Arrhythmia Part IV
Part 4: Management of the Patient with Tachyarrhythmia
Summary
Tachyarrhythmia are rhythm disorders of the heart usually associated with heart rates greater than 100 beats per minute. These are broadly divided into supraventricular tachyarrhythmia and ventricular tachyarrhythmia based on the site of origin of the arrhythmia. Supraventricular tachyarrhythmia originate above the bundle of His. These tachyarrhythmia include sinus tachycardia, ectopic atrial tachycardia, atrial fibrillation, atrial flutter, AV nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT. Ventricular tachyarrhythmia originate from the ventricles and include ventricular tachycardia and ventricular fibrillation.
General Information
Enrolled trainees 1776
Open 13.01.2020
Available for ESICM members
Student effort 1
Last Updated April 13, 2022
Intended Learning Outcomes
After studying this module on the Management of the Patient with Tachyarrhythmia you should be able to:
- Articulate the different conduction pathway abnormalities that lead to tachycardia, including both supraventricular and ventricular tachycardias;
- Define an approach to differentiating between the different types of supraventricular and ventricular tachycardias;
- Describe treatment options for some of the more common tachyarrhythmias.
Relevant competencies in CoBaTrICE
- 2.4 Performs electrocardiography and interprets the results
- 3.8 Recognises and manages the patient with circulatory failure
- 5.14 Performs defibrillation and cardioversion
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This course is available only for registered ESICM members.
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All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Arrhythmia Part III
Part 3: Management of Patient with Bradycardia
Summary
Bradyarrhythmias are heart rhythm abnormalities with slow heart rate usually less than 60 beats per minute. Bradyarrhythmias are common in the ICU setting usually related to airway manipulation, hypoxaemia, electrolyte abnormalities, medication toxicity etc. In this section we will cover diagnosis of the more common bradyarrhythmias and consider their treatment in the ICU.
General Information
Enrolled trainees 1735
Open 13.01.2020
Available for ESICM members
Student effort 1
Last Updated May 10, 2022
Intended Learning Outcomes
After studying this module on Management of the Patient with Bradycardia you should be able to:
- Articulate the different conduction pathway abnormalities that lead to bradycardia.
- Define an approach to differentiating between the different types of bradyarrhythmias.
- Describe treatment options for some of the more common bradyarrhythmias.
Relevant competencies in CoBaTrICE
- 2.4 Performs electrocardiography and interprets the results
- 3.8 Recognises and manages the patient with circulatory failure
- 5.15 Performs cardiac pacing (transvenous or transthoracic)
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Arrhythmia Part II
Part 2: Diagnosis of Rhythm Disturbances
Summary
In this section module, we will discuss how we determine heart rate and rhythm from an ECG. We will also go over the different ion channels and their role in the cardiac action potential. Then there will be discussion about the different arrhythmia mechanisms as well as their management.
General Information
Enrolled trainees 2009
Open 13.01.2020
Available for ESICM members
Student effort 1
Last Updated May 10, 2022
Intended Learning Outcomes
After studying this module on the Diagnosis of Rhythm Disturbances you should be able to:
- Articulate a systematic approach to the assessment of cardiac rhythms.
- Understand the different mechanisms of arrhythmias.
- Understand the physiological underpinnings of normal and abnormal cardiac conduction and define an approach to the initial diagnosis of arrhythmias.
- Identify general treatment options for arrhythmias.
Relevant competencies in CoBaTrICE
- 2.4 Performs electrocardiography and interprets the results
- 3.8 Recognises and manages the patient with circulatory failure
- 5.14 Performs defibrillation and cardioversion
- 5.15 Performs cardiac pacing (transvenous or transthoracic)
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
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If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Acute Myocardial Ischaemia Terminology, Pathophysiology and Recognition
Summary
The most obvious effect of coronary artery disease (CAD) is the compromise on the oxygenation of the myocardial cells, which leads to an entity known as ischemic heart disease. CAD cause approximately one third of all deaths in persons above 35 years old.
