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Basics of Electrocardiography (Medicine, 3 Course)

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54 views12 pages

Basics of Electrocardiography (Medicine, 3 Course)

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Hdrhbbb
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© © All Rights Reserved
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I.

HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY

DEPARTMENT OF INTERNAL MEDICINE PROPEDEUTICS AND PHTHISIOLOGY

«APPROVED»
Vice-Rector of Higher Education Institution
for Science and Education
_____________________Arkadii SHULHAI
«_____» _______________________ 2022

ACADEMIC PROGRAM

Course name BASICS OF ELECTROCARDIOGRAPHY


Branch of knowledge 22 HEALTH CARE
Speciality 222 MEDICINE
Training program GENERAL MEDICINE
Level of Higher Education SECOND (MASTER)
Faculty international students faculty
Academic Year 2022-2023

Developers of Academic Program:


DSc, Medicine, Professor, Head of Internal Medicine Propаedeutics and Phthisiology Department
Serhiy ANDREYCHYN;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Nataliia BILKEVYCH;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Nataliia KAVETSKA;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Nadiia YAREMA;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Tetiana CHERNETS;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Nataliia VERESHCHAHINA;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Svitlana KUCHER;
PhD, Associate Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Iryna HANBERGER;
PhD, Assistant Professor of Higher Education Institution Internal Medicine Propаedeutics and
Phthisiology Department Uliana MUDRA.

Approved at the meeting of Internal Medicine Propаedeutics and Phthisiology Department


on «___» __________ 2022, Minutes № ___

Head of Internal Medicine Propаedeutics


and Phthisiology Department ____________________ Serhiy АNDREYCHYN

Approved by the Cyclic Subject Methodical Commission on Therapeutic Disciplines of Medical Faculty
on «___» __________ 2022, Minutes № ___
1. Description of the discipline

Branch of knowledge, Discipline features


Indicators specialty,
degree of higher education Full-time learning

Elective course
Year of study
Branch of knowledge:
3rd
22”Health Care”
Semester
Duration of study – full term
5th 5th
Specialty: Lectures
Number of credits – 3 222 “Medicine”
Practical classes
Degree of higher 10 hours 10 hours
Total hours – 90 education: Student’s independent work
Second (Master) degree 35 hours 35 hours
Type of assessment
Differentiated credit
2. COMPETENCES AND PROGRAM LEARNING OUTCOMES
According to the Training Program "General Medicine" of the Second (Master) degree, specialty
222 "Medicine", branch of knowledge 22 "Health care", the course "Basics of
Electrocardiography" ensures the acquisition of the following competences and program learning
outcomes by students:

General Competences (GC)


GC 1. Capacity for abstract thinking, analysis and synthesis.
GC 2. Ability to learn and acquire modern knowledge.
GC 3. Capacity for applying knowledge in practical situations.
GC 10. Ability to use information and communications technologies.
GC 11. Ability to search, process and analyze information from various sources.

Professional competencies (PC)


PC 1. Ability to collect medical information about the patient and analyse clinical data.
PC 2. Ability to determine the required list of laboratory and instrumental studies and evaluate their
results.
PC 7. Ability to diagnose emergencies.

Program learning outcomes (PLO)


