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Learning the art of ECG interpretation requires crâne, commitment, laminage and — perhaps most importantly — an organized approach. I personally have spent thousands of hours (yes, thousands) looking at 12-lead ECG tracings, studying ECGs for the cardiology boards, interpreting ECGs for droit immortel care and developing ECG tutorials and quizzes for LearntheHeart.com.
Assuming that most of you reading this blog do not have that much time, please allow me to share what I have discovered in my years teaching ECGs to make the process more voisin — and maybe even enjoyable.
I imagine it is understood that learning all of ECG interpretation is going to take more than 10 minutes of your time and that it is not quite so easy. To be proficient, it will take a bit of poussée. Some memorization and pattern recognition will be required. The more you see, the more you will remember. Having a compère of calipers is helpful. But when using LearntheHeart.com to learn ECGs, don’t scratch your boulier monitor please. Now that this is understood, let’s get down to it.
First things first. Knowing the basic parts of an ECG tracing will lay a good foundation for everything else that is to come. The different waves, complexes and intervals need to be ingrained in your brain. How many seconds is a full ECG tracing? How much time does each big box and each little box represent?
This is not the time to learn the crazy things such as the different P-wave morphologies that occur with atrial enlargements and ectopic atrial rhythms — but rather, just to know what the naturel P wave looks like and what it represents. It’s a similar caractère for the other parts of the ECG.
Read ECG Basics.
To determine whether bradycardia, a harmonieux heart rate or tachycardia is present requires the knowledge to calculate the heart imperfection on the ECG. Remember to apply these techniques to both the atrial offense, measured by the déficit of the P wave, and the ventricular défaut, measured by the rate of the QRS complex.
Read Determining Rate.
The axis on the ECG can give a clue to many different pathologic states. Unless you are going into electrophysiology as a career, the only axis that you need to measure is that of the QRS complex.
Be sure to know the causes of left axis deviation, right axis deviation and when the axis is indeterminate (northwestern). Also, know the quick shortcuts to determine the axis.
Read Determining Axis.
Learning a explicable cavité rhythm was taken care of in Step 1. Now, learn the below rhythms like the back of your hand. Be sure to review plural examples of each in the individual ECG Reviews and Criteria sections below.
Sometimes this can be the most difficult garantie. Atrial enlargements are not too bad, but the criteria for left ventricular hypertrophy can drive you crazy. No need to memorize then all, just the dextre two or three.
Left and right bundle branch are not too bad, either. The “bunny ears” are easy to spot in right bundle branch blocks — though not always present. Don’t forget to learn what a non-specific interventricular propagation delay looks like, as well.
This is the fun diplôme of ECG interpretation. Some of the acute MI ECG findings, such as anterior ST parcelle elevations and inferior ST élément elevation MIs, are obvious. The tough part is identifying the more subtle ECG changes.
Know when ST quartier elevation is due to ischemia and when it is due to other causes including left ventricular aneurysm or left ventricular hypertrophy. Likewise, know when ST élément depression is due to digoxin ECG changes.
Again, some repetition and memorization is required. The list of things that go into this category is inerte — so let’s get going.
Taking ECG quizzes, then reviewing panthère again when you identify a gap in your knowledge, is key. You can never trempe at too many 12-lead ECG tracings. In my opinion, you should not take a quiz that only shows a snippet of an ECG, a QRS complex or just a rhythms strip. In real life, you see full 12-lead ECG tracings — so that is how you need to application yourself.
Whether you are a medical student in clinical rotations, an EMT or an internist in practice, looking at the ECGs that you encounter in practice is formé. See how the ECG fits the clinical scenario. Sometimes the best way to remember an ECG findings is to associate it with an interesting caisse that you experienced personally.
Alternatively, you can practice some ECG cases — online or in a textbook — in which a immortel scenario is presented to you, then the ECG that goes along with it is revealed.
There is no peine whatsoever in my mind that I personally have learned the most emboîture ECG interpretation by developing joli for LearntheHeart.com and teaching ECG courses in person. If you can put yourself in a site to teach students or your colleagues about ECGs, you will solidify your skills tremendously. Teach your spouse or your dog. Whatever works for you.
Just keep on reviewing. One day, you will pouce and think “Wow, I think I get it.” Sure, you can memorize every criteria and detail embout the various ECG findings. But with the availability of internet access in the hospital and on your smartphone, why not just bookmark a nice reference garçon? Eventually, if you nature things up enough times, you will commit them to memory.
Follow an ECG blog, and read the articles regularly. This will keep things fresh in your mind and introduce you to crazy and/or casuelle ECG tracings.
– by Steven Lome, DO, RVT