A brief review: history to understand fundamentals of electrocardiography

TLDR

The late 19th and early 20th centuries introduced chest X‑rays and the electrocardiograph, culminating in the modern 12‑lead ECG that is now a cornerstone of initial cardiac assessment and interpretation by clinicians at all levels. The article seeks to demonstrate that grasping the electrical basis and underlying disorders of ECGs can reduce diagnostic errors and lessen the burden of memorizing numerous patterns. The authors review the pivotal historical steps that led to the evolution of the electrocardiogram.

Abstract

The last decade of the 19th century witnessed the rise of a new era in which physicians used technology along with classical history taking and physical examination for the diagnosis of heart disease. The introduction of chest x-rays and the electrocardiograph (electrocardiogram) provided objective information about the structure and function of the heart. In the first half of the 20th century, a number of innovative individuals set in motion a fascinating sequence of discoveries and inventions that led to the 12-lead electrocardiogram, as we know it now. Electrocardiography, nowadays, is an essential part of the initial evaluation for patients presenting with cardiac complaints. As a first line diagnostic tool, health care providers at different levels of training and expertise frequently find it imperative to interpret electrocardiograms. It is likely that an understanding of the electrical basis of electrocardiograms would reduce the likelihood of error. An understanding of the disorders behind electrocardiographic phenomena could reduce the need for memorizing what may seem to be an endless list of patterns. In this article, we will review the important steps in the evolution of electrocardiogram. As is the case in most human endeavors, an understanding of history enables one to deal effectively with the present.