ECG of the Week 32

Not so much an ECG this week, but something to consider during your interpretations.

Let's be honest here: how many of you look at the computer interpretation of the ECG before you analyse it?  How many of you fold down the top of the sheet so you can't see the computer's interpretation?  You know you should, don't you?  And don't consider the computer reading as the "expert" reading.  No computer can compare to a human expert.

What are the computers good at?

  • intervals
  • Axis
  • generally good at sinus rhythm
  • generally good at normal tracings although I used to have a small collection of MI's read by the computer as "normal".  These were all inferior MI's so watch for those.

What do the computers miss?

  • any rhythm that's not sinus
  • subtle infarctions
  • over-interpret J-point elevation (calling them MI's)
  • pacemaker spikes
  • WPW
  • Tall "R" in V1
  • Wellen's syndrome
  • DeWinter T-waves
  • Age: the computer assumes the patient is over 50.  And remember, LVH cannot be diagnosed in a patient under 35.
  • Abnormal T-waves:  particularly tall, peaked ones.

My Advice:

Don't look at the computer interpretation; it's too easy to "confirm" what you already "know".

By all means, review the intervals.

Make your own interpretation based on the clinical scenario (the computer can't do this).

Then review the computer's interpretation; if there's a conflict then either revise your analysis and/or get help.

If there's still a conflict, refer.  [I'm not embarrassed in the least to fax or text an uncertain ECG to the cardiologist on call.]

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