About this game
Every strip is a real recording from the MIT-BIH databases on PhysioNet, labelled by the cardiologists who annotated it. Official Practice asks you to name the rhythm and shows you their answer. Shift attaches a patient to each strip and hands you four places to send them: the waiting room, a monitored bed, the resus bay with pads on, or a code. Patience drains by true acuity, so the meter itself teaches who cannot wait.
How to play
- 01Three modes. EKG School starts from the paper and walks a level map: boxes, finding every beat, rate, regularity, width, then naming rhythms. Practice deals every real strip in the pack, untimed, with the annotators answer and its citation.
- 02In Play, patients arrive in the waiting room with their chart already taken. Press Monitor to put the one in hand on the lead; the strip takes a few seconds, so go back to the desk while it runs.
- 03Name the rhythm, then send them to the waiting room, a monitored bed, resus or a code from the panel on the right. A wrong call still sends them to the right place, with the reason.
- 04Playing it safe costs points. Letting somebody deteriorate waiting, or sending an emergency somewhere lesser, costs a heart. Five hearts a shift; run out and the shift retries.
Controls
- Enter or M
- Open or close the monitor (Play)
- 1 to 4
- Waiting room, monitored bed, resus, code (Play)
- Arrow keys
- Choose a patient (Play) or move the cursor on a strip (School)
- Space
- Mark a beat (School) or pause (Play)
- Backspace
- Take back the last mark (School)
- Escape
- Back to the desk
What you will practice
- Read a rhythm strip in order: rate, regularity, P waves, PR, QRS width
- Recognise the common lead II rhythms on real recordings, not idealised drawings
- Sort patients by how fast they will deteriorate, using the vitals as well as the strip
- Hold accuracy while the queue builds
The clinical content
Twenty-six rhythm classes mapped one to one onto the labels the MIT-BIH Arrhythmia, Malignant Ventricular Ectopy and CU Ventricular Tachyarrhythmia databases actually carry, including artifact. Where a database label is coarser than a textbook (second-degree block without a type, SVT without a mechanism, VT without a morphology) the game says so rather than inventing precision. Disposition logic is written in our own words from the 2025 AHA adult advanced life support guideline, with the 2018 bradycardia, 2015 SVT, 2017 ventricular arrhythmia and 2023 atrial fibrillation guidelines for the specific calls. Wenckebach, third-degree block and torsades are absent because no openly licensed recording of them exists in these databases.
Written to AHA 2025 CPR & ECC.
Sources
- MIT-BIH Arrhythmia Database v1.0.0, PhysioNet. Moody GB, Mark RG. The impact of the MIT-BIH Arrhythmia Database. IEEE Eng Med Biol Mag. 2001;20(3):45-50. Goldberger AL, et al. PhysioBank, PhysioToolkit, and PhysioNet. Circulation. 2000;101(23):e215-e220. / ODC-BY v1.0
- MIT-BIH Malignant Ventricular Ectopy Database v1.0.0, PhysioNet. Greenwald SD. Development and analysis of a ventricular fibrillation detector. M.S. thesis, MIT Dept. of Electrical Engineering and Computer Science, 1986. Goldberger AL, et al. Circulation. 2000;101(23):e215-e220. / ODC-BY v1.0
- CU Ventricular Tachyarrhythmia Database v1.0.0, PhysioNet. Nolle FM, Badura FK, Catlett JM, Bowser RW, Sketch MH. CREI-GARD, a new concept in computerized arrhythmia monitoring systems. Computers in Cardiology. 1986;13:515-518. Goldberger AL, et al. Circulation. 2000;101(23):e215-e220. / ODC-BY v1.0
- Part 9: Adult Advanced Life Support. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(suppl 2).
- Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. Circulation. 2019;140(8):e382-e482.
- Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation. 2016;133(14):e506-e574.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Circulation. 2018;138(13):e272-e391.
- Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149(1):e1-e156.
- Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part I: The Electrocardiogram and Its Technology. Circulation. 2007;115(10):1306-1324.
- Surawicz B, Childers R, Deal BJ, Gettes LS. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part III: Intraventricular Conduction Disturbances. Circulation. 2009;119(10):e235-e240.