Regular rhythm, with less than 0.16-second variation in the shortest and longest durations between successive P waves.Normal heart rate (classically 60 to 100 beats per minute for an adult).Characteristics of normal sinus rhythm īy convention, the term "normal sinus rhythm" is taken to imply that not only are the P waves (reflecting activity of the sinus node itself) normal in morphology but that all other ECG measurements are also normal. Exceptions to this include complete heart block and certain ventricular artificial pacemaker rhythms, where the P waves may be completely normal in shape, but ventricular depolarization bears no relation to them in these cases, the speed of the "sinus rhythm of the atria" and the speed of the ventricular rhythm must be calculated separately. In general, each P wave in a sinus rhythm is followed by a QRS complex, and the sinus rhythm therefore gives rise to the whole heart's depolarization. If the P waves do not meet these criteria, they must be originating from an abnormal site elsewhere in the atria and not from the sinus node the ECG cannot, therefore, be classed as showing a sinus rhythm. positive in all chest leads, except for V1 which may be biphasic (+/-). any of biphasic (-/+), positive or negative in lead aVL.
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