Foundations of 12 Lead ECG Interpretation

#1 - Fundamentals: Leads, Axis, Principles of Monitoring, What’s Normal

Topics:

I. Leads of the frontal plane

A. Standard, bipolar limb leads
B. Unipolar limb leads
C. Determination of axis

II. Leads of the horizontal plane

A. Two important leads for monitoring (V1 and V5)
B. Bipolar substitutes for V-leads

III. Lead choices for various populations
IV. Rules for monitoring

A. One lead is not enough!
B. Choose lead based on patient, not policy!

Behavioral/Learning Objectives:

1. Recognize a normal 12-lead ECG.
2. Explain how the P wave, QRS complex, and T wave should look in all 12 leads.
3. Determine the electrical axis of the ECG in seconds.
4. Describe the normal precordial pattern and how it is derived.
5. Explain how bipolar substitutes for the V leads are derived, e.g., MCL1, MCL5, CM5, etc., and when they are indicated. Note: This course does not cover EASI electrode placement.

#2 - The Sinus Rhythms

Topics:

I.Normal sinus rhythm

A. ECG characteristics
B. Normal rates for various ages

II. Sinus arrhythmia

A. ECG characteristics
B. Types

1. Respiratory
2. Nonrespiratory

C. Implications of its presence

III. Sinus tachycardia

A. ECG characteristics
B. Etiology and treatment

IV. Sinus bradycardia

A. ECG characteristics
B. Etiology and treatment

V. Sino-atrial blocks

A. ECG characteristics

1. Type 1 second degree SA block
2. Type 2 second degree SA block

B. Differential diagnosis

VI. Sick sinus syndrome

A. ECG characteristics
B. Some treatment options

Behavioral/Learning Objectives:

1. Describe the features of normal sinus rhythm (NSR) for adults and children.
2. Identify the differences of physiologic from pathologic arrhythmias and identify ECG examples and characteristics of each.
3. Identify sinus tachycardia, explain factors to consider in determining clinical significance, and list ten etiologic factors associated with it.
4. Describe sinus bradycardia and compare and contrast its mechanism with sinus tachycardia.
5. Identify SA blocks and describe recognition on the ECG, differentiating from sinus bradycardia.
6. Describe “sick sinus syndrome” and common treatment for it.

#3 - Atrial Rhythm Disturbances and Suprventricular Tachycardias

Topics:

I. Atrial premature beat/contraction (APB or APC or PAC)

A. Types

1. Typical
2. Nonconducted
3. Morphology of P wave
4. P’R interval of the APB

B. Significance
C. ECG characteristics

II. Supraventricular tachycardias

A. Multiform atrial tachycardia
B. Paroxysmal supraventricular tachycardia
C. Atrial tachycardia
D. Atrial flutter
E. Atrial fibrillation

III. Wandering pacemaker
IV. Atrial escape rhythm

Behavioral/Learning Objectives:

1. Explain the clinical significance of each of the atrial arrhythmias and specify which may be found in healthy people and which may be indicative of disease.
2. Describe ECG features of atrial premature beats or contractions (APBs/APCs) and explain the various ways they may be displayed on the ECG.
3. Define paroxysmal supraventricular tachycardia (PSVT), describe possible associated findings, and list two etiologies.
4. Define atrial tachycardia with and without block and differentiate it from other atrial tachycardias, such as PSVT, atrial flutter, etc.
5. Identify and explain the ECG features of atrial flutter, listing three leads that tend to exhibit flutter waves clearly, and anticipate the ventricular rate in both adult and pediatric patients prior to treatment.
6. Identify atrial fibrillation, describe its hemodynamic effects, risk of thrombus formation, and treatment.

#4 - AV Junctional Rhythm Disturbances

Topics:

I. Junctional premature beats

A. ECG characteristics
B. Comparison of APBs and JPBs

II. Junctional tachycardia

A. ECG characteristics
B. Treatment options

III. Junctional escape beats and idiojunctional rhythm

A. ECG characteristics
B. Implications

Behavioral/Learning Objectives:

1. Describe which leads are most helpful in assessing junctional arrhythmias, differentiate junctional from atrial arrhythmias and discuss retrograde atrial depolarization.
2. Identify premature junctional contractions (PJCs) and differentiate from APCs.
3. Describe junctional tachycardia and explain how it is different from atrial tachycardias.

