THE ECG BLOG

20 Comments Add your own

• 1. anniec898  |  November 16, 2008 at 23:26

  I am an ECG enthusiast, as well. I am still learning and have far to go until I am an “expert.” I am excited to see your posts, and learn from your wisdom.

• 2. PQRST  |  November 16, 2008 at 23:42

  Great! Glad to have you reading my blog!

• 3. anniec898  |  January 12, 2009 at 06:34

  I am wondering if you would share with me how you study and progress with your EKG interpretation and knowledge.It seems you are always “spot on” with your analyses and interpretations. I am struggling a little although I’ve read a multitude of books and work in a hospital as a Telemetry Technician. It is a goal to get more adept, but I seem to be digressing instead of progressing. I am using some workbooks and aim to buy the books you suggest, but I am feeling inept at this although I practice rhythm interpretation daily. I still am not rationalizing my interpretation’s as well as the experts (i.e. the RT’s that do it all the time, the Nurse’s whom I work under, or even the Cardiologists).

• 4. PQRST  |  January 15, 2009 at 09:14

  Thanks a lot for your comment, Annie!
  I’ll be happy to share all I know with you, but I am afraid the answer is simple. When interpreting EKGs, one should try to stay disciplined and always check things in the same order. This is often the key to becoming a good interpreter. I always check the EKG by going through this list:

  1. Rate
  2. Rhythm (AV conduction, ectopy, regularity, premature beats)
  3. Axis
  4. QRS complex (hypertrophy, narrow, wide, BBB)
  5. ST-T segment (infarction, injury, ischemia)

  Also, good knowledge of the autonomic nervous system, electrophysiology and cardiac anatomy/physiology/pathophysiology is helpful, if not essential.

  Lastly, but most importantly, the key to success is nothing but practice. Photocopy and bring home both interesting and “standard” EKGs, along with some relevant patient info/anamnesis, and study them.

  Then again, interpreting live rhythms is a bit different from strips and 12 leads. While you as a telemetry technician are looking at a moving target, my EKG is lying still at the table… I’m sure you are quite skilled, alright!

  And thanks for the compliment about me always being spot on, but I’m afraid I’m not. I often misinterpret and then someone else comes over and point out something that was obvious to them which I didn’t see..

• 5. Jodie Elrod  |  February 2, 2009 at 15:23

  Thanks so much for creating this website! I am the managing editor of EP Lab Digest, a monthly medical journal in cardiac electrophysiology (EP), and I know many who still struggle with interpreting ECGs. I would love to talk with you sometime about your experiences in learning to read ECGs, and any tips and suggestions you might have. I know our readers would find this online venue to be very helpful! Please contact me at “jelrod@hmpcommunications.com” at your soonest convenience.

• 6. Trauma Junkie  |  February 3, 2009 at 20:40

  Have scheduled a post about your blog for 5pm CST on my blog. Really enjoy the quality content.

• 7. PQRST  |  February 3, 2009 at 21:05

  Really? I’m honored! Looking forward to reading it! Again, I’m very glad you like my blog. Nothing is better than teaming up with other ekg fans! Thanks again for your kind words!

• 8. Shawn  |  February 14, 2009 at 21:14

  Hello,
  I am a nursing student who is currently studying for my 2nd Test in Medsurg 3 which is over EKG’s. My question is, what does the PQRST mean on the EKG reading?

  Thanks!

• 9. SURENDER SHARMA  |  March 9, 2009 at 11:54

  HI IAM SURENDER YOUR NOTIC IS GOOD

• 10. danno  |  April 1, 2009 at 15:41

  I am an Electrophysiology/Cardiovascular Tech. I found this site because I am in a hurry to provide the answer to my EP colleagues of, Why were the letters, pqrstu, used for EKG analysis?