PLO 2. Understanding and knowledge of basic, biomedical and clinical sciences at the level
sufficient to solve professional problems in the field of health care.
PLO 3. Possess specialized conceptual knowledge, which is the basis for research, implementation
of innovative methods of diagnosis and treatment in the field of health care; critically comprehend
problems in the field of medicine and related interdisciplinary problems.
PLO 5. Collect complaints, life history and history of the disease, assess the psychomotor and
physical development of the patient, the state of organs and organ systems of the body, based on the
results of laboratory and instrumental studies to assess information about the diagnosis (list 4), with
the account of the patient’s age.
PLO 7. Prescribe and analyse additional (mandatory and optional) methods of examination
(laboratory, functional and / or instrumental) (according to list 4) to patients with diseases of organs
and organ systems of the body for differential diagnosis of diseases (list 2).
PLO 8. Determine the main clinical syndrome or the cause of severity of the injured person
(according to list 3) by making an informed decision and assessing the human condition under any
circumstances (in a health care facility, outside it), including conditions of emergency and
hostilities, in the field, in conditions of lack of information and time limitation.
PLO 22. Apply modern digital technologies, specialized software, statistical methods of data
analysis to solve health problems.
PLO 24. Organize the necessary level of individual security (one’s own and people which are taken
care of) in case of typical dangerous situations in the individual field of activity. Adhere to a healthy
lifestyle, use the techniques of self-regulation and self-control.
PLO 25. Clearly and unambiguously communicate one’s knowledge, conclusions and arguments on
health problems and related issues to specialists and non-specialists. Effectively form a
communication strategy in professional activities. Be guided in the activity by civil rights, freedoms
and duties; raise general and cultural level.
PLO 26. Manage work processes in the health care that are complex, unpredictable and require new
strategic approaches, organize the work and professional development of staff based on acquired
skills of effective teamwork, leadership positions, high quality, accessibility and fairness, ensuring
providing integrated medical care.
3. EXPLANATORY NOTE FOR THE COURSE
The academic program of the course "Basics of Electrocardiography" is drawn up for
students studying at I. Horbachevsky Ternopil National Medical University, Training program
"General Medicine", the second (master) degree of higher education, branch of knowledge 22
"Health Care", specialty 222 "Medicine".
The academic program of the course is compiled according to the relevant curriculum of
I. Horbachevsky Ternopil National Medical University, discussed and approved at a meeting of the
Academic Board of I. Horbachevsky Ternopil National Medical University, Protocol No.05, dated
April 26, 2022 and the Order No.127 entered into force on April 26, 2022.

The course “Basics of Electrocardiography” is aimed at development of systemic knowledge


and understanding of conceptual foundations of the main aspects of electrocardiogram recording
and analysis of examination results in order to diagnose the main signs of acute and chronic
diseases of the heart, to learn about modern opportunities of functional examination in cardiology.

“Basics of Electrocardiography” as a course:


a) is based on basic knowledge of the disciplines: human normal physiology,
electrophysiological research methods in medicine, pathophysiology, pathophysiology of
emergencies.
b) provides a high level of general therapeutic training;
c) provides relevant knowledge, competences and program learning outcomes for further
mastering of relevant clinical disciplines (internal medicine, general practice (family medicine),
pathophysiology of emergencies, current problems of cardiology.

When studying the course “Basics of Electrocardiography” the following teaching methods
are used: verbal (story, conversation, explanation); practical (exercise, experiment, performance
task); explanatory and illustrative (lectures, educational literature, natural objects, videos, etc.);
inductive; deductive; analytical; traductive; reproductive; problem statement; heuristic; research;
The use of interactive technologies of joint and group learning (general circle, microphone,
brainstorming, case-method, etc.) promotes understanding of learning material; situational modeling
technologies (simulation or imitation); technologies for processing argued issues (defining a
viewpoint, defending it, changing a viewpoint, debates, talk shows, etc.); elements of distance
learning (MS Teams, Google Meet services, etc.).

As a result of studying the course "Basics of Electrocardiography" the student must know:
● the structure of the electrocardiograph and ECG recording technique;
● physiological and biophysical bases of electrocardiography;
● specific changes in the electrocardiogram in various pathological conditions;
● electrocardiological changes in acute cardiac disorders.

As a result of studying the course "Basics of Electrocardiography" the student must be able
to:
● register an ECG in 12 leads;
● identify elements of a normal ECG (vawes, segments, intervals);
● analyze the ECG: determine the pacemaker, reguliarity of heart rhythm, heart rate,
voltage of the ECG vawes, the position of heart electrical axis, measure the duration
and amplitude of ECG vawes, intervals, segments, cardiac cycle;
● interpret correctly the results of the identified changes.
4. CONTENT OF THE COURSE

