The interpretation of ECGs is a difficult art to master for medical students and house officers alike. We are all taught to keep to the “Dubin method” and work through each 12-lead study with consistent patience no matter how abnormal the ECG initially appears. A particularly talented cardiologist once told me that ECG interpretation is often equal parts evidence based science, art, and gut feeling. So how is one to navigate the complexities of ECG interpretation without getting overwhelmed? Instant ECG, a well polished ECG interpretation and study guide by iAnesthesia LLC, is how.  Currently the app is on sale for $0.99 in the App Store.  I have used this application for 2 weeks (although not on a cardiology service), and so far am extremely pleased with the results.  I’ve also used the ECG guide, which was previously reviewed on this site.  In the the conclusion I’ll discuss my favored app.

Creating a useful ECG application is difficult. One can try to create a decision tree that takes user input and spits out the possible diagnosis. Unfortunately, this approach is prone to multiple errors and it prevents the user from learning while the program makes all the decisions. An alternative method is simply a digitally indexed textbook that may be inclusive of information, but lacks quick clinical utility on the floor of the hospital. Instant ECG is, in my opinion, the best attempt to create a successful hybrid of the two. Structurally the app is more of a learning reference, but there are several key features that make this ECG application much more than a study guide and solidifies its position as the “app to beat” for ECG interpretation.

What’s to Love:

Instant ECG is an excellent study guide. With the most complete set of rhythm descriptions and examples (at least 3 examples are given for each rhythm) of any of the ECG applications and accurate text to describe ECG pathology, this application is basically an easy to navigate Dubin’s ECG Guide for the iPhone or iPod touch. Descriptions in the ‘ECG Basics’ section contain advice for reading ECGs accurately and quickly and include appropriate images (such as the cardiac axis vectors and action potentials) to aid the text. I found it interesting and informative to skim this application for clinical reminders when reading an ECG and as an organized review to pass the time.

This application is also a good ECG interpretation tool. Granted, it will not do the job for you, but due to its well organized menus, the user can easily search for and compare the findings of an ECG with the text and multiple examples within the application. Each example ECG can be pinch-zoomed and explored using the iPhone interface well. Another useful feature of this application is the inclusion of movies to view the ECG findings as they are seen on telemetry rhythm strips on the hospital floor.  This feature is exceptionally useful in practice to determine the next course of action when an abnormal rhythm is seen prior to obtaining a 12-lead ECG.

Instant ECG has exams! Unlike most medical reference guides reviewed by the iMedicalApps team, Instant ECG can actually test your knowledge of the material it presents within the application. There are 144 questions (multiple choice, true/false, and rhythm strip identification) included in this ECG application. Instant ECG keeps track of your answers and progress through the questions, but be warned: many of the questions are not cupcakes.

I also enjoyed the small ‘Reference’ tab on the bottom menu that provides a quick reference for normal measurements on a 12-lead ECG and the images found in the application.

It is impossible to touch on everything this application correctly includes and performs well. It is presented cleanly and is easy to navigate with an interface that is consistent throughout all screens.

What’s to Dislike:

What Instant ECG presents is nearly perfect and leaves little to complain about. Additional images in the ‘ECG Basics’ section demonstrating close up images of the pathology described in the text could be very helpful, especially for students or house-staff on a cardiology rotation. In particular, I would have enjoyed seeing examples of T-wave changes in ischemia while reading the text without having to switch to the ‘Rhythm’ section and zooming in on an example.

A complete search feature should also be included within Instant ECG that includes the text of each section. When interpreting an ECG with the help of this application, the user has to navigate to each section to create a differential for a particular ECG finding.  The ability to search for a particular finding (i.e. regularly irregular rhythm) throughout the entire application would make interpretation with the aid of Instant ECG a bit easier. As it stands, the application is extremely easy to navigate even without this tool.

The previous version of Instant ECG crashed frequently when loading movies, but this issue seems to be resolved.  In its current state the application is quick and responsive.

The Bottom Line:

Every medical professional who ever has to handle or make clinical decisions based on an ECG, or who even possesses the slightest curiosity about the electrical conduction of our miraculous pump should purchase this application. At their current promotional price of $0.99 in the App Store, this application is a steal. In a few weeks, I used this application in the hospital many times and refreshed my knowledge of ECG pathology outside of the hospital as well.

The movies of ECG pathology seem on a rhythm strip are at first glance a waste of memory, but ultimately priceless.  The text is complete and easy to read and capable of making even the most clueless sound like a cardiology fellow.  It is highly recommended for any medical professional: for students and residents for education and patient care, as well as any hospitalist or primary care physician who needs a reference when reviewing an ECG on the floor. Cardiologists may even find it useful as a teaching tool.  Instant ECG is one of the best ECG applications currently in the App store and better than the ECG Guide app we previously reviewed.

Links to Instant ECG app: iTunes, Website