TeachingplansofDiagnostic

(Electrocardiogram)

TaishanMedicalCollege

Xiu-ChangLi,MD

2005.02.11

TeachingPlan

NameXiu-ChangLiAcademicYear2004~2005Term2DateFeb.18,2005Period1、2

Textbook

Diagnostics

SpecialtyandStratification

Undergraduate

Content

Electrocardiogram

Teachinghours

2

Objective

KnowtheprincipleofECGformation;MastertheECGleadssystemandnormalECG

KeyPoints

ECGleadsystem;NormalECG

Pointsdifficulttounderstand

TheprincipleofECGformation

Contentforselfstudy

TheprincipleofECGformation

Teachingequipment

MultimediaProjector;ECGfilm,picture

Relatedknowledge

Cellphysiology

Teachingmethods

Classroomteaching

Outlines,requirementsandtimeallocation

Section1

1ReviewofECGHistory(Forunderstanding)

2TheprincipleofECG(Forunderstanding,20min)

1)Formationofmyocardialrestmembranepotential

UseoftheECGforanyoftheseclinicallyimportantpurposesisthefinaloutcomeofacomplexseriesofphysiologicalandtechnologicalprocesses

2)Conceptofelectrocardialvector

3ECGleadssystem(Formastering,20min,Keypoint)

1)MastertheConnectionMethodofextremityleads

2)Tomastertheconnectionmethodofchestleadsystem

10min

10min

10min

10min

10min

ReferenceBook

Braunwald:HeartDisease:ATextbookofCardiovascularMedicine,6thed

Outlines,requirementsandtimeallocation

Section2

1Normalelectrocardiographiccomplexes(ForMastering)

DefinitionofQRSconplex

2MeasurementmethodofECG(Master,Keypoint)

LimbleadIIIIII,avR,avL,avF,

Chestlead:V1~V6

Heartrate,Amplitude,averageQRSaxis.androtationalonglongzxis

3rmalECG&NormalValue(Master,20,Keypoint)

Measurementoftime/durationofcomplexes,intervals

Amplitudeofwaveandsegment

3)interval,QRScomplex,Qwave,STsegment,Twave,QTinterval

5min

10min

10min

10min

10min

5min

TeachingPlan

NameXiu-ChangLiAcademicYear2004~2005Term2DateFeb.18,2005Period1、2

Textbook

Diagnostics

SpecialtyandStratification

Undergraduate

Content

Electrocardiogram

Teachinghours

2

Objective

MastertheECGcharacteristicsofatrialandventricularenlargement

KeyPoints

Characteristicsofatrialandventricularenlargement

Pointsdifficulttounderstand

MechanismofECGchangesofA/Venlargement

Contentforselfstudy

Bi-atrialandBi-ventricularenlargement

Teachingequipment

MultimediaProjector;ECGfilm,picture

Relatedknowledge

Rheumaticandcongenitalheartdisease

Teachingmethods

Classroomteaching

Outlines,requirementsandtimeallocation

Section1Atrialenlargement

1MechanismofECGchangesofatrialandventricularenlargement(Forunderstanding)

anincreaseinleftventricularmass

anenlargementincellsize,withanincreaseinsurfaceareaincreasingtransmembranecurrentflowandanincreaseinthenumberofintercalateddisksenhancingintercellularcurrentflow

2MastertheECGchangesofleftatrialenlargement(Master,Keypoint)

increasesintheamplitudeanddurationofthePwaveinthelimbleads

Conceptof“mitralvalvePwave”

ConceptofTerminalPnegativityinleadV1

3MastertheECGchangesofrightatrialenlargement(Master,Keypoint)

Conceptof“pulmonaryPwave”

4Bi-atrialenlargement(understand)

5min

10min

5min

5min

10min

5min

5min

ReferenceBook

Braunwald:HeartDisease:ATextbookofCardiovascularMedicine,6thed

Outlines,requirementsandtimeallocation

Section2

1、ValueofECGonventricularhypertrophy（Forunsterstanding）

Sensitivitiesarelowest(approximately10to30percent),Specificities,incontrast,forallmeasuresvaryfrom85percentto95percent

