EPicardio Simulation. User Reference Guide

Transcription

1 EPicardio Simulation User Reference Guide If you require technical assistance please contact For product details see here:

2 Introduction Epicardio Simulation is a fully validated advanced cloud-based 3D interactive real-time simulation of the heart that shortens the Cardiology learning curve Provides interactive e-training tutorials and online customisable testing Enables the educator to deliver more content quicker, in a far more visually engaging way Helps trainees to fully master the complexity of the heart and take tests in their own time. Epicardio Ltd All rights reserved.! 2/26

3 Introduction Epicardio Simulation is based on computer software simulation of the human heart a n a t o m y, E l e c t r o p h y s i o l o g y a n d Electrocardiography The simulator offers various adjustable views of the heart The simulator allows for adjusting parameters such as the heart rate, the AV node conduction velocity, the refractory period, etc. The simulator generates accurate and validated 12-lead ECG and EGM s The speed at which the simulated heart functionality is represented will depend upon the hardware and software specifications used. Epicardio Ltd All rights reserved.! 3/26

4 End-User Licence Agreement Epicardio Simulation EULA for MacOSX, Windows and Web-browser versions. If you are accessing the Apple ipad app you can find the Apple - Epicardio EULA on the App Store details. Read the Epicardio EULA Scroll down to the end of the EULA Tap on I ACCEPT to proceed to the app Tap on CANCEL to exit without accepting the EULA Tap on EPICARDIO EULA PDF to download a PDF copy of the EULA. Epicardio Ltd All rights reserved.! 4/26

5 Login Login for MacOSX, Windows and Web-browser versions. If you are accessing the Apple ipad app you do not need to login. Tap on LOGIN at the top right corner of the app window Use your User Name and Password to login If you do not have a valid login you may access the Base content for a limited period (15min). Epicardio Ltd All rights reserved.! 5/26

6 Top menu - left Tutorials Tap to navigate to a pathology group tutorial (1st menu level) or an individual pathology tutorial (2nd menu level). The selected tutorial is marked in red. Menu items appearing in italics are either under development or not available on your licence level. Text Show/hide the tutorial text window. See Tutorial text window for more details. ECG Test Enter the ECG Test mode. See ECG Test window for more details. Quiz Enter the ECG Quiz mode. See Quiz Test window for more details. Help Open a pop-up web-browser window with links to help and support pages. If you are accessing the Apple ipad app you can find the Help files on the App Store details. About Show important information about the Epicardio Simulation app. Epicardio Ltd All rights reserved.! 6/26

7 Top menu - right LOGIN Show/hide user login window (for MacOSX, Windows and Web-browser versions only). Show all text in the selected language. Currently available in UK English and Mandarin. Select 2-monitor display. Works best if you are connected to two monitors of the same resolution. Works on MacOSX and Windows standalone app version only. Switch to full screen mode. To exit from full screen tap on the icon again or press the ESC key on your keyboard. Works on single monitor display only. Epicardio Ltd All rights reserved.! 7/26

8 Tutorial text window TITLE The title of the tutorial. always ON Leaves the tutorial text window continuously on, when navigating from one tutorial to another (on by default). Close the tutorial text window. Curved index pointers that point to the area of focus. PREV / NEXT Tap to advance the tutorial slides. PREV / NEXT TUTORIAL Tap to advance to next/previous tutorial. The tutorial order depends on app version and customisation. Epicardio Ltd All rights reserved.! 8/26

9 Show/hide anatomical view controls. Anatomical view controls AP PA CRANIAL CAUDAL RAO LAO Standard Anatomical Views Anterior - Posterior view Posterior - Anterior view Cranial view at +45º Caudal view at -30º Right Anterior Oblique view at +60º Left Anterior Oblique view at -40º Intermediate views Zoom in/out Epicardio Ltd All rights reserved.! 9/26

