Electrocardiogaffe

Patricia McGettigan, Ian C Cooper, Jennifer H Martin, et al

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-074083 (Published 19 December 2022)Cite this as: BMJ 2022;379:e074083

Because a physician has possessed himself of an electrocardiograph, a polygraph, an x-ray machine, a blood pressure instrument, or some ingenious form of stethoscope, it does not at all follow that he has become competent to judge a patient’s condition; not infrequently the very reverse is the case, for more often than not the limitations of these devices are far from being comprehended.Thomas Lewis, British Medical Journal 19191

In 1912, the then British Medical Journal published Thomas Lewis’s work entitled “The electro-cardiogram and its importance in the clinical examination of heart affections.”2 His recording apparatus was enormously cumbersome compared with today’s sleek machines (fig 1), but, remarkably, he could record amplitude in the range of 0.1 millivolts. Lewis’s classic representation of the normal PQRST complex is still instantly recognisable over a century later (fig 2).1 2

Current media representations of ECGs, however, often fail to reflect the electrical constancy of the heart. We found, in a short search of Google Images using the terms “healthy heart,” “heart attack,” and “cardiac society,” that few depicted a normal waveform. Roughly a quarter of the 45 images we consideredshowed pathological ECG complexes, but many more featured outright bizarre complexes, previously unrecognised in clinical practice—electrocardiogaffes, as we call them. Even some well known healthcare organisations included strange ECG waveforms in their logos.4 5 6

Many of these internet ECG images would have induced palpitation in Lewis or perhaps set off a premature atrial contraction in a practising cardiologist. We hope that clinicians have acquired the essential skill of interpreting ECGs but admit that it can be hard to tell normal from abnormal from fabricated. When in doubt, do what we did—ask a cardiologist.

Electrocardiogaffe quiz

Select the most plausible pathophysiological explanation for each ECG waveform below to find the electrocardiogaffe. We do not guarantee that the clues will help.