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


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


  • 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



Multifocal PVC

Ventricular tachycardia

Ventricular flutter

!! Emergency !!

Ventricular fibrillation

!! Emergency !!


!! 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


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