EKG

Lessons. Practice Strips and Drills

EKG Definition

An EKG, also called an ECG or electrocardiogram, records the heart's electrical activity. It is a quick and painless procedure. EKGs capture information about the heart's electrical signal as it moves from the atrium (upper part of the heart) to ventricles (lower part of the heart). These electrical signal cause the heart to contract and pump blood. EKGs are interpreted by healthcare professionals to understand:

  • Heart rate
  • Heartbeat regularity
  • Strength and timing of the electrical signals
  • Any possible abnormal conditions

Introduction To EKG Training

This website provides a wide range of lessons, drills and quizzes designed to help medical professionals improve EKG knowledge and skills. The links below provide access to basic training lessons, to our reference guides well as to arrhythmia drills and quizzes.

EKG Interpretation - Introduction

This introductory interpretation training course reviews the main features of electrocardiogram strips. A method for analyzing an electrocardiogram is presented. This method includes assessment of rhythm, calculating heart rate, observing P-wave forms, measurement of wave intervals and segments and the evaluation of other relevant waves. In addition, our drills allow students to practice electrocardiogram identification.

EKG Basics

EKG Practice Drills

EKG practice drills provide users with a quick and interactive method for learning arrhythmias. Users are asked to identify the arrhythmia and then receive immediate feedback after answering a multiple choice question. Tips for analyzing are used to interactively instruct each user. A directory of ekg strips is available.

EKG Practice Drills

ECG Quiz

Our quiz presents twenty tracings. Correct (and fast answers) earn quiz points. At the end of the quiz, your score is compared to mean and top scores for all recent website visitors. We also provide a graded report of your answers compared to correct responses. Quiz ekg tracings are randomly selected from our database of our 350 tracing, so that this quiz can be repeated many times while retaining its challenge.

ECG Quiz

Abnormal EKG Guide

Our Abnormal EKG reference guide provides information on over forty different arrhythmias. For each type of arrhythmia there are multiple examples, actual patient tracings and simulated electrocardiograms. We also provide an annotated tracing with a summary of the key features used in interpreting electrocardiograms. Interactive digital calipers can be used for measuring key features on each tracing.

Abnormal EKG Guide

12 Lead EKG

12 lead ekg tracing

A slide presentation on 12 lead electrocardiograms created by Dr. Michael Mazzini, M.D., Boston University Medical Center.

12 Lead EKG

ECG Monitor Quiz (beta version)

Our Monitor Quiz is similar to the standard Quiz, but with a twist. Instead of static tracings, the ECGs are presented using a simulated patient monitor. After the twenty tracings are evaluated, we present a graded report along with static images of each tracing. Your score is compared to a mean score for all recent website visitors. Don't worry, your score is kept private.

ECG Monitor Quiz

ECG Interpretation Tutor

Try your hand at ECG interpretation with immediate coaching. Our ECG tutor provides ECG tracings that you can analysis. Then your interpretation of key ECG features can be compared to expert analysis.

ECG Interpretation Tutor

Spanish Edition

In cooperation with Project Semilla, we have recently launched Spanish Editions of several of our ECG training modules.

Guía de referencia de los ritmos cardíacos
Paciente Virtual Prueba con Monitor
Ejercicios de práctica de ritmos cardíacos
Conceptos Básicos ECG

How To Read An EKG - Lectures

Use EKG.Academy's library of free presentations on cardiac rhythms. These training materials present the fundamentals for each major category of cardiac rhythms. The fundamentals are reinforced with practice exercises throughout each lecture.

EKG Lectures

Abnormal EKG Types

A summary of each of the most common EKG types is provided below.

