Ken Grauer, MD

MARCH 1, 2024

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

EKG/ECG 421

EKG/ECG EMS Wellness 421

Ken Grauer, MD

FEBRUARY 23, 2024

The ECG in Figure-1 was obtained from a previously healthy man in his 40s — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ) that awakened him from sleep. ECG #1 was recorded ~90 minutes after the patient was awakened from sleep. He was still having CP. QUESTIONS: In view of this history — How would YOU interpret the ECG in Figure-1 ?

EKG/ECG 384

EKG/ECG Wellness 384

Ken Grauer, MD

FEBRUARY 15, 2024

The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who presented to the ED ( E mergency D epartment ) for shortness of breath. QUESTIONS: How would YOU interpret the ECG shown in Figure-1 ? Given the irregular irregularity of beats #4-through 17 — Is this a run of AFib ( A trial Fib rillation ) with aberrant conduction? Figure-1: The initial ECG in today's case.

EKG/ECG 309

EKG/ECG Wellness 309

Ken Grauer, MD

FEBRUARY 9, 2024

Imagine the only information provided for the ECG in Figure-1 — is that it was obtained from a 60-year old man with new CP ( C hest P ain ). QUESTIONS: In view of this brief history — How would YOU interpret this ECG in Figure-1 ? Is the cardiac rhythm related to the 12-lead ECG? Figure-1: The initial ECG in today’s case. MY Thoughts on the ECG in Figure-1: The goal of practicing clinicians is to interpret both parts of the tracing in Figure-1 ( = the cardiac rhythm and the 12-lead ECG ) — in an

EKG/ECG 252

EKG/ECG Operations Wellness 252

Ken Grauer, MD

FEBRUARY 3, 2024

Today’s patient is an older woman who experienced a number of fainting epiodes over the previous week. No CP ( C hest P ain ). Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. The ECG in Figure-1 was obtained following successful resuscitation. Stat Echo — obtained shortly after successful resuscitation revealed anterior wall akinesis.

EKG/ECG 348

EKG/ECG Resuscitation Hospitals Wellness 348

Ken Grauer, MD

JANUARY 26, 2024

I was sent the ECG in Figure-1 — without the benefit of any history. QUESTION: What kind of AV block is present in Figure-1 ? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing.

EKG/ECG 252

EKG/ECG 252

Ken Grauer, MD

JANUARY 20, 2024

I was sent the tracing shown in Figure-1 — told only that this was a preoperative ECG obtained from an asymptomatic older woman scheduled for non-cardiac surgery. How would YOU interpret this ECG? Would you approve her for surgery if the procedure was nonemergent? Figure-1: Preoperative ECG from an asymptomatic older woman scheduled for non-cardiac surgery.

EKG/ECG 229

EKG/ECG 229

Ken Grauer, MD

JANUARY 13, 2024

The ECG in Figure-1 was obtained from a middle-aged man with known hypertension — who presented to the ED ( E mergency D epartment ) for CP ( C hest P ain ) over the preceding 2-3 days. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? If not — What next? Figure-1: The initial ECG in today's case — obtained from a middle-aged man with CP for the past 2-3 days.

EKG/ECG 331

EKG/ECG Hospitals 331

Ken Grauer, MD

JANUARY 5, 2024

How would YOU interpret the tracing in Figure-1 — that was sent to me without additional information? QUESTIONS: What is the rhythm? Is there AV dissociation? If so — WHY? Clinically — HOW would you approach interpretation of this tracing in optimal time -efficient fashion? Figure-1: The initial ECG in today's case. KEY Clinical Point: If I was the medical provider charged with the care of the patient whose ECG is shown in Figure-1 — I would approach this tracing in the following sequential stag

EKG/ECG 367

EKG/ECG Wellness 367

Ken Grauer, MD

DECEMBER 29, 2023

QUESTION: HOW would YOU interpret the ECG in Figure-1 — if no clinical information was provided? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.

EKG/ECG 336

EKG/ECG Resuscitation Hospitals Wellness 336

Ken Grauer, MD

DECEMBER 23, 2023

The ECG in Figure-1 — was obtained from a patient with palpitations. The patient was hemodynamically stable in association with this rhythm. QUESTIONS: What is the rhythm in Figure-1 ? — How certain are you of your answer? — Why is QRS morphology changing ? Figure-1: The initial ECG in today's case. My Interpretation of the ECG in Figure-1: Since the patient is hemodynamically stable — there is time for systematic assessment of the rhythm.

EKG/ECG 406

EKG/ECG Wellness 406

Ken Grauer, MD

DECEMBER 15, 2023

== CLICK HERE — for a V ideo presentation of this case! ( 18:00 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #392 — == The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms.

