Do we have to know how to interpret ECG's

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phd89

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will we need to know this? anyone get questions like on interpreting ecg's ie counting boxes and etc. or will the question stem give away the answer most of the time before looking at the ECG's

does anyone know how common ecg's are on the real deal

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will we need to know this? anyone get questions like on interpreting ecg's ie counting boxes and etc. or will the question stem give away the answer most of the time before looking at the ECG's

does anyone know how common ecg's are on the real deal

You need to know the basics. It isn't unreasonable to make you ID a AV block, or Torsades de Pointes, inferior MI etc.
 
I had to interpret two full ECGs on my COMLEX, and none on my USMLE. I didn't have a rhythm strip on either exam. Both ECGs were classic and very easy.
 
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You need to know the basics. It isn't unreasonable to make you ID a AV block, or Torsades de Pointes, inferior MI etc.

can anyone list a good source to learn them, I don't feel like using one of the popular texts even if there only 100 pages. Any site with succinct info on how to quickly learn how to interpret an ECG?
 
can anyone list a good source to learn them, I don't feel like using one of the popular texts even if there only 100 pages. Any site with succinct info on how to quickly learn how to interpret an ECG?

The ECG chapter and the two chapters on arrythmias (if you wanted more detail) in Lilly's are pretty awesome, IMHO.

For infarct locations, look for wave abnormalities on the leads overlying the site (ex. anterior will be V1-V4, lateral will be I and aVL, and inferior will be II, III, and aVF) or in the case of a posterior wall infarct, instead of pathologic Q waves, you'll see really tall R waves in V1 and V2 (since they're on the opposite side of the posterior wall).
 
In terms of things I've seen through practice questions:

1) I'd say the highest yield ECG tidbit is recognizing the absence of P-waves. Know atrial fib for sure. Sometimes they'll just show you the ECG then want you to know mural thrombus --> stroke, etc. So that's very high-yield.

2) Know what the WPW delta-wave looks like.

3) Be able to identify the peaked T-wave vs U-wave for hyper-/hypokalaemia. In terms of what I've seen, when they want you to identify the peaked T-wave, it's absurdly peaked, so don't flip out about it.

4) Know the spiking pattern for atrial flutter. The HR is almost always 150/min as well.

5) Simple MI (usually ST-elevation in 3 leads). It would be rare to see a posterior infarct, but be vigilant for a potential ST-depression in the anterior leads.

6) Diffuse ST-elevations +/- PR-depressions = pericarditis.

7) Sinusoidal pattern = TdP

8) Wide-complex tachy = SVT with BBB, or VT. In this case, if it's one or the other, the answer is VT.

9) Mobitz I (gradually increasing PR-segments and then finally a QRS drop) + Mobitz II (random QRS drop).

10) Complete (third-degree) heart block = QRS complexes show a HR of 30-40 and the P-waves don't have any consistent pattern relative to the QRSs.

11) And as ******ed as this sounds, know how to identify a normal ECG too. I had seen a question with a vignette of a guy with chest pain who had personal Hx of atherosclerosis and a family Hx of heart disease, but the answer was actually GERD because apparently the ECG in the question was normal. So rule of thumb: don't get tricked. I got tricked on that one needless to say. I think that may have been GT QBank.
 
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In terms of things I've seen through practice questions:

1) As ******ed as this sounds, know how to identify a normal ECG too. I had seen a question with a vignette of a guy with chest pain who had personal Hx of atherosclerosis and a family Hx of heart disease, but the answer was actually GERD because apparently the ECG in the question was normal. So rule of thumb: don't get tricked. I got tricked on that one needless to say. I think that may have been GT QBank.

That's a horribly written question if that's all the question hinged on. You can't rule out a NSTEMI and rule in GERD based solely on chest pain plus a normal EKG. You at least need negative troponins. GT QBank writers are slacking, big time.
 
In terms of things I've seen through practice questions:

1) I'd say the highest yield ECG tidbit is recognizing the absence of P-waves. Know atrial fib for sure. Sometimes they'll just show you the ECG then want you to know mural thrombus --> stroke, etc. So that's very high-yield.

2) Know what the WPW delta-wave looks like.

3) Be able to identify the peaked T-wave vs U-wave for hyper-/hypokalaemia. In terms of what I've seen, when they want you to identify the peaked T-wave, it's absurdly peaked, so don't flip out about it.

4) Know the spiking pattern for atrial flutter. The HR is almost always 150/min as well.

5) Simple MI (usually ST-elevation in 3 leads). It would be rare to see a posterior infarct, but be vigilant for a potential ST-depression in the anterior leads.

6) Diffuse ST-elevations +/- PR-depressions = pericarditis.

7) Sinusoidal pattern = TdP

8) Wide-complex tachy = SVT with BBB, or VT. In this case, if it's one or the other, the answer is VT.

9) Mobitz I (gradually increasing PR-segments and then finally a QRS drop) + Mobitz II (random QRS drop).

10) Complete (third-degree) heart block = QRS complexes show a HR of 30-40 and the P-waves don't have any consistent pattern relative to the QRSs.

11) And as ******ed as this sounds, know how to identify a normal ECG too. I had seen a question with a vignette of a guy with chest pain who had personal Hx of atherosclerosis and a family Hx of heart disease, but the answer was actually GERD because apparently the ECG in the question was normal. So rule of thumb: don't get tricked. I got tricked on that one needless to say. I think that may have been GT QBank.

This is the 1 time I hope I don't get a normal ECG!
 
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