Can you interpret an electrocardiogram (ECG)?

ECG Interpretation in Clinical Practice

AI systems like myself cannot interpret actual ECG tracings, as this requires specialized medical training, direct visualization of the ECG, and integration with clinical context that only qualified physicians can provide. 1

Importance of Proper ECG Interpretation

ECG interpretation is a critical skill in clinical medicine that requires:

• Formal medical training with understanding of cardiac electrophysiology
• Experience with at least 500-800 ECGs under supervision to develop competency 1
• Maintenance of proficiency by interpreting at least 100 ECGs yearly 1
• Integration of ECG findings with clinical context and patient history

Systematic Approach to ECG Interpretation

When interpreting ECGs, qualified physicians should follow these steps:

1. Verify technical quality and settings:

   • Confirm proper lead placement
   • Ensure standard calibration (10 mm/mV and 25 mm/s)
   • Verify adequate bandwidth (≥150 Hz for adults/adolescents, ≥250 Hz for children) 1

2. Assess rate and rhythm:

   • Normal sinus rhythm: 60-100 beats/min
   • Sinus bradycardia: <60 beats/min
   • Sinus tachycardia: >100 beats/min 1

3. Measure intervals:

   • PR interval: 120-200 ms
   • QRS duration: <120 ms
   • QT interval: Use corrected QT (QTc)
     • Normal QTc: <450 ms in men, <460 ms in women 1

4. Evaluate waveform morphology:

   • P waves: normal duration <120 ms, amplitude <2.5 mm
   • QRS complex: assess for pathological Q waves (>40 ms or >25% of R wave amplitude)
   • ST segment: elevation ≥0.1 mV (1 mm) in two contiguous leads suggests myocardial injury
   • T waves: evaluate for abnormalities including T wave alternans 1

Limitations of Computer Algorithms

Computer algorithms have significant limitations in ECG interpretation:

• Error rates up to 40.7% for acute myocardial infarction
• Only 0-94% of disorders classified correctly 1
• Recent research shows AI systems like ChatGPT demonstrate only moderate accuracy in ECG interpretation, with significant discrepancies in critical cases 2

Common Pitfalls and Caveats

1. Interpretation errors are common:

   • Error rates of 4-33% even among trained physicians 1
   • Cardiologists as primary readers are more accurate (94%) than overreading cardiologists (72%) who lack clinical context 3

2. ST segment interpretation requires nuance:

   • Different thresholds for ST elevation in leads V2-V3 by gender and age:
     • ≥0.2 mV (2 mm) in men ≥40 years
     • ≥0.25 mV (2.5 mm) in men <40 years
     • ≥0.15 mV (1.5 mm) in women 1
   • Up-sloping ST-segment depression with positive T waves may indicate severe LAD obstruction 4
   • Widespread ST-segment depression with inverted T waves and ST elevation in aVR may represent diffuse subendocardial ischemia 4

3. Clinical context is essential:

   • ECG findings must be integrated with patient symptoms and history
   • Knowledge of an individual patient results in more critical rhythm assessment 3
   • Patients with cardiac symptoms (chest pain, dyspnea, palpitations, syncope) should have an ECG performed 5

Maintaining and Improving ECG Interpretation Skills

• Participate in continuing medical education
• Attend ECG conferences and workshops
• Use self-assessment programs
• Review interpretations with experienced colleagues 1
• Focus on understanding pathophysiology rather than memorizing patterns 1

ECG interpretation remains a fundamental skill in cardiology and emergency medicine, requiring proper training, experience, and clinical judgment that cannot be replaced by artificial intelligence systems 6, 2.