Guided Learning

Strip Workup

Read a real 10-second rhythm strip the systematic way, one question at a time: rhythm, rate, P waves, PR and QRS, then name it. Every answer is checked against the measurements the 12-lead machine made on that very recording.

The six steps of every read

RhythmRegular, broken by early beats, patterned, or irregularly irregular.
RateCount the complexes in 6 seconds, or divide 300 by the large boxes.
P wavesOne before every QRS, extra ones, none, or flutter waves.
PR intervalNormal, long, short, or varying from beat to beat.
QRSNarrow or wide, and whether any beats look different.
Name itPut the findings together and pick the rhythm.

Calipers and the magnifier are on every strip, and a seconds ruler runs under the paper. Rounds of 10 strips, easiest first, never the same rhythm twice in a row. Real recordings from the PTB-XL database (and one from the Ningbo First Hospital), shown in lead II, or in lead I or V1 when lead II is too small to read.

12-Lead Workup

Read a real 12-lead ECG the systematic way, one question at a time: rate and rhythm, axis, intervals, conduction, hypertrophy, Q waves and the ST segments, then put it all together. Every answer is checked against the 12-lead machine's measurements and the cardiologist's own diagnosis for that very recording.

The steps of every 12-lead read

Rate and rhythmSinus at a normal rate, slow, fast, or atrial fibrillation.
AxisLeads I and aVF: normal, left or right.
IntervalsThe PR, and the QT corrected for the rate.
ConductionA narrow QRS, a bundle branch block, or a fascicular block.
HypertrophyVoltage criteria for left ventricular hypertrophy.
Q wavesThe scar of an old infarct, and which wall.
ST segmentsElevation, depression, and which leads.
Put it togetherOne interpretation: the rhythm first, then the main finding.

Calipers, the magnifier and a full-screen view are on every ECG, and a click on any lead puts it along the 10-second strip. Rounds of 6 ECGs, easiest first, a different finding each time. With a wide QRS (a bundle branch block) the ST segments, voltage and Q waves are not graded, because the block itself changes them. Real recordings from the PTB-XL database, every one validated by a cardiologist.

STEMI Workup

Is it a STEMI? Read real 12-lead ECGs the way the Fifth Universal Definition of Myocardial Infarction asks: first whether its ST criteria can be used at all, then the ST elevation lead by lead, the region it points to and its mirror image. Every STEMI here meets the criteria and was recorded by the cardiologist as an acute or recent (subacute) infarction. The others are the ECGs most often mistaken for one.

The steps of every STEMI read

Can the criteria be used?A left bundle branch block or left ventricular hypertrophy changes the ST segment by itself.
The cut-point1 mm in most leads. In V2 and V3 it depends on the patient's age and sex.
ST elevationAt the J point, in two contiguous leads.
Mark the leadsClick every raised lead on the sheet.
The regionInferior, anterior or lateral, named from the leads that show it.
The mirror imageReciprocal depression opposite, and the posterior sign in V1 to V3.
The verdictThe STEMI criteria met, not met, or not usable on this ECG.

The criteria are the Fifth Universal Definition of Myocardial Infarction (2026), with the contiguous and reciprocal leads of AHA/ACCF/HRS Part VI: the same rules as the rest of EKGLab, one click away under "ST criteria" on every sheet. They call for new ST elevation. With no earlier ECG to compare, each read here is the pattern on the page. Rounds of 6 ECGs, easiest first. Real recordings from the PTB-XL database, every one validated by a cardiologist.

Telemetry Watch

Watch a live monitor the way a telemetry nurse does. The handoff gives you the patient's rhythm, and at a moment you cannot predict it changes. Catch it, then work it out on the printed strip: where it began, what changed, and what the new rhythm is.

Every change, step by step

Take the handoffThe patient's rhythm, rate and intervals, as at the start of a shift.
WatchLeads II and V1, live, and the SpO₂ pleth if you switch it on. Tap Something changed (or press Space) the moment a beat differs.
Find where it beganOn the printed strip, tap the first beat that changed.
Say what changedRate, rhythm, P waves, PR, QRS: pick every change and only those.
Name the new rhythmThen compare before and after, and watch the change again.

These tracings are drawn live by Waveform Studio's engine: built for teaching, not recorded from patients, so the time and kind of every beat is known exactly and so is every answer. Each play draws its own numbers, so no two are the same. Switch on SpO₂ on the monitor's bar to add the pulse oximeter: a pleth whose every pulse follows its QRS, and which loses its pulses when the heart stops pumping. Rhythm names and definitions are the EKG Dictionary's. Rounds of 6 changes, easiest first.

Guided Learning

Strip Workup

Strip Workup is included with Pro