We all make mistakes but there are some common mistakes that are completely unavoidable during ECG interpretation. The issue isn’t about missing a wide complex tachycardia diagnosis or mistaking fascicular tachycardia for an SVT. It’s the more common, everydays lapses in caution that cause most problems. Here are 10 common, everyday mistakes medical professionals who read ECGs still make:
- Accepting the ECG machine interpretation
This is completely unacceptable. Hopefully, anyone reading ECGs without supervision will have enough formal ECG training to be able to determine the diagnosis themselves. - Ignoring the Clinical Context-
The ECG is an adjunctive tool. It exists to facilitate a diagnosis, but so do other methods: physical exam, medical history, laboratory and imaging data, etc. - Failing to repeat the ECG
One should never rule out an acute MI or an intermittent, paroxysmal dysrhythmia based on a single ECG. Too much may be missed. The ECG manifestations of an acute MI sometimes take a while to develop. Never limit yourself to just one ECG. - Overreliance on Morphology
Expecting to see the same QRS in Lead V1, for instance, is not realistic. Conditions change and the morphological characteristics of the different deflections can change with them. - Thinking that 12 leads is always enough
If you suspect an MI but don’t see evidence of one on the ECG, do more leads. Keep looking. You owe it to your patient. - Dependance on fixed ECG measurements
Everything is relative on an ECG. ST elevation that is 50% or more of the amplitude of the R wave is a major finding during an acute ischemic episode. So why should the height of the R wave change things? - Accessing or relying on the wrong reference material
It is surprising and unfortunate that so much information that is uploaded to the internet is woefully out-of-date or simply incorrect. It is important to know which sources to consult and whom you can trust. - Assuming all AV dissociation is caused by third degree AV block
Most AV dissociation is caused by alterations in the autonomic nervous system – not third degree AV block. If you don’t understand the difference then you could be making a serious mistake. - Diagnosing a dysrhythmia from a single rhythm strip
This is very dangerous and can lead to very bad outcomes. Always diagnose a dysrhythmia from a 12-lead ECG! - Failing to approach each ECG methodically
Everyone develops their own approach to analyzing a 12-lead ECG and that’s fine. But one must be methodical about it, otherwise a diagnosis could be missed.
By being alert and vigilant regarding these ten mistakes, many avoidable incidents in the standard of care can be caught before becoming a problem.