Accelerated Idioventricular Rhythm
EKG Strip
The EKG rhythm will appear regular with heart rate that is 50-120 bpm. The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec), bizarre looking. .
Accelerated Junctional Rhythm
EKG Strip
The EKG rhythm will appear regular with heart rate that is normal (60-100 bpm). The P wave features: present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec). .
Asystole
EKG Strip
The EKG rhythm will appear not present with heart rate that is absent. The P wave features: absent. Observe that the PR interval is absent. The QRS complex will typically be absent. confirm with multiple leads.
Atrial Fibrillation
EKG Strip
The EKG rhythm will appear irregular with heart rate that is very fast (> 350 bpm) for atrial, but ventricular rate may be slow, normal or fast. The P wave features: absent - erratic waves are present. Observe that the PR interval is absent. The QRS complex will typically be normal but may be widened if there are conduction delays. .
Atrial Flutter
EKG Strip
The EKG rhythm will appear regular or irregular with heart rate that is fast (250-350 bpm) for atrial, but ventricular rate is often slower. The P wave features: not observable, but saw-toothed flutter waves are present. Observe that the PR interval is not measureable. The QRS complex will typically be normal (0.06-0.10 sec). .
Bundle Branch Block
EKG Strip
The EKG rhythm will appear regular with heart rate that is the underlying rate. The P wave features: normal. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be wide (>0.12 sec). .
First Degree Heart Block
EKG Strip
The EKG rhythm will appear regular with heart rate that is the underlying rate. The P wave features: normal. Observe that the PR interval is prolonged (>0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). a first degree av block occurs when electrical impulses moving through the atrioventricular (av) node are delayed (but not blocked). first degree indicates slowed conduction without missed beats..
Idioventricular Rhythm
EKG Strip
The EKG rhythm will appear regular with heart rate that is slow (20-40 bpm). The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec), bizarre appearance. .
Junctional Escape Rhythm
EKG Strip
The EKG rhythm will appear regular with heart rate that is slow (40-60 bpm). The P wave features: present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec). .
Junctional Tachycardia
EKG Strip
The EKG rhythm will appear regular with heart rate that is fast (100-180 bpm). The P wave features: present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is absent or short. The QRS complex will typically be normal (0.06-0.10 sec). .
Multifocal Atrial Tachycardia
EKG Strip
The EKG rhythm will appear irregular with heart rate that is fast (> 100 bpm). The P wave features: often changing shape and size from beat to beat (at least three differing forms). Observe that the PR interval is variable. The QRS complex will typically be normal (0.06-0.10 sec). t wave is often distorted also review wandering atrial pacemaker lesson.
Normal Sinus Rhythm
EKG Strip
The EKG rhythm will appear regular with heart rate that is normal (60-100 bpm). The P wave features: normal (positive & precedes each qrs). Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). .
Pacemaker Failure to Capture
EKG Strip
The EKG rhythm will appear irregular with heart rate that is slow or normal. The P wave features: . Observe that the PR interval is . The QRS complex will typically be . pacemaker spikes are not followed by p waves or qrs complexes.
Pacemaker Failure to Pace
EKG Strip
The EKG rhythm will appear irregular with heart rate that is . The P wave features: . Observe that the PR interval is . The QRS complex will typically be . pacemaker spikes do not appear.
Pacemaker Single Chamber Atrial
EKG Strip
The EKG rhythm will appear regular with heart rate that is 60 bpm. The P wave features: normal. Observe that the PR interval is normal. The QRS complex will typically be normal. .
Premature Atrial Complex
EKG Strip
The EKG rhythm will appear irregular with heart rate that is usually normal but depends on underlying rhythm. The P wave features: premature, positive and shape is abnormal. Observe that the PR interval is normal or longer. The QRS complex will typically be 0.10 sec or less. .
Premature Junctional Complex
EKG Strip
The EKG rhythm will appear regular with premature beats with heart rate that is the underlying rate. The P wave features: present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is absent or short. The QRS complex will typically be normal (0.06-0.10 sec). .
Premature Ventricular Complex
EKG Strip
The EKG rhythm will appear irregular with heart rate that is the underlying rate. The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec), bizarre appearance. two pvcs together are termed a couplet while three pvcs in a row with a fast rhythm is ventricular tachycardia.
Premature Ventricular Complex Bigeminy
EKG Strip
The EKG rhythm will appear irregular with heart rate that is the underlying rate. The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec), bizarre appearance. pvc appears every second beat.
Premature Ventricular Complex Quadrigeminy
EKG Strip
The EKG rhythm will appear irregular with heart rate that is the underlying rate. The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec), bizarre appearance. pvc appears every fourth beat.
Premature Ventricular Complex Trigeminy
EKG Strip