EKG/ECG 283

EKG/ECG EMS Hospitals 283

Ken Grauer, MD

DECEMBER 8, 2023

== CLICK HERE — for a V ideo presentation of this case! (22:3 0 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #292 — == The 2 ECGs shown in Figure-1 were obtained from a man in his 30s — who presented to the ED ( E mergency D epartment ) with chest pain that began several hours earlier. ECG #2 was recorded 1 hour after ECG #1.

EKG/ECG 306

EKG/ECG Hospitals 306

Ken Grauer, MD

DECEMBER 1, 2023

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier.

EKG/ECG 323

EKG/ECG EMS Wellness 323

Ken Grauer, MD

NOVEMBER 25, 2023

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. On the basis of this rhythm strip — she was diagnosed as being in complete AV Block.

EKG/ECG 379

EKG/ECG 379

Ken Grauer, MD

NOVEMBER 18, 2023

== — CLICK HERE — for a V ideo presentation of this case! ( 15 minutes ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #344 — == How would YOU interpret the lead II rhythm strip shown in Figure-1 ? Is the rhythm Mobitz I or Mobitz II 2nd-degree AV Block? Or — Is it “ something else ”? Figure-1: How would YOU interpret this lead II rhythm strip?

EKG/ECG 237

EKG/ECG 237

Ken Grauer, MD

NOVEMBER 10, 2023

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. HOW would you interpret this tracing?

EKG/ECG 405

EKG/ECG Emergency Department 405

Ken Grauer, MD

NOVEMBER 4, 2023

You are told that the patient next door is in the regular SVT ( S upra V entricular T achycardia ) rhythm shown in Figure-1. QUESTIONS: Is the rhythm AVNRT or AVRT? Is Adenosine likely to convert this rhythm? Figure-1: How would YOU interpret this ECG? MY Thoughts on the ECG in Figure-1: When faced with a challenging cardiac arrhythmia — It is a "luxury" to have access to a long lead rhythm strip containing 3 simultaneously -recorded leads.

EKG/ECG 334

EKG/ECG Wellness 334

Ken Grauer, MD

OCTOBER 29, 2023

= NOTE: These are my "slides" for November 2, 2023 — for my M edALL p resentation. The talk will be recorded and posted on-line. Based on ECG Blog #351 ( www.tinyurl.com/KG-Blog-351 ) LINK to this Page — www. tinyurl.com/KG-MedAll-351 — = = ECG Blog #205 = The Systematic Approach I favor. The "formula" = [link] LINK for Blog #205 = [link] - = Figure: The Systematic Approach that I favor.

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

OCTOBER 27, 2023

The ECG in Figure-1 was obtained from an elderly woman — who presented to the ED ( E mergency D epartment ) for dyspnea on exertion over recent weeks. What are YOUR "Quick Thoughts" about this case? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY " Q uick T houghts" on Today's CASE: The ECG in Figure-1 is highly concerning — so it is indeed fortunate that this elderly woman came to the ED when she did!

EKG/ECG 245

EKG/ECG Resuscitation Hospitals Wellness 245

Ken Grauer, MD

OCTOBER 21, 2023

The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. Troponin is pending. QUESTIONS: In view of this history — How would you interpret the ECG in Figure-1 ? Should the cath lab be activated? Figure-1: The initial ECG in today's case.

EKG/ECG 237

EKG/ECG Shock Wellness 237

Ken Grauer, MD

OCTOBER 13, 2023

The ECG in Figure-1 was obtained from a woman in her 60s — who was seen in the ED ( E mergency D epartment ) as part of her evaluation for trauma following a motor vehicle accident. She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. QUESTIONS: HOW would you interpret the rhythm in Figure-1 ? Is this " high -grade" AV block?

EKG/ECG 309

EKG/ECG 309

Ken Grauer, MD

OCTOBER 6, 2023

The ECG in Figure-1 was obtained from a middle-aged woman who presented with "palpitations". Of note — she has a history of untreated hyperthyroidism. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Can you explain the atrial activity in this rhythm strip? Figure-1: The initial long lead II rhythm strip in today's case. MY Approach to the Rhythm in Figure-1: As per ECG Blog #185 — I favor the P s, Q s, 3 R Approach for interpretation of the cardiac rhythm — beginning with whichever o

EKG/ECG 333

EKG/ECG 333

Ken Grauer, MD

SEPTEMBER 29, 2023

You are asked to interpret the ECG in Figure-1. What is the rhythm in ECG #1 ? Figure-1: You are asked to interpret this tracing. What is the rhythm? MY Thoughts on the ECG in Figure-1: I routinely begin assessment of each 12-lead ECG I encounter — with interpretation of the rhythm. To do this — I apply the P s, Q s, 3 R Approach ( See ECG Blog #185 — for review of my system ).

