# Sinus arrhythmia



## EMTMandy (Jan 10, 2008)

Does anybody know if sinus arrhythmias are always dependent on one's respiratory pattern? if not, is there an arrhythmia that looks like a sinus arrhythmia that really isnt? what if the ST segments on an EKG are slightly elevated as well? Any info I could get on this would be greatly appreciated. 
Thanks!


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## DT4EMS (Jan 10, 2008)

EMTMandy said:


> Does anybody know if sinus arrhythmias are always dependent on one's respiratory pattern? if not, is there an arrhythmia that looks like a sinus arrhythmia that really isnt? what if the ST segments on an EKG are slightly elevated as well? Any info I could get on this would be greatly appreciated.
> Thanks!



If the rhythm is going to be called a Sinus Dysrhythmia is has to follow the rules. I am no cardioloigist.... but in order for it to be Sinus Dysrhythmia it has to have NO other clinical significance other than the rate changing with the respiratory pattern.

If a person is having ST elevation changes, it has nothing to do with the Sinus Dysrhythmia.

Maybe Rid or Vent may have somoe more to add............


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## katgrl2003 (Jan 10, 2008)

Oh, something that I can answer!  This is my normal rhythm, so I researched it a little.

There are two types of sinus arrhythmia: respiratory and non-respiratory.  With the respiratory, heart rate increases with inspiration and decreases with experation.  Non-respiratory has the same increases and decreases, but they show no relation to breathing.

Sinus arrhythmia is most common in young children and those that have had cardiac issues in the past, but may be seen in any age group.  This is a rhythm by itself, but it can be associated with a bradycardic or tachycardic rate.

The only rhythm I can think of that may look similar is a-fib. They are both irregular, but a-fib is all over the place while sinus arrhythmia speeds up, then slows down.  I haven't heard of any ST changes related to this rhythm, but you may want to ask a medic more in depth questions.

Hope this helps.

-Kat


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## Ridryder911 (Jan 10, 2008)

Sinus Arrhythmia is usually pronounced in younger children, athletes, and thin persons. Usually disappear with increasing age. Yes, usually associated and prominent with respirations due to vagal tone. Anything that can alter such can increase or produce sinus arrhythmias. 

Was this a true ST elevation or ST changes? There is a major difference. 

The S T segment change can have multiple reasons other than AMI or ischemia changes. Electrolyte imbalance, medications, refractory conduction, or they can be just idiopathic. Be sure that the tracing is correctly performed, even a slight deviation of electrode placement can produce faulty or false elevation. 


R/r 911


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## EMTMandy (Jan 10, 2008)

Ridryder911 said:


> Sinus Arrhythmia is usually pronounced in younger children, athletes, and thin persons. Usually disappear with increasing age. Yes, usually associated and prominent with respirations due to vagal tone. Anything that can alter such can increase or produce sinus arrhythmias.
> 
> Was this a true ST elevation or ST changes? There is a major difference.
> 
> ...



Well, from what another medic (told a friend who) told me (without much further knowledge on the subject, it was a true elevation.  this is a situation of my own, in fact.  Along with the newly irregular rhythm, I have been having intermittent angina-like symptoms.  (20 years of age, nonsmoker, health nut, athlete) As of the end of Oct '06, my EKG showed a dropped beat every 15th continuously.  (this was of course after some pretty traumatic events but still) As of now, it varies soo much in its patterns that it makes no sense to me and seems to be worstening.


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## EMTMandy (Jan 10, 2008)

I forgot to mention too, that sometimes my rate feels completely regular as well


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## EMTMandy (Jan 10, 2008)

well thanks for the info anyway...I'm not seeking a diagnosis as much as I am trying to get educated before I do so. Anything and everything helps


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## Ridryder911 (Jan 10, 2008)

I would have it examined. It might be something or nothing at all. Seriously, as a female (no gender bias) they are finding our many may coronary problems that are different in symptoms and younger as well. Again, it may be nothing. 

The usual work up is echocardiography to check valves, ejection fraction, chamber size, etc... then a stress test to check arrythmias, & maximum HR. They may even sen you home with a Holter monitor to see irregluarities, and finally a cardiac CT/to check tenacity of the vessels. 

Again, that is the usual.. all dependent on the physician request. 

Good luck, 
R/r 911


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## EMTMandy (Jan 10, 2008)

yeah...i will. and thanks again!


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## MasterIntubator (Jan 10, 2008)

Also, keep in mind.... the rhythm you typically see on the screen of the monitor will not always be the same you see on the printed 12-lead due to the filters they use.

Example: You see ST elevation on your peripheral leads on the monitor screen, you hook up the 12 lead, and when it prints out, the same peripheral leads look different.... no ST elevation.  The filters that process the ECG waves for the screen are different than the ones that process the 12 lead. 

Which one do you trust?  The 12-lead.  

All in all.... if the pt is symptomatic, you treat the pt.  But if not symptomatic, its a cardio referral.

( for your future education if you choose to climb the ladder of ALS )


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## MSDeltaFlt (Jan 10, 2008)

There is something else you need to figure out or know.  You were told you had ST elevation.  Which leads?  How many leads?  Were they anatomically contiguous; as in II, III, and aVL?  This requires a 12 lead.  When it comes to ST elevation, this is very important.  Otherwise it is essentially benign.

What is important enough to be looked at is the fact that you are a 20-something athelete with angina-like symptoms.  This is not supposed to happen.  If I were you, I'd make an appointment to see a doctor.

Good luck.


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## EMTMandy (Jan 10, 2008)

MasterIntubator said:


> Also, keep in mind.... the rhythm you typically see on the screen of the monitor will not always be the same you see on the printed 12-lead due to the filters they use.
> 
> Example: You see ST elevation on your peripheral leads on the monitor screen, you hook up the 12 lead, and when it prints out, the same peripheral leads look different.... no ST elevation.  The filters that process the ECG waves for the screen are different than the ones that process the 12 lead.
> 
> ...



Yeah, I have a 12-lead about three pages long in my hands. good to know though,,,since if allgoes as planned I'll be attending medic school in the fall!! thanks for the info!


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## EMTMandy (Jan 10, 2008)

MSDeltaFlt said:


> There is something else you need to figure out or know.  You were told you had ST elevation.  Which leads?  How many leads?  Were they anatomically contiguous; as in II, III, and aVL?  This requires a 12 lead.  When it comes to ST elevation, this is very important.  Otherwise it is essentially benign.
> 
> What is important enough to be looked at is the fact that you are a 20-something athelete with angina-like symptoms.  This is not supposed to happen.  If I were you, I'd make an appointment to see a doctor.
> 
> Good luck.



well if I'm looking at it right, it's most prominent in the 2nd lead...but that's pretty much all I know based on what I've read online in conjunction with looking at my strip (outside this forum..not Quite as reliable.)  and yes, I have an appointment in my area however The moreeducation I can get while dealing with something like this the better. I've been brushed off by docs Several times with true lifethreatning problems, usually caught by some fluke or miracle.  Kinda getting tired of the same old song and dance. 

thanks again!


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## MasterIntubator (Jan 11, 2008)

You can take a ruler, place it on the isoelectric line horizontally ( the flat line after all your beats come to rest ), if the highest point of the ST elevation is greater than 1 small box tall ( or 2 small boxes tall on the precordial leads ).  For the most part, this would be normal variation.


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## EMTMandy (Jan 11, 2008)

ahhh well looking at it that close...

on lead II it shows anywherefrom 1-2 boxes higher than the flat line. There isn't really a pattern there, but there's some elevation in all ofthem I think?  

gee I love learning...haha


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