लोकसेवा आयोग,स्वास्थ्य सेवा सहायक पाचौ तह ईसीजी टेक्निसियनको पाठयक्रम २०७२


    1. ECG Basics
      1.1 Introduction and history of ECG (Electrocardiogram)
      1.2 Cardiac electrical activity: ECG, anatomic orientation of the heart, cardiac impulse formation and conduction
      1.3 Basic principles of instruments
      1.4 Patient preparation
      1.5 Placement of leads in adult and paediatric patients
      1.6 Recording of cardiac electrograms:
      1.6.1 Evolution of frontal plane leads
      1.6.2 Correct and incorrect lead placement
      1.6.3 Display 12 standard electrocardiogram leads
      1.7 ECG Measurement:
      1.7.1 Identify and relate waveform components (P, Q, R, S, T and U) with cardiac cycle
      1.7.2 Definition and normal range of PR interval, QRS duration, QT interval and calculation of corrected QT interval from Bazett’s formula.
      1.7.3 ECG wave measurement and segment
      1.7.4 Vertical measurement (voltage)
      1.7.5 Horizontal measurement (millisecond)
      1.7.6 Regularity of P wave and / or QRS complexes
      1.8 Utilize a systematic process when approaching the interpretation of the ECG
      1.8.1 Recognition of normal sinus rhythm
      1.8.2 Identify normal and abnormal components on ECG
      1.9 Heart rate: Introduction, measurement of heart rate from ECG
      1.10 Electrical axis:
      1.10.1 Determination of normal axis
      1.10.2 Methods of electrical axis estimation
      1.10.3 Left Axis Deviation
      1.10.4 Right Axis Deviation
      1.11 Recognition of electrocardiogram to the electrical events in the heart
      1.11.1 Tachyarrhythmias Narrow QRS tachycardia Wide QRS tachycardia
      1.11.2 Bradyarrhythmias Sinus bradycardia and sinus pause Conduction defects: Sino-atrial exit block, AB block: First degree, second degree (Mobitz type I and type II) and third degree AV block Bundle branch/fascicles block: Right Bundle Branch Block and Left Bundle Branch Block, bifascicular and trifascicular block 1.11.3 ECG of patients with devices (Pacemakers, Implantable cardio defibrillators (ICD) and Cardiac resynchronization therapy (CRT) Obtaining magnet ECG in pacemaker patients
      1.11.4 ECG of patients with dextrocardia 1.12 Coronary artery disease:
      1.12.1 Effects of myocardial injury and infarction in ECG
      1.12.2 Manifestations of ST elevation MI and non ST elevation MI
      1.12.3 Types of myocardial infarction (MI): anterior, inferior, lateral, posterior and right ventricular infarction
      1.13 Chamber enlargement and hypertrophy:
      1.13.1 Right atrial and left atrial enlargement
      1.13.2 Right ventricular hypertrophy
      1.13.3 Left ventricular hypertrophy
      1.14 Miscellaneous :
      1.14.1 Pericarditis and pericardial effusion
      1.14.2 Hyperkalemia and hypokalemia
      1.14.3 Pre excitation (WPW)
      1.14.4 Electrode misplacement (technical dextrocardia).
      1.14.5 Long and short QT syndrome
      1.14.6 Early repolarization pattern
      1.14.7 Brugada pattern
      1.15 Recognition of normal variations in ECG regarding age, sex, body built and ethnicity, state of activity, obesity, pregnancy, presence of other pathological conditions like Chronic Obstructive Airway Disease
      1.16 Reporting of ECG
      1.17 Special lead placements:
      1.17.1 Inferior myocardial infarction with suspected right ventricular infarction Right sided placement of chest leads Posterior placement of chest leads
      1.17.2 Brugada pattern ECG(elevated lead position)
      1.17.3 Dextrocardia
    2. Electricity
      2.1 Circuits and units:
      2.1.1 Electron theory of conduction
      2.1.2 Watts and Joules.
      2.1.3 Resistance, properties of electrical charge
      2.1.4 Properties of capacitor, potential difference (voltage)
      2.1.5 Properties of AC and DC circuits
      2.2 Electromagnetism:
      2.2.1 Electromagnetic induction
      2.2.2 Magnetic poles, fields, flux and influx density
      2.2.3 Magnetic field due to straight and circular coil wire
    3. ECG Instrument

    3.1 ECG instrumentation: understanding the function and control of ECG instrument, paper speed, calibration, lead selection, gain filters, manual and automatic operation, need for grounding of the instrument, battery maintenance

    3.2 Care: Care of instrument and recording paper (thermal and laser)
    3.3 Understanding electrodes, application and connection of electrodes, electrode positions, care of electrodes and cables
    3.4 Understanding lead system, unipolar and bipolar, limb leads, augmented and chest leads
    3.5 Einthoven’s theory and its application, Wilson’s central terminal
    3.6 Recording: Assess the recording to see the need for re recording
    3.7 Artifacts: Recognition and elimination / minimization of the artifacts
    3.8 Labeling of the completed recording sequentially as appropriate
    3.9 Cleaning and storage of instruments and cables ready for subsequent recording and correct sterilization and disposal procedures
    3.10 Calibration and servicing of the instrument

    4. Basic Science

    4.1 Normal Anatomy and physiology of heart, conduction system and the coronary circulation
    4.1.1 Function of cardiovascular system
    4.1.2 Structure of cardiovascular system
    4.1.3 Cardiac cycle
    4.1.4 Functional tissue of the heart and their function
    4.1.5 Cardiac output, blood pressure and heart rate
    4.2 Basic diseases of heart:
    4.2.1 Coronary disease
    4.2.2 Rhythm disorders
    4.2.3 Others: heart failure, pericardial effusion, cardiomyopathy, myocarditis

    5. Practical Issues

    5.1 Social aspect of ECG recording
    5.1.1 Counselling, explaining and assurance
    5.1.2 Well ventilation, screening of the recording room
    5.1.3 Procedure of ECG recording (hygiene, sanitation, after care, etc.)
    5.2 Ethical Issues
    5.2.1 Verbal consent
    5.2.2 Patient’s right, dignity and witness (male, female patient)
    5.2.3 Duty of ECG technician
    5.3 ECG Reporting
    5.3.1 Report presentation, folding and delivery labeling and authenticity)

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