In its acute form, it initially presents as a particularly serious condition known as acute coronary syndrome (ACS) and represents a group of medical conditions with different stages of a continuum that may be indistinguishable at presentation to emergency departments. They share similar pathogenic mechanisms, being the common link the rupture of a vulnerable coronary atherosclerotic plaque and the formation of the intracoronary thrombus.
General Information
Enrolled trainees 2917
Open 24.09.2019
Available for ESICM members
Student effort 1
Last Updated June 3, 2022
Intended Learning Outcomes
After studying this module on Acute Myocardial Ischaemia Terminology, Pathophysiology and Recognition, you should be able to:
- Review the latest definition, causes and pathophysiology of acute coronary syndrome
- Recognise how to confirm a diagnosis of acute coronary syndrome with the use of the contemporary detection strategies
- Demostrate how to manage acute coronary syndrome with the latest strategies
- Recognise the evidence based secondary prevention strategy in acute coronary syndrome.
- Distinguish between myocardial injury and myocardial infarction (MI)
- Distinguish between acute myocardial injury with/without myocardial ischaemia and chronic myocardial injury
- Define and differentiate UA, NSTEMI, and STEMI.
- Distinguish between acute myocardial injury related to either acute coronary athero-thrombosis (MI type 1) or to an imbalance between myocardial oxygen supply/demand secondary to underlying stressor(s) (MI type 2)
- Distinguish between procedural related myocardial injury and procedural related myocardial infarction (MI types 4a or 5)
- Discuss the pathophysiology of acute coronary syndromes describing the role of atherosclerotic plaque, platelets, and the coagulation system.
- Describe the therapy for acute coronary syndromes (aspirin, thrombolytic therapy, etc.) in terms of the underlying pathophysiology
- Explain the complications of acute myocardial infarction
- Define the mechanisms of heart failure and cardogenic shock in coronary artery disease
- Triage, identify and activate immediate management strategies of patients with suspected ACS
- Apply algorithm diagnostic to rule in/out ACS (ECG, biomarkers and imaging techniques) and confirm a diagnosis of AMI
- Distinguish ST-segment elevation MI (STEMI) and non-STEMI by different prognosis and treatment strategy
- Detect ACS and distinguish the types of myocardial infarction that can occur in critically ill patients
- Discuss the role of primary PCI in the management of AMI and appropriate pharmacotherapy
- Establish risk stratification models (clinical, ischemic and bleeding) of STEMI and non-SETMI
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 1.4 Triages and prioritises patients appropriately, including timely admission to ICU.
- 2.1 Obtains a history and performs an accurate clinical examination
- 2.2 Undertakes timely and appropriate investigations
- 2.4 Performs electrocardiography (ECG / EKG) and interprets the results
- 2.9 Monitors and responds to trends in physiological variables.
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis.
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.3 Recognises and manages the patient with circulatory failure.
- 4.1 Prescribes drugs and therapies safely.
- 5.1 Administers oxygen using a variety of administration devices
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
- 12.1 Communicates effectively with patients and relatives
- 12.2 Communicates effectively with members of the health care team
- 12.3 Maintains accurate and legible records / documentation
- 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
- 12.7 Collaborates and consults; promotes team-working
- 12.8 Ensures continuity of care through effective hand-over of clinical information
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
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If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Right Ventricular Failure in ICU
Summary
In 1616, Sir William Harvey was the first physician to realise the importance of the right ventricle (RV) and its interactions with the pulmonary circulation, yet up until the mid-20th century little emphasis had been placed on the RV. In recent times however there has been increased recognition of the role of RV function in many disease states. This has followed an increased understanding of the interactions of the pulmonary and systemic circulations, particularly in pathophysiological conditions. Additionally, the widespread treatment of patients with pulmonary hypertension and associated RV dysfunction, along with advances in management strategies with newer pulmonary vasodilators and the increasing role of extra-corporeal life support mean a new focus on the role of RV function in critically ill patients.
