ECG

ECG Training and Practice Web Apps

We provide a wide range of ECG training with an emphasis on practice, coaching and quizzes. Use this page to access these training materials and web apps:

  • Practice Drills
  • Quizzes and Tests
  • Analysis and Interpretation Coaching
  • Reference Guide
  • Short Courses
  • Rhythm Practice Strips
  • Free ECG Teaching Resources


ECG Practice Drills and Tests

The ECG practice tests (drills) provide a fast and interactive method for ECG strip practice. Users are asked to interpret the ECG using a multiple choice format. Immediate feedback is available after answering each question. These ECG practice tests can be used on desktops, tablets and smartphones.

ECG Practice Drills

ECG Quizzes

Our ECG rhythm practice strip present 25 tracings for ECG interpretation. These graded ECG quizzes can be selected based upon the user's educational objectives. Quiz ECG tracings are randomly selected from our database of over 600 tracings, so the quiz can be repeated many times. Scoring as well as immediate answer feedback are provided. Our quizzes include:

  • Comprehensive (over 50 categories)
  • Physician Assistant
  • Nurse Practitioner
  • ECGs for Nurses
  • ECGs for ACLS
  • ECGs for NCLEX Prep
  • Patient Monitor Simulator
  • Basic EKG Quizzes - Standardized
ECG Graded Quizzes



ECG Interpretation Practice Coach

Our ECG coach breaks down interpretation into five analysis steps followed by classification of the ECG tracing. Scoring based upon both analysis and interpretation are available..

ECG Rhythm Interpretation Coach


ECG Monitor Quizzes

Patient Monitor

Use our basic patient monitor simulator:
Basic Monitor Quiz
And our new, advanced, patient monitor simulator, developed by Steve Collmann:
Advanced ECG Monitor Quiz


ECG Reference Guide

Our ECG Reference Guide provides information on reading ECG strips with over forty different abnormal ECG examples. For each arrhythmia, there are ECG strip examples and descriptive text. We also provide an annotated tracing with a summary of the key features and values.

ECG Reference Guide


ECG Training Modules

We are pleased to announce our new ECG training modules. These modules provide in-depth training in ECG basics, rhythm analysis and a wide range of ECG topics. Each module includes lessons, interactive drills and a course quiz.

ECG Training Modules

12 Lead ECG

Practice 12 lead ECG interpretation coaching with step-by-step feedback.

12-Lead Analysis and Interpretation Coaching

A slide presentation on 12 lead ECG, written by Dr. Michael Mazzini, M.D., Boston University.

12-Lead ECG Lecture

https://app.sendgrid.com/login

Spanish Edition

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

Ejercicios de práctica de ritmos cardíacos

Guía de referencia de los ritmos cardíacos

Paciente Virtual Prueba con Monitor





French, German & Spanish ECG Training

EKG-Schulung

Entrenamiento-EKG

Entrainement-ECG


ECG Definition

An EKG, also called an ECG or electrocardiogram, is a recording of the heart's electrical activity. It is a quick and painless 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 to understand the following:

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

Abnormal ECG Strips

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

Accelerated Idioventricular Rhythm
Accelerated Idioventricular Rhythm ECG Strip

The ECG rhythm will appear regular. The heart rate is 50-120 bpm, which is faster than a ventricular rhythm but slower than ventricular tachycardia. The P wave is absent and PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and bizarre looking.

Accelerated Junctional Rhythm
Accelerated Junctional Rhythm ECG strip

The ECG rhythm will appear regular with heart rate that is normal (60-100 bpm). The P wave is present before, during (hidden) or after QRS. If visible it is inverted. The PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec).

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

The ECG rhythm will appear irregular. Heart rate is very fast: over 350 bpm for atrial, but ventricular rate may be slow, normal or fast. The P wave features are absent - erratic waves are present. The PR interval is absent. The QRS complex will typically be normal but may be widened if there are conduction delays.


Please enroll in one of our paid plans to view an additional 35 ECG abnormalities. Use the Join button in the upper right of this page.

Atrial Flutter
Atrial Flutter ECG strip

The atrial heart rate is rapid (250-350 bpm), but ventricular rate is often slower. ECG rhythm will appear more regular thank atrial fibrillar. 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

The ECG rhythm P wave features should appear normal and the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be wide (>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 (>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). The adjective first degree indicates slowed conduction without missed beats.

Idioventricular Rhythm
Idioventricular Rhythm ECG strip

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


https://app.sendgrid.com/login

Junctional Escape Rhythm
Junctional Escape Rhythm ECG strip

The ECG rhythm will appear regular. Heart rate that is slow (40-60 bpm). The P wave will be present before, during (hidden) or after QRS, if visible it is inverted. The PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec).

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, 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
Multifocal Atrial Tachycardia ECG strip

The ECG rhythm will appear irregular with a fast heart rate (> 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

The ECG rhythm will appear regular with a normal (60-100 bpm) heart rate. The P wave appears normal and 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
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.

Pacemaker Single Chamber Atrial
image for pacemaker ECG tracing

The ECG rhythm will appear regular with heart rate that is normal. The P wave and PR interval will both appear normal. The QRS complex is also normal. Pacemaker spikes will precede the P wave.

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

Premature Ventricular Complex Trigeminy
Premature Ventricular Complex Trigeminy ECG strip

The ECG rhythm will appear irregular. 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. 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 when SA 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
Sinus Arrhythmia ECG strip

The 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). 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
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

The ECG rhythm will appear regular with a slow heart rate (under 60 bpm). 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

The ECG rhythm will appear regular with a fast heart rate (> 100 bpm). The P wave 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 appear may 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 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

Author of ECG Rhythm modules is Thomas O'Brien.
Author of 12 Lead Course is Dr. Michael Mazzini, MD.
Medical review by Dr. Jonathan Keroes, MD
ECG tracings medical review by Dr. Pedro Azevedo, MD, Cardiology
Author and ECG monitor simulation developer: Steve Collmann
Last Update: 8/9/2022

Sources

An error has occurred. This application may no longer respond until reloaded. Reload 🗙