17
Jan
Management Of Sinus Rhythm. Transfer to ICU or CCU. Call for expert help. Due to the absence of atrioventricular node conduction disease andor structural heart disease pacemaker implantation was not considered. Several basic principles should be considered when management approaches are planned for any patient with AF Table 1.
If it is caused by underlying heart disease eg myocardial ischemia the treatment is directed at that process. Management of AF aims to reverse the arrhythmia to sinus rhythm or otherwise to slow AV conduction rates thus reducing the ventricular response rate to a near normal rate. When the sinus also called the sinoatrial or SA node is pacing the heart atrial depolarization spreads from right to left and downward toward the AV junction. Sinus arrhythmia is a normal finding among young and healthy individuals. Table 36-2 describes ECG waveforms and intervals normal durations and possible sources of disturbances in these features. You diagnose it by finding P waves with a predictable polarity see Chapter 4.
Sinus rhythm is the primary physiologic mechanism of the heartbeat.
Normal sinus rhythm NSR is another name for the normal heart rhythm. 36-9 shows the components of a normal ECG tracing. Normal sinus rhythm refers to a rhythm that starts in the SA node at a rate of 60 to 100 times per minute and follows the normal conduction pathway Fig. NSR is considered to be present in adults if the heart rate is between 60 and 100 beats per minute the P wave vector on the electrocardiogram ECG is normal ie consistent with SA nodal impulse origin and the rate is largely regular waveform 1. A rhythm is defined as three consecutive heart beats with identical waveforms on the ECG. This management plan resulted in a successful outcome with return to sinus rhythm within 24 hours of admission.