Harry T Harper Jr., M.D. School of Cardiac and Vascular Technology
A Program of University Hospital’s Georgia Heart Institute
CVT 103 - ELECTROPHYSIOLOGY I
Fall 2004
Date
Sept 28 (tue)
Unit
I
Sept 30 (thu)
Oct 5 (tue)
Oct 7 (thu)
2
Topic
Course Description
A& P
Reading
Handout
Chapter 1
Quiz
A&P
Chapter 1
A&P
Chapter 1
The Electrocardiogram
Components of the
Electrocardiogram
Chap 2
Chap 3
Oct 12 (tue)
TEST 1 (A & P)
Oct 19 (tue)
Components of the
Electrocardiogram
Oct 26 (tue)
TEST 2 (Chapters 1 & 2)
Oct 28 (thu)
ECG Interpretation
Nov 1 (mon)
MIDTERM
Nov 2 (tue)
TEST 3 (Chapters A & P, 1, 2 & 3 & 4
Comprehensive Midterm )
Nov 4 (thu)
3
Chap 3
Chap 4
Sinus Node Arrhythmias
Atrial Arrhythmias
Chap 5
Chap 6
Nov 9 (tue)
Junctional Arrhythmias
AV Blocks
Chap 7
Chap 9
Nov 11 (thu)
Holiday
Nov 16 (tue)
Quiz
Ventricular Arrhythmias
4
Nov 18 (thu)
TEST 4 (Chapters 5,6,& 7)
Nov 22-26
Holiday
Nov 30
Study Lab
Dec 2 (thu)
TEST 5 (Chapters 8 & 9)
Dec 16 (tue)
FINAL EXAM (Comprehensive)
Revised 9/27/04
Chap 8
Harry T Harper Jr., M.D. School of Cardiac and Vascular Technology
A Program of University Hospital’s Georgia Heart Institute
CVT 103 - ELECTROPHYSIOLOGY I
COURSE SYLLABUS
Credit:
3
Instructor:
Class Time:
Lecture 2 hours/week
Lab
2 hours/week
Course Description:
Introduces the field of cardiovascular technology, basic
cardiac anatomy, physiology and electrophysiology.
Introduces the concepts essential in the interpretation and
management of cardiac arrhythmias. Laboratory experiences
are provided. Professionlism and Work Ethics will be
evaluated.
Assignment Schedule:
A schedule indicating class dates, lectures, units tests and
final exam is provided to each student.
Course Competencies:
1.
Identify parts of the thoracic cage.
a.
b.
c.
d.
e.
2.
Sternum
Ribs
Mediastinum
Pleura
Pericardial sac
Identify the major components of the
cardio-vascular system.
a.
b.
c.
d.
e.
f.
g.
Revised 9/27/04
Thomas
Great vessels
Layers of the heart wall
Cardiac chambers
Cardiac valves
Structure of coronary vessels
Coronary anatomy
All arteries and veins of the body
3.
Describe basic cardiac hemodynamics.
4.
Identify the major components of the vascular
system.
5.
Describe basic cardiac physiology.
6.
Describe the conduction system.
Textbooks:
1.
2.
3.
4.
5.
7.
Describe the circulatory system.
8.
Apply the five step method in analyzing and
identifying the following arrhythmias.
a.
Normal sinus rhythm
b.
Sinus bradycardia
c.
Sinus tachycardia
d.
Sinus arrhythmia
e.
Sinus arrest
f.
Atrial escape beats
g.
Wandering atrial pacemaker
h.
Premature atrial contractions
i.
Atrial tachycardia
j.
Atrial flutter
k.
Atrial fibrillation
l.
Junctional escape beat/rhythm
m.
Premature junctional contraction
n.
Accelerated junctional rhythm
o.
Junctional tachycardia
p.
Junctional bradycardia
q.
First degree AV block
r.
Second degree type I AV block
s.
Second degree type II AV block
t.
Third degree AV block
u.
Ventricular escape beats
v.
Idioventricular rhythm
w.
Premature ventricular contractions
x.
Ventricular tachycardia
y.
Ventricular fibrillation
z.
Atrial and ventricular pacemaker rhythm
Robert J. Huszar, Basic Dystryhymias - Interpretation and
Management, third Edition, 2002
Netter H. Frank, The Ciba Collection, Volume 5
Tabers Medical Dictionary
Marieb N. Elaine, Human Anatomy & Physiology –
(optional)
Class Policy
Course Instructor:
Patricia L. Thomas, MBA, RCIS, BSRT
Tools and Supplies:
Calipers and ECG workbook.
Grading Procedure:
Revised 9/27/04
Unit tests
Midterm
Quiz/Homework
Final exam
Work Ethics
Total
30%
20%
10%
20%
20%
100%
Work Ethics Grades:
Evaluation Form
Course Requirements:
Complete all tests and performances with a 70% average.
NOTE:
If there is a student in this class who needs a testing or classroom
accommodation due to a disability, please feel free to come to my
office and discuss this with me.
