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Examination Matrix

CONTENT CATEGORY AND APPROX. PERCENTAGE OF EXAM

Detailed Outline
A. Basic Cardiovascular Anatomy and Physiology
I. Heart
  a. Size
  b. Location
  c. Layers
    1. Pericardium
    2. Epicardium
    3. Myocardium
    4. Endocardium
  d. Chambers
    1. Atrial
    2. Ventricular
  e. Valves
    1. Semilunar
    2. Atrioventricular


II. Heart and Coronary Circulation
  a. Blood flow
    1. Through the heart
    2. Systemic through the body
    3. Coronary Arterial
      a. Myocardial wall distribution
      b. Ischemihanges
      c. Patterns of injury
      d. Infarction types
    4. Right and left oxygen saturations
  b. Arteries (major)
    1. Systemic
    2. Coronary
  c. Veins
    1. Major systemic
    2. Coronary
  d. Capillaries
  e. Arterioles
  f. Venules

III. Physiology
  a. Cardiac valve function
  b. Pressures
   1. Determination of mean pressure
   2. Blood pressure
     a. Measurement
     b. Pulse pressure determination
   3. Aortic pulse pressure
   4. Pressure difference in the right and left heart
  c. Cardiac output (relationship to)
    1. Heart rate
    2. Stroke volume
  d. Control Mechanisms
    1. Blood pressure
    2. Cardiac output
    3. Peripheral resistance
    4. Baroreceptors/chemoreceptors
    5. Compliance
    6. Preload
    7. Afterload
    8. Contractility
  e. Cardiaycle
    1. Relationship to the EKG
    2. Relationship to heart sounds
   3. Relationship to valve opening and closure
  f. Normal values
    1. Measurement sites of heart rate
    2. Blood pressure

IV.  Conduction System
  a. Nodes
  b. Pathway
  c. Blood supply
  d. Heart rate
    1. Factors affecting heart rate
    2. Blood pressure

V. Anatomical Terms
 a. Definition and position of:
   1. Anterior -ventral
   2. Posterior -dorsal
   3. Superior
   4. Inferior
   5. Medial
   6. Lateral
   7. External
   8. Internal
   9. Superficial
 10. Distal
 11. Sagittal
 12. Peripheral
 13. Visceral
 14. Parietal
 15. Transverse or horizontal
 16. Proximal


B. ECG Techniques and Recognition
 I. Define, identify, measure, explain and analyze:
   a. Waveforms
    1. P, Q, R, S and T waves
    2. Baseline values
    3. Normal sinus rhythm
   b. ECG Measurement
    1. Time
    2. Heart rate
    3. Voltage
    4. Axis/hexaxial system
    5. Intervals
    6. Segments
    7. Complexes
    8. Normal and abnormal ST segment


II. ECG Leads
  a. Bipolar leads
  b. Umpolar leads
  c. Precordial leads
  d. Einthoven's triangle and law


III. ECG, Holter and Stress Testing Instrumentation
  a. ECG calibration methods
  b. Single channel
  c. Three channel
  d. Troubleshooting
  e. Paper speed

IV. Recognition of Recording Errors
  a. Incorrect standardization
  b. Incorrect paper speed
  c. Lead reversals
  d. Incorrect lead placement

V. Recognition of Recording Artifacts
  a. Electrical interference
  b. Somatic tremor
  c. Wandering baseline
  d. Other causes

VI. Patient and Electrical Safety Hazards of Electrical Apparatus
  a. Common hazards (broken cords, plugs and sockets)
  b. Subtle hazards (current leakage)
  c. Ground connectors
  d. Pacemaker hazards
  e. Electrical shock

VII. Distinguish, Interpret and Describe:
  a. Recognition of Cardiac Arrhythmias
    1. Sinus arrhythmias
    2. Sinus bradycardia
    3. Sinus tachycardia
    4. Atrial arrhythmias/PSVT
    5. Ventricular arrhythmias
    6. AV disassociation/aberration
    7. SA Blocks/sinus pause
    8. Bundle branch block
    9. Heart blocks
      a. First degree block
      b. Second degree block
         1. Type I
         2. Type II
  10. Third degree block
  11. Cardiac pacemakers
  12. Wolff-Parkinson White
  13. ST segment and T wave alterations
  14. Ambulatory electrocardiography artifacts
    b. Recognition and Interpretation of Normal and Abnormal 12 lead Electrocardiogramc 
15. Myocardial infarction
  a. Injca. Injury
  b. Ischemia


C. Basic Cardiovascular Electrophysiology

Define, Identify, and Explain:
I. Basic Electrophysiology
  a. Cardiac cycle
  b. Electrical conduction system
  c. Refractory
 d. Transmembrane potential
    1. Polarization
    2. Depolarization
    3. Repolarization
  c e. Action potential
    1. Phase 0
    2. Phase I
    3. Phase 2
    4. Phase 3
    5. Phase 4


D. Stress Test Techniques Indications and Contraindications
I. Stress Testing
  a. Indications
  b. Contraindications
  c. Protocols
    1. Bruce
    2. Modified Bruce
    3. Naught on
  d. Prep techniques
  e. Test interpretation
  f. Calculation
    1. Double product
    2. METs
  g. Bicycle procedures
  h. Thallium/Muga Stress Test