Topic 1. Anatomy and clinical electrophysiology of the heart. Biophysical bases of formation
of an electrocardiogram.
Topic. Method of electrocardiogram registration.
Electrocardiographic leads: standard, amplified from the extremities, chest leads, additional.
Topic 3. Electrical axis of the heart.
Six-axis coordinate system (according to Bayley). Methods for determining the electrical axis of the
heart. Variants of normal ECG.
Topic 4. ECG recording technique.
Conditions of ECG - research, application of electrodes, attachment of wires to electrodes,
selection of amplification of the electrocardiograph, recording an electrocardiogram. Formation of a
normal ECG. Atrial depolarization (P-wave), P-Q (R) segment, ventricular depolarization, S-T
segment, ventricular repolarization, ventricular systole (Q-T interval)
Topic 5. Analysis of normal ECG.
ECG analysis: general scheme (plan) of ECG decoding. Визначення водія ритму, ознаки
нормального синусового ритму. Частота серцевих скорочень. Визначення вольтажу.
Визначення електричної осі серця. The main elements of the ECG: diagnostic meaning of the
duration and amplitude of waves, the duration of the intervals and segments. The ECG conclusion.
Topic 6. Hypertrophy of heart chambers.
ECG signs of left and right atrial hypertrophy. Signs of hypertrophy of both atria. ECG signs
of left and right ventricular hypertrophy. Signs of hypertrophy of both ventricles.
Topic 7. Violation of the function of automatism.
ECG signs of sinus tachycardia, sinus bradycardia, sinus arrhythmia. Sick sinus syndrome,
sinus arrest.
Topic 8. Active ectopic complexes and rhythms.
Extrasystole: classification, ECG signs of supraventricular (atrial, atrioventricular) and
ventricular extrasystoles. Paroxysmal tachycardia: classification, ECG signs of supraventricular
(atrial, atrioventricular) and ventricular paroxysmal tachycardias.
Topic 9. Atrial and ventricular flutter and fibrillation.
Classification, ECG signs.
Topic 10. Impaired conduction of the heart.
Classification. ECG signs of premature ventricular excitation (Wolf-Parkinson-White
syndrome). ECG signs of sinoatrial, atrial, AV block. The concept of Morgagni-Adams-Stokes
syndrome and Frederick syndrome.
Topic 11. Impaired intraventricular conduction of the heart.
ECG signs of intraventricular block: unifascicular, bifascicular and threefascicular.
Topic 12. ECG diagnosis in chronic forms of coronary heart disease.
ECG signs in chronic forms of coronary heart disease: angina pectoris, cardiosclerosis, silent
ischemia. Functional tests: types and diagnostic ECG criteria. The concept of Holter ECG
monitoring.
Topic 13. ECG diagnosis in myocardial infarction
ECG signs of myocardial infarction: STEMI and non-STEMI (Q myocardial infarction and
non-Q myocardial infarction). ECG stages of myocardial infarction, its topical diagnosis, reciprocal
changes.
Topic 14. ECG in some pathological conditions.
ECG signs of myocarditis, pericarditis, cardiomyopathy, electrolyte disbalance, intoxication with
cardiac glycosides, pulmonary embolism. ECG in patients with an artificial pacemaker.
5. STRUCTURE OF THE COURSE

Lectures Training Student’s


Topics sessions independent
work
1. Anatomy and clinical electrophysiology of the - -
heart. Biophysical bases of formation of an 4,0
electrocardiogram.
2. Method of electrocardiogram registration. ECG -
leads. 0,25 2,0

3.Electric axis of the heart. Methods of its position -


assessment. Variants of normal ECG (or axis 0,25 4,0
position)
4. ECG recording technique. Electrocardiogram -
8,0
recording. Formation of a normal ECG. 0,5
5. Electrocardiogram analysis: general scheme (plan) -
of ECG decoding. Electrocardiographic conclusion. 1,0 8,0

6. Hypertrophy of heart chambers. - 2,0 -


7. Violation of the function of automatism. - 2,0 4,0
8. Active ectopic complexes and rhythms. - 2,0 8,0
9. Atrial and ventricular flutter and fibrillation. - 2,0 6,0
10. Disorders of conduction of the heart. - 2,0
6,0
11. Disorders of intraventricular conduction of the - 2,0
6,0
heart.
12. ECG diagnosis in chronic forms of coronary - 2,0
6,0
heart disease.
13. ECG diagnosis in myocardial infarction - 2,0 -
14. ECG in some pathological conditions. - 2,0 8,0
TOTAL - 20 70
6. THEMATIC PLANS

