Introduction to Cardiac Science

Module details

Title

Introduction to Cardiac Science

Type

Rotation

Module code

SPS104

Credits

10

Requirement

Compulsory

Aim of this module

This rotation will provide trainees with the knowledge and understanding of resting and ambulatory electrocardiography and blood pressure measurement so that they can perform simple cardiac investigations. This rotation will enable trainees to gain underpinning knowledge, skills and experience of Cardiac Science through introduction to the range of cardiac diagnostic services provided in the specialism and the interaction with patients and patient-centred practice. Trainees will be expected to perform some routine cardiac investigations and develop and build their professional practice.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,3,4,5,7	Competency Control infection risks in accordance with departmental protocols.	Action View
# 2	Learning outcome 1,3,4,5,7	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 3	Learning outcome 1,3,4,5,7	Competency Obtain a suitably completed request form, greet the patient, check patient identity and take a recent clinical history.	Action View
# 4	Learning outcome 1,3,4,5,7	Competency Prepare the environment and set up equipment ready for use for each type of investigation, including resuscitation equipment.	Action View
# 5	Learning outcome 1,3,4,5,7	Competency Explain the procedure for each type of investigation to the patient, address any procedure-related questions they may have and provide information on how the patient will be informed of the results.	Action View
# 6	Learning outcome 1,3,4,5,7	Competency Treat patients in a way that respects their dignity, rights, privacy and confidentiality.	Action View
# 7	Learning outcome 1,3,4,5,7	Competency Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.	Action View
# 8	Learning outcome 1,3,4,5,7	Competency Gain informed consent for each investigation.	Action View
# 9	Learning outcome 1	Competency Perform a resting ECG on an adult patient to meet the needs of the referral request.	Action View
# 10	Learning outcome 1	Competency Measure all amplitudes and intervals from the ECG.	Action View
# 11	Learning outcome 1,2	Competency Check and annotate ECG recording and identify both normal and variations from normal, including: life-threatening arrhythmias myocardial ischaemia and infarction.	Action View
# 12	Learning outcome 3	Competency Set up a cardiac monitor on a range of adult patients.	Action View
# 13	Learning outcome 4	Competency Measure blood pressure in a range of adult patients, using both an: manual method automated method.	Action View
# 14	Learning outcome 5	Competency Fit ambulatory ECG monitoring equipment in a range of adult patients, explaining the procedure to the patient and checking the patient’s understanding.	Action View
# 15	Learning outcome 7	Competency Fit ambulatory BP monitoring equipment in a range of adult patients.	Action View
# 16	Learning outcome 5,7	Competency Remove ambulatory monitoring equipment.	Action View
# 17	Learning outcome 6,7	Competency Prepare the results for analysis and review the report with senior staff, where appropriate.	Action View
# 18	Learning outcome 6	Competency Critically evaluate a range of cardiac diagnostic services and treatment pathways for patients with common cardiac diseases.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Perform 12 lead ECG resting	DOPS
Perform ambulatory ECG hook up and removal	DOPS
Perform ambulatory BP hook up and removal	DOPS
Perform resting BP	DOPS
Greet patient, explain the procedure, consent and explain the results	OCE
Introduce yourself to a patient during the set up of a piece of equipment at the bedside	OCE

Learning outcomes

1. Plan and perform a resting ECG in a range of patients in a variety of clinical settings, to current nationally accepted standards.
2. Recognise normal and abnormal ECG results, particularly myocardial infarction and life-threatening arrhythmias.
3. Set up a patient for cardiac monitoring.
4. Plan and perform BP measurement on a range of patients, using manual and automatic methods.
5. Fit ambulatory ECG equipment, including patient instruction.
6. Critically analyse ambulatory ECG recordings and produce a report under clinical supervision.
7. Fit ambulatory BP equipment, including patient instruction, and produce the results in the appropriate format.
8. Document local diagnostic and treatment pathways for patients with angina and heart failure.

Learning outcomes

1. Describe the anatomy and physiology of the cardiovascular system and apply and extend knowledge to Cardiac Science.
2. Explain the range of basic equipment and techniques used in Cardiac Science and discuss the application of safe and effective clinical practice.
3. Describe and evaluate the role of cardiac physiology in the patient pathway across primary/community care, secondary care and one-stop clinics.
4. Describe the principles of physics and instrumentation underpinning the routine diagnostic investigations and procedures in Cardiac Science.
5. Explain the concept of ‘normal’ and the calculation and use of normal ranges, and recognise the normal physiological variability in humans.
6. Describe the clinical framework, normal ranges, calibration and quality assurance for, and basic principles of:
   • Clinical electrocardiography
   • The normal ECG from birth to old age
   • Common and life-threatening arrhythmias
   • Development of a framework for interpretation of ECGs
   • Blood pressure measurement
   • Ambulatory blood pressure recording
   • Ambulatory electrocardiography
   • Signal averaged ECG
   • The practice and principles of provocative testing
7. Describe the basic cardiac chest X-ray
8. Gain experience of the linkages between the Cardiac Science and other clinical specialisms in the investigation of diseases of the cardiac system.

