From the Guidelines
To interpret an EKG effectively, follow a systematic approach examining rate, rhythm, axis, intervals, and waveform morphology, as recommended by the American Heart Association 1.
EKG Interpretation Steps
To begin, determine the heart rate by counting the number of QRS complexes in a 6-second strip and multiplying by 10, or using the rule of 300 divided by the number of large squares between consecutive R waves. Next, assess the rhythm for regularity and identify the underlying mechanism (sinus, atrial, junctional, or ventricular). Evaluate the cardiac axis by examining leads I and aVF, then analyze intervals including PR (normal 120-200ms), QRS (normal <120ms), and QT (should be less than half the preceding RR interval). Finally, examine waveform morphologies for abnormalities such as ST elevation/depression, T wave inversions, pathological Q waves, and conduction blocks.
Importance of Standardization and Interpretation
The accurate recording and precise interpretation of the EKG are critical, and adherence to professionally developed and endorsed evidence-based standards is essential 1. The use of computerized systems for storage and analysis can aid in interpretation, but different automated systems may have different technical specifications that result in significant differences in measurement and diagnostic statements. Therefore, computer ECG analysis should be considered a helpful adjunct to, but not a substitute for, physician interpretation in clinical decision making 1.
Developing Proficiency in EKG Interpretation
Regular practice with various EKG patterns is essential for developing proficiency in interpretation. Training in EKG interpretation during residency should provide physicians with knowledge of the pathophysiology of electrocardiographic abnormalities, the skills to recognize common normal, abnormal, and technical artifact patterns, and the opportunity to apply this knowledge in bedside clinical decision making 1. Determination of initial competency in EKG interpretation at the end of residency training should be based on periodic objective assessment and documentation of resident interpretation skills in a clinical context rather than completion of a minimum number of interpretations.
From the Research
EKG Interpretation
There are no research papers provided that directly assist in answering the question about EKG interpretation. The studies available discuss the use of antiplatelet agents and anticoagulants in the treatment of cardiovascular disease, but do not provide information on EKG interpretation.
Related Information
- The use of antiplatelet agents, such as aspirin, is well established in the treatment of cardiovascular disease, including acute coronary syndromes and secondary prevention after myocardial infarction 2, 3, 4.
- Anticoagulant therapy, including heparin and warfarin, is also used in the treatment of cardiovascular disease, but the clinical effects of adding heparin to aspirin are not well established 5.
- The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation has been questioned due to an increased risk of major bleeding with little to no benefit in preventing ischemic events 6.
Key Points
- Aspirin is recommended for all patients with acute myocardial ischemic syndromes unless contraindications are present 2.
- The use of antiplatelet agents and anticoagulants in the treatment of cardiovascular disease is well established, but the clinical effects of different treatment strategies are not always clear 3, 4, 5.
- The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation requires careful consideration of the potential benefits and risks 6.