ECG Training, Practice Tests and Quiz

Your complete ECG study guide

Practice ECG Interpretation Strips

Quickly learn ECG interpretation. Use our practice tests, graded quizzes, coaching, and lessons.

  • ECG Practice Strips
  • Graded ECG Quizzes
  • Interpretation Coaching
  • Reference Guide
  • Interactive Lessons
  • Practice Drills and Tests
  • Free ECG Classroom Resources

ECG Practice

EKG practice has never been easier or more convenient. With our EKG strip practice drills, it is easy to engage in fast, interactive learning. Every answer has immediate feedback, allowing users to speed their understanding of pathalogic and normal ECGs. Plus, our practice tests and quizzes can be used on desktops, tablets, and smartphones. And the best part? We have both free and paid versions! Become fluent in recognizing abnormal ECGs today.

ECG Practice Drills

ECG Interpretation Courses

Our rhythm interpretation courses enable you to hone your ECG reading skills! With lessons and exercises covering a wide range of heart rhythms, you can build up your confidence in rhythm interpretation.

ECG Training Courses

ECG Quizzes

Take your ECG skills to the next level! These graded quizzes allow you to practice your knowledge of pathological ECGs. With over 500 randomly-selected tracings, there's no limit on how far you can go. Registered users can receive a certificate of achievement!

  • General Nursing ECGs
  • ACLS ECGs
  • NCLEX Preparation
  • Physician Assistant
  • Nurse Practitioner
  • ECG Patient Monitor Simulation
  • Comprehensive Quiz (50 categories)
ECG Graded Quizzes

ECG Interpretation Practice Coach

Feeling stumped by ECG tracings? Our ECG Interpretation Coach uses a five step interpretation procedure followed by a classification of the tracing. These coaching sessions provide step by step coaching for both analysis and interpretation. Learn to rapidly recognize abnormal QRS complexes and other abnormalities!

ECG Rhythm Interpretation Coach


ECG Monitor Quizzes

Patient Monitor

We offer two patient monitor simulations. Our EKG.Academy basic monitor quiz is a multiple choice interpretation test:
Basic Monitor Quiz

Our advanced patient monitor simulator is more challenging:
Advanced ECG Monitor Quiz

ECG Reference Guide

Do you need a quick lookup of an abnormality? Our ECG Reference Guide is a ready reference for ECGs with forty different abnormalities. Each ECG category includes a strip along with descriptive text.

ECG Reference Guide


12 Lead ECG

You can use our 12 lead ECG interpretation coach to receive step-by-step feedback as you interprete 12 lead tracings including precordial lead signals.

12-Lead Analysis and Interpretation Coaching

Use our free 12 lead ECG interprestation powerpoint lecture.

12-Lead ECG Lecture

French, German & Spanish ECG Training

We also have begun translating other content into French, Spanish and German.

EKG-Schulung

Entrenamiento-EKG

Entrainement-ECG

ECG Interpretation Courses

ECG Definition

An ECG or electrocardiogram, is a recording of the heart's electrical activity. It is a fast procedure. EKGs captures a tracing of cardiac electrical impulse as it moves from the atrium to the ventricles. These electrical impulses cause the heart to contract and pump blood. ECGs are interpreted by medical professionals using features such as:

  • Heart rate
  • Regularity of heart beats
  • Timing of the electrical signals
  • Strength of the ECG
  • Possible abnormal electrical patterns

Abnormal ECG Strips

Learn to recognize normal ECG vs abnormal. A summary of each of the most common ECG heart rhythm strips is available in our ECG reference guide.

ECG Practice Strips

Our web apps include hundreds of ECG practice test strips.

Accelerated Idioventricular Rhythm
Accelerated Idioventricular Rhythm ECG Strip

The heart rate range is faster than a ventricular rhythm but slower than ventricular tachycardia. The ECG rhythm will appear regular. The PR interval is not measurable and P wave is absent. The QRS complex will usually be over 0.10 sec (wide) and bizarre looking.

Accelerated Junctional Rhythm
Accelerated Junctional Rhythm ECG strip

The heart rate should be in the normal range (60-100 bpm) and the ECG rhythm will appear regular. The P wave appears before, hidden within, or after QRS. If the P wave is visible, it is inverted. The PR interval is not measurable. The QRS complex will typically be 0.06-0.10 sec (normal).

Asystole
Asystole ECG strip

Cardiac electrical activity is absent. No ECG rhythm can be observed. The P wave and QRS complex are not visible. Confirm using multiple leads.

