EKG Challenges. From basic principles to clinical presentation.
In 1902, Willem Einthoven, the father of modern electrocardiogram, published the first recording of the electrocardiogram using the string galvanometer. Since that time, the clinical use of the electrocardiogram as a diagnostic tool has grown tremendously. It has become an integral part in the evaluation and management of cardiac arrhythmias, conduction abnormalities, myocardial ischemia and infarction, acute pericarditis, valvular heart disease, hypertensive heart disease, and cardiomyopathies. The EKG (or ECG) is also utilized in the evaluation of electrolyte abnormalities, channelopathies, Brugada syndrome, and in the management of cardiac pacemakers, implantable defibrillators, and cardiac resynchronization therapy. The abbreviation ECG (electrocardiogram) or EKG (elektrokardiogramm) has been used interchangeably since Einthoven’s original article was published in German more than one hundred twenty years ago.
As an Attending Faculty in the Cardiology Division of Mount Sinai Medical Center for more than forty years and currently as Director of EKG Laboratory since 2010, I have been teaching the Cardiology Fellows, Medical Residents, ED Residents, Medical Interns, and ICU nurses on how to improve their skills in electrocardiographic interpretation. Numerous EKG case studies obtained from thousands of patients admitted to the hospital or seen in the Emergency Department or Outpatient Clinic were discussed on a weekly basis. On several occasions, I have been asked to write a book on EKG interpretations, but for various reasons, I kept postponing it. Then in February 2021, I met Dr. Albert Roig, a young physician from Cuba who has been passionately involved in teaching EKGs since he was in medical school. When he came to Miami in 2016, he started working on a website with the help of his team that led to the creation of EKGDX, an interactive platform to learn electrocardiogram using computer simulation. I was amazed when I reviewed the website which contained EKG criteria, videos, and simulated EKG tracings which are currently being used by the American Board of Internal Medicine. Albert asked me to include the EKG cases that I have accumulated for teaching purposes. After more than a year of working together with Albert and his team, we successfully created the Volume II. This innovative platform includes (1) Electrocardiographic Criteria; (2) Gallery of more than 500 videos of echocardiogram, coronary angiogram, and many others; (3) Volume I, which contains a question bank for learning electrocardiogram with a single EKG lead; and (4) Volume II, which contains 100 EKG case studies, from basic principles to clinical presentation. Each case study is presented in the standard twelve-lead EKG format with a brief history and an EKG answer sheet similar to the American Board of Internal Medicine, Cardiovascular Disease Certification Exam.
At this point, I would like to thank the Columbia Division of Cardiology at Mount Sinai Medical Center for granting me the permission to utilize the various EKG tracings from the EKG Laboratory obtained from patients whose vital information were completely altered to protect their identity. For demonstration purposes, click here to try a sample case, or watch this video that containing a twelve-lead EKG case, with a brief clinical history, and an EKG answer sheet.
Alfonso O. Tolentino, MD
Vice Chairman of Medicine
Director of Electrocardiography Laboratory at the Columbia Division of Cardiology at Mount Sinai Medical Center
Co-author of “EKG Challenges. From Basic Principles to Clinical Presentations”
Albert Roig, MD
Founder of Roinova
Author of EKGDX
Co-author of “EKG Challenges. From Basic Principles to Clinical Presentations”