A systematic approach to interpreting electrocardiograms

Course curriculum

• Fundamental basics of ECG recording, description, and interpretation o The concept of cell electrophysiology and membrane potentials o Stimulation, excitation, and impulse transmission o Depolarization and repolarization o Myocardial cells and pacemaker cells, division of labor in the heart muscle o The place of ECG in patient examination and when it is necessary o Leads as a view of the heart o The principle of the 12-lead ECG model o Diagram of the heart's conduction system o Cardiac rhythm and the formation of electrical impulses in the heart's conduction system o Patterns of the ECG complex and its components: waves, intervals, and segments o ECG paper, paper speed, and grid scale o Determining the heart rate o Calibration of the ECG recorder o Formation of the heart's electrical picture on the ECG o The shape of the QRS complex, the electrical axis, the summary electrical vector, and why to care about them o The role of the J point o The transition point and its clinical meaning o Rhythmogram o Electrode placement errors o Artifacts in ECG recording and how to deal with them o Basics of ECG interpretation o ECG description technique o Additional leads
• ECG diagnostics of cardiac conduction disorders o Pacemaker activity of the heart. Impulse propagation time and delay o Heart blocks (atrioventricular blocks) o Right and left bundle branch block of the His bundle o Clinical significance of cardiac conduction system pathology
• ECG assessment of cardiac rhythm o Principles of rhythm analysis o Hierarchy of pacemakers o Activation of atrial, AV-nodal and ventricular pacemakers – escape rhythms o Supraventricular, nodal, ventricular rhythms o Sinus arrhythmia o Bradycardias, tachycardias, extrasystoles, fibrillation and flutter o Role of carotid sinus massage in diagnosing rhythm disturbances o Wolff-Parkinson-White syndrome (WPW) and re-entry tachycardias o Clinical significance of detecting an abnormal rhythm
• ECG patterns in pathology – screening for chamber enlargement, P-wave, QRS complex and T-wave patterns. Acute coronary syndrome, STEMI, NSTEMI, dynamics of ischemia development o Enlargement (hypertrophy) of the right and left atrium o Hypertrophy of the right and left ventricle o Biventricular hypertrophy o Voltage and scoring diagnostic criteria o Pulmonary artery thromboembolism o Diagnostic features of Q waves o Concept of the electrical window o Abnormalities of the ST segment and T waves o ST segment elevation o Variants of upsloping, horizontal and downsloping ST segment depression o STEMI and NSTEMI infarction o ECG changes during digoxin therapy o deWinter waves o Biphasic waves o Hour-by-hour dynamics of myocardial infarction signs o Wellens syndrome o ECG patterns of ischemia development over time: subendocardial ischemia, subepicardial ischemia, myocardial injury, myocardial necrosis o Advanced topographic diagnosis of ischemia, the Bayes De Luna system o Electrolyte disturbances o «Nonspecific» ST segment changes o QT interval abnormalities o Short and long QT syndromes o QT in ischemia
• Specific ECG cases. Examination of an asymptomatic patient o Analysis of ECG variants in normal cardiac rhythm o Differential diagnosis of normal and pathological ECG o Dangerous conditions and their predisposing factors in an asymptomatic patient o ECG variations depending on body constitution o Features of a normal ECG in sports and high physical activity
• Specific ECG cases. ECG in pain syndrome and dyspnea o Analysis of the ECG in a patient with acute pain syndrome o Acute coronary syndrome o Unstable angina o STEMI and NST-ACS o Ischemic cascade o Analysis of the ECG in a patient with transient pain syndrome o Signs of ischemia after exercise o Analysis of the ECG in a patient with dyspnea o Pulmonary artery thromboembolism and chronic lung diseases o Features of detecting myocardial infarction in patients with left bundle branch block and a pacemaker
• Specific ECG cases. ECG in syncopal conditions o The concept of palpitations and syncope o The relationship between syncopal conditions and the ECG pattern o Wide-complex tachycardia o Narrow-complex tachycardias o Pre-excitation syndromes: Wolff-Parkinson-White syndrome (WPW), Lown-Ganong-Levine syndrome (LGL), torsade de pointes tachycardia o Sick sinus syndrome o Heart blocks o Intermittent bradycardia o Brugada syndrome o Basic pacing patterns on the ECG o Cardiac arrest, shockable and non-shockable rhythms
• ECG of elite athletes. Use of ECG in sports medicine. Martinet test o Assessment of sudden cardiac death risk in athletes based on ECG data o Indications for further examination based on international guideline documents o Physiological adaptation to exercise – the normal ECG of the «athlete's heart» o Juvenile ECG pattern o National features of athletes' ECG patterns o Borderline ECG changes in the professional athlete (grey zone). T-associated abnormalities o Q- and ST-associated abnormalities o Bundle branch blocks and nonspecific conduction disturbances in athletes o QT-associated abnormalities o Brugada syndrome in athletes o Bradycardia and AV blocks o Premature contractions o Tachyarrhythmias: sinus, atrial, ventricular tachycardia o Atrial fibrillation and flutter o ECG patterns requiring monitoring o Clinical significance of ECG findings and family history, choosing patient management strategy o 2023 updates o Martinet–Kushelevsky test
• ECG assessment of pacemaker function: types, modes, and options for monitoring their operation. Pacemaker syndrome o Specifics of terms used in describing pacemaker operation o Structure and operating modes of pacemakers o Biventricular pacing (cardiac resynchronization therapy – CRT) o ECG diagnostics of pacemaker malfunctions o Pacemaker software algorithms o Pacemaker-induced tachycardia o Use of the magnet switch o Myocardial infarction with a functioning pacemaker
• Use of "home" ECG devices. ECG diagnostics in patients with presyncope and syncope o Portable, wearable, and adhesive devices o Overview of devices on the market, the appropriateness of using different device types in various cardiac pathologies
• Ambulatory (Holter) monitoring - AECG o The AVSEP system – the basis of modern monitoring systems o Formation of the norm pattern during long-term recording o Methods, technologies and equipment o Holter systems popular in Russia o Electrode placement schemes and lead systems used in AECG Holter monitoring o Recording duration options, their advantages and disadvantages o The patient's role in AECG recording o External and implantable loop recorders o Signal registration, processing and interpretation in AECG o Patient preparation and recording stabilization o Combating artifacts o Indication for Holter monitoring o Assessment of rhythm disturbances: bradyarrhythmias, tachyarrhythmias, SSS o Extrasystole and ventricular tachycardias, WPW o Diagnostic criteria of ischemia in AECG o Prognosis assessment and risk stratification of cardiac death o The cardiologist's view of the Holter monitoring technique – clinical significance of the method o Channelopathies and cardiomyopathies o Specific features of AECG in a patient with end-stage renal failure, neurological and muscular diseases, sleep apnea syndrome o Markers of autonomic nervous system tone and repolarization in ECG Holter monitoring o Heart rate variability o Circadian profile o Frequency analysis o Heart rate turbulence o Clinical efficacy and safety of therapy, assessment of arrhythmias