Learning the art of ECG interpretation requires intellect, commitment, effort, and — perhaps most importantly — an organised approach.
I have spent quite some time learning and understanding the art of ECG interpretation. Assuming that most of you reading this blog are looking for a simpler process to learn the same, I am hoping my notes and a few following steps will make it a bit easier for you.
Learning all of ECG interpretation is going to take time and initially, it may not seem quite so easy but with consistency and repetition, you will get the hang of it. The more ECGs you see the more you will get the hang of it.
ECG made Easy - Steps -
Learn the Basics of a 12 - lead ECG Tracing - Knowing the basic parts will help lay a strong foundation for everything else. Understand what normal waves, complexes, and intervals look like, so understanding the abnormalities becomes easier.
Determine Heart Rate on the ECG - To determine whether bradycardia, a normal heart rate, or tachycardia is present requires the knowledge to calculate the heart rate on the ECG. Remember to apply these techniques to both the atrial rate, which is measured by the rate of the P wave and the ventricular rate, which is measured by the rate of the QRS complex.
Determine Axis on the ECG -The axis on the ECG can give a clue to many different pathologic states. Mainly you need to know how to measure the axis of QRS complex. 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.
Learn Abnormal Heart Rhythms - Learning normal sinus rhythms was taken care of in step 1. Now, you need to understand and learn the abnormal rhythms like atrial fibrillation, atrial flutter, ectopics, etc.
Learn Chamber Hyperthrophies and Bundle Blocks - Learning chamber hypertrophies and bundle blocks might seem overwhelming to some, but it is not that hard to understand.
Learn Acute MI and Ischemic ECG finding - This is the fun part of ECG interpretation. Some of the acute MI ECG findings, such as anterior ST segment elevations and inferior ST segment elevation MIs, are obvious. The tough part is identifying the more subtle ECG changes. Know when ST segment 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 segment depression is due to digoxin ECG changes.
Learn Everything else including Atypical ECG Findings - Some repetition and memorization are required here. This category includes findings like WPW syndrome, Digoxin effect, hypocalcemia, hypercalcemia, hypokalaemia, hyperkalemia, etc.
Quiz and Review ECGs - Whether you are a medical student in clinical rotations, an EMT or an internist in practice, or another health care professional, looking at the ECGs that you will encounter in everyday practice is important. See how the ECG fits the clinical scenario. Sometimes the best way to remember an ECG finding is to associate it with an interesting case that you experienced personally.
Alternatively, you can practice with various ECGs available online.
My ECG notes -
Reference books for ECG -
The ECG made easy
The ECG in Practice
150 ECG problems
All these books are by the same author - John R. Hamptom
So these are a few suggestions for you to study ECG more effectively. I hope these suggestions and well as my notes can help you. If you have any doubts, please feel free to reach out.
All the Best.
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