In this overview of the RV and intensive care, we will discuss the underlying normal anatomy and physiology of the RV, conditions associated with right ventricular failure (RVF), diagnosis and provide a systematic approach to managing the critically-ill patient with RVF.
General Information
Enrolled trainees 2150
Open 13.01.2020
Available for ESICM members
Student effort 3
Last Updated September 28, 2022
Intended Learning Outcomes
At the end of this course the student should be able to:
- Describe the epidemiology and importance of right ventricular failure in intensive care medicine
- Understand the normal anatomy and physiology of the right ventricle
- Understand the concepts of preload, afterload, coupling and ventricular interdependence in relation to the right ventricle.
- Describe the pathophysiology of the failing right ventricle
- Describe the variety of clinical conditions related to right ventricular failure in intensive care.
- Demonstrate the work up of a patient with right ventricular failure including clinical assessment and key investigations
- Describe a structured approach to management including attention to rate/rhythm, coronary perfusion, preload, contractility and afterload.
- Describe the indications and timings for short term mechanical circulatory support in acute right ventricular failure
- Describe the key features of mechanical circulatory support including TandemHeart, ImpellaRP and veno-arterial extracorporeal membrane oxygenation.
- Understand the role of long term mechanical support and heart transplantation
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilization of the acutely ill patient with disordered physiology
- 1.3 Manages the patient post-resuscitation
- 2.2 Undertakes timely and appropriate investigations
- 2.3a Performs and interprets focused transthoracic echocardiography
- 2.4 Performs electrocardiography (ECG / EKG) and interprets the results
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
- 3.3 Recognises and manages the patient with circulatory failure
- 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
- 4.5 Describes the use of devices for circulatory or respiratory assist
- 5.17 Demonstrates a method for measuring cardiac output and derived haemodynamic variables
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Left sided Heart Failure
Summary
Acute heart failure (AHF) represents a diverse spectrum of clinical presentations resulting from an array of acute and chronic pathologies that compromise cardiac function. It can present de novo or, more commonly, as a decompensation of pre-existing chronic heart failure. Presentations can range from a normotensive patient with breathlessness and fluid retention to one with florid cardiogenic shock.
General Information
Enrolled trainees 2234
Open 15.07.2019
Available for ESICM members
Student effort 3
Last Updated August 29, 2022
Intended Learning Outcomes
After completing this module, the student should be able to:
- Describe the epidemiology and the importance of heart failure within intensive care medicine.
- Describe the pathophysiological responses of the failing heart, specifically the neurohormonal response and how these impact on the left ventricular pressure-volume loop.
- Classify the diverse causes of acute decompensated heart failure.
- Discuss the workup for a patient with acute heart failure describing the key features of clinical assessment and investigations.
- Outline the place for grading systems, prognostication and scoring systems for the patient with acute heart failure and their limitations.
- Outline the basic and advanced monitoring available for the critically unwell patient with acute heart failure including cardiac output monitoring.
- Describe the management of heart failure as outlined within the European Society of Cardiology Guidelines.
- Outline the physiological targets and standard organ support when treating the patient with acute heart failure.
- Describe the indications and timing for short term mechanical circulatory support in acute heart failure.
- Outline the haemodynamic goals and effects of mechanical circulatory support
- Describe the key characteristics of specific devices including, intra-aortic balloon pump (IABP), Impella, TandemHeart, Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO).
- Discuss the role of long term mechanical circulatory support and heart transplantation.
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 1.3 Manages the patient post-resuscitation
- 2.2 Undertakes timely and appropriate investigations
- 2.3a Performs and interprets focused transthoracic echocardiography
- 2.4 Performs electrocardiography (ECG / EKG) and interprets the results
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
- 3.3 Recognises and manages the patient with circulatory failure
- 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
- 4.5 Describes the use of mechanical assist devices to support the circulation
- 5.17 Demonstrates a method for measuring cardiac output and derived haemodynamic variables
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Hypotension
Summary
Hypotension is a common clinical problem and in certain situations, may represent a life-threatening emergency. A logical approach to managing the hypotensive patient is required for those practicing within the intensive care unit, acute medical or surgical wards, operating theatres and emergency department.