#5 - AV Blocks

Topics:

I. AV blocks
II. First degree AV block
III. Second degree AV block

A. Type I (Wenckebach)
B. Type II

IV. Third degree AV block
V. ECG characteristics of each of the AV blocks

Behavioral/Learning Objectives:

1. Identify first, second (both type I and type II), and third degree AV blocks.
2. Define second degree AV block.
3. Define types I and II second degree AV block.
4. Differentiate between types I and II second degree AV block.
5. Discuss AV dissociation.
6. Define the Wenckebach phenomenon and describe two of its ECG manifestations.

#6 - Ventricular Rhythm Disturbances

Topics:

I. Ventricular premature beat or contraction (VPB or VPC or PVC)

A. ECG characteristics
B. Incidence and implications

II. Ventricular tachycardia (VT)

A. ECG characteristics
B. Incidence and implications

III. Ventricular fibrillation

A. ECG characteristics
B. Treatment

IV. Accelerated idioventricular rhythm

A. ECG characteristics
B. Implications

V. Idioventricular rhythm

A. ECG characteristics
B. Implications

Behavioral/Learning Objectives:

1. Define sudden cardiac death and relate the arrhythmias most often responsible for it and the type of patient most likely to be at higher risk.
2. List five causes of ventricular premature beats (or contractions) (VPBs, VPCs, or PVCs) and describe the ECG features and patterns of occurrence.
3. Recognize ventricular tachycardia and contrast it with supraventricular tachycardia.
4. Differentiate accelerated idioventricular rhythm and ventricular tachycardia, explaining differences in treatment and outcome.
5. Discuss ventricular fibrillation and delineate treatment.
6. Recognize ventricular asystole and discuss treatment options.
   

Accreditation Information

Respiratory Therapists – This course meets the requirements for continuing education for Respiratory Care Professionals in AL, CA, CT, DE, FL, ID, IL, IN, IA, KS, LA, ME, MA, MN, MS, MT, NE, NV, NY, OH, OK, OR, RI, SC, TN, TX, WA, WV, WY.

Because each state’s continuing education requirements for respiratory therapists is subject to change, please verify this information with your state board. Thank you.

Nurses – Academy Medical Systems is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

Academy Medical Systems (AMS) is also a provider approved by the California Board of Registered Nursing, provider #CEP14413.

AMS is also a provider approved by the Florida Board of Nursing, provider #50-19.

Iowa Nurses – The Iowa Board of Nurses will recognize the recorded webinars as a home study program. They recognize our ANCC approved provider status as well as our CA and Fl Board of Nursing provider approval for home study products for nurses in Iowa.

All other states recognize our approved provider status listed in the above text for continuing education credit for nurses.

9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Dietitians - Academy Medical Systems is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR.) Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 9.0 continuing professional education units (CPEUs) for completion of this program/material.

Occupational Therapist - Occupational Therapist will receive 9, continuing education hours for completion this program and a test score of 70% or better. AMS is an approved provider for the AOTA , provider # 5470.  This course is an intermediate education level.

Exercise Physiologist – ACSM recognizes AMS’s approved provider status with the ANCC and will honor our continuing education for Certified Exercise Physiologist recertification purposes.

Certified Cardiovascular Techs – Cardiovascular Credentialing International recognizes our approved provider status with the ANCC for continuing education courses for CCTs.

Certified Athletic Trainers – Academy Medical Systems is recognized by the Board of Certification (BOC) to offer continuing education for certified athletic trainers. 9 hours will be awarded at the completion of this program.

Physical Therapists - PTs and PTAs in the following states will receive 9 contact hours for completion of all 6 courses: AK, AL, AZ, CA, CO, CT, GA (Class 1), HI, IA, ID, IN, KS (Cat 2), KY,  MA, ME, MI, MN (Cat 2), MO, MS, MT, NE, NM, ND, OK (Cat 2), OR, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WI, WY.

We are an approved provider to offer continuing competency courses to CA PTs, approval date 4/5/10.  The following state boards recognize other state’s approval: AL, AZ, GA (Class 1), KY, MO, MS, OK (Cat 2), WI.

The AR Board of Physical Therapy has approved this course for 9 Contact hours.

Because each state’s continuing education requirements for physical therapists is subject to change, please verify this information with your state board. Thank you.

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