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Recognizing heartrhythm disturbances in PSG

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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  1. Recognizing heartrhythm disturbances in PSG Ann Ryckx

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

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

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

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

  6. 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

  7. 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

  8. Supraventricular tachycardia = paroxysmal atrial tachycardia

  9. AF: Atrial fibrillation

  10. 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.

  11. Atrial extra systoly = premature beat

  12. 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

  13. Atrial ventricular BlockAV Block

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

  15. 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

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

  17. Ventricular tachycardia !! Life threatening !!

  18. PVC:Premature ventricular complexe

  19. Bigeminy

  20. Trigeminy

  21. Multifocal PVC

  22. Ventricular tachycardia

  23. Ventricular flutter !! Emergency !!

  24. Ventricular fibrillation !! Emergency !!

  25. Asystoly !! Emergency !!

  26. CPR Cardio Pulmonary Resuscitation Newest guidelines

  27. Step 1: check consciousness

  28. Step 2: call for help

  29. ABCD of basic life support

  30. Check and free the upper airway

  31. Hyperextension, lift the chin

  32. Close the nose, hyperextension

  33. 2 breaths, deep and slow

  34. Check the circulation: carotis

  35. Automatic External Defibrillation (AED)

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

  37. Check for the lower ribs

  38. Lower third of the sternum

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

  40. 15 compressions / 2 breaths

  41. 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

  42. Automatic External Defibrillation (AED)

  43. Automatic External Defibrillation (AED)

  44. Safetyposition after reanimation

  45. THANKS !!

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