Category: ECG Interpretation

Free ECG teaching from the Academy of Elite Doctors. Almost every ECG finding that gets missed was visible on the trace — it was missed because the reader went straight to the part that matched their expectation and never systematically examined the rest. These articles are built around fixing that.
Coverage runs from a fixed ten-step reading sequence, through rate, rhythm, axis and interval assessment, to ischaemic patterns, conduction disease, complex arrhythmia and the electrolyte and drug effects that mimic both. Particular attention is given to the high-risk patterns that do not meet STEMI criteria and are therefore routinely under-treated — de Winter T waves, the Wellens pattern, posterior infarction and the aVR findings that suggest left main disease.
Written for cardiology trainees, and equally for emergency physicians, intensivists and general physicians who read ECGs under time pressure without a cardiologist beside them. All material is written and clinically reviewed by Dr A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., a senior interventional cardiologist in practice.

ECG Changes in Acute Myocardial Infarction

Posted on 03/08/2026 by Dr A M Thirugnanam

ST elevation is the pattern everyone is taught and the one that causes least difficulty. The infarcts that are missed are the ones whose ECG does not meet the elevation threshold, or whose elevation is in leads nobody recorded. This is an account of both. On this page The sequence of change Territory and culprit (more…)

How to Read an ECG: A Systematic Ten-Step Sequence

Posted on 03/08/2026 by Dr A M Thirugnanam

Almost every ECG finding that gets missed was visible on the trace. It was missed because the reader went straight to the part of the ECG that matched their expectation and never systematically examined the rest. Interpretation becomes reliable when the reading order stops being decided by the trace and starts being decided in advance. (more…)