory cycle May be caused by enhanced vagal tone

Clinical Significance
Normal variant

Treatment
Typically, none required

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sinus Arrest
Rate
Rhythm Pacemaker Site P Waves PRI QRS

Normal to slow
Irregular

SA node
Upright and normal Normal Normal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sinus Arrest
Etiology
Occurs when the sinus node fails to discharge May result from ischemia of the SA node, digitalis toxicity, excessive vagal tone, or degenerative fibrotic disease

Clinical Significance
Frequent or prolonged episodes may decrease cardiac output and cause syncope Prolonged episodes may result in escape rhythms

Treatment
None if patient is asymptomatic Treat symptomatic bradycardia
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sinus Block
Rate Normal to slow

Rhythm
Pacemaker Site P Waves PRI QRS

Irregular SA node
Upright and normal Normal Normal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sinus Block
Etiology
Occurs when the sinus node fires on time but the impulse is blocked before it exits the sinus node Ischemia, digitalis toxicity, excessive vagal tone, degenerative fibrotic disease

Clinical significance
Prolonged episodes may compromise cardiac output Escape rhythms may develop

Treatment
None if patient is asymptomatic Treat symptomatic bradycardia

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sinus Pause
Rate Rhythm Pacemaker Site P Waves PRI QRS Normal to slow Irregular SA node Upright and normal Normal Normal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sinus Pause
Etiology
Occurs when the sinus node fails to discharge for a brief period Ischemia, digitalis toxicity, excessive vagal tone, degenerative fibrotic disease

Clinical significance
May compromise cardiac output Escape rhythms

Treatment
None if patient is asymptomatic Treat symptomatic bradycardia

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Rules of Interpretation

Sick Sinus Syndrome

Rate
Rhythm Pacemaker Site P Waves PRI QRS

Extremely variable
Irregular

SA node
Upright and normal Normal Normal

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmias Originating in the SA Node

Sick Sinus Syndrome
Etiology
A combination of dysrhythmias Occurs when the sinus node is diseased or ischemic Ischemia, digitalis toxicity, fibrotic disease

Clinical significance
May compromise cardiac output Escape rhythms

Treatment
None if patient is asymptomatic Treat symptomatic bradycardia
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