Advanced EKG Refresher Course (CET)

Foundation of the EKG

• Basic anatomy and physiology of the heart
• Cardiac electrophysiology
• Automaticity, contractility, conductivity
• The Action Potential: Depolarization and Repolarization

 

Components of the EKG

• EKG basics – waves, intervals, segments
• Reading the EKG
• Measurements
• Calculation of heart rate
• Leads
• Performing an EKG
• Cardiac monitors
• Normal EKG
• Interpret EKG
• Limitations and Uses of the EKG

Recognition of Sinus Rhythms

• Normal Sinus Rhythm
• Normal Sinus P Wave
• Normal Sinus QRS Complex in Chest Leads
• Normal Sinus QRS Complex in Limb Leads
• Normal Sinus ST Segment
• Normal Sinus T Wave

 

Sinus Node Arrhythmias

• Normal Sinus Rhythm
• Sinus Bradycardia
• Sinus Tachycardia
• Sinus Arrhythmia
• Escape Patterns
• Sick Sinus Syndrome

 

Cardiac and Pulmonary Syndromes

• Cardiac Enlargement
• Acute Pericarditis
• Pericardial Effusion
• Chronic Constrictive Pericarditis
• Myocarditis
• Congestive Heart Failure
• Pulmonary Embolism
• Chronic Obstructive Pulmonary Disease

Bundle Branch Blocks

• Right Bundle Branch Block (RBBB)
• Left Bundle Branch Block (LBBB)
• Fascicular Blocks

 

Myocardial Injury, Ischemia, and Infarction

• Myocardial Injury
• Myocardial Ischemia
• Myocardial Blood Supply
• Acute Coronary Syndrome (ACS)
• STEMI and Acute Myocardial Infarction
• Q Waves of Infarction
• Localization of Infarction
• Anterior Wall Q Waves
• Inferior Wall Infarctions
• Posterior Infarctions
• Right Ventricular Infarctions
• Q Waves: Normal or Abnormal
• Ventricular Aneurysm
• Silent Myocardial Infarctions
• Subendocardial Ischemia
• Angina pectoris (Stable Angina)
• Stress Testing and Coronary Artery Disease
• Silent Myocardial Ischemia
• NSTEMI “Subendocardial Infarction”
• Unstable Angina
• Noninfarction Ischemia
• Prinzmetal’s (Variant) Angina
• Early Repolarization

Atrial Arrhythmias

• Wolff-Parkinson-White (WPW) Syndrome
• WPW Treatment
• Premature Atrial Contraction (PAC)
• Paroxysmal Atrial Tachycardia (PAT)
• AV Nodal Reentrant Tachycardia (AVNRT)
• AV Reentrant Tachycardia (AVRT)
• Management of Acute PAT
• Long-Term Management of PAT
• Atrial Flutter
• Atrial Fibrillation
• Differentiation of Atrial Flutter and Atrial Fibrillation
• Clinical Implications for Atrial Flutter and Atrial Fibrillation
• Treatment of Atrial Flutter and Atrial Fibrillation

 

Ventricular Arrhythmias

• Premature Ventricular Contraction (PVC)
• Ventricular Tachycardia (VT)
• Torsade des Pointes (TdP)
• Accelerated Idioventricular Rhythm (AIVR)
• Ventricular Fibrillation (VF)
• Cardiac Arrest
• Clinical Causes of Cardiac Arrest
• Sudden Cardiac Death

AV Conduction Abnormalities

• Degrees of Heart Block
• First Degree AV Block: PR Interval Prolongation
• Second Degree AV Block Syndromes
• Third Degree (Complete) AV Block
• Location of the Block
• Onset and Progression of Block
• 2:1 AV Block
• Atrial Fibrillation or Flutter with AV Heart Block
• Symptoms of Heart Block
• Treatment
• AV Heart Block in Acute MI
• AV Dissociation Syndromes

Medication Effects, Electrolyte Imbalances, and Metabolic Factors

• Medications Used to Treat Arrhythmias
• Psychotropic Medications
• Digitalis Toxicity
• Electrolyte Disturbances
• Additional Metabolic Factors
• ST-T Segment Repolarization Changes

Pacemakers and Implantable Cardioverter Defibrillators (ICD)

• Pacemakers
• Implantable Cardioverter Defibrillators (ICD)
• Pacemaker and ICD Malfunction
• Indications for a Pacemaker or ICD

An Approach to EKG Interpretation

• Thirteen Specific EKG Features to Analyze
• The EKG Report
• Examples of EKG Interpretation Documentation

 

Cardiac Stress Tests

• What Causes Chest Pain?
• Exercise Stress Test
  • Risks
  • Before the Test
  • Placing the ECG leads
  • Beginning the Stress Test
  • After the Stress Test

 

Nuclear & Echo Stress Tests

• Before the Test
• Placing the ECG leads
  • Limb Lead Placement for ECG
    • During the Test
    • After the Test
  • Stress Echocardiogram
    • Before the Test
    • During the Test
    • After the Test

 

Holter Monitors

• History
• Modern Holter Monitors
• Heart Conditions Detected via Holter Monitor
  • Atrial Fibrillation (A-Fib):
  • Bradycardia:
  • Tachycardia:
  • Supraventricular Tachycardia (SVT):
  • Premature Ventricular Contractions (PVCs):
  • Premature Atrial Contractions (PACs):
  • Non-sustained Ventricular Tachycardia (NSVT):
• Placing the Holter Monitor