Module - Introduction to Cardiac Science (SPS104)

STP

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.

Work-based 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.

Work-based Competencies


Learning outcome Title Knowledge
1 1,3,4,5,7

Control infection risks in accordance with departmental protocols.

  • Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation.
  • Protocol for hand washing and how effective hand washing contributes to control of infection.
2 1,3,4,5,7

Minimise risks and hazards in compliance with health and safety policies.

  • The relevant health and safety regulations specific to cardiac science investigations, the potential hazards and risks, and the actions to be taken to minimise these.
3 1,3,4,5,7

Obtain a suitably completed request form, greet the patient, check patient identity and take a recent clinical history.

  • Referral routes for cardiac diagnostic investigations.
  • Requirements for correct completion of request forms and how to validate.
  • The importance of checking and confirming the patient identity and the implications of not doing so.
  • Structure of a patient history and key information required.
4 1,3,4,5,7

Prepare the environment and set up equipment ready for use for each type of investigation, including resuscitation equipment.

  • Range of equipment used, relative merits and principles of measurement.
  • Requirements for the investigation environment to ensure the privacy, dignity and comfort of the patient.
  • Recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use.
  • Identification of common faults and remedial action.
  • Current safety standards, including safety testing and routine maintenance.
  • Preparation and calibration of equipment.
5 1,3,4,5,7

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.

  • The importance of explaining the procedure to the patient.
  • The pathophysiology of the cardiovascular system and the appropriate choice of investigation, considering the findings from the history and clinical examination.
  • The use of diagnostic investigations, relevant to competency, in the management of a patient presenting with myocardial infarction, angina or an arrhythmia requiring pacemaker insertion.
  • Common questions and concerns of patients about procedures.
  • Risks and benefits of undertaking the investigation.
  • The information needs of patients following investigation.
  • The authority level for provision of information to patients.
  • The process of notifying patients of the results.
  • The range of treatment pathways and their relevance/applicability to cardiac disease.
  • The options available to patients with cardiac disease and the implications and benefits of each.
  • Factors affecting selection of treatment option.
6 1,3,4,5,7

Treat patients in a way that respects their dignity, rights, privacy and confidentiality.

  • The rights of the patient with regard to consent for treatment and confidentiality of consultation and medical records.
  • Key factors influencing dignity, rights, privacy and confidentiality, including age, gender, culture and beliefs.
  • Correct positioning of the patient to ensure comfort, co-operation and optimal investigation results.
  • The impact of incorrect positioning or non-co-operation on investigation results.
7 1,3,4,5,7

Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.

  • Recognition of the contraindications to testing prior to the test, as defined by department protocol.
  • The range of needs of people with disabilities within a typical care pathway for patients with diseases affecting the lower cardiovascular system.
8 1,3,4,5,7

Gain informed consent for each investigation.

  • The importance of explaining the procedure for each investigation to the patient and gaining informed consent.
  • The relevant procedures and requirements for patient conformance.
  • Clinical indications for and contraindications to each investigation.
  • Principles, guidance and law with respect to informed consent.
9 1

Perform a resting ECG on an adult patient to meet the needs of the referral request.

  • How to identify electrode sites in line with current Society for Cardiological Science and Technology /American Heart Association guidelines to achieve optimum ECG waveform.
  • How to prepare the patient’s skin for electrode placement.
  • Correct placement and positioning of electrodes to minimise artefact.
  • Selection of machine settings to meet the needs of the referral/request.
  • Correct operation of ECG equipment.
  • How to monitor the recording and make adjustments to maximise results.
  • Routine maintenance and calibration procedures.
10 1

Measure all amplitudes and intervals from the ECG.

