Can you interpret this ECG (electrocardiogram)?

ECG Interpretation: Guidelines and Recommendations

I cannot interpret an actual ECG image as I don't have the capability to view images. ECG interpretation requires a qualified physician with appropriate training and experience to examine the actual tracing.

Importance of Qualified Interpretation

• ECG interpretation should always be performed by a qualified physician, as computer interpretation alone is not recognized as a properly interpreted ECG according to the American Heart Association 1
• The American College of Physicians emphasizes that computer ECG analysis should be considered a helpful adjunct to, but not a substitute for, physician interpretation in clinical decision making 2
• Despite improvements in automated interpretation algorithms, limitations in diagnostic accuracy of computerized ECG interpretation persist, potentially leading to clinical mismanagement if not reviewed by an experienced reader 3

Key Components of Proper ECG Interpretation

• A systematic approach to ECG interpretation includes evaluating:
  • Heart rate (60-100 bpm is normal sinus rhythm in adults) 1
  • Rhythm regularity and presence of P waves before each QRS complex 1
  • Intervals: PR (normal: 120-200 ms), QRS (normal: <120 ms), QTc (normal: <450 ms for men, <460 ms for women) 1
  • Electrical axis determination using leads I and aVF 1
  • Chamber enlargement assessment 1
  • Evaluation for ischemia, injury, or infarction patterns 1

Technical Considerations and Accuracy

• The quality of the ECG recording must be evaluated to identify any technical artifacts that may affect interpretation 1
• Digital electrocardiographs improve measurement reproducibility compared to analog tracings 1
• Electrode placement, particularly for precordial leads, is critical as misplacement can significantly alter ECG interpretation and lead to false diagnoses 1

Clinical Context in Interpretation

• The ECG should always be interpreted in the context of the patient's clinical presentation, as the same finding may have different implications depending on symptoms 1, 4
• Studies show that noncardiologists are more influenced by patient history in interpreting ECGs than cardiologists, making clinical context particularly important 1
• For patients with cardiac symptoms (chest pain, dyspnea, palpitations, syncope), an ECG should be performed in the office 5

Computer Interpretation Limitations

• Computer interpretations have shown less accuracy than physician interpreters, with only 0% to 94% of disorders classified correctly; arrhythmias are particularly problematic 2
• A 2024 study found that ECGs with computerized interpretations of "normal" or "otherwise normal" had a negative predictive value of 100% for STEMI, suggesting these may safely wait for physician interpretation 6
• Despite this, over-reliance on computer interpretation without physician verification can lead to diagnostic errors 1, 3

Maintaining Competency in ECG Interpretation

• The American College of Physicians recommends continuing medical education through seminars or self-assessment programs to keep ECG interpretation skills current, especially for physicians who read ECGs infrequently 1
• Periodic objective assessment and documentation of interpretation skills in a clinical context is recommended rather than completion of a minimum number of interpretations 2
• Comparing with previous ECGs when available is important to avoid missing significant changes 1

Common Pitfalls to Avoid

• Inadequate filtering settings can distort waveforms and affect measurements 1
• Failure to compare with previous ECGs when available can miss important changes 1
• Interpreting ECG findings in isolation without considering clinical context may lead to inappropriate management decisions 1, 4