The Society for Cardiological Science and Technology

PROFICIENCY IN ELECTROCARDIOGRAPHY

2000

The award of the Certificate in Electrocardiography is made by the Society to candidates who satisfy the examiners on their clinical competence to record safely and accurately a 12-lead resting electrocardiogram, and on their understanding of the features which distinguish an abnormal from a normal electrocardiogram.

The syllabus leading to the award of the Certificate is designed to encourage accurate and efficient recording of the 12-lead resting electrocardiogram in accordance with safe and responsible working practices.

The syllabus prescribes the following areas of supporting knowledge and understanding expected of the successful candidate:

a) Medical and technical terminology applicable to the subject area.

b) Essential anatomy and physiology of the heart and circulation as relevant to electrocardiography.

c) The work and responsibilities of a support worker in cardiology.

d) Problems encountered in the recording of a 12-lead resting electrocardiogram and their solutions.

e) Features of the normal 12-lead resting electrocardiogram and the recognition of some common abnormalities.

The syllabus is in three sections

1) Anatomy and physiology of the heart and circulation.

2) Electrocardiography.

3) Interpretation of the electrocardiogram in health and disease.

 

1. 0 ELECTROCARDIOGRAPHY:

1. 1 INSTRUMENTATION:

Knows the basic principles of physics and instrumentation needed for the effective and safe practice of electrocardiography.

1.1.1 Basic Physics and instrumentation

Understands basic electricity principles.

· Basic electricity.

· Fuses as safety components, correct fusing of equipment.

· Alternating current

· International U.K. and EU. mains supply standards.

· Use of colour-coded mains cables and their correct connections in mains plugs for equipment.

· Continuity testers.
1.1.2 The Electrocardiograph Specification of the Electrocardiograph in relation to recognised standards

· Understands the function of the components of the E.C.G.machine.
1.1.3. Understands maintenance of equipment: Care and routine maintenance of recorders in respect of:

· Writing method, paper charts.

· Battery maintenance.

· Lead continuity and electrode connections
1.1.4 Understands electrodes and electrolyte:

· Use of electrolyte between the skin and the electrode.

· Type of electrodes and their use.

· Care of electrodes.

· Electrode positions.
1.1.5.Understands lead systems:

· Unipolar and bipolar leads.

· Einthoven's theory and it's application.

· Goldberger leads.

  • Wilson's central terminal.

 

1.2 PRACTICAL ELECTROCARDIOGRAPHY:

Is able to record the electrocardiogram accurately from all types of patient.

1.2.1. Preparation:

· Routine maintenance and measurements for checking

specification (A.H.A.) calibration and accurate performance of the electrocardiograph (sensitivity and paper speed).

· Choice of appropriate leads for a particular patient category.

· Selection and assembly of equipment.

· Setting of controls as appropriate for the specific recording to be undertaken.

· Preparation of electrode sites to give optimum electrode contact and to minimise artefacts.

· Connection of electrodes to patient.
1.2.2. Recording and follow-up:

· Recording of a resting electrocardiogram from patients of all ages using both manual and automatic mode.

· Recording of the resting electrocardiogram from a patient who:

· Is unconscious,

· Has language or communication difficulty,

· Is infectious or is in isolation,

· Has a physical disability (including amputation),

· Is visually impaired,

· Evaluation of the recording to assess the need for re-recording,

· Re-recording as appropriate,

· Recognition and elimination or reduction of artefacts,

· Labelling of completed recordings as appropriate for specific recording.

· Cleaning, preparation and storage of equipment ready for subsequent recordings as appropriate for the specific recordings (correct sterilisation and disposal procedures where appropriate).

 
1.2.3. Electrode positions:

· Correct application and positioning of limb and precordial electrodes, in accordance with the Society for Cardiological Science and Technology guidelines.

 

1.3 ELECTROCARDIOGRAPHIC INTERPRETATION:

Recognises the features of the electrocardiogram and makes appropriate measurements.

