Check patient details, date, and ECG quality
Confirm calibration and paper speed
Assess heart rate
Assess rhythm
Determine if rhythm is regular or irregular
Identify the P waves
Check P wave relation to QRS complexes
Measure PR interval
Measure QRS duration
Assess QRS axis
Inspect for atrial enlargement
Inspect for ventricular hypertrophy
Evaluate R wave progression
Look for pathological Q waves
Assess ST segments
Assess T waves
Assess QT interval
Compare with previous ECGs
Correlate findings with clinical context
Identify acute ischemia or infarction
Identify conduction blocks
Identify electrolyte abnormalities
Identify arrhythmias
Identify pacemaker activity
Summarize the overall ECG impression