The Cardiac Course

Welcome to the Cardiac Course. This is an online course that has been built from the Cardiac Bootcamp Workshops, which have been attended by just over 2000  doctors, nurses and paramedics and our online cardiac bootcamp. The Course is included in your EM Mastery Membership.

Introduction: The ECG in 20 Seconds Approach

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 2.1 Basic ECG: Leads

Module 2.2 Basic ECG: Axis

Module 2.3 Basic ECG:BBB / Hypertrophy

Module 2.4 Basic ECG:Rate Calculation

Module 3. The Paediatric ECG

Paediatric ECG

In this section we look at:

  1. The Paediatric ECG and How to Read it.
  2. The differences to know between Adult and Paediatric ECGs
  3. Paediatric Arrhythmias
  4. Myocarditis.

Module 4.1 Arrhythmias: Wide Complex Tachycardias

4.0 Arrhythmias

In this section we look at:

  1. Wide Complex Tachycardias
    1. Regular
    2. Irregular
  2. Narrow Complex Tachycardias
  3. Atrial Fibrillation and Flutter
  4. Blocks

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Wide Complex Tachycardia

Here is the GREAT NEWS!
​Even if we have no idea, we know that 80% of wide complex tachycardias are Ventricular Tachycardia
Remember these causes of wide complex rhythms:

  1. Ventricular Tachycardia
  2. SVT with Aberrancy
  3. Hyperkalaemia
  4. Na+ Channel Blockade
  5. Ischaemia
  6. Paced Rhythm
So let’s be a little clever about this……..
If you checked the potassium and knew they hadn’t taken some kind of overdose that block Na+ channels and they had no pacemaker and there was no chest pain and you couldn’t see any ischaemia…..it leaves us with VT and SVT with aberrancy.
​Let’s say you were convinced that it was SVT with aberrancy…….Now remember that it would have to be regular ie it were not Atrial fibrillation.

Rules for VT

There are rules that can help us Rule IN VT and Rule IN SVT. There are the rules below as well as others

BRUGADA Criteria
Sensitivity of 92% and Specificity of 65%
Inconsistent across observers
VERECKEI Criteria
Similar sensitivity and specificity to Brugada

So many Things to Look for

There are a lot of things to look for in an ECG when trying to diagnose VT:
1. What is the patient’s age? older= more chance of ischaemia and VT
2. Are the complexes wide? >4 small squares (>160ms)
3. Are there p waves and is there AV dissociation?
4. Are there Capture beats or Fusion beats
5. Is axis extreme?
6. Is there concordance in V1-V6
7. Is there RSr pattern?
8. Are the signs present
(a)Brugada’s Sign- QRS to S wave > 100ms
(b)Josephson’s Sign-Notching in S wave

Here’s a Case

A 78 yo male presents to the emergency department with palpitations. He has no chest pain.
His rate is as you see it.
His BP is 110/60.
What is the diagnosis?
IS IT VT?

Now if the BP were low, it would be easier, you would give electricity. However it’s not low, now what?
If you ruled out hyperkalaemia and he hasn’t taken a Na channel blocker and he doesn’t have a pacemaker…. You could if you were convinced that it was SVT(given that it is regular) give adenosine. If it were SVT it would break. if it were VT, it would not.

Case 2

A 50 yo male presents with palpitations. His ECG is shown below. Is this VT? Try it and then see what the answer is as we work through the algorithm.

The 120 CRAM Formula for VT

The rule I use to diagnose VT is the 120 CRAM rule

It hasn’t been validated etc, but it’s my personal rule which brings the Brugada and Vereckei together. It may help you.

120 is an important number. “Faster than 120 and wider than 120”
​It isn’t VT unless the rate is > 120
The QRS must also be wider than 120ms

C

Concordance

This simply means: Are all complexes in the praecordial leads pointing in the same direction?
IF ALL THE PRAECORDIAL LEADS HAVE EITHER:
•A MONOPHASIC R WAVE OR
•A MONOPHASIC S WAVE THEN IT IS VT

R

R Wave in aVR

This is really the Vereckie ONE STEP.
Is there an initial Dominant R wave in aVR? YES=VT
If we look at the ECG from CASE 2 from above.
​There is a dominant R wave in aVR. This is VT.

A

AV Dissociation

This occurs as the arrhythmias is coming from the ventricle.

M

The Morphology: This is the most involved section.
Let’s go over it slowly. You can then follow on the video below.
We are looking for the following:

1.Capture Beats ad Fusion Beats

2. Do the Complexes have a RBB or LBB Morphology?

2(a) RBB Morphology

  • R wave(V1)
  • Right Rabbit Ear(V1)
  • qR(v1)
  • R/S < 1 in V6

2(b) LBB Morphology

  • Notched S wave
    • Josephson’s Sign
    • Brugada Sign
  • qR in V6

3.Is there a QS in V6?

Let’s look at case 1 and use the 120 CRAM approach

 

So it is Faster than 120 and wider than 120 and it looks real.

There is no Concordance

 

There is no dominant R wave in aVR

Is this AV dissociation? Probably not. If it were we can call it VT at this point.

Is this a capture beat? If it is we can stop here. Let’s keep going.

 

This is LBB morphology, so we look for BRUGADA or JOSEPHSON’S Sign. There is a Josephson sign. THIS IS VT.

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 4.2 Arrhythmias: Narrow Complex Tachycardias

In this section we look at:

  1. Wide Complex Tachycardias
    1. Regular
    2. Irregular
  2. Narrow Complex Tachycardias
  3. Atrial Fibrillation and Flutter
  4. Blocks

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 4.3 Arrhythmias: Atrial Fibrillation

In this section we look at:

  1. Wide Complex Tachycardias
    1. Regular
    2. Irregular
  2. Narrow Complex Tachycardias
  3. Atrial Fibrillation and Flutter
  4. Blocks

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 4.4 Arrhythmias: Atrial Flutter

In this section we look at:

  1. Wide Complex Tachycardias
    1. Regular
    2. Irregular
  2. Narrow Complex Tachycardias
  3. Atrial Fibrillation and Flutter
  4. Blocks

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

 

 

Module 4.5 Arrhythmias: Bradycardia / Blocks

In this section we look at:

  1. Wide Complex Tachycardias
    1. Regular
    2. Irregular
  2. Narrow Complex Tachycardias
  3. Atrial Fibrillation and Flutter
  4. Blocks

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 5. Syncope

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 6.1 Ischaemia: Subtle Ischaemic Changes

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 6.2 Ischaemia: STEMI Equivalents

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 6.3 Ischaemia: Type II MI

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 6.4 Ischaemia: Pericarditis

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 6.5 Ischaemia: Perimyocarditis

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 6.6 Ischaemia: Benign Early Repolarisation

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 7. Pacemakers

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 8.1 Syndromes: Brugada Syndrome

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 8.2 Syndromes: Takotsubo Cardiomyopathy

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 8.3 Syndromes: Wellens Syndrome

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 8.4 Syndromes: WPW

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything

Module 9.1: Resuscitation

This is content for subscribers.

For less than the price of a cup of coffee a week, you can get full access to everything