TOPICS OF LECTURES
This course does not include lectures

THEMATIC PLAN OF TRAINING SESSIONS


№ Topics of training sessions Hours

1. Algorithm for normal ECG analysis. 2


2. Hypertrophy of heart chambers. 2
3. Violation of the function of automatism. 2
4. Active ectopic complexes and rhythms. 2
5. Atrial and ventricular flutter and fibrillation. 2
6. Disorders of conduction of the heart. 2
7. Disorders of intraventricular conduction of the heart. 2
8. ECG diagnosis in chronic forms of coronary heart disease. 2
9. ECG diagnosis in myocardial infarction 2
10. ECG in some pathological conditions. 2
TOTAL 20

.
THEMATIC PLAN OF STUDENT’S INDEPENDENT WORK

№ Topics of student’s independent work Hours

1. Anatomy and clinical electrophysiology of the heart. Biophysical bases of


1. 4
formation of an electrocardiogram.
2. Method of electrocardiogram registration. ECG leads. 2
Electrical axis of the heart. Method of its assessment. Variants of normal
3. 4
ECG.
4. ECG recording technique. Recording an ECG. Formation of normal ECG. 8
Electrocardiogram analysis: general scheme (plan) of ECG decoding.
5. 8
Electrocardiographic conclusion.
6. Violation of the function of automatism. 4
7. Active ectopic complexes and rhythms. 8
8. Atrial and ventricular flutter and fibrillation. 6
9. Disorders of conduction of the heart. 6
10. Disorders of intraventricular conduction of the heart. 6
11. ECG diagnosis in chronic forms of coronary heart disease. 6
12. 8
TOTAL 70
7. CRITERIA FOR STUDENTS’S KNOWLEDGE ASSESSMENT IN THE COURSE

The knowledge in the course is assessed by current and final performance. The maximum points a
student receives for the course is 200 points.

ASSESSMENT OF CURRENT PERFORMANCE


Current performance consists of:
- academic performance during training sessions / seminars (by a twelve-point scale);
- student’s individual work (from 1 to 6 points).

CRITERIA FOR ASSESSMENT OF STUDENTS’ KNOWLEDGE AND SKILLS


DURING A TRAINING SESSION / SEMINAR.
Scoring Criteria for assessment
In cases the student does not interpret the content of the learning material, has not
1
completed performance tasks, has not drawn up a protocol.
In cases the student has poor knowledge of the learning material, which is checked by
2 offering them additional questions, and they are not aware of the content of
performance tasks.
In cases the student reveals the content of the educational material in fragments,
3 makes gross mistakes in defining the concepts and use of terminology, performance
tasks are completed, protocol is drawn up partly.
In cases the student is aware of the main material, but can not independently and
4 consistently formulate the answer, encouraging the teacher to offer him leading
questions, performance tasks are completed fragmentarily.
In cases the student fragmentarily reveals the content of learning material, has an
5
initial idea of ​the subject matter, performance tasks are not completed.
In cases the student is aware of the basic learning material, but with significant
mistakes when presenting it; they give simple examples, insufficient definitions of
6
concepts, adequate characteristic of general features of objects; the protocol of the
lesson is not completed.
In cases the student reveals the main content of the learning material with minor
mistakes in the sequence of material presented, in using scientific concepts and terms,
7
they draw conclusions vaguely, are aware of the methodology of performance tasks,
which are not completed.
In cases the student reveals the main content of the learning material; gives
incomplete definitions of concepts; uses scientific terms inaccurately, draws
8
conclusions vaguely, performance tasks are completed but with minor mistakes
during the research.
In cases the student reveals the main content of the learning material; gives
definitions of concepts and terms in full with minor mistakes in the sequence of
9
presentation; performance tasks are completed independently with good knowledge
of the methodology but with some inaccuracies in its sequence.
In cases the student shows profound knowledge of the material; can analyze, evaluate
and reveal the essence of phenomena and processes; establish causal relationships;
10
logically draw conclusions; a protocol of training session is drawn up with minor
mistakes in using scientific terms and concepts.
In cases the student shows deep, profound and systematic knowledge in the volume of
the academic program, answers all questions unmistakably, reasonably formulates
11 conclusions using the materials of students’ independent work; performance tasks are
compleded competently and consistently preserving the technique; the protocol of the
training session is drawn up in full using scientific terms and concepts correctly.
In cases the student independently, competently and consistently, comprehensively
12
answeres questions using additional literature and characterizing various biological
phenomena and processes; clearly and correctly defines and reveals the content of
scientific terms and concepts, performance tasks are compleded independently and
correctly, the protocol of the training session is drawn up without any errors.