Atrial Fibrillation
Atrial Fibrillation ECG strip

Heart rate is very fast: over 350 bpm for atrial, but ventricular rate may be slow, normal or fast. The ECG rhythm will appear irregular. The P wave features are absent. The PR interval is absent. The QRS complex will usually be normal but is there are conduction delays, it will be wider.


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Atrial Flutter
Atrial Flutter ECG strip

The atrial heart rate is rapid (250-350 bpm), but ventricular rate is often slower. ECG heart rhythm will be regular or irregular. P wave and PR interval are not observable, but saw-toothed flutter waves are present. The QRS complex will typically be normal (0.06-0.10 sec).

Bundle Branch Block
Bundle Branch Block ECG strip

In a bundle branch block ECG, the P wave features should be normal and the PR interval is normal (0.12-0.20 sec). The QRS complex will usually be wide, over 0.12 sec.

First Degree Heart Block
First Degree Heart Block ECG strip

The P wave will be normal while the PR interval is prolonged, over 0.20 sec. The QRS complex will typically be normal (0.06-0.10 sec). A first degree atrioventricular (AV) block occurs when electrical impulses moving through the AV node are delayed, but not blocked. The adjective first degree signifies that conduction is only slowed with no missed beats.

Idioventricular Rhythm
Idioventricular Rhythm ECG strip

The ECG rhythm will be regular with a very slow heart rate of about 20-40 bpm. The PR interval is not measurable while the P wave will be absent. The QRS complex will typically be over 0.10 sec (wide) and will have a bizarre appearance.


Junctional Escape Rhythm
Junctional Escape Rhythm ECG strip

Heart rate will usually be slow (40-60 bpm) and the ECG rhythm will appear regular. The P wave will be present before, during (hidden) or after QRS. When visible the P wave is inverted. The PR interval is not measurable. The QRS complex will typically be in the range of 0.06-0.10 sec (normal). Learn more about junctional rhythms.

Junctional Tachycardia
Junctional Tachycardia ECG strip

The ECG rhythm will appear regular with a fast heart rate (100-180 bpm). The P wave can appear before, during (hidden) or after QRS. When visible it will be inverted. The PR interval is short or absent. The QRS complex will typically be 0.06-0.10 sec (normal).

Multifocal Atrial Tachycardia
Multifocal Atrial Tachycardia ECG strip

The ECG rhythm will appear irregular with a fast heart rate over 100 bpm. The P wave features often change shape and size from beat to beat with at least three differing forms. Observe that the PR interval is variable. The QRS complex will typically be normal (0.06-0.10 sec). In addition, the T wave can be distorted.

Normal Sinus Rhythm
Normal Sinus Rhythm ECG strip

A normal (60-100 bpm) heart rate and an ECG regular. The P wave appears normal and before each QRS. The PR interval is normal (0.12-0.20 sec). The QRS complex will also be normal (0.06-0.10 sec).

Pacemaker Failure to Capture
Pacemaker Failure to Capture ECG strip

The ECG rhythm will appear irregular with heart rate that is slow or normal. Observe that the pacemaker spikes are not followed by p waves or QRS complexes.

Pacemaker Failure to Pace
Pacemaker Failure to Pace ECG strip

The ECG rhythm will appear irregular and pacemaker spikes do not appear or appear irregularly.

Pacemaker Single Chamber Atrial
image for pacemaker ECG tracing

Normal heart rate and ECG rhythm will be present. The P wave and PR interval will both be normal. The QRS complex is also normal. Pacemaker spikes will precede the P wave on the ECG tracing.

Premature Atrial Complex
Premature Atrial Complex ECG strip

The ECG rhythm will appear irregular with heart rate that is usually normal but depends on underlying rhythm. The P wave will appear premature, positive and a shape that 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
Premature Junctional Complex ECG strip

The ECG rhythm will appear regular with premature beats with heart rate that is the underlying rate. The P wave is present before, during (hidden) or after QRS. If the P wave is 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
Premature Ventricular Complex ECG strip

The ECG 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) with a bizarre appearance.

Premature Ventricular Complex Bigeminy
Premature Ventricular Complex Bigeminy ECG strip

The ECG rhythm will appear irregular with an absent P wave and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance. The PVC appears on every second beat.

Premature Ventricular Complex Quadrigeminy
Premature Ventricular Complex Quadrigeminy ECG strip

The ECG rhythm will be irregular. The PR interval is not measurable and the P wave is absent. The QRS complex will typically over 0.10 sec (wide) and bizarre in appearance. The PVC appears every fourth beat.