II. Interpretation of the Exercise ECG

III. Ergometers
  a. Arms
  b. Leg
  c. Treadmill

IV. Pharmacologic
  a. Dipyridamole
  b. Dobutamine
  c. Thallium
  d. Cardiolyte

E. Holter Monitoring
I. Concepts of Holter Monitoring
  a. Indications
  b. Contraindications
  c. Preparation techniques
  d. Lead placement
  e. Interpretation
    1. Recognition of artifact
    2. Advanced ECO interpretation

F. Cardiac Medications
I. Categories
  a. Antihypertensives
  b. Nitrates
  c. Calcium Channel Blockers
  d. Beta Blockers
  e. Cardiac Olycosides
  f. Antiarrhythmics
II. Indications
  a. Effect on heart rate
  b. Effect on blood pressure
  c. Correlation to arrhythmias
  d. Routes of administration
  e. Emergency Cardiac Medications
    1. Epinephrine
    2. Atropine
    3. Verapamil
    4. Lidocaine
    5. Oxygen
    6. Isuprel

Sample Questions
1. The heart is divided into ______ chambers:
a. One
b. Two
c. Four
d. Three

2. Which of the following supplies blood to the arterial system after contraction?
a. Left atrium
b. Right atrium
c. Left ventricle
d. Right ventricle

3. The Sensitivity switch controls the:
a. Heat
b. Speed
c. Amplification
d. ECG position

4. The little "spark" that makes the heart beat, originates in the:
a. AV node
b. SA node
c. Purkinje fibers
d. Bundle branches

5. Which of the following is a poor conductor of electric current?
a. Metal
b. Blood
c. Dry skin
d. Body fluids

6. Leads AVR, AVL and AVF are the ______ leads.
a. Bi-polar
b. Standard
c. Precordial
d. Augmented

7. Ventricular repolarization occurs during the ______ wave on the ECG.
a. P wave
b. T wave
c. P-R interval
d. QRS complex

8. Which of the following would not be diagnostic for right ventricular hypertrophy?
a. Tall R wave in VI
b. Left axis deviation
c. Right axis deviation
d. ST segment depression and inversion in the right chest leads

9. A posterior infarction is caused by an occlusion of the:
a. Aorta
b. Right coronary artery
c. Circumflex branch of the left coronary artery
d. Anterior descending branch of the left coronary artery

10.Which of the following is an absolute contraindication for performing a maximal graded exercise test?
a. Atrial fibrillation
b. Patient over 65 years of age
c. Six weeks post-bypass surgery
d. 10 to 14 days post myocardial infarction

11.What type of infarction is indicated by Q waves in lead 1,AVL, V5 and V6?
a. Lateral
b. Inferior
c. Anterior
d. Posterior

12.Which two ions travel across the cell membrane during the transmembrane action potential?
a. Organic phosphate ions
b. Sodium and protein ions
c. Sodium and potassium ions
d. Calcium and phosphate ions

13.A number of factors may bring about ST segment depression besides the classical ischemic syndrome.
The most common of these is an excess of:
a. Nitro
b. Digitalis
c. Sulfuric acid
d. Bicarbonate soda

14.Which coronary artery provides the main blood supply to the Atrioventricular node and Bundle of His?
a. Right coronary artery
b. Left main coronary artery
c. Left circumflex coronary artery
d. Left anterior descending coronary artery

15.Somatic tremor artifact may be caused by:
a. Switching leads
b. Circuit overload
c. Defective machine
d. A cold, uncomfortable environment

16.Which of the following arrhythmias may lead to death if asynchronous counter shock is not available?
a. Atrial tachycardia and atrial flutter
b. Atrial fibrillation and bundle branch block
c. Ventricular fibrillation and ventricular standstill
d. Sinus tachycardia and wandering pacemaker


Answers
1. c   5. c    9. b     13. b
2. c   6. d   10. d     14. a
3. c   7. b   11. a     15. d
4. b   8. b   12. c     16. c


References


 1. The Ciba Collection of Medical Illustrations: Vol. 5, The Heart, Frank Netter, MD, Ciba Collection of Medical 
    Illustrations, Morris Avenue, Summit, NJ.
 2. Gray's Anatomy, Charles Goss, Lea and Febiger, 30th edition, 1985, Philadelphia, PA.
 3. Examination of the Heart -The ECG #5, American Heart Association.
 4. ECG a Better Way, Burdick Corporation, 1993, Milton, WI.
 5. How to Quickly and Aurately Master ECG Interpretation, Dale Davis, RCT, 2nd edition, 1993,
    J.B. Lippincott Co., Philadelphia, PA.
 6. Rapid Interpretation of ECG, Dale Dubin, MD, 5th edition, 1996, Cover Publishing Co., Tampa, FL.
 7. Practical Electrocardiography, Henry Marriott, MD, 10th edition, 2001, Williams and Wilkins Co.,
    Baltimore, MD.
 8. Emergency Cardiac Care, Robert Huzar, MD, 2nd edition, 1982, Prentice Hall, Bowie, MD.
 9. Any textbook of general anatomy and physiology.
10. Any textbook of nursing care of the cardiac patient and ECG dysuthmia.