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ECGs: lead placement, axis, rate and rhythm

Content developed by MIMS Learning


In this module, the second of a series on ECG interpretation, we discuss key steps including practicalities of ECG acquisition, lead placement, determining cardiac axis, calculating heart rate and assessing rhythm. Key learning points include causes of axis deviation, methods of calculating rate and categories of heart rhythm. This module includes a 2-question test of ECG interpretation.


After completing this activity, you should be better able to:

  • Ensure that ECGs are acquired in the right environment
  • Understand what constitutes a 12-lead ECG and how leads are placed
  • Determine cardiac axis and possible causes of deviation
  • Calculate heart rate from a 12-lead ECG and assess heart rhythm


Dr Sayan Sen, consultant cardiologist, Hammersmith Hospital, London and Dr Ravi Assomull, consultant cardiologist, London Northwest Healthcare NHS Trust & Imperial College NHS Healthcare Trust, London

This resource is provided at an intermediate level by MIMS Learning. Read the article and reflect on what you have learned, then answer the test questions at the end.

Complete the resource to obtain a certificate of completion to include in your revalidation portfolio. You should record the time spent on this resource in your CPD log.


Practical Skill in Primary Care Part 2 Stephanie Garner

Understanding Electrocardiography Margaret Perry