Can you help interpret my electrocardiogram (ECG) results?

ECG Interpretation: Capabilities and Limitations

Yes, I can help interpret electrocardiogram (ECG) results, but interpretation should always be performed by a qualified healthcare provider with appropriate training due to the potential impact on mortality and morbidity outcomes.

Understanding ECG Interpretation Standards

The American College of Cardiology/American Heart Association and other professional organizations have established clear guidelines for ECG interpretation that emphasize several key points:

• ECG interpretation requires specialized knowledge of electrocardiographic abnormalities, pattern recognition skills, and clinical experience 1
• Computer analysis of ECGs can be helpful but should only serve as an adjunct to physician interpretation, not a replacement 1
• Interpretation accuracy varies significantly even among expert electrocardiographers 1

Limitations of Remote ECG Interpretation

Several important limitations exist when interpreting ECGs remotely:

• Diagnostic accuracy is significantly reduced without clinical context 2
• Physician agreement on ECG interpretation is often poor (kappa = 0.33) 2
• Even for critical conditions like STEMI, sensitivity is only about 65% and specificity about 79% 2
• Single-lead ECGs (like those from consumer devices) have even lower diagnostic accuracy, with substantial variability among cardiologists 3

Abnormal ECG Findings Requiring Further Evaluation

The following ECG abnormalities are not normal variants and require further evaluation 1, 4:

• T-wave inversion ≥1mm in ≥2 contiguous leads (excluding leads aVR, III, and V1)
• ST-segment depression ≥0.5mm in ≥2 contiguous leads
• Pathologic Q waves (Q/R ratio ≥0.25 or ≥40ms duration)
• Complete left bundle branch block
• Profound nonspecific intraventricular conduction delay (≥140ms)
• Epsilon waves
• Ventricular pre-excitation (WPW pattern)
• Prolonged QTc interval
• Brugada Type 1 pattern
• Advanced heart block
• Ventricular arrhythmias

Recommended Approach for ECG Interpretation

For proper ECG interpretation, the following approach is recommended:

1. ECGs should be interpreted by qualified physicians with appropriate training 1
2. Initial evaluation of abnormal ECGs should be performed under the direction of a cardiologist 1
3. Computer interpretation can be used as a helpful adjunct but not as the sole interpreter 1
4. Additional testing should be guided by initial findings and clinical suspicion 1
5. For athletes or patients with concerning findings, comprehensive cardiac evaluation may be necessary 1

Conclusion

While I can provide general information about ECG patterns, proper interpretation requires a qualified healthcare provider who can integrate the findings with clinical context to make appropriate diagnostic and treatment decisions. This is essential for optimizing mortality, morbidity, and quality of life outcomes.