Learning to interpret ECGs is not easy – but there’s a world of help out there.
Authors: Bennett J, Rhee D, Wagh A, Pusic M, Tse AB.
Being able to efficiently and accurately read an ECG is an important yet very difficult skill to learn. Online resources can help you improve your abilities at any learner level; however, navigating the multitude of resources can be overwhelming. Our goal is to describe high yield online resources, point you towards robust educational social media, and introduce you to a new NYU-developed database of ECGs with over 80,000 ECGs for learners to practice, learn, and develop their ECG interpretation skills. Click here to view a table summary of the free ECG resources on the web today!
Online resources come in several formats.
There are four main types of resources:
- Web-page indices of conditions in which an alphabetical list of links connects to one or more representative examples of a given condition. For example:
- Pure didactics where the point is to learn the vocabulary and basic processes of ECG interpretation. For example:
- Searchable databases of ECGs. For example:
- Practice/Quiz Modes of ECGs. For example:
Social Media and ECG Learning:
Social media plays a large role in medical education. With widely accessible information and access to the opinions of innovators across many platforms, the landscape for ECG learning is visibly shifting. Twitter, for example, provides students with the ability to connect with respected clinician-educators as well as formulate questions and answers with other students. Below are some of the many ways that students can further their ECG skills outside the classroom.
- Amal Mattu
- Anand Swaminathan
- Shreya Trivedi
- John Larkin
- Stephen W. Smith
- Simon Mark Daley
- Haney Mallemat
- Smith’s ECG Blog
- John Larkin’s ECG Blog
- Amal Mattu’s Site (paid)
- Journal of Electrocardiology (on twitter)
- Core IM Twelve Lead Thursday
- Approach every ECG systematically. This helps to keep you organized early on. As you become more advanced, maintaining a systematic approach (rate, rhythm, axis, intervals, ST analysis/signs of ischemia) helps you avoid missing more subtle findings.
- Begin learning about core ECG findings such signs of STEMI, hyperkalemia, AV blocks, atrial fibrillation, LBBB, RBBB, LVH, etc. Keeping it simple at the start will prevent you from feeling overwhelmed early on. There are untold numbers of nuances to learn, so solidify a foundation of knowledge before approaching the rarer and more complicated cases and findings. For this we recommend beginning with didactic based websites:
- Next, build your knowledge base by learning about other pathologies. Do this slowly. Learn about new pathologies and findings from cases you see, from conference learning, from social media, from blogs, or from further exploration of the above didactic sites (e.g. Hypertrophic cardiomyopathy, Digoxin toxicity, TCA toxicity, WPW, Brugada, Sgarbossa criteria, etc.)
- As you learn new concepts, solidify them by practicing using practice sites such as:
- At some point you will begin to feel relatively comfortable identifying most common pathologies. When you get to this stage (likely after several years of steps 1-4), shift your focus towards seeking out rarer pathologies, more nuanced findings, and abnormal presentations of pathologies you know. This can be done using more advanced resources such as Dr. Smiths ECG blog, or Amal Mattu’s ECG weekly. Staying involved with social media is a good way to keep up to date on newer information and rarer findings.
There is a wide breadth of ECG learning material online to allow every engaged learner to develop this important clinical skill to the level necessary to appropriately care for their patients. Below is an info-graphic based on learning curves that can guide which materials to choose at which stage of development. Early on you’ll want to spend your time with the didactic materials and do few cases but in depth, puzzling out the process for yourself. In the middle zone, practice with unknown but routine cases is key. Develop fluidity. After the bend in the learning curve, this is where nuance and artistry starts to enter the picture. Difficult cases, rare cases, controversial cases make up the curriculum at this point. Learning is harder but this tiger country needs to be mastered to provide the highest levels of clinical care!
|Source of ECGs
|# of ECGs
|Subject of ECGs
|NYU ECG Database
|NYU Langone Dept of Emergency Medicine
|Spans many different conditions/diagnoses
|PDF, Rhythm strip
|LIfe In the Fast Lane;
LITF: Top 100 ECGss
|Indexed in multiple ways: alpha by condition; quiz mode; basics
|Search by keyword
|A few examples of many different conditions/diagnoses.
|Social Sharing APIs
|Queens University ECG Skills page
|Top down index
|Examples of normal features and ~30 abnormals
|Tight list of representative examples; with didactics
|Whole module in document format
|Resembles wikipedia; textbook format
|Broad consortium of contributors
|Mainly alpha indexed but with a large number of learning cases for practice.
|Several hundred cases
|Arrhythmias, electrolyte disorders, Ischemia & Myocardial Infarction, Miscellaneous
|JPG download for ECGs and document format for the rest of the module
|Database of databases with an emphasis on the underlying signal.
|The eICU Collaborative Research Database is populated with data from a combination of many critical care units throughout the continental United States
|Search across database titles
|Too many to count!
|Depends on the database you select
|Depends on database
Raw material for application development
|Clean single webpage listing ~100 conditions with case examples
|Dr. Dean Jenkins, Dr. Stephen Gerred
|Top down index
|Spans many different conditions/diagnoses. Well labeled.
|ECG Learning Center (Utah)
|Clean webpage index with complementary Google search feature
|Frank G. Yanowitz, MD , Professor of Medicine (Retired), University of Utah School of Medicine, Dr. Alan E. Lindsay
|Top down index and search feature
|Spans many different conditions/diagnoses; quiz mode
|PDF (of whole module0
|UBC ECG Learning Modules
|Serial tutorials on the component processes for interpreting ECGs
|Rose Hatala MD, Associate Professor of Internal Medicine
|Tutorials indexed by subject
.Ischemia, Infarction and Pericarditis;