I have a bit of a love/hate relationship with ECGs. I find them very interesting, but I despair of how poorly I learned how to read them in my early career (pattern recognition anyone?) I therefore spend a lot of time being terrified that I am missing important, but subtle findings.
Fortunately a US paramedic Christopher, from Wilmington, North Carolina is on hand to remind me of just how hopeless I am! Christopher is a computer programmer by day, paramedic by night, and is a bona fide ECG guru. He blogs at Paramedicine101 and My Variables Only Have 6 Letters and is very active at EMS12Lead.
One of his latest undertakings is an ECG quiz that will test your ability to pick up STEMI in a series of ECGs. You can take the quiz over at This Page.
The quiz is simple: You are shown a standard set of 36 ECGs taken from a previously published paper in which physicians were tested in their ability to identify coronary artery occlusion (1). You then answer the question yes or no: “Based on the ECG below, is there a blocked coronary artery present causing a STEMI?”
Easy, right? Hell no! There are some ECGs in the set appear (to me at least) to be quite straight forward. But they are few and far between, with most of them being absolute bastards!
It’s important to note that the quiz does not use any of the traditional (and arbitrary) definitions of STEMI that we have drilled into us (1mm in this lead, 2mm in that or whatever) The ECG doesn’t know how many millimeters of elevation it should manifest, so it doesn’t play by the rules we get taught.
The cool thing is, thanks to Christopher’s programming nous, at the end of the quiz you will be given a run down of your overall Sensitivity, Specificity, Negative Predictive Value and Positive Predictive Value (and an explanation what these terms mean). You are then shown a breakdown of each individual ECG and what findings there are on each of them. You will also be shown how your accuracy compares to other groups: Emergency Physicians and Cardiologists
Head on over and take the quiz. You may be surprised and/or dismayed at what you discover about your ability to identify coronary artery occlusion. I sure as hell was! Feel free to let us know how well you did as well. Anonymously if you prefer…
I will hopefully one day get Christopher on line to talk about ECGs, pharmacology and his service in North Carolina as he has graciously agreed to have a chat (I just need to sort my shit out and make it happen)
1. McCabe JM, et al. Physician Accuracy in Interpreting Potential ST-Segment Elevation Myocardial Infarction Electrocardiograms. J Am Heart Assoc. 2013;2:e000268.