  • The derivation of the ECG.
  • The relationship between the ECG and the cardiac cycle.
  • Identification of amplitudes and intervals in ECG and normal ranges.
  • Effect of exercise on the normal ECG.
11 1,2

Check and annotate ECG recording and identify both normal and variations from normal, including:

  • life-threatening arrhythmias
  • myocardial ischaemia and infarction.
  • How to check and annotate recordings to ensure accuracy, completeness, legibility and suitability for analysis and reporting.
  • Normal variations related to age, gender, activity and ethnic origin.
  • When to refer results to a senior colleague for further action.
  • ECG changes associated with myocardial infarction and myocardial ischaemia.
  • ECG changes of life-threatening arrhythmias.
  • Diagnosis and pharmacological treatment of myocardial infarction and myocardial ischaemia.
  • Non-pharmacological treatment of cardiac disease.
  • Invasive treatment of myocardial infarction and myocardial ischaemia.
  • Treatment of life-threatening arrhythmias.
12 3

Set up a cardiac monitor on a range of adult patients.

  • Standard Operating Procedure for setting up a cardiac monitor.
  • Electrode sites for cardiac monitoring to achieve optimum ECG waveform.
  • Choice of monitor and monitor settings and rate alarm.
  • Routine maintenance and cleaning of cardiac monitors.
13 4

Measure blood pressure in a range of adult patients, using both an:

  • manual method
  • automated method.
  • British Hypertension Society Guidelines for Blood Pressure Measurement.
  • Importance of cuff size.
  • Location of pulse in the cubital fossa.
  • The correct use of palpation to estimate systolic BP.
  • Correct inflation of the cuff to at least 30 mmHg above the estimated BP.
  • Correct rate of pressure reduction to maximise results.
  • Difficulties that may be encountered in obtaining an accurate BP measurement and relevant remedial actions.
  • How to check and confirm results.
  • Normal range for systolic and diastolic blood pressure.
  • White coat hypertension.
  • When to refer results to a senior colleague for further action.
  • Routine maintenance and calibration procedures.
14 5

Fit ambulatory ECG monitoring equipment in a range of adult patients, explaining the procedure to the patient and checking the patient’s understanding.

  • Standard Operating Procedure for ambulatory ECG monitoring.
  • Factors influencing selection of correct ambulatory monitoring devices.
  • Correct preparation of ambulatory ECG recording equipment, including recorder and choice of the most appropriate electrodes for the ambulatory ECG monitoring.
  • Requirements for preparation of the patient’s skin for electrode placement and how to instruct a patient for self-positioning.
  • Correct positioning of electrodes on the patient’s skin.
  • The importance and use of the patient diary.
  • How to activate ambulatory devices.
  • Information needs of patients fitted with ambulatory devices, including pre-test, fitting, use, activation, deactivation, diary, cleaning and removal.
  • Factors influencing the quality of results from ambulatory recordings, including minimisation of artefacts.
  • Routine maintenance and calibration procedures.
15 7

Fit ambulatory BP monitoring equipment in a range of adult patients.

  • SOP for ambulatory BP monitoring.
  • Pharmacological treatment of hypertension.
  • Non-pharmacological treatment of hypertension.
  • Choice of programmes/settings for ambulatory blood pressure recording.
  • Normal ranges for ambulatory BP and home BP.
  • Identification of white coat hypertension.
  • The information needs of patients following ambulatory BP monitoring.
  • Routine maintenance and calibration procedures.
16 5,7

Remove ambulatory monitoring equipment.

  • Correct removal of ambulatory devices.
  • Requirements for cleaning devices in compliance with infection control.
  • The information needs of patients following ambulatory monitoring.
17 6,7

Prepare the results for analysis and review the report with senior staff, where appropriate.

  • How to check accuracy of recording, identify artefacts and determine suitability for analysis.
  • How to download data and produce results in an appropriate format for next stage of processing.
  • The possible clinical outcomes for the patients.
18 6

Critically evaluate a range of cardiac diagnostic services and treatment pathways for patients with common cardiac diseases.

  • Requirements for patient-centred diagnostic services.
  • Treatment pathways for patients with common cardiac diseases.
  • The evidence base underpinning diagnostic services and treatment pathways.

Work-based assessment


Complete 1 Case-Based Discussion(s)
Complete 1 of the following DOPS and/or OCEs
Type Title
DOPS 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
OCE 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