ACC list

Knowledge targets

category	item	nurse	physician	cardiologist
Normal tracing
	Normal ECG	x	x	x
Technical Problems
	Leads misplaced	x	x	x
	Artifacts	x	x	x
Sinus node rhythms and arrhythmias
	Sinus rhythm	x	x	x
	Sinus tachycardia (>100 beats per minute)	x	x	x
	Sinus bradycardia (<50 beats per minute)	x	x	x
	Sinus arrest or pause	x	x	x
	Sino-atrial exit block	x	x	x

1. Normal ECG

TECHNICAL PROBLEMS

2. Leads misplaced

3. Artifact

SINUS NODE RHYTHMS AND ARRHYTHMIAS

4. Sinus rhythm

5. Sinus tachycardia (>100 beats per minute)

6. Sinus bradycardia (<50 beats per minute)

7. Sinus arrhythmia

8. Sinus arrest or pause

9. Sino-atrial exit block

OTHER SUPRAVENTRICULAR RHYTHMS

10. Atrial premature complexes

11. Atrial premature complexes, nonconducted

12. Ectopic atrial rhythm

13. Ectopic atrial tachycardia, unifocal

14. Ectopic atrial tachycardia, multifocal

15. Atrial fibrillation

16. Atrial flutter

17. Junctional premature complexes

18. Junctional escape complexes or rhythm

19. Accelerated junctional rhythm

20. Junctional tachycardia, automatic

21. Supraventricular tachycardia, paroxysmal

VENTRICULAR ARRHYTHMIAS

22. Ventricular premature complexes

23. Ventricular escape complexes or rhythm

24. Accelerated idioventricular rhythm

25. Ventricular tachycardia

26. Ventricular tachycardia, polymorphous (including torsade de pointes)

27. Ventricular fibrillation

ATRIAL VENTRICULAR CONDUCTION

28. First-degree AV block

29. Mobitz Type 1 second-degree AV block (Wenckebach)

30. Mobitz Type 2 second-degree AV block

31. AV block or conduction ratio, 2:1

32. AV block, varying conduction ratio

33. AV block, advanced (high-grade)

34. AV block, complete (third-degree)

35. AV dissociation

INTRAVENTRICULAR CONDUCTION

36. Left bundle branch block (fixed or intermittent)

37. Right bundle branch block (fixed or intermittent, complete or incomplete)

38. Intraventricular conduction delay, nonspecific

39. Aberrant conduction of supraventricular beats

40. Left anterior fascicular block

41. Left posterior fascicular block

42. Ventricular pre-excitation (Wolff-Parkinson-White pattern)

QRS AXIS AND VOLTAGE

43. Right axis deviation (+90 to +180 degrees)

44. Left axis deviation (-30 to -90 degrees)

45. Indeterminate axis

46. Electrical alternans

47. Low voltage (less than 0.5 mV total QRS amplitude in each extremity lead and less than 1.0 mV in each Precordial lead)

CHAMBER HYPERTROPHY OR ENLARGEMENT

48. Left atrial enlargement, abnormality, or conduction defect

49. Right atrial abnormality

50. Left ventricular hypertrophy (QRS abnormality only)

51. Left ventricular hypertrophy with secondary ST-T abnormality

52. Right ventricular hypertrophy with or without secondary ST-T abnormality

REPOLARIZATION (ST-T,U) ABNORMALITIES

53. Early repolarization (normal variant)

54. Juvenile T waves (normal variant)

55. Nonspecific abnormality, ST segment and/or T wave

56. ST and/or T wave suggests ischemia

57. ST suggests injury

58. ST suggests ventricular aneurysm

59. Q-T interval prolonged

60. Prominent U waves

MYOCARDIAL INFARCTION

61. Inferior MI (acute or recent)

62. Inferior MI (old or age indeterminate)

63. Posterior MI (acute or recent)

64. Posterior MI (old or age indeterminate)

65. Septal MI (acute or recent)

66. Anterior MI (acute or recent)

67. Anterior MI (old or age indeterminate)

68. Lateral MI (acute or recent)

69. Lateral MI (old or age indeterminate)

70. Right ventricular infarction (acute)

CLINICAL DISORDERS

71. Chronic pulmonary disease pattern

72. Acute pericarditis

73. Suggests hypokalemia

74. Suggests hyperkalemia

75. Suggests hypocalcemia

76. Suggests hypercalcemia

77. Suggests CNS disease

PACEMAKER

78. Atrial-paced rhythm

79. Ventricular-paced rhythm

80. Atrial-sensed ventricular-paced rhythm

81. AV dual-paced rhythm

82. Failure of appropriate capture, atrial

83. Failure of appropriate capture, ventricular

84. Failure of appropriate inhibition, atrial

85. Failure of appropriate inhibition, ventricular

86. Failure of appropriate pacemaker firing

87. Retrograde atrial activation

88. Pacemaker mediated tachycardia