2ECGchangesofleftventricularhypertrophy(ForMastering,Keypoint)

leftventriclehighvoltage

leftaxisdevation

secondaryST-Tchanges

4)UnderstandtheclinicalvalueofLeftventricularhypertrophy

3ECGchangesofrightventricularhypertrophy(ForMastering,Keypoint)

1)rightventriclehighvoltage

2)rightaxisdevation

3)secondaryST-Tchanges

4)Understandtheclinicalvalueofrightventricularhypertrophy

4Biventricularhypertrophy(understand)

Complex,forunderstanding

5min

7min

3min

5min

5min

7min

5min

3min

5min

5min

TeachingPlan

NameXiu-ChangLiAcademicYear2004~2005Term2DateFeb.18,2005Period1、2

Textbook

Diagnostics

SpecialtyandStratification

Undergraduate

Content

Electrocardiogram

Teachinghours

2

Objective

MastertheEcgchangesofmyocardialischemiaandinfarction

KeyPoints

TheECGchangesofmyocardialischemiaandinfarction

Pointsdifficulttounderstand

MechanismofECGchangesofmyocardialischemiaandinfarction

Contentforselfstudy

coronarycirculation

Teachingequipment

MultimediaProjector;ECGfilm,picture

Relatedknowledge

Coronaryanatomy

Teachingmethods

Classroomteaching

Outlines,requirementsandtimeallocation

Section1

1Coronarycirculationandnormal&abnormalcoronaryarteryangiography

Requestunderstanding,10min

2CoronarycirculationandrelatedECGleads(Forunderstanding)

3ChangesandmechanismofECGinmyocardialischemia

ForMastering,30min,Keypointtobemastered

ischemicTwave

injurySTsegment

4Clinicalvalueofischemia-likeECGchanges(Forunderstanding)

Section2

1BasicECGgraphofmyocardialinfarction(Formastering,15min)

IschemiatypeT

InjurytypeSTelectrocardiographycharacteristicsandmechanism

necrosisQ

2ECGevolvement&substageinMI(Formastering,15min)

BesidescharacteristicECGchange,theECGevolvementbytimeismoreimportant

earlystage

acutestage

subscutestage

oldstage

10min

5min

15min

15min

5min

Keypoint

5min

5min

5min

Keypoint

3min

4min

4min

4min

ReferenceBook

Braunwald:HeartDisease:ATextbookofCardiovascularMedicine,6thed

Outlines,requirementsandtimeallocation

3LocalizationdiagnosisofMI(Formastering,15min)

4AtypicalECGchangeofMIanddifferentialdiagnosis

Forunderstanding,5min

Current-of-injurypatternswithacuteischemia.Withpredominantsubendocardialischemia(A),theresultantSTvectorisdirectedtowardtheinnerlayeroftheaffectedventricleandtheventricularcavity.OverlyingleadsthereforerecordSTdepression.Withischemiainvolvingtheouterventricularlayer(B)(transmuralorepicardialinjury),theSTvectorisdirectedoutward.OverlyingleadsrecordSTelevation.ReciprocalSTdepressioncanappearincontralateralleads

Keypoint

15min

5min

TeachingPlan

NameXiu-ChangLiAcademicYear2004~2005Term2DateFeb.18,2005Period1、2

Textbook

Diagnostics

SpecialtyandStratification

Undergraduate

Content

Electrocardiogram

Teachinghours

2

Objective

Tomastersinousarrhythmia,prematurebeat,andtachycardia

KeyPoints

Prematurebeat,tachycardia,andfibrillationandflutter,SSS

Pointsdifficulttounderstand

1.Conceptofcompensatoryinterval,2.conceptofreentry.

