Interpretation of the Electrocardiogram

A systematic approach to reading the 12-lead ECG should be practised so as to avoid missing data and making mistakes. The following or similar approach is advised:

Back to contents Check these data (patient¡¦s name, birthday, and identification number; date and time of tracing)on the ECG to make sure:

    Back to contents It belongs to the patient you are reviewing.

    Back to contents It was obtained on the day and time you requested the examination.

Back to contents Review the patient¡¦s medical history, physical and laboratory findings, diagnosis, and indication of the ECG examination. These pieces of information help to focus your attention when reviewing the tracing. However, to focus attention does not mean developing tunnel vision. You still should review all aspects of the ECG before drawing your conclusion.

Back to contents Make old tracings available for comparison. In medical practice, changes in findings over time are as important as the presence or absence of findings at any discrete moment in time.

Back to contents Check heart rate.

Back to contents Check rhythm:

    Back to contents Primary rhythm: supraventricular (sinus, atrial, junctional) or ventricular in origin.

    Back to contents Superimposed abnormalities (escape or premature beats).

Back to contents Check heart blocks.

Back to contents Check QRS axis.

Back to contents Check signs of clinical abnormalities:

    Back to contents Right and left atrial abnormalities.

    Back to contents Right and left ventricular hypertrophy.

    Back to contents Right and left bundle branch block.

    Back to contents Acute myocardial infarction.

    Back to contents Electrolyte abnormalities.

    Back to contents Drug effects.

    Back to contents Pulmonary embolism.

Back to contents Correlate the ECG findings with the patient¡¦s clinical presentation. Treat the patient; not the waveforms.

Back to contents