10 Anatomical view controls Show/hide atria Show atria in cross/section or full anatomy Show atria in opaque colour / opaque b/w / x-ray display modes Show/hide ventricles Show ventricles in cross/section or full anatomy Show ventricles in opaque colour / opaque b/w / x-ray display modes Epicardio Ltd All rights reserved.! 10/26

11 Anatomical view and other display controls Show/hide conduction pathway. Show/hide coronary arteries. Show/hide main vessels. Show/hide torso. Changes the camera view. Show/hide rib cage and hip bone. Changes the camera view. Show/hide P, R and T wave labels on the ECG signal. Works in EP mode only. Show/hide AP wave colour spectrum. Tap on the colour bar to toggle between colour schemes. Use the min/max sliders to set the AP wave display. Works in EP mode only. Epicardio Ltd All rights reserved.! 11/26

12 Electrophysiology controls Show/hide the electrophysiology controls. Enter/exit the EP mode. Show/hide the 12-lead simulated ECG window. Works in EP mode only. Show/hide the 12-lead patient ECG window. Works in EP mode and pathology tutorials only. Show/hide intra-cardiac electrograms EGM s. Works in EP mode and the Cardiac EP tutorials only. Scale ECG/EGM speed and voltage. ECG speed can be scaled between mm/s. ECG voltage can be scaled between 2-20mm/mV. Tap on the red bent arrow to reset. Epicardio Ltd All rights reserved.! 12/26

13 Electrophysiology controls Show/hide the pacemaker. Tap on +/- to modify the pacing rate between bpm). Tap on the label to reset the rate. Tap anywhere on the heart to place the blue pacing electrode. Observe the change on the ECG signal depending on the pacing location and the pacing rate. This is a simple pacemaker with a single wire. Look into the Pacing tutorials for more details on pacemakers. Show/hide the defibrillator. Tap on CHARGE and wait for a few seconds. When the CHARGED label appears (green) and SHOCK starts flashing red/green, tap on SHOCK to activate the defibrillator. Listen to the characteristic sounds. Observe the shock spike on the ECG signal. Show/hide ECG leads and electrodes. The selected lead is shown in blue and the respective ECG signal is shown below. Select a different lead and ECG signal by tapping on the < > icons on the left and right of the ECG signal. You may select any ECG lead from I to V6. Pick-drag-drop each electrode to a new position on the torso and observe the change on the ECG signal. Tap on the red bent arrow to reset the electrodes to default positions. Epicardio Ltd All rights reserved.! 13/26

14 Electrophysiology controls Switch on/off ventricular myocardium contraction. Observe the synchronisation between the AP wavefront and the muscle excitation and contraction in the ventricles. You may observe this better in slow motion. To emphasise the result you may switch on the pacemaker. Atrial myocardium contraction coming soon. Show/hide the Action Potential graph. You may opt to show the AP graph for each region in the heart. Currently you may select between Atria (A), AV Node (AV), Conduction Pathway (CT) and the Purkinje Fibre Network (P). Pick-drag-drop on the small red dots on the AP graph to modify the curve. Tap on Apply and observe the changes on the ECG signal. Tap on Reset to revert to the default curve. Show/hide the Potassium channel control K+. Tap on the +/- or on the white dots to add or remove Potassium. Observe the changes on the ECG signal. You may show the AP graph and observe the changes on the respective AP graph. Epicardio Ltd All rights reserved.! 14/26

15 Electrophysiology controls Show/hide the measurements window. S-L Delay: this calculates the time delay between activation on the septum and the lateral wall of the left ventricle. Observe the green dots marked S and L on the left ventricle. This delay will be low (~20ms) in normal rhythm and high (~200ms) in some pathologies (e.g. LBBB). LVEF: Left Ventricle Ejection Fraction. This only works with the myocardium contraction switched on. It calculates the ejection fraction in % of the left ventricle. It takes two heartbeat cycles to complete the calculation. EDV: End Diastolic Volume ESV: End Systolic Volume LVEF = 100 x (EDV-ESV) / EDV Observe the LVEF in Normal Rhythm (~50%) and in LBBB (~30%). Show hide the simulation speed control. This allows you to slow down the simulation speed and observe the AP wave in greater detail. Tap on the red bent arrow to reset the speed. Epicardio Ltd All rights reserved.! 15/26