Contentforselfstudy

Electrophysiologyofarrhythmia

Teachingequipment

MultimediaProjector;ECGfilm,picture

Relatedknowledge

Electrophysiology

Teachingmethods

Classroomteaching

Outlines,requirementsandtimeallocation

Section1

1Outlineofarrhythmia(Forunderstanding)

ClassificationofArrhythmia

Electrophysiologyofarrhythmia

2Normalsinusrhythmandsinusarrhythmia(35min)

1)Tounderstandthesinusbradycardia

HR>100bpm(inadult)

2)sinustachcardia

HR<60bpm

3)sinusarrest:apauseinthesinusrhythm.TheP-PintervaldelimitingthepausedoesnotequalamultipleofthebasicP-Pinterval

4)Tomastersicksinussyndrome(Keypoint)

(1)persistentspontaneoussinusbradycardianotcausedbydrugsandinappropriateforthephysiologicalcircumstance,(2)sinusarrestorexitblock,(3)combinationsofSAandAVconductiondisturbances,or(4)alternationofparoxysmsofrapidregularorirregularatrialtachyarrhythmiasandperiodsofslowatrialandventricularratesbradycardia-tachycardiasyndrome

5)TounderstandtheclinicalvalueandtreatmentofSSS

5min

10min

5min

5min

5min

15min

5min

ReferenceBook

Braunwald:HeartDisease:ATextbookofCardiovascularMedicine,6thed

Outlines,requirementsandtimeallocation

Section2

1Prematurecontraction(20min)

1)Tomasterthecharacteristicsofatrial,ventricularandjunctionalprematurecontraction

2)TounderstandthemechanismofPrematurecontraction

3)Tounderstandtheconceptofcompensatoryintervalandcoupledinterval

2EctopicTachycardiaandRhythm(30min)

1)Tomasterthecharacteristicsofsupraventricular(Keypoint)

2)TomastertheECGchangeofventriculartachycardia(Keypoint)

3)TounderstandtheacceleratedtachycardiaandTdP

3)Tomasterthemechanismofreentry(difficultpoint),toexpoundparticularly

10min

5min

5min

8min

7min

5min

10min

TeachingPlan

NameXiu-ChangLiAcademicYear2004~2005Term2DateFeb.18,2005Period1、2

Textbook

Diagnostics

SpecialtyandStratification

Undergraduate

Content

Electrocardiogram

Teachinghours

2

Objective

TomasterFlutterandfibrillation,andHeartblock,preexcitationsyndrome

KeyPoints

Atrialflutterandfibrillation;A-Vconductionblock;preexcitationsyndrome

Pointsdifficulttounderstand

MechanismofECGchangesofbundlebranchblock;Wenckebachphenomenon

Contentforselfstudy

EffectsonECGofElectolytesDisturbanceanddrugs

Teachingequipment

MultimediaProjector;ECGfilm,picture

Relatedknowledge

Conductionsystemanatomy

Teachingmethods

Classroomteaching

Outlines,requirementsandtimeallocation

Section1

1Flutterandfibrillation(25min)

1)Tomasterthecharacteristicsofatrialflutter(Keypoint)

Atrialflutterisnowrecognizedasamacro-reentrantatrialrhythm

2)atrialfibrillation(Keypoint)

Theventricularresponseisgrosslyirregular("irregularlyirregular")

small,fine,rapidfwavescanoccur

3)Tounderstandthecharacteristicsofventricularflutterandfibrillation.

4)Tounderstandtheclinicalvalueandtreatmentofflutterandfibrillation

2Heartblock(25min)

1)Tounderstandtheclassificationofheartblock

2)TounderstandSino-AtrialExitBlockandIntra-atrialblock

3)TomasterthecharacteristicsofA-Vconductionblock(keypoint)

IdegreeAVB

IIdegreeAVB

IIIdegreeAVB

4)TounderstandtheWenckebachphenomenon(Difficultpoint,toexpoundparticularly)

8min

7min

5min

5min

5min

5min

10min

5min

ReferenceBook

Braunwald:HeartDisease:ATextbookofCardiovascularMedicine,6thed

Outlines,requirementsandtim