A Visual Guide to ECG Interpretation attempts to break down how to systematically read and analyze an ECG graphically. This book is a 525-page compilation of ECG basics, specific ECG findings, and ECG examples from actual patients. The work is divided into 13 chapters, each covering a different topic, including ECG concepts, abnormalities organized by the different components of an ECG, arrhythmias, ischemic findings, and other unique ECG clinical pictures. The chapters are broken down into specific topics, and an attempt is made at visually organizing each topic in a pseudo-flowchart format with standard headings. However, the heading order changes from topic to topic within a chapter, making the inconsistent organization not readily apparent and disturbing the flow of the read. Occasionally, the author includes clinically correlated information such as presentation or management of an ECG finding; unfortunately, this section is an example of one of the book’s inconsistencies and is not found for each subject.

For an emergency physician looking for a refresher in ECGs, this book may provide too much “textbook” detail. Although some individuals may prefer the “big picture” view of ECGs using methods such as “big box” versus “small box” for determining intervals, those who prefer to use formulas for interval calculations will find solace in this work. Many times I had to reread sections because they were riddled with details one would expect in a thick textbook. In addition, the graphics associated with these sections did not adequately display what the authors were attempting to say, sometimes causing more confusion than explanation. For example, the “Benign Early Repolarization” section provides a relatively complicated formula for distinguishing a subtle anterior myocardial infarction from benign early repolarization. Although this may be helpful to some individuals, to those looking for a more visual comparison, there are no graphics to help provide a different approach.

Chapters 12 (“Ischemia”) and 13 (“Pacemakers”) are the best ones in the book. They do an excellent job summarizing the topics, explaining the “why” for each subject, and using pictures and graphics to effectively demonstrate what the text is trying to convey. The chapters are also well organized and are easier to follow.

At least half of the book is a compilation of ECGs from actual patients, with examples of findings that were covered previously in that chapter. Each ECG is provided twice, the first without markings and with a short clinical history limited to one sentence. The second highlights the findings and provides a brief explanation of what was found. Some of the explanations are inadequate, and the lack of information may not assist with the repetition of learning for some readers. Also, some of the ECGs in a chapter had abnormalities not covered in the preceding chapter, although it is unclear whether this was intentional.

The best audience for this text would be fourth-year medical students or interns (of any specialty), not someone who has a good grasp of ECGs and is just looking for a refresher. The amount of detail provided is good but slows the reader down. In addition, if the reader is more visually inclined, some of the topics could use more graphics and pictures to demonstrate concepts. Chapters 12 and 13, however, do a great job at summarizing and organizing their topics, with excellent ECG examples to practice, and can be used for a quick review.