16 ECG signal controls Tap to select the next ECG lead. It will cycle through all 12 ECG leads. Observe the lead label (e.g. II ) on the left side under the ECG signal. Tap to select the previous ECG lead. It will cycle through all 12 ECG leads. Observe the lead label (e.g. II ) on the left side under the ECG signal. Tap anywhere on the ECG signal to pause the simulation. Tap again to un-pause and continue the simulation. A grey slider bar will appear below the ECG signal. Scroll the slider backwards & forwards. Observe the yellow line on the ECG signal in correlation to the AP wavefront on the 3D heart simulation. You may advance the slider by ±5ms steps by tapping on the left/right arrows on your keyboard. Show/hide the calliper tool. It works only while the ECG signal is on pause. Tap once at the start point on the ECG line, then tap again on the end point and observe the distance between the two points displayed in ms and bpm. Tap between the two points and drag to reposition the segment. Hide the calliper tool to un-pause. Epicardio Ltd All rights reserved.! 16/26

17 12-lead ECG window controls Tap to pause the simulation. Use the grey slider below the ECG signal win the simulation window to scroll backwards and forwards. Observe the line across all ECG signals. - Tap to un-pause the simulation. Tap to change the background on the ECG window. Choose between white and ECG paper with various resolutions. 12x1 Tap to change the 12-lead ECG display format. Choose between 12x1 and 6x2. Tap to expand the 12-lead ECG window to full screen. Tap to close the 12-lead ECG window. Show/hide the calliper tool. It works only while the ECG signal is on pause. Epicardio Ltd All rights reserved.! 17/26

18 Full screen 12-lead ECG window controls Tap to pause the simulation. Tap to un-pause the simulation. Show/hide the calliper tool. It works only while the ECG signal is on pause. Tap to change the background on the ECG window. Choose between white and ECG paper with various resolutions. 12x1 Tap to change the 12-lead ECG display format. Choose between 12x1, 6x2 and 3x4 + rhythm strip. Tap to reduce the 12-lead ECG window to half screen. Tap to close the 12-lead ECG window. Epicardio Ltd All rights reserved.! 18/26

19 ECG test window controls HELP Tap to open/close the help/intro window. PRACTICE Tap to enter Practice mode. In this mode you can go back to the tutorials and return to continue with the test. TEST REVIEW Tap to enter Test mode. You cannot leave until you complete the test. After you complete, you can review the correct/incorrect answers. [MCQ options] Tap to select one of the five options. PREV/NEXT ECG Tap to proceed to the next or previous ECG. FINISH & UPLOAD Tap to upload the test results after you complete the test. CANCEL TEST Tap to cancel the test and exit. Epicardio Ltd All rights reserved.! 19/26

20 Quiz window controls The simulation window and the ECG signal below show a random pathology. Tap to show/hide the 12-lead simulated ECG window. [MCQ options] Tap to select one of the five options. NEW Tap to receive a new random pathology. EXIT Tap to exit the quiz. Epicardio Ltd All rights reserved.! 20/26

21 Tools and settings Tap to open/close the tools/settings row. Default: off. Tap to change the foreground / background colours. There are two options. Default: blue background with black labels. Tap to switch on/off the app sounds. Default: on. Tap on +/- to change the background brightness. Tap on the icon to reset. Epicardio Ltd All rights reserved.! 21/26

22 Tools and settings Tap to switch on/off the timer and progress labels. By default (off), it shows the number of days remaining on your licence. When on, it show the time since app start and your progress towards the tutorials. Tap to switch on/off the curved indicators on the text window. Default: on. Tap to display pop-up window the information on how to take screen-shots and video. Tap to switch on/off the camera auto rotation. Epicardio Ltd All rights reserved.! 22/26

