Faculty Peer Reviewed
The electrocardiogram (EKG) is a test not only interpreted by cardiologists.
In fact, it is usually early in the year that the new medical student is handed an EKG; top flipped down as not to “cheat” and asked to interpret the rhythmic black squiggles on red graph paper. I still remember the anxiety provoking questions asked on my Medicine Clerkship. As with many skills I thought would magically become part of my repertoire on July 1st of my intern year, reading an EKG was still anxiety provoking. Now after having read Dubin, I was able to keep my hands from shaking and go through the steps, including rate, rhythm, and axis. Now in the era of having almost infinite amount of information at our fingertips, it is only natural that the internet plays a role in learning how to read EKGs.
Typing “EKG interpretation” into Google results about 1,180,000 sites. The following sites are some of the first results and vary in usability.
To simplify the review, websites will be grouped into:
Highly recommended, recommended or not recommended based on my review; however, please feel free to explore all websites at your own timely discretion.
http://www.rnceus.com/course_frame.asp?exam_id=16&directory=ekg An excellent website that covers only rhythms using rhythm strips (no 12 leads here). This site goes through very basic physiology, how to read an EKG, and common abnormal EKGs. It is user friendly and has quiz questions interspersed through the course and at completion. The table of contents that is present throughout the course makes this site especially easy to navigate. This is a recommended site for beginners to EKG interpretation or to learning sites.
http://library.med.utah.edu/kw/ecg/ A helpful library of EKGs with advanced physiology, a robust library of EKGs, and an advanced array of quiz questions. It is easy to navigate. It includes a section with the AHA competencies for EKG interpretation with examples of each diagnosis considered to be the minimum knowledge needed to be deemed competent in EKG interpretation. This is a good site for someone more advanced.
http://en.ecgpedia.org/ A great website modeled after ‘Wikipedia’ with a basic introduction to EKG reading. There is a lot of information on the site which breaks down EKG reading in to “7+2” easy steps. It stresses the importance of step-wise interpretation of EKG’s so nothing is missed. It also includes a lot of physiology behind the waves we interpret on the EKG to help us understand the EKG slightly better. The only down-side I can see is that this website, just like Wikipedia, can be edited by the public. As such, interpretation of information should be at your own risk and countered with another website or ECG book.
http://www.themdsite.com/ Unfortunately though the Dr. Dale Dubin site may have all of the necessary information, I was distracted by the 80’s video game feel complete with neon green and blue lettering and flashing animation. It includes many helpful images from his book, but is difficult to read. It feels more like an advertisement than a learning site.
http://www.ecglibrary.com/ As the name suggests, this website is a library of different EKGs, with a brief explanation on abnormal findings. This website is useful for those who do not need a lengthy explanation or prefer lists. For example a list of causes of right axis deviation or a description of trifascicular blocks. It also has a section describing the history of electrocardiography for you history buffs.
http://www.mauvila.com/ECG/ecg.htm This website provides a great overview of all the information one would need to know to master interpretation of EKGs. It does this in a sophisticated way; however, simple enough for a beginner to understand with the addition of fundamental pictures. In addition, it includes some basic pathophysiology and historical facts for those self-pronounced historian buffs out there. It also includes a quiz at the end to test your skills. The down-side of the website is that it is a long read and rather wordy in each section and definitely should be complemented with another EKG website or tutorial book.
http://www.learntheheart.com/EKGBasics.html A basic review of EKG findings with explanations. Similar in structure to a few of the websites already reviewed; however, includes EKG case scenarios as well as quiz review which places the EKG in a medical situation which anyone of us in the medical field can encounter.
http://www.emedu.org/ecg/index.htm This website includes a brief and incomplete overview of EKGs. Included in this brief overview, are commonly-seen and not-so commonly seen rhythms. The great part of the site is that it includes actual EKG’s with arrows and circles pointing out the commonly seen findings on EKGs based on the situation. It also provides explanations/differentials on why certain things are found on EKGs. This is a good website for someone already advanced in the basics of EKG reading. Negatives include that it is not too easy to navigate—you need to click back on your browser to go to the home page every time you want to go to a new page, “Answers” for EKG’s are very sparse with explanations (e.g. “ischemia”) and there is not a diverse library of EKG’s.
There are no websites listed above that I would not recommend. Everyone can get some benefit out of evaluating each and every website listed above and placing this evaluation in to a clinical context. For those unable to evaluate all websites, those ‘highly recommended’ should be evaluated prior to delving into the ‘recommended’ websites.
Dr. Melissa Mroz is a 3rd year resident at NYU Langone Medical Center
Dr. Rachel Bond is a 3rd year resident at NYU Langone Medical Center
Peer reviewed by Robert Donnino, MD, cardiology editor, Clinical Correlations
Image courtesy of Wikimedia Commons