The ECG Basics Course:
Part 2: How to record your findings
When you interpret an ECG you must record your findings in a systematic way. This will allow both you and your colleagues to go back to the medical record and read the ECG findings, rather than re-interpret the original ECG tracing.
Even as a beginner it is important to write down your findings. This serves the purpose of good medical record keeping, but it also forces the learner to commit to an interpretation before discussing the case with someone more experienced. That commitment and subsequent revision is a key part of the learning process and will eventually seperate those who seek ECG adequacy from those who seek ECG mastery.
When recording ECG findings the rate, rhythm and axis should always be noted. This is true in both written and verbal communication; example “The ECG shows sinus rhythm at 85 beats per minute with a leftward axis.” The novice ECG reader may want to note all of the parts of the ECG in their interpretation as an exercise in applying a systematic approach. As the beginner solidifies the approach they may switch to charting by exclusion, that is only mentioning the parts of the ECG with non-normal findings, with the underlying assumption that the ECG has been examined in a complete and systematic way; “The ECG shows sinus rhythm at 85 beats per minute with a leftward axis. There is 2mm ST segment elevation in leads V1 to V4, and 1mm ST segment depression in leads II and III.”
The final portion of recording the findings of an ECG is to synthesize the recorded information into an interpretation. This is perhaps the most difficult part of ECG interpretation but it is important that the beginner make an attempt as part of the learning process. In the medical record this might look like; “The ECG shows sinus rhythm at 85 beats per minute with a leftward axis. There is 2mm ST segment elevation in leads V1 to V4, and 1mm ST segment depression in leads II and III. This is consistent with anterior ST elevation myocardial infarction.”
As the ECG reader advances in training and has more demands on their time, abbreviations may be used to record the same findings; “NSR @ 85bpm. Anterior STEMI with inferior reciprocal changes.”
As a starting point the novice might record the following information for an ECG, with normal values being recorded as “N”.
- Rate, Rhythm, Axis
- Intervals
- Blocks?
- The QRS complex
- Left Ventricular Hypertrophy?
- The ST segment
- The T wave
- Overall interpretation