From the Guidelines
The interpretation of an ECG reading is a critical process that requires accurate recording and precise interpretation to ensure high-level precision and patient care.
Key Components of ECG Interpretation
- Standardization: The establishment of and adherence to professionally developed and endorsed evidence-based standards for all phases of the ECG procedure is crucial 1.
- Computerized Systems: The widespread use of computerized systems for storage and analysis of ECGs has improved the process, but different automated systems may have different technical specifications that result in significant differences in measurement and diagnostic statements 1.
- Clinical Correlations: The accurate interpretation of ECG findings requires an understanding of the anatomic, pathological, electrophysiological, and genetic information underlying ECG abnormalities, as well as clinical correlations of ECG abnormalities 1.
Recommendations for ECG Interpretation
- Training and Competency: Training in ECG interpretation during residency should provide physicians with knowledge of the pathophysiology of electrocardiographic abnormalities and the skills to recognize common normal, abnormal, and technical artifact patterns 1.
- Computer Analysis: Computer analysis of ECGs is a useful adjunct to physician interpretation, but should not replace a qualified physician in making patient management decisions due to the potential for errors in computer interpretation 1.
Best Practices
- Objective Assessment: Determination of initial competency in ECG interpretation at the end of residency training should be based on periodic objective assessment and documentation of resident interpretation skills in a clinical context 1.
- Standardized Examination: To maintain competency in ECG interpretation, physicians should have the ability to make diagnoses and tests for this ability on a standardized examination, such as the ECGEXAM 1.
From the Research
ECG Interpretation
The interpretation of an ECG reading is a complex process that involves analyzing the electrical and biomechanical aspects of the heart. The ECG provides information on:
- Rhythm: the pattern of electrical activity in the heart
- Rate: the number of heartbeats per minute
- Axis: the direction of electrical activity in the heart
- Biomechanical information: such as ventricular hypertrophy and repolarization changes that may be associated with ischemia or myocardial injury 2
Computerized ECG Interpretation
Computerized interpretation of the ECG has become routine, with millions of interpretations recorded yearly. While computerized interpretations have contributed to medical care by reducing physician reading time and accurately interpreting most normal ECGs, errors can occur 3, 4. These errors can be due to:
- Recording errors: such as muscle artifacts or lead reversal
- Incorrect detection of arrhythmias, pacemakers, and myocardial infarctions Therefore, it is essential to have computerized statements over-read by trained physicians who have the advantage of clinical context 3, 4
Importance of ECG Interpretation
ECG interpretation is an important skill for clinicians, including pharmacists and emergency nurses, as it provides valuable information for diagnosis, prognosis, and treatment of common clinical conditions such as atrial fibrillation, ischemic heart disease, and QT interval prolongation 2, 5. A stepwise approach to systematic interpretation of ECG tracings can help guide primary care physicians and emergency nurses in their approach to ECG interpretation 6, 5