11 Steps to Read an ECG ( EKG )

Key Steps — Reading an ECG in 11 steps

A systematic read-through prevents missed findings: work through the same eleven checks, in the same order, on every tracing.

1. Step 1 — Check the details: patient identity, date and time, and the machine's calibration and paper speed.
2. Step 2 — Heart rate: calculate it from the R-R interval or the machine's readout, and confirm it yourself.
3. Step 3 — Rhythm: is each QRS preceded by a P wave, and is the rhythm regular?
4. Step 4 — Cardiac axis: work out the direction of the QRS forces from the limb leads.
5. Step 5 — P waves: present before every QRS, and of normal shape and size?
6. Step 6 — PR interval: measure it and check it is neither short nor prolonged.
7. Step 7 — QRS complex: check its width and shape for bundle branch patterns or abnormal Q waves.
8. Step 8 — ST segment: look for elevation or depression against the baseline.
9. Step 9 — T waves: check they are upright where expected and of normal shape.
10. Step 10 — QT interval: measure it and correct it for the heart rate.
11. Step 11 — Compare and conclude: set this tracing beside any previous ECG, then summarise the findings and escalate anything concerning under local protocol.

Download the printable Key Steps checklist (PDF)

Steps summarise this demonstration for education. Always follow your institution's protocol. More Monitoring & Assessment skills →