A “STAT ECG” is an urgent electrocardiogram performed immediately on patients with acute symptoms. Knowing how to interpret one is essential for rapid diagnosis and treatment in critical medical situations.

Key Points

  • Many Different Methods Exist: There are various established methods for ECG interpretation. Commonly, these methods emphasize systematic analysis of heart rate, rhythm, axis, intervals, voltage, signs of hypertrophy, and ischemia.
  • Develop & Master Your Method: It’s crucial to develop a practical but standardized, step-by-step approach for ECG interpretation that you will actually use every time. Personalizing and mastering a method that works best for you will enhance the accuracy of your reads and help you avoid missing critical findings.
  • Speed Comes with Practice: commit to spending just a few minutes every week to learn more about STAT ECGs, and you will be amazed by how quickly your skills grow. As you become more practiced, you’ll find that a quick glance at an ECG will reveal a wealth of clinically relevant information that you can use to save and improve more lives.
  • Focus on Rapidly Fatal Conditions First: In emergency and acute care settings, you must prioritize identifying time-sensitive ECG findings that will significantly impact your immediate clinical decisions.

 The following suggested approach to STAT ECG interpretation focuses on rapid identification of the most deadly and time sensitive findings:

STEP 1: Heart Rate & Rhythm

  • Is the rate too fast (> 100 bpm) or too slow (< 60 bpm)?
  • Is the rhythm regular or irregular (may be regularly irregular or irregularly irregular)?
  • What is the atrium doing (P waves), what is the ventricle doing (QRS complexes), and what is their relationship (PR-interval)?

STEP 2: QRST Analysis

  • Is the QRS interval narrow or wide?
  • Is the axis normal or deviated?
  • Do you see pathologic Q waves?
  • Voltage and proportions
    • Do you see high or low voltages?
    • Abnormal or disproportionately large T-waves?
    • Electrical alternans?

STEP 3: Critical Findings

  • STEMI/STEMI equivalent criteria or other evidence of Occlusion MI?
  • New right axis deviation?
  • New ST depression or T wave inversion?
  • Short or long QT interval?
  • Signs of hyperkalemia or sodium channel blocker toxicity?


  • Focus Amidst Chaos: Interpreting emergency ECGs often occurs in hectic, interruption-filled settings. Maintaining a systematic and focused approach is crucial to avoid errors and misdiagnoses in these situations.
  • Comparative Analysis: Whenever possible, compare the current STAT ECG with previous ones. Pay close attention to all 12 leads, looking for subtle but potentially fatal abnormalities.
  • Leverage ECG STAT: Utilize ECG STAT as a guide for your systematic approach. It helps in remembering critical differential diagnoses and key findings that you cannot afford to miss.
  • Monitor for Changes: If you’re uncertain, obtain serial ECGs to observe dynamic changes that could influence your management decisions.