Recognizing heartrhythm disturbances in PSG

1. Recognizing heartrhythm disturbances in PSG Ann Ryckx

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

4. P-wave: contraction of the atria • QRS-complex: contraction of the ventricles • T-wave: recovery of the ventricles

5. ECG in PSG • Mostly only 1 channel • Recognition of heartrhythm disturbances • Not a diagnostic tool for other heartpathologies s.a. signs of ischaemia

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

7. 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

8. 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

9. Supraventricular tachycardia = paroxysmal atrial tachycardia

10. AF: Atrial fibrillation

11. 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.

12. Atrial extra systoly = premature beat

13. 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

14. Atrial ventricular BlockAV Block

15. Prolonged pr-interval (>200 msec) Atrial ventricular AV Block 1st degree

16. 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

17. Atrial ventricular AV Block3d degree • No atrial impulses reach the ventricles • Possibly lifethreatening if the subsidiary pacing in the ventricles is not sufficiant

18. Ventricular tachycardia !! Life threatening !!

19. PVC:Premature ventricular complexe

20. Bigeminy

21. Trigeminy

22. Multifocal PVC

23. Ventricular tachycardia

24. Ventricular flutter !! Emergency !!

25. Ventricular fibrillation !! Emergency !!

26. Asystoly !! Emergency !!

27. CPR Cardio Pulmonary Resuscitation Newest guidelines

28. Step 1: check consciousness

29. Step 2: call for help

30. ABCD of basic life support

31. Check and free the upper airway

32. Hyperextension, lift the chin

33. Close the nose, hyperextension

34. 2 breaths, deep and slow

35. Check the circulation: carotis

36. Automatic External Defibrillation (AED)

37. No circulation:No AED available Basic Life Support • 15 compressions on the chest • 2 breaths • Same rhythm, even if 2 reanimators

38. Check for the lower ribs

39. Lower third of the sternum

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

41. 15 compressions / 2 breaths

42. 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

43. Automatic External Defibrillation (AED)

44. Automatic External Defibrillation (AED)

45. Safetyposition after reanimation

46. THANKS !!