How to read an EKG? The ROIG method may help you.

In the early stages of our careers, many doctors, nurses, and students face challenges in accurately interpreting an electrocardiogram (EKG/ECG). One of the main reasons for this difficulty is the lack of a systematic approach to interpretation.

As a medical student, I encountered the same struggle. It was frustrating until one day, I decided to create a structured method to help me stay organized.

To address this issue, I developed a basic method that is both simple to use and easy to remember. I chose to base it on the acronym ROIG, which also happens to be my last name.

With that in mind, I’d like to share the steps of this method with you. My hope is that it will serve you as effectively as it served me when I was just starting out.

Note: This method ONLY applies to the standard 12-lead EKG. Let's start:

Rate

Observe the rhythm

Intervals

Go for the signs of Myocardial Infarction

Here are the steps in text:

Rate

The first step is to calculate the Heart Rate (HR).
Total QRS x 6 = HR.
If HR > 100 bpm = Tachycardia.
If HR < 60 bpm = Bradycardia.

Observe the rhythm
The second step is to observe the rhythm.
If R-R interval is equal = Regular rhythm.
If R-R interval varies = Irregular rhythm.
If P wave is upright in lead II = Sinus rhythm.

Intervals
The third step is to analyze the intervals.
Analyze the PR, QRS and QT intervals.
Are they normal, shortened or prolonged?

Go for the signs of Myocardial Infarction. 
The fourth step is to look for MI.
Is there ST elevation?
Is there ST depression in V1-V3?
Are there abnormal Q waves?

Each person has their way of reading an EKG, but if you are just starting to learn how to interpret an EKG, the basic method of Dr. Roig may help you organize yourself every time you interpret an EKG. As soon your knowledge increases, you should add to the second step (Observe the rhythm) the following:

Let's see some examples applying the method.

Example one.

Sinus bradycardia in the setting of first degree AV block. 

Example two. 

Sinus tachycardia with inferior acute MI, in the setting of complete AV block. 

Example three

2:1 AV block in the setting of RBBB. What else do you see?

I hope this method will be useful for you as much as it was for me in the beginning. 

Dr. Roig