Complex ECGs - Interpretation and Management
Advanced ECG Execution, Analysis and Interpretation
Need for program
Despite the rapid advances in investigative cardiology, the 12 lead ECG remains a cornerstone of cardiac assessment. Nurses are increasingly involved in both performing and evaluating ECGs. However, interpretation can be difficult due to the complex nature of the underlying pathology and its manifestation on ECG. Interpretation of such traces requires regular, extra education from specialists in the field.
Aims of Program
This program is especially designed for nurses who already have a solid understanding of the basic principles underlying the 12 lead ECG. It teaches interpretation of complex arrhythmias. It will be ideal for those nurses whose practice requires advanced cardiac knowledge and skills. It will also be relevant to advanced paramedics, and nurses working in rural and remote areas.
At the conclusion of this program it is expected that the participants will be able to:
- Outline the normal electrophysiology of the heart in simple terms
- Determine the cause of complex cardiac arrhythmias and how to identify them on ECG traces
- Examine the impact of electrolyte derangements on cardiac function
- Appraise and consolidate skills in advanced ECG interpretation and differentiation of abnormal cardiac rhythms through case discussion and practice.
8:30am - Registration and Refreshments
Review of Cardiac Electrophysiology
In order to interpret electrocardiograms (ECGs), it is essential that you understand the underlying electrophysiology and conductive mechanisms of the heart and how they impact on the heart's function. This introductory session will set the scene for the two-day program. It will rapidly refresh and review your knowledge of the:
- Conduction system
- Electrophysiology of the heart.
Heart block occurs when the electrical system of the heart is impaired. Importantly, heart block can be caused by a blockage in any part of the electrical conduction system of the heart. This has wide implications for the appearance of an ECG trace. The remainder of the morning sessions will review the heart block in some detail. You will revise the different types of heart block and their underlying pathophysiology. This will enable you to better understand the rationale behind their characteristic presentation and appearance on the ECG trace.
Sinoatrial Nodal Blocks
This interesting session offers an in-depth look at the sinoatrial node or sinus node (also referred to as SA nodal, blocks) and its role in the pathophysiology of heart blocks.
10:30am - Morning Tea and Coffee
Atrioventricular Nodal Blocks
Atrioventricular node (also referred to as AV nodal, blocks).
- First degree heart blocks.
- Second degree heart blocks.
- Third degree heart blocks.
Practice identifying SA nodal blocks and AV nodal blocks on an ECG trace. Clearly understand the distinctive features of these conditions. Describe why they look as they do.
12:30pm - Lunch Break and Networking
Recognising Supraventricular Tachycardia
- Atrial fibrillation.
- Atrial flutter.
- Atrial tachycardia.
- Junctional tachycardia.
- Re-entry tachycardia.
2:45pm - Afternoon Tea and Coffee
Bundle Branch Blocks and Fascicular Blocks
Both these types of heart blocks are conduction abnormalities that can be identified on the ECG. In this session, you will learn about:
- Right bundle branch block
- Left bundle branch block
- Left anterior fascicular block
- Left posterior fascicular block.
Practice identifying right and left bundle branch blocks and right and left fascicular blocks on an ECG trace. Learn how to clearly understand the distinctive features of these conditions.
4:30pm - Close of Day One of Program
9:00am - Commencement of Day Two
Chamber Hypertrophy and Enlargement
An interesting session that looks at the impact of chamber hypertrophy and cardiac enlargement on ECG traces. What happens to the ECG trace when the following parts of the heart are enlarged?
- Left atrium.
- Right atrium.
- Left ventricle.
- Right ventricle.
Practice testing your skills and see if you can figure out when part of the heart is enlarged in the displayed sample of ECG traces.
This syndrome, a heart condition in which there is an extra electrical pathway in the heart, causes unusual traces on an ECG which you need to be aware of. This session will look at this syndrome in some depth and explain why the ECG trace presents in such a manner. It will also show you how to identify this condition on an ECG trace.
- Mechanism of the disease.
- Recognising the condition of an ECG trace.
Practice testing your skills to see if you can identify this syndrome on an ECG trace. Link the pathophysiology to the ECG recording.
11:00am - Morning Tea and Coffee
Supraventricular (SVT) versus Ventricular Tachycardia (VT)
It is important that you can quickly determine whether a person is experiencing SVT or VT. In this session, you will learn to determine, at a glance, whether a person has SVT or VT. What are the causes of SVT and VT and how do these manifest on an ECG trace? What are the major differences in treatment. Practice looking at a range of ECGs and determine which are SVT and which are VT.
1:00pm - Lunch Break and Networking
Unusual ECG Abnormalities
This challenging session will look at some of the aberrant and less common cardiac disorders, that cause ECG traces to be abnormal. In this session you will continue to be challenged and asked to connect underlying cardiac function to ECG traces.
- How does a long-QT syndrome appear on an ECG trace and why does it look like it does?
- Learn about Brugada syndrome.
- Why would pulmonary embolism be evident on an ECG trace?
- How do electrolyte derangements manifest on an ECG trace?
3:00pm - Afternoon Tea and Coffee
Final Practice Session
Can you defend the assumptions you are making about heart health from your interpretation of an ECG? Now is the time to ensure you understand the basics of ECG interpretation. Test how much you have learned from the program and ask any final questions to ensure you have absolute clarity in regard to this important nursing skill.
4:30pm - Close of Program and Evaluations