Recognizing heartrhythm disturbances in psg
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Recognizing heartrhythm disturbances in PSG. Ann Ryckx. Arrhythmias. Any change in the normal sequence of the electrical impulses from the sinus node (SA) to the ventricles can cause arrhythmia. P-wave: contraction of the atria QRS -complex : contraction of the ventricles

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Recognizing heartrhythm disturbances in PSG

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Recognizing heartrhythm disturbances in PSG

Ann Ryckx


Arrhythmias

Any change in the normal sequence of the electrical impulses from the sinus node (SA) to the ventricles can cause arrhythmia


  • P-wave: contraction of the atria

  • QRS-complex: contraction of the ventricles

  • T-wave: recovery of the ventricles


ECG in PSG

  • Mostly only 1 channel

  • Recognition of heartrhythm disturbances

  • Not a diagnostic tool for other heartpathologies s.a. signs of ischaemia


Tachy-arrhythmia (too fast: > 100 bpm)Brady-arrhyhthmia(too slow: < 60 bpm)


Atrial arrhythmia

An atrial arrhythmia is an arrhythmia caused by

  • a dysfunction of the sinus node or

  • the development of another atrial pacemaker within the heart tissue that takes over the rhythm of the sinus node


Sinus Tachykardia

A condition in which the heart rate is faster than 100 beats per minute because the sinus node is sending out electrical impulses at a rate faster than usual


Supraventricular tachycardia = paroxysmal atrial tachycardia


AF: Atrial fibrillation


Atrial flutter

The electrical signals come from the atria at a fast but even rate.

When the signals from the atria are coming at a faster rate than the ventricles can respond to, the ECG pattern develops a "sawtooth" pattern, showing two or more flutter waves between each QRS complex.


Atrial extra systoly = premature beat


Ventricular arrhythmia

A ventricular arrhythmia is an arrhythmia caused by

  • a dysfunction of the sinus node

  • an interruption in the conduction pathways

  • the development of another pacemaker


Atrial ventricular BlockAV Block


Prolonged pr-interval

(>200 msec)

Atrial ventricular AV Block 1st degree


Atrial ventricular AV Block2nd degree

  • Wenckebach. Progressive prolongation PR interval until a p-wave is blocked

  • Mobitz Type II: pr-interval constant, evt. shorter after a p-wave block


Atrial ventricular AV Block3d degree

  • No atrial impulses reach the ventricles

  • Possibly lifethreatening if the subsidiary pacing in the ventricles is not sufficiant


Ventricular tachycardia

!! Life threatening !!


PVC:Premature ventricular complexe


Bigeminy


Trigeminy


Multifocal PVC


Ventricular tachycardia


Ventricular flutter

!! Emergency !!


Ventricular fibrillation

!! Emergency !!


Asystoly

!! Emergency !!


CPR Cardio Pulmonary Resuscitation

Newest guidelines


Step 1: check consciousness


Step 2: call for help


ABCD of basic life support


Check and free the upper airway


Hyperextension, lift the chin


Close the nose, hyperextension


2 breaths, deep and slow


Check the circulation: carotis


Automatic External Defibrillation (AED)


No circulation:No AED available

Basic Life Support

  • 15 compressions on the chest

  • 2 breaths

  • Same rhythm, even if 2 reanimators


Check for the lower ribs


Lower third of the sternum


Arms stretched, 4-5 cm impression, rhythm 100/min.


15 compressions / 2 breaths


No circulationAED available

  • In case of fibrillation or ventricular tachycardia connect the patient to the AED , perform analysis

  • Without pulse: defibrillation

  • Repeat ABC

  • No result: restart BLS and defibrillation after 1 minute

  • No fibrillation: BLS


Automatic External Defibrillation (AED)


Automatic External Defibrillation (AED)


Safetyposition after reanimation


THANKS !!


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