Tuesday, February 18, 2014

Those Terribly Inaccurate EKG Tracings On Book Covers

Imagine my surprise when I found someone just as incensed as I was about medical inaccuracy in print but with a different focus. He analyzes book covers. So, I hope you'll join me in the land of analyzing book covers and discover why nobody's heart beats this way. Ever.

Welcome, Drew!!

I don’t mean to alarm anyone, but aliens are coming.

As we speak, the Voyager 1 and 2 satellites are crossing the bounds of our solar system into the interstellar medium. Once those spacecraft are discovered by extraterrestrial life forms, they will decipher the code on the Voyager Golden Records allowing them access to the hidden files within, including the location of Earth. The aliens will then return here expecting to find intelligent life, and when we don’t deliver, there will be a reckoning. 

I submit to you, these most egregious book covers:


How can cholesterol sufferers or aliens trust any of the information in these books when we can’t even be bothered to put a proper heart rhythm on the cover? Now look at these novels:

Think novels should get a free pass? Think you’ve seen enough? Well just check out these actual ECG training manuals:



The squiggly lines seen on these book covers are supposed to be electrocardiograms (ECGs or EKGs), which are graphical representations of the electrical activity of the heart. Electrical conduction follows very specific pathways through the heart, creating predictable line patterns on the ECG. It is a science, and every ECG you see above is a complete fraud. It is easy for artists to forge ECGs with little or no accuracy, because the general public does not know what a real ECG looks like. For the sake of our planet, it is time we come together to eradicate this scourge. 

The Normal Sinus Rhythm

Many books have been written about the normal structure of various ECG waveforms. It would be impossible to duplicate all of that information here. But we can at the very least cover what a normal ECG should look like: the normal sinus rhythm.

The whole picture above represents one beat of the heart, and is one sinus heartbeat. The repeating pattern of sinus heartbeats is then referred to as a sinus rhythm. This rhythm is named for the part of the heart where its normal electrical impulse originates, and not for the things in your head that fill up with snot when you’re sick. Each aspect of this beat is labeled with a letter of P through T, and each wave represents a different, specific operation of the heart as it moves through one coordinated beat. You will notice right away that it appears vastly different from any of our previously mentioned book covers. 

There are very specific tolerances for how large or small, wide or narrow each wave can be in a healthy heart. Normally this ECG would be printed on graph paper for ease of measurement, but since we are dealing with art and advertising it is sufficient to be ballpark proportionate. Follow these rules:

1. There is a flat baseline from which the different waves rise and fall. 

2. The first wave is the P wave, which is typically rounded in shape, and smaller than the rest of the waves in the sinus beat.

3. There is a small pause after the P wave.

4. Waves Q, R and S are all lumped together into something called the QRS complex, and the QRS complex is fairly narrow. 

5. There is another small pause after the QRS complex.

6. And finally, the T wave is a rounded wave in shape, and is usually larger than the P wave.

String these together not too close, and not too far apart, and you will have a sinus rhythm with a normal rate of 60-100 beats per minute. To learn more about proper ECG waveform, check out Rapid Interpretation of EKG's by Dale Dubin, MD. Dr. Dubin makes these ridiculously easy to understand, and you will become an ECG expert in no time. 

In the future, our alien overlords will judge our species by our literature and our art, and we will be punished accordingly. Heed my words people, we must ensure this doesn’t happen by designing our book covers, TV commercials and billboards as accurately as possible. Take some time to study the shape of the normal sinus rhythm. Learn, and correct others who have not yet found the way. The fate of our world is in your hands.


Drew Rinella is a paramedic and fighter of lost causes. He maintains an archive of bad and wrong ECGs in advertising at http://stupidheartrhythms.blogspot.com. As a free public service, Drew will review your cover art for proper morphology. Email him at drew.rinella@gmail.com.


  1. The covers my publisher designed for my first four novels all have an EKG tracing along the bottom, and fortunately I was able to review them before they saw the light of day. Normal tracings, with P wave, QRS complex, T wave all in order--whew! I didn't think anyone ever took a second look at them. Thanks, Drew--and thanks, Jordyn, for hosting him.

    1. Thank you, sir, for doing your part to save our planet!

    2. Of course, I had to go back and look, Richard. Strong work!!

  2. I believe mine--for the most part--aren't too horrible. BUT the XRAYS on the cover of my first medical novel aren't even human. We had some discussions, things were "fuzzed" a bit, but it still appears to me that Dr. McSnarly is treating extraterrestials. I was sure I'd hear from someone about that--didn't.

    1. Oh, Candace. So of course-- I had to go look!! Yea, I'd go with extraterrestials for sure. Just what are they?!? Too funny.

  3. Ah, the joys of OCD medical people. When our local hospital replaced the doctors associated with my former group with their new docs, they advertised how they were bringing in board certified emergency medicine physicians. The local paper showed one of these touted docs reviewing an Xray on a viewer.

    The Xray was upside down. We laaaaaaughed.

    1. That's funny. I once saw a news broadcast here locally where the nurse manager of the ER was taped in front of the patient tracking board!! I mean, hello HIPAA-- my name is violation in every sense of protecting our patient's medical info. Also, people, do not post pictures of your patient bracelet of FB. It drives me nuts.

  4. Hear, hear, Drew! :) excellent synopsis.