Arrhythmia

Recognizing heartrhythm disturbances in PSG

Ann Ryckx

Arrhyhtmia-CPR

Arrhyhtmia-CPR

Arrhythmias

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

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P-wave: contraction of the atria

QRS-complex: contraction of the ventricles

T-wave: recovery of the ventricles

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ECG in PSG

Mostly only 1 channelRecognition of heartrhythm

disturbances Not a diagnostic tool for other

heartpathologies s.a. signs of ischaemia

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Tachy-arrhythmia (too fast: > 100 bpm)

Brady-arrhyhthmia(too slow: < 60 bpm)

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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

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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

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Supraventricular tachycardia = paroxysmal atrial tachycardia

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AF: Atrial fibrillation

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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.

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Atrial extra systoly = premature beat

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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

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Atrial ventricular BlockAV Block

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Atrial ventricular AV Block 1st degree

Prolonged pr-interval

(>200 msec)

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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

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Atrial ventricular AV Block3d degree

No atrial impulses reach the ventricles

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

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Ventricular tachycardia

!! Life threatening !!

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PVC: Premature ventricular complexe

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Bigeminy

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Trigeminy

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Multifocal PVC

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Ventricular tachycardia

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Ventricular flutter

!! Emergency !!

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Ventricular fibrillation

!! Emergency !!

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Asystoly

!! Emergency !!

Arrhythmia

CPR Cardio Pulmonary

Resuscitation

Newest guidelines

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Step 1: check consciousness

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Step 2: call for help

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ABCD of basic life support

A Airways

B Breathing

CCheck circulation

D Defibrillation

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Check and free the upper airway

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Hyperextension, lift the chin

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Close the nose, hyperextension

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2 breaths, deep and slow

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Check the circulation: carotis

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Automatic External Defibrillation (AED)

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No circulation:No AED available

Basic Life Support

15 compressions on the chest2 breathsSame rhythm, even if 2 reanimators

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Check for the lower ribs

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Lower third of the sternum

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

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15 compressions / 2 breaths

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No circulationAED available

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

Without pulse: defibrillationRepeat ABCNo result: restart BLS and defibrillation after 1

minute No fibrillation: BLS

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Automatic External Defibrillation (AED)

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Automatic External Defibrillation (AED)

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Safetyposition after reanimation

Arrhythmia

THANKS !!