Reading an ECG appears complicated at first, but with a methodical approach, it is easier. Begin by making certain the ECG was recorded correctly: verify the patient’s identification, calibration (typically 25 mm/sec speed and 10 mm/mV), and lead placement. Start reading by determining the heart rate—count the large squares between two R waves (RR interval) and calculate 300 divided by the resulting number for a normal rhythm. Look at the rhythm next: check whether it is steady or irregular and whether each P wave is accompanied by a QRS complex. A normal sinus rhythm has P waves upright in leads I and II, and each is followed by a QRS.
Assess the P wave for atrial activity, checking it is neither wide nor peaked. Next, take measurement of the PR interval (normal 120–200 ms) to gauge AV conduction. Look at the QRS complex (normal <120 ms) for width and shape to identify bundle branch blocks or ventricular hypertrophy. Finally, examine the ST segment and T wave: ST elevation/depression might indicate ischemia or infarct, while unusual T wave shapes might reflect electrolyte disturbances or myocardial damage. Don’t miss the QT interval, heart rate-corrected (QTc), which ought to normally be below 440 ms in males and 460 ms in females. Finally, synthesize all findings. Inquire: Is the rate normal? Is the rhythm sinus? Are there any signs of ischemia, hypertrophy, or conduction abnormalities? Comparison to previous ECGs is useful to identify changes. A systematic “rate-rhythm-axis-intervals-waves” system ensures no information is overlooked. With practice over time and recognizing patterns, skills in interpreting ECG improve. It is also necessary to compare ECG results with clinical presentations to achieve correct diagnosis and care of the patient.
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