ECG Interpretation Capability and Limitations
I cannot interpret your ECG image, and you should not rely on any non-physician source for ECG interpretation—all ECGs must be reviewed by a qualified physician who can integrate the findings with your clinical presentation. 1
Why Physician Interpretation is Mandatory
Computer-generated ECG interpretations are helpful adjuncts but cannot replace physician interpretation for clinical decision-making. 1 Here's why:
- Computer ECG analysis correctly classifies only 0% to 94% of disorders, with arrhythmias being the most problematic diagnosis 1
- Errors in computer interpretation remain common despite technological advances 1, 2
- Erroneous computer interpretations can negatively affect clinical decision-making, even when physicians correctly interpret the ECG itself—residents with erroneous computer interpretations were 3 times more likely to recommend unnecessary revascularization (30% vs 10%) 3
The Critical Role of Clinical Context
ECG findings must always be interpreted in conjunction with your symptoms, medical history, and physical examination—the same ECG pattern can indicate different conditions depending on clinical context. 4, 5
- The ECG alone has only 76% sensitivity and 88% specificity for acute cardiac ischemia in chest pain patients 5
- Clinical signs and symptoms alone have insufficient sensitivity (35-38%) and specificity (28-91%) to rule in or rule out acute coronary syndrome without ECG and biomarkers 5
- Noncardiologists are more influenced by patient history when interpreting ECGs than cardiologists, making clinical integration even more critical 1, 5
What You Should Do Instead
Take your ECG to a qualified physician immediately, especially if you have chest pain, syncope, dizziness, or other cardiac symptoms. 5 The physician will:
- Verify proper electrode placement and recording quality before interpretation 4, 5
- Systematically evaluate rate, rhythm, intervals, axis, and ST-segment changes 4, 5
- Compare with any previous ECGs to identify dynamic changes 4, 5
- Integrate ECG findings with your clinical presentation to determine appropriate management 5
- Order additional testing (cardiac biomarkers, echocardiography) if abnormalities are detected 6
Competency Requirements for Interpretation
Physicians require extensive training to interpret ECGs competently—residency training with Advanced Cardiac Life Support certification is the minimum standard for bedside interpretation in routine and emergency situations. 1, 5
- The ACC/AHA recommends interpretation of 500 ECGs under supervision to attain initial competency 1
- Competency requires knowledge of pathophysiology, skill in recognizing abnormal patterns, and experience relating ECG findings to clinical situations 1
- Even among expert electrocardiographers, interpretation varies greatly, with interreader agreement (kappa) of only 0.33 for potential STEMI ECGs 7
Critical Pitfall to Avoid
Do not delay seeking medical attention if you have concerning symptoms while waiting for ECG interpretation—time-sensitive conditions like STEMI require ECG acquisition within 10 minutes of first patient contact. 5, 8