Structured Approach to ECG Interpretation

There are many variations on a structured approach to reviewing and interpreting an ECG. All apporaches cover the same principles with variations in the order things are done. A structured appraoch to ECG analysis is essential to avoid missing important clues and also provides a framework for presenting and discussing ECGs.
Sample framework below :

ECG Interpretation Framework

  • Identification
    • Confirm patient details, location in the Emergency Department, and time of ECG.
  • Calibration
    • Is the calibration standard ?
  • Leads
    • Standard 12 lead ECG or alternative lead placement.
    • Alternative lead placement includes right ventricular leads (V3R-V5R) or posterior leads (V7-V9).
  • Rate
  • Rhythm
  • Axis
  • Intervals
    • PR interval, QRS duration, QT, and QTc duration.
  • Morphology
    • P wave, QRS complex, ST segements, and T waves
    • Addition findings including U waves, delta waves, epsilon waves and J waves.
  • Summary of findings
  • Clinical correlation