SIM Beat – 21st Century approach to Cardiac Arrhythmias

Course Description

Cardiac Arrhythmia can be defined as any abnormality in the rate, regularity, or sequence of cardiac activation. It can originate from abnormal impulse initiation in an individual myocyte or, more realistically, in a close cluster of myocytes.
Several mechanisms such as hypoxia, myocarditis, myocardial ischemia, or abnormal host immune response, which induce cardiac arrhythmias, have been described.
The principle of diagnosis in electrophysiology is to find the critical culprit anatomical site of the patient’s clinical arrhythmia.
The SIM Beat course provides the knowledge and skills needed to interpret and treat cardiac arrhythmias, namely, Brady and Tachyarrhythmias in Emergency Room and Consultation environments.
The emphasis in this course is to practice,on virtual patients, rhythm interpretation, and appropriate treatment for chronic and life-threatening arrhythmias.

Course Overview

• 10 Modules
  • The course consists of 10 modules, with each containing a Clinical Scenario. You can attempt each case up to 3 times.
• Average Time to practice (per module)
  • Clinical Scenario: 20 minutes per attempt (3 attempts: 60 minutes)
  • Final attempt (if applicable): 20 minutes
  • Multiple Choice Question: 5 minutes
  • Feedback Area: 10 minutes
  • Learning Objectives and Scientific References: 5 minutes
  • Debriefing Video: 10 minutes
• Online, Self-paced
  • You have up to 2 months to complete the 10 modules at your own pace. The course can be accessed through Body Interact at any time.
• Certificate of Completion
  • After completing the course, you will receive a Certificate of Completion that can be added to your CV or Resume.

Learning Objectives

• Manage the non-valvular paroxysmal atrial fibrillation according to internationally accepted guidelines;
• Diagnose and treat ventricular arrhythmia and supraventricular tachycardia in several clinical settings;
• Define and deliver the best therapy for each arrhythmia.

Clinical Competencies

Safety

• Universal safety measures procedures
• Promote patient safety

Airway and Breathing

• Airway – naso/oropharyngeal
• Oxygen therapy (nasal cannula; non-rebreather; high-flow mask)
• Pulse oximetry
• Suctioning – upper airway

Circulation

• Cardiopulmonary resuscitation (CPR)
• Assess and interpret pulse (rate, rhythm and volume)
• Cardiac monitoring – 12-lead ECG

Medication- Routes

• Aerosolized / nebulized
• Intramuscular – auto-injector
• Intranasal – unit-dosed, premeasured
• Mucosal / Sublingual
• Oral

Module 1 – Catheter or Pill

Context: Symptoms including palpitations, fatigue, dizziness, dyspnoea, chest pain, and anxiety may be present in a cardiac arrhythmia. For each patient focus must be to identify the arrhythmia and deliver the best therapy to ensure clinical stability and optimal quality of life. This mainly includes drugs, lifestyle modifications, and state-of-the-art catheter-based therapies.
Virtual Scenario: Mr. Bradley had a heavily symptomatic atrial fibrillation crisis and went to the Emergency Department. He was discharged with a prescription consisting of a beta-blocker and a direct thrombin inhibitor, after undergoing successful cardioversion.

Module 2 – MI + 1

Context: How to approach De Novo Atrial Fibrillation? The focus must be set on ischemia and bleeding risk evaluation, eligibility for anticoagulation, and determining the best anti-arrytmic and risk factors therapy.
Virtual Scenario: Mr. Keith is going to have his first appointment for long-term health care management, after requiring emergency medical care due to a STEMI about four weeks ago.

Module 3 – A heart with bad rhythm

Context: Irregular heartbeats are a common complaint. How to address this symptom? How to value the Holter findings? Should we treat everyone? What is the best drug?
Virtual Scenario: Mrs. Walker arrives at the visit with many palpitations, some episodes of lightheadedness, fainting, and loss of consciousness with some days of evolution.

Module 4 – The machine that fixes the machine

Context: Pacemakers have complete change the cardiac arrhythmia landscape. However, they are not perfect. How to approach a pacemaker dysfunction?
Virtual Scenario: Ms. Craig has a past medical history of hypertension and dyslipidemia.

Module 5 – A Tale of two illnesses

Context: Patients with cardiac arrhythmias often have other cardiac diseases. Sometimes that disease triggers arrhythmias, sometimes arrhythmias trigger other cardiac diseases.
Virtual Scenario: Mr. Hale started to feel not well during a morning walk. His neighbor called for assistance as soon as he realized that Mr. Hale needed help.

Module 6 – No time to die?

Context: In extreme conditions, arrhythmias may lead to severe instability and even death. In this setting, we have to rapidly figure out what is happening and make sure that we stabilize the patient ASAP.
Virtual Scenario: Mr. Grey has always been healthy. However, one day he started feeling bad without apparent reason, and he didn’t get better the next day. He decided to go to the Emergency Department.

Module 7 – Fast and Furious

Context: VT is often a life-threatening condition. Clear judgment and fast decisions are paramount.
Virtual Scenario: Ms. Andresson was in her garden, doing some gardening when suddenly she felt her heart racing and had chest discomfort. She called the Emergency Department as soon as she could and was brought to the hospital.

Module 8 – Blackout

Context: Some AF patients may develop syncope and lightheadedness. In this setting ECG may show significant pauses, requiring a permanent device.
Virtual Scenario: Mrs. Smith was packing to go on a trip with her husband when she had a syncope. Her husband called for an ambulance.

Module 9 – One pacemaker, two pacemakers…three pacemakers?!

Context: What if the patient has not one but 2 pacemakers? This is good or bad? Does the patient need a third pacemaker?
Virtual Scenario: Mr. Abbott was at home with his wife when he had a syncope.

Module 10 – Is this love?

Context: Many arrhythmias present as palpitations, sometimes benign other times may lead to cardiac instability and severe quality of life impairment. How to approach and treat these clinical situations?
Virtual Scenario: Mr. Allen was at home with his son when he started feeling palpitations when he was at rest.