The EKG rhythm will appear irregular with heart rate that is the underlying rate. The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec), bizarre appearance. pvc appears every third beat.
Second Degree Heart Block Type I
EKG Strip
The EKG rhythm will appear irregular but with progressively longer pr interval lengthening with heart rate that is the underlying rate. The P wave features: normal. Observe that the PR interval is progressively longer until a qrs complex is missed, then cycle repeats. The QRS complex will typically be normal (0.06-0.10 sec). .
Second Degree Heart Block Type II
EKG Strip
The EKG rhythm will appear regular (atrial) and irregular (ventricular) with heart rate that is characterized by atrial rate usually faster than ventricular rate (usually slow). The P wave features: normal form, but more p waves than qrs complexes. Observe that the PR interval is normal or prolonged. The QRS complex will typically be normal or wide. .
Sinoatrial Block
EKG Strip
The EKG rhythm will appear irregular when sa block occurs with heart rate that is normal or slow. The P wave features: normal. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). pause time is an integer multiple of the p-p interval try to identify specific type of atrial tachycardia - see other pages.
Sinus Arrest
EKG Strip
The EKG rhythm will appear irregular due to pause with heart rate that is normal to slow. The P wave features: normal. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). pause time is not an integer multiple of the p-p interval.
Sinus Arrhythmia
EKG Strip
The EKG rhythm will appear irregular, varying with respiration with heart rate that is normal (60-100 bpm) and rate may increase during inspiration. The P wave features: normal. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). heart rate frequently increases with inspiration, decreasing with expiration.
Sinus Bradycardia
EKG Strip
The EKG rhythm will appear regular with heart rate that is slow (< 60 bpm). The P wave features: normal. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). .
Sinus Tachycardia
EKG Strip
The EKG rhythm will appear regular with heart rate that is fast (> 100 bpm). The P wave features: normal, may merge with t wave at very fast rates. Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). qt interval shortens with increasing heart rate.
Supraventricular Tachycardia
EKG Strip
The EKG rhythm will appear regular with heart rate that is fast (150-250 bpm). The P wave features: merged with t wave. Observe that the PR interval is normal (0.12 sec). The QRS complex will typically be normal (.10 sec). pr interval can be difficult to measure.
Third Degree Heart Block
EKG Strip
The EKG rhythm will appear regular, but atrial and ventricular rhythms are independent with heart rate that is characterized by atrial rate usually normal and faster than ventricular rate. The P wave features: normal shape and size, may appear within qrs complexes. Observe that the PR interval is absent: the atria and ventricles beat independently.. The QRS complex will typically be normal, but wide if junctional escape focus. .
Ventricular Fibrillation
EKG Strip
The EKG rhythm will appear highly irregular with heart rate that is unmeasurable. The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be none. ekg tracings is a wavy line.
Ventricular Tachycardia
EKG Strip
The EKG rhythm will appear regular with heart rate that is fast (100-250 bpm). The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec), bizarre appearance. .
Ventricular Tachycardia Monomorphic
EKG Strip
The EKG rhythm will appear regular with heart rate that is fast (100-250 bpm). The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec), bizarre looking. .
Ventricular Tachycardia Polymorphic
EKG Strip
The EKG rhythm will appear regular or irregular with heart rate that is fast (100-300 bpm). The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be normal or wide (>0.10 sec), bizarre looking. .
Ventricular Tachycardia Torsade de Pointes
EKG Strip
The EKG rhythm will appear irregular with heart rate that is fast (200-250 bpm). The P wave features: absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec), bizarre looking. .
Wandering Atrial Pacemaker
EKG Strip
The EKG rhythm will appear may be irregular with heart rate that is normal (60-100 bpm). The P wave features: changing shape and size from beat to beat (at least three diffferent forms). Observe that the PR interval is variable. The QRS complex will typically be normal (0.06-0.10 sec). t wave normal. if heart rate exceeds 100 bpm, then rhythm may be multifocal atrial tachycardia (map).
Wolff-Parkinson-White Syndrome
EKG Strip
The EKG rhythm will appear regular unless atrial fibrillation present with heart rate that is normal (60-100 bpm). The P wave features: normal. Observe that the PR interval is can be short (<0.12 sec). The QRS complex will typically be usually wide (> 0.12 sec). look for short pr interval and/or delta wave a delta wave (positive or negative) distorts the early part of the qrs complex.

Authors

Our website contributors and authors include:

  • Dr. Jon Keroes
  • Dr. Barbara Erikson
  • David Lieberman
  • Diane Wrigley
  • Dr. Michael Mazzini
  • Tom O'Brien
  • The simulation software team at Medical Training and Simulation, LLC

Quick Links

About

This website is intended for use by medical professionals. All information is for educational purposes only. For medical care please contact a qualified healthcare provider.

2016 © Medical Training and Simulation LLC. All Rights Reserved.