ECG interpretation site.

[bike mike]

A fun site that may help with ECG interpretation. Yes, they are perfectly clean and may not represent real world ECGs, but can still sharpen your skills.

 

http://www.skillstat.com/Flash/ECGSim531.html

[Acebecker]

When it comes to interpreting EKGs, the most important thing that I have found is that each of us needs to develop a system for looking at the EKG. Something along the lines of an ABCDE approach -

 

Assess the rhythm: p waves present, QRS interval, rate, etc. You should identify things like a-fib, atrial flutter, and the different AV blocks here.

Bundle branch block: This determines how you assess the EKG later so it comes #2 in this system. Look at the QRS duration. If it is less than 100ms, good-to-go. If it is >110 but less than 120ms then you have an incomplete bundle. If it is >120 then you have a bundle. This is a bit of a generalization - there are other criteria to determine whether there is a complete bundle branch block. Also you need to assess whether or not the block is R bundle or L bundle. Use Dubin's L turn signal/R turn signal rule for this. Straightforward.

Chamber enlargement: Do you have peaked p waves? Notched p waves? LVH criteria? Or right axis deviation and RVH criteria?

axis Deviation: this goes with chamber enlargement. But if you see axis deviation without chamber enlargement criteria, you need to find out why. This could be a tension pneumo or pericardial tamponade.

evaluate Each area: This is where you look at the different contiguous leads of the heart for signs of ischemia - II, III, aVF look at the inferior aspect of the heart. V1, V2 are the septal leads. V3, V4 are the anterior leads. V5, V6 are the low lateral leads. I, aVL are the high lateral leads. When discussing contiguous leads, it's important to understand that V1-V6 have a little bit over overlap and it's difficult to determine where the cutoff between septal, anterior, and lateral leads especially considering the variability of lead placement.

 

Take home message: this is not the definitive system for EKG evaluation. I freely admit that it's imperfect - but it gets my brain started and in a crisis I can rely on it to examine an EKG pretty thoroughly. Find your own system and MEMORIZE it.

 

Here's a good website for a step-wise approach to EKG interpretation. More thorough than ABCDE. http://www.unm.edu/~lkravitz/EKG/interpekg.html

 

Thus ends my soapbox on EKG interpretation.

 

Andrew

[MCHAD]

Another good ECG Resource: http://library.med.utah.edu/kw/ecg/

[2010PA]

Garcia's EKG interpretation hands down is the best EKG reference.

[Ernie]

I would caution everyone to avoid "flash card" style learning (like skillstat) for EKG interpretation. What happens is that you get focused on recognizing patterns instead of reading the strip. The problem here is that you get into the real world, and a patient has axis deviation or some other variation that causes the rhythm to appear different than the flash card that you memorized. I catch students on that all of the time: If I suspect that they have memorized the rhythm by using flash cards, I do something tricky like flip the QRS complexes over, throw in a bundle branch block, or some other mischief, and this usually reveals their weakness.

 

Acebecker is on the right track, but remember that fascicular blocks can cause axis deviation, and more than one practitioner (myself included) has been fooled into an incorrect Dx by the wide complexes of a pacemaker rhythm. I made a pretty good series of power points for rhythm recognition, if anyone wants it. I just don't know how to post files here.

[2010PA]

I would caution everyone to avoid "flash card" style learning (like skillstat) for EKG interpretation. What happens is that you get focused on recognizing patterns instead of reading the strip. The problem here is that you get into the real world, and a patient has axis deviation or some other variation that causes the rhythm to appear different than the flash card that you memorized. I catch students on that all of the time: If I suspect that they have memorized the rhythm by using flash cards, I do something tricky like flip the QRS complexes over, throw in a bundle branch block, or some other mischief, and this usually reveals their weakness.

 

Acebecker is on the right track, but remember that fascicular blocks can cause axis deviation, and more than one practitioner (myself included) has been fooled into an incorrect Dx by the wide complexes of a pacemaker rhythm. I made a pretty good series of power points for rhythm recognition, if anyone wants it. I just don't know how to post files here.

 

Correct, which is why it is called "interpretation". Understanding the basic rhythm patterns and incorporating them with pt presentation can help with a dx. Of course, there will be the one or two missed Dx, but noone's perfect. There's also a website I think is great with over 1000 ECGs and based upon the comfort level of reading ECGs

 

http://ecg.bidmc.harvard.edu/maven/mavenmain.asp

 

http://www.amazon.com/12-Lead-Ecg-Interpretation-Tomas-Garcia/dp/0763712841 <----Garcia's ECG book. Great book to buy