From the Guidelines
To accurately interpret a 12-lead Electrocardiogram (EKG), a systematic approach should be used, combining clinical context with a thorough evaluation of each lead, as errors in interpretation can occur even among experienced cardiologists 1. When interpreting a 12-lead EKG, it's essential to:
- Start with a systematic approach to assess rate, rhythm, axis, P waves, PR interval, QRS complex, ST segment, T waves, and QT interval.
- Examine each lead individually, focusing on limb leads (I, II, III, aVR, aVL, aVF) and chest leads (V1-V6).
- Look for patterns or abnormalities across leads, considering the clinical context when interpreting findings.
- Compare with previous EKGs if available to identify any changes or developments.
- Utilize computer analyses of ECGs as useful adjuncts to EKG interpretation, but not as a replacement for a qualified physician's interpretation, as errors in computer interpretation are still common 1. Key points to consider:
- Major interpretation errors are common (4% to 33%), but adverse patient outcomes resulting from these errors are rare, typically occurring in less than 1% of interpretations 1.
- Computer interpretation of ECGs can be a useful adjunct to physician interpretation, decreasing the time needed to interpret EKGs and modestly reducing medical errors, but should not replace a qualified physician in making patient management decisions 1.
- Training in EKG interpretation during residency is crucial for attaining competency in interpretation of 12-lead EKGs, emphasizing the importance of education and practice in accurate EKG interpretation.
From the Research
Interpretation of a 12-lead Electrocardiogram (EKG)
The interpretation of a 12-lead Electrocardiogram (EKG) is a crucial diagnostic tool in various clinical settings, including emergency care, preoperative and post-operative assessment, and primary care 2.
Key Components of EKG Interpretation
- A 12-lead EKG is used to assess and diagnose patients with suspected arrhythmias, hypertension, coronary heart disease, or heart failure 2.
- Correct positioning of the electrodes using anatomical landmarks is essential to ensure an accurate and high-quality EKG recording 2.
- Skin preparation is also crucial, as suboptimal electrode contact or electrodes being placed where there is a significant amount of dry or dead skin cells, grease, sweat, or hair can negatively affect the quality of the EKG recording 2.
Clinical Applications of 12-lead EKG
- Continuous 12-lead EKG monitoring provides prognostic information and improves early risk stratification in patients with ECG nondiagnostic of acute myocardial infarction (AMI) and symptoms suggestive of acute coronary syndrome 3.
- A 12-lead EKG can be used to detect and screen for coronary artery disease (CAD), left ventricular hypertrophy (LVH), and left ventricular systolic dysfunction (LVSD) 4.
- Advanced 12-lead EKG scoring is more accurate than strictly conventional ECG in screening for CAD, LVH, and LVSD 4.
Education and Training
- Nursing students and nurses require education and training to ensure accurate placement and interpretation of 12-lead EKG 5.
- A study found that there is a need for more education to prevent mistaken interpretation, misdiagnosis, patient mismanagement, and/or inappropriate procedures due to 12 leads EKG misplacement 5.