Revised 9/27/04
Harry T Harper Jr., M.D. School of Cardiac and Vascular Technology
A Program of University Hospital’s Georgia Heart Institute
CVT 103 - ELECTROPHYSIOLOGY I
COURSE OUTLINE
UNIT 1
ORIENTATION, CHAPTER 1 - ANATOMY AND PHYSIOLOGY
OF THE HEART AND VESSELS OF THE BODY
UNIT 2
CHAPTER 2 - THE ELECTROCARDIOGRAM
CHAPTER 3 - COMPONENTS OF THE ELECTROCARDIOGRAM
CHAPTER 4 - ECG INTERPRETATION
UNIT 3
CHAPTER 5 - SINUS NODE ARRHYTHMIAS
CHAPTER 6 - ATRIAL ARRHYTHMIAS
CHAPTER 7 - JUNCTIONAL ARRHYTHMIAS
UNIT 4
CHAPTER 8 - VENTRICULAR ARRHYTHMIAS
CHAPTER 9 - AV BLOCKS
Revised 9/27/04
CVT 103 - ELECTROPHYSIOLOGY I
UNIT 1 OBJECTIVES
ANATOMY AND PHYSIOLOGY OF THE HEART
Upon completion of this unit of study, you should be able to complete the objectives using
instructional materials and obtain a grade of 70% on a criterion referenced evaluation.
1.
Describe the thoracic cavity and some of its anatomical features.
2.
Discuss the four components of the thorax.
3.
Name and identify the following anatomical features of the heart on an
anatomical drawing:
a.
b.
c.
d.
The four chambers of the heart
The two main septa of the heart
The three layers of the ventricular walls
The base and apex of the heart
4.
Name and identify the layers of the pericardium and it major space or cavity.
5.
Define the right heart and left heart and the primary function of each with respect to the
pulmonary and systemic circulations.
6.
Name and locate on an anatomical drawing the following major structures of the
circulatory system: the veins and arteries of the body the aorta, the pulmonary artery, the
superior and inferior vena cava, the coronary sinus, the pulmonary veins, and the four
valves.
7.
Define (a) atrial systole and diastole and (b) ventricular systole and diastole.
8.
Name and identify the parts of the electrical conduction system of the heart.
9.
Name the two basic kinds of cardiac cells and give their functions.
10.
Name and define the four properties of cardiac cells.
11.
Describe a resting, polarized cardiac cell and a depolarized cardiac cell.
12.
Define the following:
a.
b.
c.
Revised 9/27/04
Depolarization process
Repolarization process
Threshold potential
13.
Name and locate on a schematic of a cardiac action potential the five phases of
a cardiac potential.
14.
Define and locate on an ECG the following:
a.
b.
c.
d.
Absolute refractory period
Relative refractory period
Vulnerable period of repolarization
Supernormal period
15.
Explain the rationale behind the property of automaticity (spontaneous
depolarization) and how the slope of phase 4 depolarization relates to the rate of impulse
formation.
16.
Define (a) dominant and latent pacemaker cells and (b) nonpacemaker cells.
17.
Define and locate the primary, escape, and ectopic pacemakers of the heart.
18.
Define inherent firing rate and give the inherent firing rates of the following:
a.
b.
c.
SA node
AV junction
Ventricles
19.
Give three conditions under which an escape pacemaker may assume the role of
pacemaker of the heart.
20.
List and define the three basic mechanisms that are responsible for ectopic beats and
rhythms.
21.
Describe the part of the autonomic nervous system controlling the heart.
22.
List the effects on the heart produced by the stimulation of the sympathetic and
parasympathetic nervous system.
CVT 103 - ELECTROPHYSIOLOGY I
UNIT 2 OBJECTIVES
THE ELECTROCARDIOGRAM
COMPONENTS OF THE ELECTROCARDIOGRAM
ECG INTERPRETATION
Upon completion of this unit of study, you should be able to complete the objectives using
instructional materials and obtain a grade of 70% on a criterion referenced evaluation.
Revised 9/27/04
1.
Explain what the electrocardiogram (ECG) represents.
2.
Name and identify the components of the ECG, including the waves, complexes,
segments, and intervals on an ECG.
3.
List at least four causes of artifacts in the ECG.
4.
Identify the measurements of time and distance as represented by the dark and light
vertical and horizontal lines on the ECG grid.
5.
Define the following components of the electrocardiogram:
a.
b.
c.
d.
e.
6.
QT interval
R-R interval
ST segment
PR segment
TP segment
Normal P wave
Abnormal P wave
Ectopic P wave
Normal QRS complex
e.
f.
g.
h.
i.
Abnormal QRS complex
Normal T wave
Abnormal T wave
Abnormal T wave
U wave
Give the characteristics, description, and significance of the following intervals and
segments:
a.
b.
c.
d.
8.
f.
g.
h.
i.
j.
Give the characteristics, description, and significance of the following waves and
complexes:
a.
b.
c.
d.
7.
P wave
QRS complex
T wave
U wave
PR interval
Normal PR interval
Abnormal PR interval
QT interval
R-R interval
e.
f.
g.
h.
Normal ST segment
Abnormal ST segment
PR segment
TP segment
Define the following:
a.
b.
c.
d.
e.
f.
g.
