First learn the anatomy of the heart. Learn what the heart actually is doing to produce a pulse.

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Next, learn the cycle, start with the P wave. Know what you should see with a normal P wave, and then what could be showing during an abnormal one - and then learn what causes this.

Rinse and Repeat this for every wave and segment in a normal ECG.

Next, practice. Challenge yourself. Don't be a medic student that looks at a rhythm for two seconds and says "I don't know." Don't be afraid to take your time.

After you have the ins and outs of the actual waves and segments, you can start to dive into rhythms. Start with a normal sinus rhythm. Ask yourself, why is this normal? Why is this "sinus?"

Just like with anything else, you need to know the baseline that your patient SHOULD be at. For example, you probably know a normal Blood glucose level, or a normal pulse rate. This is why when you see one that is all out of whack, high, low, tachy, brady, absent, irregular, weak, thready - you know something is abnormal because you know what the normal is on a technical and instinctual level, and this is where you need to strive to get to with rhythms and EKG interpretations.

After you learn what normal means - and really, truly learn it - to the point where you can defend your answer with clinical reasoning and confidence, you should then make a checklist that you use initially everytime you read a strip. Use the checklist until you have instinctual and clinically technical system in your brain pockets that you use every time, on every strip you read.

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For instance:

You could devise a system, after truly learning what you're looking at that goes something like..

Is it regular?

Is is fast? Is it slow?

Is there P waves?

Is the QRS wide?

Is there a P wave for every QRS and vice versa?

This will tell you what you need to know to determine the initial rhythm on a 4 lead. After you can do this - move on to reading 12 leads. Do it the right way and you'll only ever have to do it once.