The grade for the training session is positive if it is 4.0 points or more.

Students’ individual work involves realization of their creative potential through


individually directed development of abilities, research, creativity. The tasks for student’s individual
work and the criteria for its assessment are defined by a department independently.

TASKS FOR STUDENTS’ INDIVIDUAL WORK


1. Involvement into the student scientific circle and speeches (presentations) in
scientific forums.
2. Designing schemes on relevant topics of the discipline.
3. Designing laminated tables on relevant topics of the discipline.
4. Recording videos for discipline parts.
5. Selection of two videos and/or two audios for discipline parts.
6. Writing an abstract.

CRITERIA FOR STUDENTS’ INDIVIDUAL WORK ASSESSMENT


Individual student’s work at the department is scored from 0 to 6 points.

Scoring Criteria od assessment


Selection of two videos and/or two audios for discipline parts
1 or
Speech (presentation) at a meeting of the student scientific circle
Designing a laminated table on the relevant topics of the discipline
2 or
Compiling a crossword puzzle from the relevant sections of the discipline
Selection of ECG-strips for the educational collection of the department
or
3
Participation in an interuniversity or international student scientific forum with
publication of the research results.
Involvement into the student Olympiad in the discipline
or
4
Participation in an interuniversity or international student scientific forum with a
poster report.
Selection of materials and designing of a presentation on the relevant topic or part
of the discipline
5
or
Participation in the student scientific forum with a report.
Prize in the student Olympiad in the discipline
6 or
Prize in an interuniversity or international student scientific forum.

Сurrent performance is calculated at the end of studying a discipline taking into account the average
grade in training sessions/seminars (rounding of the GRADE is carried out according to the scheme:
the range from 0 to 0,24 is rounded to a smaller unit; the range from 0.25 to 0.74 is rounded to 0.5;
the range from 0.75 to 0.99 is rounded to a larger unit). Subsequently, the average performance
garde is converted into a 200-point assessment scale.
Average grade Scores on a 200-point assessment scale
4 66
4,5 69
5 72
5,5 75
6 78
6,5 81
7 84
7,5 87
8 90
8,5 93
9 96
9,5 99
10 102
10,5 105
11 108
11,5 111
12 114

The maximum points a student can score for current academic performance is 120 points
(114 points for formative assessment and another 6 points for students’ individual work).
ASSESSMENT OF FINAL PERFORMANCE
Performance at the end of studying the parts of a course is assessed in the form of a credit.

CRITERIA FOR KNOWLEDGE ASSESSMENT IN THE COURSE


WITH THE FORM OF SUMMATIVE ASSESSMENT OF A CREDIT
The credit takes place at the last training session, involves determining the level of student’s
mastering the discipline and their individual work.
The level of mastering the discipline is determined by calculating the average grade in
training sessions / seminars to the tenth (by mathematical rounding). Subsequently, the average
performance score is converted into a 200-point assessment scale:

Points by a Points by a Points by a


Average 200-point Average 200-point Average 200-point
grade assessment grade assessment grade assessment
scale scale scale
4,0; 4,1 117 6,7 143 9,4 169
4,2 118 6,8 144 9,5 170
4,3 119 6,9 145 9,6 171
4,4 120 7,0; 7,1 146 9,7 172
4,5 121 7,2 147 9,8 173
4,6 122 7,3 148 9,9 174
4,7 123 7,4 149 10,0; 10,1 175
4,8 124 7,5 150 10,2 176
4,9 125 7,6 151 10,3 177
5,0 126 7,7 152 10,4 178
5,1 127 7,8 153 10,5 179
5,2 128 7,9 154 10,6 180
5,3 129 8,0 155 10,7 181
5,4 130 8,1 156 10,8 182
5,5 131 8,2 157 10,9 183
5,6 132 8,3 158 11,0 184
5,7 133 8,4 159 11,1 185
5,8 134 8,5 160 11,2 186
5,9 135 8,6 161 11,3 187
6,0 136 8,7 162 11,4 188
6,1 137 8,8 163 11,5 189
6,2 138 8,9 164 11,6 190
6,3 139 9,0 165 11,7 191
6,4 140 9,1 166 11,8 192
6,5 141 9,2 167 11,9 193
6,6 142 9,3 168 12,0 194

The maximum points a student receives for a credit is 200 points (194 points for academic
performance and 6 points for individual work).
The score obtained by a student in the discipline is converted according to the scale of the
European Credit Transfer System (ECTS).