Premature Ventricular Complex Trigeminy
Premature Ventricular Complex Trigeminy ECG strip

The ECG rhythm will be irregular. The PR interval is not measurable and the P wave is absent. The QRS complex will typically over 0.10 sec (wide) with a bizarre appearance. The PVC appears every third beat.

Second Degree Heart Block Type I
Second Degree Heart Block Type I ECG strip

The ECG rhythm will appear irregular but with progressively longer pr interval lengthening. The P wave is normal. Observe that the PR interval becomes 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
Second Degree Heart Block Type II ECG strip

The ECG rhythm will appear regular (atrial) and irregular (ventricular) with heart rate that is characterized by atrial rate that is usually faster than ventricular rate (usually slow). The P wave has a normal form, but more P waves than QRS complexes. The PR interval is normal or prolonged. The QRS complex will typically be normal or wide.

Sinoatrial Block
Sinoatrial Block ECG strip

The ECG rhythm will appear irregular. Sinoatrial block occurs with a normal or slow heart rate. The P wave will be normal and the PR interval will be normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). The pause time is an integer multiple of the p-p interval.

Sinus Arrest - Pause
Sinus Arrest ECG strip

A sinus arrest or sinus pause ECG rhythm will appear irregular due to a pause with heart rate that is normal to slow. The P wave is normal. The PR interval is normal (0.12-0.20 sec). An ECG sinus arrest 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
sinus arrhythmia tracing

The ECG 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 is normal and the PR interval is also 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
Sinus Bradycardia ECG strip

Sinus bradycardia is characterized by a slow heart rate (under 60 bpm). The ECG rhythm will be regular. The P wave and the PR interval are normal. The QRS complex will typically be normal (0.06-0.10 sec).

Sinus Tachycardia
Sinus Tachycardia ECG strip

Sinus tachycardia is characterized by a fast heart rate of over 100 bpm. The ECG rhythm will be regular. The P wave is normal but 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). The QT interval shortens with increasing heart rate.

Supraventricular Tachycardia
Supraventricular Tachycardia ECG strip

The ECG rhythm will appear regular and heart rate that will be fast (150-250 bpm). The P wave will be merged with T wave. The PR interval is normal (0.12 sec) but can be difficult to measure. The QRS complex will typically be normal (.10 sec).

Third Degree Heart Block
Third Degree Heart Block ECG strip

The ECG rhythm will appear regular, but atrial and ventricular rhythms are independent. Heart rate is characterized by atrial rate usually normal but faster than the ventricular rate. The P wave will have normal shape and size but may appear within QRS complexes. 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
Ventricular Fibrillation tracing image

The ECG rhythm will appear highly irregular with an unmeasurable heart rate. The P wave is absent, the PR interval is not measurable and no QRS complex. The ECG tracings is a wavy line.

Ventricular Tachycardia
Ventricular Tachycardia ECG strip

The ECG rhythm will appear regular with heart rate that is fast (100-250 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) with a bizarre appearance.

Ventricular Tachycardia Monomorphic
Ventricular Tachycardia Monomorphic ECG strip

The ECG rhythm will appear regular with a fast (100-250 bpm) heart rate. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and bizarre looking.

Ventricular Tachycardia Polymorphic
Ventricular Tachycardia Polymorphic ECG strip

The ECG rhythm will appear regular or irregular with heart rate that is fast (100-300 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be normal or wide (>0.10 sec) with a bizarre shape.

Ventricular Tachycardia Torsade de Pointes
Ventricular Tachycardia Torsade de Pointes ECG strip

The ECG rhythm will appear irregular with heart rate that is fast (200-250 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec). Its shape is characterized by a gradual change in the ECG amplitude and a twisting of the QRS complexes around a line.

Wandering Atrial Pacemaker
Wandering Atrial Pacemaker ECG strip

The ECG rhythm will be irregular with a normal heart rate. The P wave can be observed changing shape and size from beat to beat (at least three different forms). The PR interval is variable in duration. The QRS complex will typically be normal (0.06-0.10 sec) and the T wave normal. If heart rate exceeds 100 bpm, then rhythm may be multifocal atrial tachycardia (MAT).

Wolff-Parkinson-White Syndrome
Wolff-Parkinson-White Syndrome ECG strip

The ECG rhythm will appear regular unless atrial fibrillation is present. Heart rate is normal (60-100 bpm). The P wave is normal. Observe that the PR interval is can be short (less than 0.12 sec). The QRS complex will typically be wide (over 0.12 sec). A delta wave (positive or negative) distorts the early part of the QRS complex.


Authors and Reviewers


Sources


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