A Systematic Approach to Reading Electrocardiograms by Using 2 Mnemonics

A Systematic Approach to Reading Electrocardiograms by Using 2 Mnemonics

Author: V. Dimov, M.D., Department of General Medicine, Cleveland ClinicThis is a 2-step approach remembered by 2 mnemonics:

Step 1: Evaluate all elements of the EKG systematically: A RARE PQRST.

Step 2: Differential diagnosis. Look for diseases that may have caused the abnormalities noted in step 1: DR III EEE !

This systematic approach to reading electrocardiograms (ECGs or EKGs) works every time, just like a machine. By using it, you will not miss any major abnormalities in electrocardiograms (EKGs).

What is the meaning of the mnemonics?

A RARE PQRST:

Age, e.g. a 60-yo patient is likely have a different pathology from a 30-yo patient

Rate, e.g. fast or slow?

Axis, e.g. left or right?

Rhythm, e.g. regular or irregular?

Evaluate each EKG element as follows:

P wave, e.g. peaked or absent?

Q wave, e.g. deep Q wave?

R wave, e.g. tall? look at QRS complex width for RBBB or LBBB

ST segment, e.g. elevation or depression?

T wave, e.g. peaked or inverted?

DR EEE III:

Drugs , e.g. Digoxin, tricyclic antidepressants

Rhythm and rate abnormalities, e.g. AV block of 1,2,3 degree, AFib, SVT?

Ischemia?Infarct? Deep Q wave?Infection, e.g. pericarditis

Enlargement, e.g. LVH, RVH, left or right atrium enlargement?

Electrolyte disturbances, e.g. hyperkalemia, hypokalemia, hypercalcemia,

Endocrine causes, e.g. hypothyroidism

How to use this approach in practice?

Look at the EKG and write down on a piece of paper:

A R A R E P Q R S T

D R I I I E E E

Circle the abnormalities you discover in step 1 -- A RARE PQRST. Then, connect and try to explain these abnormalities by looking at the list of possible etiologies presented in step 2 -- DR EEE III.

That's it!

An example: