This is actually a good thing.
I always advise medical students to have a system, or a way of approaching ECG interpretation.
Today's blog post will focus on the basics of ECG interpretation, which is something a student should know as soon as they start to hit the wards (somewhere around year 3, depending on the medical school).
Usually, during first and second year, medical students will be thought the physiological basis for the ECG, which can be summed very briefly by:
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| From: Diagram of Cardiac Conduction System |
- SA node
- AV node
- left and right bundle branches
- Purkinje fibers
We then consider the different waves that make up the ECG.
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| From: ECG waves |
- P wave is the electrical activity that precedes atrial contraction,
- QRS complex is the electrical impulse that generates ventricular contraction
- T wave is the electrical impulse that causes ventricular relaxation.
You should recap that a 12 lead ECG is a standard tracing obtained by placing chest and limb leads on the patient.
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| 12 Lead ECG sample from Wikipedia. |
The 12 lead ECG sample above is inadequate. Usually there is a rhythm strip given at the bottom.
The clinical approach to ECG interpretation first involves knowing why the ECG was done in the first place. What are the patient demographic details like age and gender, did the patient have chest pain or palpitations, was there any findings on physical examination, and what the differential diagnosis is.
Then, look at the ECG and determine:
- The rate
- The rhythm
- Axis
- ST segment for depression or elevation
- LVH
Using the ECG sample above for interpretation, we imagine a 20 year old medical student who went for a medical check up. Patient has no previous medical history.
Students. please attempt and let me know your answers.
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