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ECG Interpretation Technique When looking at ECGs, the same systematic method should be used each time to ensure a complete evaluation. Many methods have been described and everyone seems to have their own personal favorite way to approach ECG interpretation. The method described below is the most simple and most commonly used method. It consists of a 6 step approach: 1) Determine the rate See the ECG Basics section for detail on how to determine the rate. 2) Determine the rhythm This is frequently the most difficult part of ECG interpretation. Remember that normal sinus rhythm is present if there is an upright P wave in lead II. If there are P waves in lead II that are not upright (either inverted or biphasic), then an ectopic atrial rhythm is present. If no P waves are seen, then either a junctional rhythm (regular QRS complexes) or atrial fibrillation (irregularly irregular QRS complexes) is present. Review the sections on these rhythms for further details including the section on AV nodal blocks. 3) Determine the QRS axis See the ECG Basics section for detail on how to determine the QRS axis. 4) Evalutate for chamber enlargements/hypertrophies See the sections on left/right atrial enlargements and left/right ventricular hypertrophies under ECG review. 5) Examine the ST segements ST segements are either normal, depressed, or elevated. See the ST segments section for details. 6) Look for miscellaneous findings Many random ECG findings may be missed without an astute eye. Things such as R wave progression, the presence of Q waves indicating old infarctions, PR segment depression, Sgarbossa ST changes, delta waves, Osborne waves, or epsilon waves can be missed if each ECG is not approached in a systematic fashion ending with a look for these findings. ECG Basics | ECG Review | ECG Archive | ECG Cases | ECG Quizes |
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