A Systematic Approach to Pharmacotherapeutically Relevant ECG Findings

Facilitator: Dr.Peter Loewen, B.Sc(Pharm), ACPR, Pharm.D., FCSHP, R.Ph.

LMPS Residents Dec 2022: We have a tricky challenge for this one. Many of you have received formal ECG interpretation training, whether in your E2P program (some from me!) and/or rotations so far. Others are new to ECG interpretation. We only have 3 hours together and it's difficult to know how to pace our time. My plan is for us to rapidly work through the ECG approach, expecially the foundational stuff (first 32 slides of the first set of visuals below), with the hope of getting to at least some of the additional scenarios to challenge those who have ECG training already. I don't know how this will go, but for everyone it will be extra-important to be VERY familiar with the "required prior knowledge and skills" items, without which our time together will make little sense. If you review the first set of visuals beforehand (whether to refresh or start learning the standard approach to ECG interprtation), that will help a lot too.

GOAL

Residents will have an APPROACH to interpreting 12-lead ECGs such that they can INDEPENDENTLY identify pharmacotherapeutically relevant findings to enhance drug related issue detection and drug monitoring.

This workshop forms the basis for residents to go out and practice these skills on their own. Like most things, only repetition will allow residents to use these skills in their own practice.

SESSION OBJECTIVES

Following the workshop and following personal reflection and practice, residents should:

1. Explain each of the 6 steps of their approach to ECG interpretation

2. Use the 6-step approach, identify pharmacotherapeutically relevant findings on a 12-lead ECG, including:

3. Identifying NSR vs. not

4. Identifying AF
5. Recognizing ventricular hypertrophy
6. Recognizing injury/ischemia/infarction and its anatomic location
7. Recognizing conduction delays (AV node, repolarization) and correlating them to drug therapy

DURING THE SESSION

We will:

• talk through the approach to ECG interpretation using examples.
• residents will practice interpreting the case ECGs independently
• if it goes smoothly, we'll have time to look at some extra scenarios

If you've already had ECG training (UBC PharmD students, residents trained during cardiology rotation, other sources of learning), throughout the session you will be relied upon to add your thoughts, ask deep questions, help other learners understand.

REQUIRED PRIOR KNOWLEDGE & SKILLS

1. Describe normal cardiac function (the cardiac cycle) from a HEMODYNAMIC and ELECTRICAL viewpoint: YouTube video | YouTube video
2. Have a correct mental picture of the orientation of the heart in the thorax: YouTube video
3. Relationship between the cardiac cycle and ECG waves: P, Q, R, S, T: YouTube video
4. Acquire Loewen’s ECG Approach 1-pager of the 6 steps to take notes on.

RESOURCES

• visuals of the approach to ECG interpretation
• case scenarios
• additional relevant situations to recognize

Online

• Life in the Fast Lane
• Conquering the ECG
• ECGpedia | quick reference card | ECG textbook
• Medscape’s ECG of the Month
• ECG Wave-Maven
• ECG Made Simple
• ECG Learning Center

Primary Literature

• BMJ's ABC of clinical electrocardiography Series

Old-school

• Dubin D. Rapid Interpretation of EKG’s. 6th Ed. 2007. amazon.com

iOS & Android Apps

There are dozens. Search the relevant App store.

updated December 2022