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Is that a normal EKG tracing?

When I was studying for the Step 1 I remember how much time I spent on memorizing pathology, biochemistry, and genetics. I spent hardly any time on minor areas such as biostatistics, EKGs (Electrocardiograms), and heart sounds. Now I did make the socially isolating decision early in university to minor in math, so I always felt comfortable with statistics. When it came to EKGs I was more looking for all those First Aid buzzwords like “saw tooth waves.” EKG’s are important not only for the USMLE Step 1, but also the Step 2 CK, and the Canadian exams such as the NAC OSCE.

Many of you have probably been handed many an EKG by an attending and asked to interpret it. This may lead to you staring at the sheet hoping the answer will pop out like the image on an autostereogram in Figure 1. (you know those pictures you stare at cross eyed to make a 3d image). Even if you have not started rotations yet, the importance of understanding an EKG for all USMLE exams cannot be overstated. This is similar to my blog about biostatistics, learning how to read an EKG is lost in the shuffle while studying pathology or general medicine. Subjects like biostatistics, EKGs, and hearts sounds alone will not give you the score you want, but what they will do is increase your score from say a 230 to a 240 if you had not put any time into them.


Figure 1. There is an image of a boat in there somewhere…

Why can these smaller subjects change your marks so much? You are guaranteed questions from these small subjects. Let me reinforce that point. You are guaranteed to receive several questions that have EKGs, hearts sounds, and biostatistics. Remember there are only so many questions on the exam and although I cannot say an exact number, over a half dozen questions are used in these subject areas. Are you really going to leave the answers to those all up to chance just so you can learn another obscure pathology concept that will likely not be on the test?

In my previous blog entry I wrote about how to get better with biostatistics. The next question you may have is how do I master reading an EKG? First you will need to develop a systemic method of the reading the EKG just like with X-rays. You can do this by reading: This book is the Bible of reading EKGs. It is also interactive with practice EKGs to read. The second thing you need to do is get as much practice as you can by looking at EKGs and try and figure out what the tracing suggests.

After you have mastered EKGs you should try your hand with the tracing below and tell me what you think the diagnosis is in the comments below. This is a more complicated strip (ie. will not exactly be on the exam, but will happen in real life), so use a systematic approach to it.

Learn to read EKGs

That is all for this post, so if you want a free and non-obligatory consult on how to study for the USMLE, NBME exams, or MCCEE or any other medical exam check out and send me an email! If you liked this article just say so in the comments below!

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