• 11. PQRST  |  April 1, 2009 at 15:59

  @Danno: Thanks for stopping by. I am not sure about why the exact letters were chosen by Einthoven. However, the ECG Library at ecglibrary.com present an ECG historical timeline that explains this:
  “1895
  Einthoven, using an improved electrometer and a correction formula developed independently of Burch, distinguishes five deflections which he names P, Q, R, S and T. Einthoven W. Ueber die Form des menschlichen Electrocardiogramms. Arch f d Ges Physiol 1895;60:101-123
  Why PQRST and not ABCDE? The four deflections prior to the correction formula were labelled ABCD and the 5 derived deflections were labelled PQRST. The choice of P is a mathematical convention (as used also by Du Bois-Reymond in his galvanometer’s ‘disturbance curve’ 50 years previously) by using letters from the second half of the alphabet. N has other meanings in mathematics and O is used for the origin of the Cartesian coordinates. In fact Einthoven used O ….. X to mark the timeline on his diagrams. P is simply the next letter. A lot of work had been undertaken to reveal the true electrical waveform of the ECG by eliminating the damping effect of the moving parts in the amplifiers and using correction formulae. If you look at the diagram in Einthoven’s 1895 paper you will see how close it is to the string galvanometer recordings and the electrocardiograms we see today. The image of the PQRST diagram may have been striking enough to have been adopted by the researchers as a true representation of the underlying form. It would have then been logical to continue the same naming convention when the more advanced string galvanometer started creating electrocardiograms a few years later. ”

  See the full text at http://www.ecglibrary.com/ecghist.html

• 12. Gabriel  |  June 1, 2009 at 14:54

  Hi there, Im a student currently studying Physiology and I came across a question which troubles me. Its quite technical,

  As we know,
  P = Atrial Depolarization / Atrial Contraction
  QRS = Ventricular Depolarization / Ventricular Contraction
  T = Ventricular Repolarization / Ventricular Relaxation

  Im wondering how about the Atrial Repolarization / Atrial Relaxation? Which part of the ECG graph shows this “missing link”?

  Enlighten me

• 13. PQRST  |  June 1, 2009 at 17:31

  Hi there, Gabriel!

  The surface ECG has its limits, and a lot of the electrical activity that occurs in both normal and abnormal heart activity, is not shown. Normally, atrial repolarization is not visible on the surface ECG, as it is usually extends into ventricular activation and the deflection it makes gets hidden in the QRS complex. However, it is sometimes seen in the presence of AV block as a negative deflection called the Ta wave (atrial T wave). It is usually directed opposite to P wave in the same lead. Chou mentions one study on persons with AV block, which showed an average Ta wave amplitude of 0.38 mV, and a duration of 230 to 384 ms. Chou also notes that the diagnostic importance of the Ta wave is hard to define, because it is difficult to measure it and can only be done in the presence of AV block or prolonged PR interval. However, there are cases where atrial repolarization extends into the ST segment and causes a false-positive ST segment depression.

  Hope this answered your question! Thanks for stopping by and please ask again if anything!

  klaus

• 14. Gabriel  |  June 3, 2009 at 18:19

  awesome reply

• 15. PQRST  |  June 3, 2009 at 18:24

  I’m glad you think so! It’s an interesting subject – thanks for bringing it up! Please stop by again to discuss or ask questions! Have a great day! Recommended reading: Chou’s Electrocardiography In Clinical Practice; Marriott’s Practical Electrocardiography.

• 16. macSPENCER  |  June 23, 2009 at 01:33

  MacSPENCER, is my name n a psychiatric student nurse. I appreciate ur efforts.

• 17. macSPENCER  |  June 23, 2009 at 01:44

  MacSPENCER, is my name n a psychiatric student nurse. can I ask any other Qn. apart from an ECGs Qn ?

• 18. PQRST  |  June 23, 2009 at 02:03

  Thanks, that´s very much appreciated! Glad you like the website!

• 19. PQRST  |  June 23, 2009 at 02:06

  Sure, go ahead ask anything you like. However, ECG is my speciality, so if you ask about other stuff I can´t guarantee you an answer …

• 20. AppDev  |  June 24, 2009 at 18:00

  What is current thinking on ST depression and slope? Useful only with exercise ECG? Also with resting?

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