1.3.1 . Wave forms and measurements of the normal electrocardiogram:

· Relationship of the electrocardiogram to the electrical events of the heart.

· Relationship of the electrical events to the mechanical events of the cardiac cycle.

· Wave forms, intervals, shapes and normal ranges.

· The appearance of the normal resting electrocardiogram
1.3.2 Recognises the normal variations of the electrocardiogram. Recognises the normal variations of the electrocardiogram

related to:

· Age.

· State of activity.

· Body build.

· Ethnic origin.

  • Heart rate.

1.4 The normal Electrocardiogram and common abnormalities:

Recognises and interprets normal and abnormal electrocardiograms from variations of rhythms in the heart.

1.4.1 Rhythms arising from the sinus node:

Rhythms arising from the sinus node:

· Normal sinus rhythm.

· Sinus arrhythmia.

· Sinus tachycardia.

· Sinus bradycardia.
1.4.2 Rhythms arising from the atria:

Rhythms arising from the atria:

· Atrial premature contractions (ectopics).

· Atrial tachycardia.

· Atrial flutter.

· Atrial fibrillation.
1.4.3. Rhythms arising from the atrio-ventricular node and junction

Rhythms arising from the atrio-ventricular node and junction

· Pre-excitation syndrome.(e.g.Wolff-Parkinson White only).

Atno-ventricular block:

· First degree.

· Second degree Mobitz I. (Wenchebach).

· Second degree Mobitz 11.

  • Third degree (complete heart block).
1.4.4. Rhythms arising from the ventricles:

Rhythms arising from the ventricles:

· Ventricular escape beats.

· Ventricular premature escape beats (ectopics).

· Ventricular bigeminy, trigeminy, quadrigeminy, couplets, triplets.

· Unifocal, bifocal, and multifocal ectopic beats.

· Ventricular tachycardia.

· Ventricular flutter.

· Ventricular fibrillation.

· Ventricular arrest (standstill).
1.4.5. The Electrocardiogram associated with an artificial cardiac pacemaker.

The Electrocardiogram associated with an artificial cardiac pacemaker.

· Correctly identifies a pacemaker spike on the Electrocardiogram.
1.4.6 Interprets changes in the

Electrocardiogram arising from

Morphological abnormalities in the heart.

 Interpretation of morphological electrocardiographic changes in bundle branch block:

· Right and Left bundle branch block.

Interpretation of electrocardiographic changes in ischaemic heart disease and myocardial infarction.

· Electrocardiographic changes associated with ischaemia and acute myocardial infarction

2.0 ANATOMY, PHYSIOLOGY AND CONTROL OF THE CARDIOVASCULAR SYSTEM:

2.1 Knows the structure and function of the heart, the anatomy of the blood vessels and the role of the vessel types in the circulatory system.

Is familiar with the circulation before birth and how it relates to that of an adult.

2.1.1. General structure and function of the heart: · Basic anatomy of the heart.
2.1.2. Conduction system of the heart. · Simple anatomy and function of the specialised conduction system.

2.2. Pathology of the Cardiovascular System:

Knows common pathological terms used in a cardiac department, and where applicable the relationship to changes found in the electrocardiogram.

The learner is expected to know only the briefest outline of the pathological terminology in this section.

2.2.1 Knows common pathological terms used in a cardiac department and where applicable the relationship to changes found in the electrocardiogram. Knows the meaning of:

· Arteriosclerosis. Atherosclerosis, atheroma, ischaemia.

· Angina pectoris, tissue injury, infarction ,necrosis,fibrosis.

· Unstable and Prinzmetal's angina.

· Cardiogenic shock.

· Hypertension.

· Atrial and ventricular septal defects.

· Cyanosis.

· Coarctation of the aorta.

· Oedema.

· Valve disorders : mitral and aortic. Cardiac failure and its causes.