P pulmonale
P mitrale
Retrograde conduction
J point
Prime (')
Double prime (")
Notch in the R or S wave
Ventricular activation time
j.
k.
l.
m.
n.
o.
p.
Supraventricular arrhythmia
Aberrant ventricular conduction (aberrancy)
Anomalous AV conduction
(preexcitation syndrome)
Delta wave
Ectopy
QTc
Torsades de pointes
9.
List the five steps in determining an arrhythmia
10.
List and describe the three steps in identifying and analyzing the QRS complexes.
Revised 9/27/04
11.
Determine heart rate and describe the following methods of determining it:
a.
b.
c.
d.
Six second count method
Heart rate calculator ruler method
Triplicate method
R-R intergal method
seconds method
small square method
large square method
conversion table method
12.
List and describe two methods of determining the ventricular rhythm.
13.
Define the following terms as they apply to ventricular rhythm: essentially regular and
irregular.
14.
List and describe the steps in identifying and analyzing the P, P', F and f waves.
15.
Define the basic differences between the following components of the ECG,
including shape, width, height, relationship to the QRS complexes, and rate and rhythm:
a.
b.
c.
d.
Normal P wave
Abnormal P wave
Atrial flutter waves
Atrial fibrillation waves
"course"
"fine"
16.
List and describe the three steps in determining the PR and RP' intervals and the AV
conduction ratio.
17.
Define normal and abnormal PR inntervals.
18.
Give the causes of a PR interval less than 0.12 second in duration and one greater than
0.20 second.
19.
Define the following terms:
a.
b.
c.
d.
e.
f.
20.
Atrioventricular block
Variable AV block
Isoelectric line
Incomplete AV block
Complete AV block
First degree AV block
g.
h.
i.
j.
k.
l.
m.
Second degree AV block
Third degree AV block
Dropped beat
Wenckebach phenomenon
AV dissociation
AV conduction ratio
Anomalous AV conduction
List the most likely site or sites of origin (or pacemaker sites) of arrhythmias under the
following circumstances:
a.
Upright P waves preceding each QRS complex in Lead II.
b.
Negative P waves preceding each QRS complex in lead II.
c.
Negative P waves following each QRS complex in lead II.
d.
QRS complexes occurring along without P waves.
Revised 9/27/04
e.
f.
g.
h.
i.
Revised 9/27/04
Atrial flutter waves.
Atrial fibrillation waves.
Normal QRS complexes with no set relationship to the P waves.
Slightly widened QRS complexes (0.10 to 0.12 second in duration) with
no set relationship to the P waves.
Widened QRS complexes (greater that 0.12 second in duration and
bizarre) with no set relationship to the P waves.
CVT 103 - ELECTROPHYSIOLOGY I
UNIT 3 OBJECTIVES
SINUS NODE ARRHYTHMIAS
ATRIAL ARRHYTHMIAS
JUNCTIONAL ARRHYTHMIAS
Upon completion of this units of study, you should be able to complete the objectives using
instructional materials and obtain a grade of 70% on a criterion referenced evaluation.
1.
Define and give the diagnostic characteristics, cause, and clinical significance of the
following arrhythmias:
a.
b.
c.
d.
e.
f.
2.
Define and give the diagnostic characteristics, cause, and clinical significance of the
following arrhythmias:
a.
b.
c.
d.
e.
f.
3.
Normal sinus rhythm
Sinus arrhythmia
Sinus bradycardia
Sinus arrest
Sinoatrial block (SA exit block)
Sinus tachycardia
Wandering atrial pacemaker
Premature atrial contractions
Atrial tachycardia
nonparoxysmal AT
paroxysmal AT (PAT)
Paroxysmal supraventricular tachycardia
Atrial flutter
Atrial fibrillation
Define and give the diagnostic characteristics, cause, and clinical significance of the
following arrhythmias:
a.
b.
c.
d.
Revised 9/27/04
Premature junctional contractions
Junctional escape rhythm
Paroxysmal junctional tachycardia
Nonparoxysmal junctional tachycardia
accelerated junctional rhythm
junctional tachycardia
CVT 103 - ELECTROPHYSIOLOGY I
UNIT 4 OBJECTIVES
VENTRICULAR ARRHYTHMIAS
AV BLOCKS
Upon completion of this unit of study, you should be able to complete the objectives using
instructional materials and obtain a grade of 70% on a criterion referenced evaluation.
1.
Define and give the diagnostic characteristic, cause, and clinical significance of the
following arrhythmias:
a.
b.
c.
d.
e.
f.
2.
Premature ventricular contractions
Ventricular tachycardia
Ventricuar fibrillation
Accelerated idioventricular rhythm
Ventricualr escape rhythm
Ventricular systole
Define and give the diagnostic characteristics, cause, and clinical significance of the
following arrhythmias:
a.
b.
c.
d.
e.
f.
Revised 9/27/04
First degree AV block
Second degree type I AV block
Second degree type II AV block
Second degree, 2:1 and high-degree (advanced) AV block
Third degree (complete AV block)
Pacemaker rhythm