Indicative content

Introduction to Cardiac Science

• Normal anatomy and physiology of the cardiovascular system
• Investigations and procedures carried out in the diagnosis and treatment of cardiac disease
• Characteristics of recording equipment and their evaluation
• Basic cardiac electrocardiography
• Recognition and interpretation of normal ECG waveforms
• Signal averaged ECG
• Control of the circulation
• Cardiac embryology and fetal heart development
• Atherosclerosis and its relationship with ischaemic heart disease
• Heart failure and its effect on the cardiovascular system and other body systems
• Main clinical applications/diagnostic techniques in cardiac science
• Normal ranges

Planning and preparing for each investigation

• Indications for and contraindications to testing
• Adherence to health and safety of patient, public, staff and self
• The requirements for pre-test instructions and their implications on testing
• Basic clinical assessment of patients
• Monitoring of patients during assessment
• The requirements for accurate demographics and patient data
• Patient confidentiality and Data Protection Act
• Basic principles of infection control
• Knowledge of local and national guidelines specific to procedure

 In this module trainees will develop detailed learning that underpins the routine practical techniques:

• Clinical 12-lead electrocardiography
  • Characteristics of recording equipment
  • Components and functions
  • Settings and adjustments made based on patient category
  • Recommended measurement technique
• Development of a framework for interpretation of standard 12-lead ECGs
  • The normal ECG from birth to old age
    • Anatomy
    • Physiology
    • Leads
    • Rate
    • Rhythm
    • Cardiac axis
    • Terminology
    • Normal sinus rhythm
• Recognition of life-threatening arrhythmias
  • Ventricular tachycardia
  • Torsades de Pointes
  • Ventricular fibrillation
  • Asystole/p-wave asystole
  • Pulseless electrical activity (PEA)
• Myocardial infarction and ischaemia
• Recognition of common arrythmias
  • Sinus arrhythmia
  • Sinus bradycardia
  • Sinus tachycardia
  • Atrial fibrillation
  • Atrial flutter
  • Atrial ectopics
  • Atrial tachycardia
  • AV nodal re-entrant tachycardia
  • AV re-entrant tachycardia
  • Atrioventricular conduction blocks
  • Ventricular ectopics/bigeminy/trigeminy
  • Ventricular arrhythmias

• Ambulatory electrocardiographic recording
  • Characteristics of recording equipment
  • Indications
  • Limitations and optimisation of recording
  • Common problems
  • Analysis, presentation and evaluation of results
• Routine blood pressure measurement
• Principles and limitations of range of recording equipment used to measure blood pressure
  • Mercury and aneroid sphygmomanometers
  • Electronic devices including wrist devices
  • Device calibration
• Indications for blood pressure measurement
• Factors affecting blood pressure, including diurnal variation and white coat hypertension
• Recommended measurement technique
• Common errors in blood pressure measurement
  • Observer
  • Equipment
  • Patient
  • Cardiac arrhythmias
• Normal blood pressure ranges
• Definition of hypertension
• Ambulatory blood pressure recording
  • Characteristics of recording equipment
  • Indications
  • Contraindications
  • Recommended measurement technique
  • Normal ranges
  • Common problems
  • Analysis, presentation and evaluation of results
• Features of a normal chest X-ray
  • Proportional heart size
  • Aortic root
  • Aortic arch
  • Lung fields/Kerley lines
  • Diaphragm position

Activities

• Observe a range of routine investigations undertaken in Cardiac Science and critically evaluate how these investigations contribute to the diagnosis, management and care of patients, and the range of needs of people with disabilities within a typical care pathway for patients with common cardiac
• Attend outpatient clinics and/or inpatient ward rounds and/or physiologist/nurse-led clinics and discuss with your supervisor the diagnostic pathways linked to Cardiac Science, including suspected myocardial infarction, suspected angina and arrhythmia requiring
• Attend outpatient clinics and/or inpatient ward rounds to gain experience of the linkages between Cardiac Science and other clinical specialisms in the investigation of cardiac diseases, critically evaluate a medical treatment pathway for a cardiac patient and discuss the importance of a multidisciplinary approach to patient care. (This may include ECG, ambulatory ECG monitoring, ambulatory BP monitoring, exercise testing, the catheter laboratory including diagnostic and therapeutic procedures, echocardiography, bradycardiac pacing and follow-up.)
• Attend a heart failure or cardiac rehabilitation clinic where patients with cardiac disease are treated, and discuss the role of nutrition in the management of cardiac
• Attend a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with disorders of the cardiovascular