EKG/ECG 237

EKG/ECG 237

Ken Grauer, MD

SEPTEMBER 22, 2023

The ECG in Figure-1 — was obtained from a middle-aged man with palpitations and shortness of breath. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? Is there evidence of a recent or ongoing acute MI? What might you do first? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 372

EKG/ECG Wellness 372

Ken Grauer, MD

SEPTEMBER 15, 2023

The tracing in Figure-1 was sent to me for my interpretation. As per the title of today's Blog post — There is no simple explanation for all that is happening in this challenging tracing. Are YOU up for the challenge? I found that the most challenging part of today's tracing is determining the etiology of beat "X". As I explain below — I think it unlikely that beat "X" represents a single, slightly accelerated junctional beat.

EKG/ECG 237

EKG/ECG Academics Wellness 237

Ken Grauer, MD

SEPTEMBER 8, 2023

The ECG in Figure-1 — was obtained from an older man with a history of prior infarction and coronary bypass surgery. How would you interpret this tracing? Clinical implications? Figure-1: The ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on the ECG in Figure-1: The rhythm in ECG #1 is sinus at ~65/minute — with an upright P wave in lead II, and a constant and normal PR interval (ie, not more than 0.21 second in duration ).

EKG/ECG 281

EKG/ECG Research 281

Ken Grauer, MD

SEPTEMBER 1, 2023

The interesting rhythm shown in Figure-1 was obtained after Adenosine was given for a regular SVT ( S upra V entricular T achycardia ). How would YOU interpret this rhythm in Figure-1 ? Why are there so many shapes for the QRS complex in the long lead II rhythm strip? Figure-1: 12-lead ECG and long lead II rhythm strip obtained after Adenosine was given for a regular SVT rhythm.

EKG/ECG 274

EKG/ECG Administration 274

Ken Grauer, MD

AUGUST 26, 2023

The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms. In view of this history — How would YOU interpret this ECG? Should the cath lab be activated? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 293

EKG/ECG EMS Hospitals 293

Ken Grauer, MD

AUGUST 18, 2023

This patient was seen in the office — and during his exam, was found to have an “irregular heart beat”. He was not symptomatic with the ECG shown in Figure-1. How would YOU interpret this ECG? As the primary care clinician — What would YOU do? Extra Credit ( which is a HINT to the Answer! ): How many beats are recorded on the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Dehydration Wellness 195

Ken Grauer, MD

AUGUST 11, 2023

I was sent the ECG in Figure-1 , with a request for my opinion — without the benefit of any history. How would YOU interpret the ECG in Figure-1 ? What might you suspect clinically? Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on the ECG in Figure-1: In these days of widespread smart phone availability — transmission of ECGs to request expert opinion is an increasingly used practice, that on many occasions o

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

AUGUST 4, 2023

The long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy 30-year old woman, who presented with new abdominal pain. Her vital signs were stable — and she did not have an acute abdomen. QUESTIONS: Is there complete AV block? If not — How would YOU interpret this rhythm? What is unusual about this conduction disturbance?

EKG/ECG 361

EKG/ECG Academics Resuscitation Wellness 361

Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. QUESTIONS: In light of the above clinical history. How would YOU interpret her post-resuscitation ECG? Does this ECG in Figure-1 provide clue(s) to the etiology of this patient's cardiac arrest? Figure-1: The initial ECG in today's case — obtained following resuscitation from cardiac arrest of an 18-year old woman.

EKG/ECG 348

EKG/ECG Resuscitation Documentation/Coding Hospitals 348

Ken Grauer, MD

JULY 22, 2023

The ECG in Figure-1 was obtained from an elderly man with a history of coronary disease — who contacted EMS for "burning" chest discomfort that woke him at 3am. Unlike his "usual" anginal episodes — this chest discomfort was not relieved by NTG. Some amount of time passed at home — during which his chest discomfort persisted The patient was hemodynamically stable at the time he was seen by EMS, when ECG #1 was recorded.

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

Ken Grauer, MD

JULY 15, 2023

The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who while performing his regular exercise routine, developed "slight" chest discomfort and "palpitations". These symptoms persisted for over an hour, which led the patient to contact EMS. Surprisingly — he was hemodynamically stable with minimal discomfort at the time his initial ECG in Figure-1 was recorded.

EKG/ECG 195

EKG/ECG Shock EMS 195

Ken Grauer, MD

JULY 9, 2023

The ECG in Figure-1 was obtained from a 60-year old woman — who presented to the ED ( E mergency D epartment ) for “palpitations”. Her vital signs were normal at the time this triage ECG was recorded. Blood was drawn , and the patient was promptly placed in a room to be seen — but on entering, the ED physician found her unresponsive in cardiac arrest.

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

JUNE 26, 2023

The ECG in Figure-1 was obtained from a young man with a history of rheumatic heart disease — who presented with “palpitations”. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? How would you treat the patient? Figure-1: The initial ECG in today’s case. What is the rhythm? How would you treat the patient?

EKG/ECG 305

EKG/ECG Wellness 305