SYSTEMATIC APPROACH TO READING AN ECG

CARDIOLOGY, ECG

It’s vital to use a systematic approach to ECG interpretation. Try to always follow the same steps for every ECG you look at. Don’t skip around. Your speed will increase without decreasing your efficiency.

Mine mnemonic is Rhythm Rate I AM P-QRS-T

-Rhythm  – Is the rhythm regular or  Irregular? (what is the relationship between P and QRS).
-Rate – Is it fast or slow? (i.e. tachycardia or bradycardia?)
-Ischemia or Infarction – is ischemia/Infarction present? – ST changes (ST elevation/depression), T-wave changes?
-Axis (? LAD or RAD) 
-Morphology (? LAA and or RAA? LVH and/or RVH)
-P-QRS-T:-Intervals –  QRS – Are the QRS complexes Wide or narrow? Is the PR interval prolonged/shortened? Is the QT interval prolonged? Are there Q waves? Is there poor R-wave progression in V1-V6?.

NB: Intervals are the same for every lead. They are looking at the electrical activity.

Mnemonic: Rhythm, Rate, I AM P-QRS-T: Rhythm, Rate, Ischemia or Infarction, Axis, Morphology, P-QRS-T intervals and individual waves.

Tips

Rhythm, rate, and intervals: Use one lead to examine them, e,g, Lead II if you have a 12 lead ECG
V1-V3 is the best place to look at QRS morphology.
Axis – Use I & aVF or I & II. See explanation here.
P-QRS-T is a good way to remember the important ECG intervals. The PR (or PQ) interval and the ST interval. The PR=PQ segment. However, they are usually called the PR segment because the Q wave is usually missing.

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 Personal Quick Reference Sheets from Dale Dubin’s Rapid EKG Interpretation.

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