ECG Boot Camp

#1 - Cardiac Anatomy, Physiology, and Electrophysiology

Class Description:

The first step in reading an ECG is understanding how the ECG is generated and what it represents in the heart. While you have studied much of this in your basic health care education, this class will reiterate what you have already learned, adding to it and stressing additional factors that relate to the ECG. This is the foundation for everything that follows in this six-hour course.

Topics:

I. Gross cardiac anatomy

A. Atria
B. Ventricles
C. Vessels
D. Normal circulation through the heart
E. Coronary arteries

II. Conduction system
III. Electrophysiology terms
IV. Components of the electrocardiogram

A. P wave
B. PR interval
C. QRS complex
D. ST segment
E. T wave
F. U wave

V. ECG paper, measurements, settings, voltage
VI. Determining rate on the ECG
VII. Rules for interpreting cardiac rhythms

A. Rate
B. Rhythm
C. P waves
D. PR interval
E. QRS complex

Behavioral/Learning Objectives:

1. Describe the sequence of circulation through the heart and the supply of blood to the heart through the coronary arteries.
2. List structures of the conduction system, explain the sequence of normal cardiac activation, and describe the resultant wave forms produced on the ECG.
3. Define the electrophysiologic terms depolarization, repolarization, refractory period, and conduction.
4. Define time and voltage values on the ECG and compute heart rate and rhythm.
5. Explain the derivation of the P-wave, QRS complex, PR interval, PR segment, ST segment, T-wave, and U-wave and define the normal durations and amplitudes of each.
6. Explain the QRS descriptors.
   

#2 - Absolute Necessities: Leads, Axis, Principles of Monitoring, What’s Normal

Class Description:

To determine what’s abnormal in a 12-lead ECG, it is imperative to know what is normal and be able to make that determination quickly. Determining the QRS axis on the frontal plane, if the T wave and ST segments are directed normally, and thoroughly understanding leads and how to manipulate them are skills fundamental to rapid 12-lead ECG interpretation. Often not taught in arrhythmia interpretation courses, this information is basic and necessary to understand the remaining sessions in this series.

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

III. Lead choices for various populations
IV. Other leads (posterior, right ventricular, etc.)
V. Rules for monitoring

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

Behavioral/Learning Objectives:

1. Identify a normal 12-lead ECG.
2. Explain how the P wave, QRS complex, and T wave should look in all 12 leads.
3. Identify 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.
6. List advantages of using V1 and V5 for monitoring in cardiac rehabilitation.
   

#3 - Absolute Necessities: The Sinus Rhythms

Class Description:

The sinus rhythms differ from other anatomic classifications, such as atrial, junctional, and ventricular arrhythmias, mainly because not all are pathologic. Some are known as physiologic rhythms or variations of normal sinus rhythm and are found in healthy people. While it is important to recognize the variations, it is equally important to remember that these rhythms are not necessarily prognostically significant.

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. Differentiate 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. Define sinus bradycardia and compare and contrast its mechanism with sinus tachycardia.
5. Define SA blocks and discuss recognition on the ECG, differentiating from sinus bradycardia.
6. Describe “sick sinus syndrome” and common treatment for it.
   

#4 - Absolute Necessities: Atrial Rhythm Disturbances and Supraventricular Tachycardias

Class Description:

The atrial arrhythmias and supraventricular tachycardias are rhythm disturbances that will be encountered often in electrocardiograms of all age groups. It is essential that the clinician is able to quickly differentiate supraventricular rhythms from ventricular, diagnose atrial arrhythmias, and be able to distinguish significant atrial rhythm disturbances from normal variations.

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.
   

#5 - Necessities: AV Junctional Rhythm Disturbances and AV Blocks

Class Description:

The atrioventricular (AV) junction includes the AV node and the bundle of His. The junctional tissue contains cells capable of automaticity. The junction is also capable of slowing and blocking impulses from traveling from the atria to the ventricles. Thus, this class will discuss the AV blocks as well as the junctional arrhythmias.

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

IV. AV blocks

A. First degree
B. Second degree

1. Type I
2. Type II

C. Third degree
D. ECG characteristics of each of the AV blocks
E. Treatment options

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. Define junctional tachycardia and explain how it is different from atrial tachycardias.
4. Identify first, second (both type I and type II), and third degree AV blocks.
5. Describe AV dissociation.
6. Define the Wenckebach phenomenon and describe two of its ECG manifestations.

#6 - Absolute Necessities: Ventricular Rhythm Disturbances

Class Description:

The ventricular arrhythmias are the most important of the cardiac rhythm disturbances because the ventricles are responsible for pumping blood to the body. If faulty ventricular depolarization results in little or no ventricular pumping, the result may be lethal. Yet, as will be seen in this class, ventricular arrhythmias are ubiquitous and may be benign or malignant. The trick is distinguishing lethal or potentially lethal from benign ventricular arrhythmias.

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. Describe ventricular fibrillation and delineate treatment.
6. Identify ventricular asystole and discuss treatment options.

Accreditation Information

Nurses – Academy Medical Systems is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 9.0 contact hours will be rewarded to nursing professionals at the completion of this workshop.

Academy medical Systems is also a provider approved by the California Board of Registered Nursing, provider #CEP14413, for 9.0 hours. And we are also a provider approved by the Florida Board of Nursing, provider #50-19, for 9.0 hours.

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.

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.

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 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 in the following states will receive 9 contact hours for completion of all 6 webinars: AK, CO, CT, HI, IA, ID, IN, KS (Cat 2), MA, ME, MI, MN (Cat 2), MT, NE, NM, ND, OR, PA, RI, SC, SD, UT, VA (Type 2), VT, VI, WA, WY.

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

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.

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