23 Physiological Parameters Displays the physiological parameters that are relevant to each pathology. Heart Rate (bpm) Sino-Atrial Node rate in beats per minute. Tap on +/- to modify the rate. Tap on the label to reset. AVN ON/OFF Switch the Atrio-Ventricular Node on/off. When set to off it enforces a complete block on the AV Node. AVN Cond. Vel. (m/s) Atrio-Ventricular Node cell conduction velocity in meters per second. AVN Delay (ms) Atrio-Ventricular Node delay on milliseconds. AVN Refr. Period (ms) Atrio-Ventricular Node cell refractory period in milliseconds. Escape Rhythm HIS Escape rhythm from the Bundle of His at 50 bpm. Escape Rhythm RBB Escape rhythm from the Right Bundle Branch at 45 bpm. Escape Rhythm PUR Escape rhythm from the Left Purkinje System at 40 bpm. Verapamil Administers 5mg of Verapamil. Adenosin Administers 18mg of Adenosin. Epicardio Ltd All rights reserved.! 23/26

24 Pacing Parameters Displays the Pacing Parameters. These parameters are available in the Pacing tutorials only. PACE Switches the pacemaker on/off. Pacing Rate (bpm) Controls the rate of the pacing stimulus. Tap on +/- to modify the rate. Tap on the label to reset. Stimulus Voltage (V) Controls the stimulus voltage. The Pacing Threshold can be found following these steps: 1. Set the Pacing rate to higher than the intrinsic rate (> 50 bpm) 2. Turn the Stimulus Voltage down until capture is lost 3. Turn the Stimulus Voltage up again until capture is just regained The Pacing Threshold is the minimum stimulus that is required for reliable capture. Pacing Sensitivity (mv) Pacemakers are equipped with a sensing function. If this detects an intrinsic beat, normally the next paced beat will be inhibited. Sensing prevents the pacemaker stimulating in the vulnerable period of repolarisation, causing R on T, which is a potent trigger of ventricular fibrillation. The sensitivity of the pacemaker can be changed. If the pacemaker sensitivity is set too low, the patient's intrinsic rate is no longer sensed by the pacemaker, so the pacemaker is not inhibited, and as a result it paces at the wrong times. Epicardio Ltd All rights reserved.! 24/26

25 Pacing Parameters Displays the Pacing Parameters. These parameters are available in the Pacing tutorials only. Sensed AV Delay (ms) This is the interval, in milliseconds, between the sensed atria (As) and the paced ventricle (Vp). Paced AV Delay (ms) The ventricular channel awaits, listening, an allocated amount of time before pacing - This is the Paced AV Delay. Distal 1, Mid 2, Mid 3, Proximal 4 Sets the pacing point on the multi-polar catheter inserted in one of the coronary veins. Show Phrenic Nerve Displays the Phrenic Nerve and the Diaphragm. If the Distal 1 electrode is selected and paced, you will notice the diaphragmatic twitch. Epicardio Ltd All rights reserved.! 25/26

26 Cardiac EP Parameters Displays the Cardiac EP Parameters. These parameters are available in the Cardiac EP tutorials only. Select Pathology Select any of the pathologies in the menu. Default: Normal Rhythm. Program Electrical Stimulus Show/hide the PES window. This allows you to set the pacing protocol with the following parameters: RVA Select intra-cardiac catheter tip to pace from. Choose between: HRA - Right Atrium, CS1 - Coronary Sinus 1, CS2 - Coronary Sinus 2, CS3 - Coronary Sinus 3, HIS - Bundle of HIS and RVA - Right Ventricle Apex. PACE Tap to start pacing. S1/S2/S3 Switch on/off the pacing protocols. Coupling Interval Set the coupling interval for each pacing protocol (in ms). Number of Beats Set the number of beats for each protocol. Epicardio Ltd All rights reserved.! 26/26