The students are admitted to take a credit test if they have no academic debt; have
minimum points for academic performance (4.0); completed all types of work according to the
academic program on the discipline.
9. MEANS FOR FORMATIVE AND SUMMATIVE ASSESSMENT

1. Test tasks
2. Case problems.
3. Recorded electrocardiograms.

9. REFERENCES
Basic:
1. Romeo J Vecht. ECG Diagnosis Made Easy..Informa Healthcare; 9th Edition. – 2019.- 207
pp.
1. Ashcheulova Т. V. Electrocardiographic examination of patients with conductivity function
alterations : mеthodical instruction for students / Т. V. Ashcheulova, O. N. Kovalyova, A. V.
Demydenko ; Kharkiv National Medical University. – Kharkiv: KhNMU, 2017. – 16 p.
2. Electrocardiographic method of cardiac function examination. Technique of ECG
registration and reading : methodical instructions for students / Т. V. Ashcheulova, O. N.
Kovalyova, A. V. Demydenko. – Kharkiv : KhNMU, 2017. – 25 p.
3. Ashcheulova Т. V. Electrocardiographic examination of patients with automaticity and
excitability function alterations : mеthodical instruction for students / Т. V. Ashcheulova, O.
N. Kovalyova, A. V. Demydenko ; Kharkiv National Medical University. – Kharkiv :
KhNMU, 2017. – 27 p.
4. ECG signs of hypertrophy of heart atriums and ventricles : methodical instructions for
students / Т. V. Ashcheulova, O. N. Kovalyova, A. V. Demydenko. – Kharkiv : KhNMU,
2017. – 15 p.
5. Ashcheulova Т. V. The main ECG syndromes of the myocardium damage (ischemia, injury,
necrosis). ECG in myocardial infarction : mеthodical instruction for students / Т. V.
Ashcheulova, O. N. Kovalyova, A. V. Demydenko ; Kharkiv National Medical University. –
Kharkiv : KhNMU, 2017. – 12 p.
2. Propedeutics of internal diseases. - Vinnytsya : Nova knyha publ., 4th edition .P. 1 :
Diagnostics / O. N. Kovalyova, T. V.Ashcheulova. - 2nd ed. - 2020. - 424 pp.
3. Kaplan Qbank and USMLE World.

Additional:
1. Malcolm Thaler. The Only EKG Book You'll Ever Need.б 9 th edition– 2019. – 260 pp.
2. Centhia Webner, Karen Marzlin. Advanced 12 leads ECG interpretation, 2016. – P.2-30.
3. J. Huff. ECG Workout: Exercises in Arrhythmia Interpretation (Huff, ECG
Workout) 7th Edition Publisher ‫‏‬: ‎Lippincott Williams & Wilkins. – 2016. · 378 pp.
4. D. Anderson, medical Creations, M. Mastenbjork, S. Meloni. EKG/ECG Interpretation:
Everything you Need to Know about the 12-Lead ECG/EKG Interpretation and How to
Diagnose and Treat Arrhythmias. – Independently Published, 2016. — 217 p.

Web resources:
1. https://www.tdmu.edu.ua/
2. https://library.tdmu.edu.ua/
3. http://www.webcardio.org/
4. https://www.escardio.org/
5. http://www.international.heart.org
6. https://moodle.tdmu.edu.ua/login/index.php
7. https://guidelines.moz.gov.ua/
8. https://www.youtube.com/channel/UCPHpx55tgrbm8FrYYCflAHw
9. https://www.youtube.com/c/osmosis
10. https://www.youtube.com/user/MEDCRAMvideos
11. https://www.lecturio.com/medical/
12. https://pubmed.ncbi.nlm.nih.gov/

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