How/where to learn to read EKGs

EKG/ECG instruction is a mixed-bag nationwide. Every physician is supposed to know how to read an EKG, though for many students, EKG interpretation is a skill one is supposed to somehow pick up naturally (magically) on the wards. No one seems as confident in their abilities as they’d like. And while EKG machines themselves can and do identify many abnormalities, part of the challenge of real life is to know when to ignore the machine reading.

There is a basic subset of foundational EKG knowledge that (second or) third-year medical students should acquire, and many of the resources below will easily get you there. Also note that a strong background in cardiology informs your knowledge of EKGs and vice versa.

When it comes time to learn, do the following three things:

  1. Pick a source and read it thoroughly
  2. Pick a system/routine of interpretation (your source should detail) and stick to it. Use it every time until it becomes natural.
  3. Do examples. Do more examples. Wait until you’re feeling rusty and do some examples again.

 

If you’re looking for dead trees to hold, then these are the two entry-level EKG texts I recommend:

The most famous and popular EKG book around is hands down Dale Dubin’s Rapid Interpretation of EKG’s (often just called Dubin’s for short). The early portions utilize the same “programmed” learning as Felson’s, which is both effective and makes you feel like a child. Unfortunately, Dr. Dubin has also spent time in jail for making and owning child pornography, so let that information color your reading accordingly. His quite good 14-page summary (taken from the book) is also available for free online and in many ways is all you need to learn the basics or freshen up, depending on your background and the demands of your coursework. Dubin’s website itself also has some good information, but it’s very poorly designed.

Another one stop shop for basic EKG for medical students and non-cardiology-bound residents is The Only EKG Book You’ll Ever Need, which is more of a traditional text, extremely readable, and surprisingly quick. I personally prefer it to Dubin, though Dubin’s is absolutely the more popular of the two.

Your school library will probably have copies of both, but Dubin was always a bit hard to get a hold of at ours.

 

If you don’t mind the screen, then you can probably get away with a subset of these free resources:

ECGWaves has a free e-book and online course.

Learntheheart.com has what amounts to a complete standalone EKG online coursebook, which is broken down into the basic, topic review, cases, quizzes, and tons of example EKG tracings. The design could use a refresh, but the content is stellar and could easily replace a purchase. There’s also a lengthy review of cardiology.

The University of Utah runs an ECG Learning Center, which includes an “Outline” which is pretty good and also available as a free 88-page pdf.

The University of Wisconsin also has an online ECG course, though I’d say it’s not quite as good as Learn the Heart’s.

ECG Teacher has nice video tutorials: well-produced content, clear illustrations, good sound quality. Probably better than you’ll receive in the classroom.

ECG Made Simple requires a simple free registration but is quite good once past that hurdle. Lots of tutorials (including videos, for those so inclined)

SkillStat has a what seems like most of their The Six Second ECG Workbook available as free pdf chapters online from their website, which would make a nice addition to your iPad or other electronic reading device. They also have a nifty EKG simulator/generator for review and for testing. Either the software generates a tracing for the rhythm you select, or it generates a tracing and you identify it. Sorta fun. For those with ACLS on the horizon, it also has a nice little ACLS testing tool.

Quick ECG highlights and plenty of samples can be out at Online ECG Interpretation for Emergency Physicians (thanks, Paul).

If you’re still looking for some more sample tracings, then look no further than EKG’s for EM Physicians, which has 100 tracings with answers in addition to a succinct “How to read an EKG” section. ECG Wave Maven is a massive collection of cases. ECG library also has a good collection of tracings, though the picture quality leaves something to be desired.

10 Comments

  1. Nice summary. One of my EM residents recommended another free site for learning 12-lead ECG interpretation: http://www.emedu.org/ecg/

    It has a bunch of nice markups of common emergency rhythms and a useful quiz tool.

    Cheers,
    Paul

    Reply
  2. Hello ben,
    Very nice article.!May i suggest the following resources.
    Books:
    The art of 12 lead interpretation-Tomas Garcia.
    It has a systematic format along with fill in the blanks that just hammers the point right away.

    Podrids read world ECGs-For practice.

    ONLINE RESOURCES;
    Ecginterpretation.blogspot.com By dr.Ken grauer.
    Astounding simplified explanation to complex phenomenon.Must visit.

    Dr.smiths ecg site.-Probably the most updated site -recommended for basic level readers to enhance their knowledge.

    ems12lead.com-Brilliant site that contain articles regarding EM as well.

    Amal Mattus ECG for the week series -available on youtube.You could subscribe for it as well.
    facebook-EKG Club
    ECG oasis.

    youtube-Dr.ken grauer page has outlines all the basics to some advanced concepts on reading ECGs..Would be useful to start there.

    Hope these help.

    Regards and good day,
    Vijay Balaji.K

    Reply
  3. For those who like a more thorough understanding, I recommend http://www.ecgwaves.com or Galen Wagner’s book which I forgot the title of, but it’s amazingly well written. Dale Dubin’s book is great until you actually meet a patient, then you’ll notice its blatant shortcomings. Another great book is Ary L Goldbergers ECG a simplified approach.

    Reply
  4. If you want to learn ECGs from a heart rhythm specialist (electrophysiologist) or already know the basics but want something more comprehensive, the video tutorials at ECGAcademy.com are easy to understand but delve into the physiology behind the ECG and arrhythmias. This the most advanced content available on the web and is recognized worldwide. Plus, each week a new 5-6 minute “how to” ChalkTalk video is released to help you practice your approach to real ECGs. Each one tells a story and shows you step by step how to approach more complex tracings. CE contact hours are available for nurses, nurse practitioners and EMS professionals. An archived library of nearly 300 ChalkTalks is available to paid subscribers.

    Reply

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