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Recognizing heartrhythm
disturbances in PSG
Ann Ryckx
Arrhythmia
Arrhyhtmia-CPR
Arrhythmias
Any change in the normal
sequence of the electrical
impulses from the sinus node
(SA) to the ventricles can cause
arrhythmia
Arrhyhtmia-CPR
P-wave:
contraction of
the atria
QRS-complex:
contraction of
the ventricles
T-wave:
recovery of the
ventricles
Arrhyhtmia-CPR
ECG in PSG
Mostly
only 1 channel
Recognition of heartrhythm
disturbances
Not a diagnostic tool for other
heartpathologies s.a. signs of
ischaemia
Arrhyhtmia-CPR
Tachy-arrhythmia
(too fast: > 100 bpm)
Brady-arrhyhthmia
(too slow: < 60 bpm)
Arrhyhtmia-CPR
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
Arrhyhtmia-CPR
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
Arrhyhtmia-CPR
Supraventricular tachycardia =
paroxysmal atrial tachycardia
Arrhyhtmia-CPR
AF: Atrial fibrillation
Arrhyhtmia-CPR
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.
Arrhyhtmia-CPR
Atrial extra systoly =
premature beat
Arrhyhtmia-CPR
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
Arrhyhtmia-CPR
Atrial ventricular Block
AV Block
Arrhyhtmia-CPR
Atrial ventricular AV Block
st
1 degree
Prolonged pr-interval
(>200 msec)
Arrhyhtmia-CPR
Atrial ventricular AV Block
nd
2 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
Arrhyhtmia-CPR
Atrial ventricular AV Block
d
3 degree
 No
atrial impulses reach the ventricles
 Possibly
lifethreatening if the subsidiary
pacing in the ventricles is not sufficiant
Arrhyhtmia-CPR
Ventricular tachycardia
!! Life threatening !!
Arrhyhtmia-CPR
PVC: Premature ventricular
complexe
Arrhyhtmia-CPR
Bigeminy
Arrhyhtmia-CPR
Trigeminy
Arrhyhtmia-CPR
Multifocal PVC
Arrhyhtmia-CPR
Ventricular tachycardia
Arrhyhtmia-CPR
Ventricular flutter
!! Emergency !!
Arrhyhtmia-CPR
Ventricular fibrillation
!! Emergency !!
Arrhyhtmia-CPR
Asystoly
!! Emergency !!
Arrhyhtmia-CPR
CPR
Cardio Pulmonary
Resuscitation
Newest guidelines
Arrhythmia
Step 1:
check consciousness
Arrhyhtmia-CPR
Step 2: call for help
Arrhyhtmia-CPR
ABCD of basic life support
A
Airways
B
Breathing
C
Check
circulation
D
Defibrillation
Arrhyhtmia-CPR
Check and free the upper
airway
Arrhyhtmia-CPR
Hyperextension, lift the chin
Arrhyhtmia-CPR
Close the nose,
hyperextension
Arrhyhtmia-CPR
2 breaths, deep and slow
Arrhyhtmia-CPR
Check the circulation:
carotis
Arrhyhtmia-CPR
Automatic External
Defibrillation (AED)
Arrhyhtmia-CPR
No circulation:
No AED available
Basic Life Support
15
compressions on the chest
2 breaths
Same rhythm, even if 2 reanimators
Arrhyhtmia-CPR
Check for the lower ribs
Arrhyhtmia-CPR
Lower third of the sternum
Arrhyhtmia-CPR
Arms stretched, 4-5 cm
impression, rhythm 100/min.
Arrhyhtmia-CPR
15 compressions / 2 breaths
Arrhyhtmia-CPR
No circulation
AED 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
Arrhyhtmia-CPR
Automatic External
Defibrillation (AED)
Arrhyhtmia-CPR
Automatic External
Defibrillation (AED)
Arrhyhtmia-CPR
Safetyposition after
reanimation
Arrhyhtmia-CPR
THANKS !!
Arrhythmia