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On several occasions during residency, a junior colleague approached me with some variation of the following request: "I'm starting a cardiology rotation soon, and I feel uncomfortable reading ECGs … can you recommend a resource?" I have spent a lot of time since then considering the mechanism by which residents and students learn the art and science of ECG interpretation.

First, what are the ECG abnormalities that most physicians should be comfortable recognizing, or, put differently, "what do I need to know?" Second, in what context is this information best delivered? I was taught to read ECGs in a fairly haphazard fashion using several different exercises. A faculty member would host the occasional workshop or lecture (during which I would invariably embarrass myself!). A random assortment of ECG tracings would invariably appear on in-service, shelf, and board examinations. Much learning necessarily happened in the context of clinical care—myself and fellow interns intently studying the ECGs of our patients, oft en in the wee hours of the morning and without senior staff guidance. Finally, many of us have had the privileged experience of a truly gifted clinical teacher reading an ECG with us on morning rounds, skillfully linking ECG abnormalities to the patient in the bed in front of us.

It is this final method of learning that this book attempts to replicate. I endeavor to present a set of tracings, which, taken together, demonstrate most abnormalities that a generalist physician trainee would "need to know." Each tracing is followed by clinical questions meant to reinforce electrocardiographic concepts and simulate the experience of rounding with a master clinician teaching in the Socratic Method. At the conclusion of the book, I hope you will have been exposed to a wide array of ECG abnormalities relevant to your current practice.

Practical interpretation, cogitation, and cognition are the focus rather than memorizing vast arrays of criteria. You can choose to interpret the tracings by level of difficulty, by teaching topic, or sequentially as presented (see Table of Contents). I assume a basic knowledge of the skills of ECG interpretation, which will be reviewed only briefly; readers are referred to several excellent texts for a more in-depth review of basic interpretation skills and the physiology of the ECG. Likewise, this book is not a comprehensive reference text for ECG criteria, and readers are referred to several excellent texts for this purpose.

I hope you find this book useful and enjoyable. Interpreting ECGs connects us to our roots as medical physiologists, clinicians, and teachers, and I hope that sense of joy and purpose shows through in this work.

Warm regards,




Disclaimer: The cases presented herein are fictional and created by the authors solely for illustrative teaching purposes alone. Any resemblance of cases to actual patients in any context is purely coincidental. This book does not purport to offer medical advice nor management guidance on specific cases. As always, all ECG interpretation and clinical decisions rendered in the context of patient care are solely at the discretion of the treating physician.

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