General Information
Enrolled trainees 2147
Open 07.09.2018
Available for ESICM members
Student effort 2
Last Updated March 30, 2022
Intended Learning Outcomes
After studying this module on Hypotension, you should be able to:
- To understand the physiology of normal blood pressure regulation.
- To appreciate the relationship between blood pressure and cardiac output, and how these can be measured.
- To define and classify shock, giving examples of important pathology within each type.
- To give an overview of resuscitation for patients in shock, including administration of oxygen, fluid, vasopressors and inotropes.
Relevant competencies in CoBaTrICE
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.3 Recognises and manages the patient with circulatory failure
- 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
- 5.17 Demonstrates a method for measuring cardiac output and derived haemodynamic variables
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Hypertension
Summary
Hypertension is one of the most common medical problems that affects approximately 1 billion individuals worldwide. Hypertension also results in significant morbidities despite the availability of antihypertensive medications. Severe hypertension usually develops in individuals with chronic hypertension but may also occur in individuals with no previous elevation of blood pressure. Patients with severe hypertension may present to their primary care physician with relatively mild symptoms or to the emergency department or intensive care unit (ICU) with life-threatening complications. Some patients can be managed in the outpatient setting but others require hospitalisation on the general ward, an intermediate care unit, or the ICU. Appropriate evaluation and management of patients with severe hypertension is important because inadequate therapy as well as overaggressive therapy can result in adverse consequences.
General Information
Enrolled trainees 1953
Open 30.03.2018
Available for ESICM members
Student effort 3
Last Updated August 1, 2022
Intended Learning Outcomes
After studying this module on Hypertension, you should be able to:
- Clinical evaluation of the hypertensive patient
- Emergency measures and initial treatment
- Pharmacotherapy of hypertensive crises
- Management of specific conditions
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 2.9 Monitors and responds to trends in physiological variables
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.11 Recognises life-threatening maternal peripartum complications and manages care
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.
Arrhythmia Part I
Part 1: Introduction to Arrhythmia
Summary
Key Points
- Recognition, diagnosis, interpretation and treatment of arrhythmias represents an important task and competence for every intensivist.
- Mechanisms, stepwise recognition, and therapeutic management of arrhythmias, relevant to the intensive care environment will be reviewed.
- Management of arrhythmias, updated with new anti-arrhythmic drugs and novel techniques such as radiofrequency catheter ablation, with consideration of the circumstances in which the intensivist might consider such options and consultation to cardiology.
- Sections on pacemaker, implantable cardioverter defibrillator and cardiac resynchronisation therapies.
- Specifics and potential problems encountered during the potential, escalating treatment of such patients in ICU.
- Note: The prevalence of sustained arrhythmias in general ICU patients is 12%. Ventricular arrhythmias increase the risk of death and of neurological sequelae.
- Note: Appropriate and timely referral for specialist opinion may be life saving.
- Intensive care physicians need to be thoroughly familiar with the diagnosis, appropriate investigation and treatment of patients with cardiac rhythm disturbances. They also need to be aware of the indications for specialist intervention that a cardiologist and/or cardiac surgeon might have to offer. Useful reviews are found below.
General Information
Enrolled trainees 2651
Open 13.01.2020
Available for ESICM members
Student effort 1
Last Updated April 13, 2022
Intended Learning Outcomes
After studying this module on Introduction to Arrhythmia, you should be able to:
- Articulate a structured approach to EKG assessment
- Describe normal electrical conduction pathways through the heart and the resulting EKG tracings
- Contrast abnormal cardiac electrical activity with normal activity, and explain how this abnormal activity results in clinically relevant arrhythmias
Relevant competencies in CoBaTrICE
- 2.4 Performs electrocardiography and interprets the results
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
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Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.