Ken Grauer, MD

JANUARY 5, 2024

Regarding the 1 2- L ead E CG: Applying the systematic approach I favor for 12-lead ECG interpretation ( as detailed in ECG Blog #205 ): Rate & Rhythm: As stated above — there is a regular, supraventricular rhythm with some P waves, group beating, and an acceptable overall ventricular rate between ~60-80/minute. I begin with Figure-5.

EKG/ECG 417

EKG/ECG Wellness 417

Ken Grauer, MD

MARCH 15, 2024

By the P s, Q s, 3 R Approach ( which I review in ECG Blog #185 ): Lots of P waves are present — being well seen in the long lead II rhythm strip. This slight variation in sinus P wave regularity tends to be greater when a 2nd- or 3rd-degree AV block is present ( called ventriculophasic sinus arrhythmia — as shown in ECG Blog #344 ).

EKG/ECG 390

EKG/ECG Wellness 390

Ken Grauer, MD

DECEMBER 1, 2023

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. ECG Blog #205 = The Systematic Approach I favor. Below are slides used in my video presentation.

EKG/ECG 375

EKG/ECG EMS Wellness 375

Ken Grauer, MD

APRIL 13, 2024

NOTE: For more on ECG recognition of RVH and/or pulmonary hypertension ( re the qR pattern in lead V1 ) — See ECG Blog #234 and Blog #248. This could have been an optimal time to try a Lewis Lead — which sometimes reveals atrial activity not evident with standard lead placement ( See ECG Blog #223 ).

EKG/ECG 284

EKG/ECG Wellness 284

Ken Grauer, MD

JANUARY 13, 2024

For more regarding ECG criteria for LVH — See the ADDENDUM below and/or ECG Blog #73 and ECG Blog #245. A bout H CM ( Different Forms of this Entity ): I've excerpted what appears below from My Comment in the December 26, 2023 post in Dr. Smith's ECG Blog. ECG Blog #245 — Reviews the ECG diagnosis of LVH.

EKG/ECG 379

EKG/ECG Hospitals 379

Ken Grauer, MD

FEBRUARY 15, 2024

For more on fusion beats — See ECG Blog #128 and Blog #129 ). See ECG Blog #133 ). R elated E CG B log P osts to Today’s Case : ECG Blog #185 — Reviews my System for Rhythm Interpretation , using th e P s, Q s & 3 R Approach. ECG Blog #198 — Can VT be Irregular? ECG Blog #393 — Case of multiple Fusion beats.

EKG/ECG 312

EKG/ECG Wellness 312

Ken Grauer, MD

FEBRUARY 3, 2024

As discussed in detail in ECG Blog #228 — this seemingly qualifies as a “ Silent ” MI ( Approximately half of those MIs not accompanied by CP — have some other associated symptom such as syncope, which substitutes as a “chest pain equivalent” ). ECG Blog #218 — Reviews HOW to define a T wave as being H yperacute ? What is T-QRS-D?

EKG/ECG 393

EKG/ECG Resuscitation Hospitals Wellness 393

Ken Grauer, MD

MARCH 11, 2024

By the P s, Q s & 3 R Approach ( which I review on ECG Blog #185 ): The R ate of the rhythm in Figure-1 is somewhat fast — averaging ~100/minute ( ie, with an R-R interval close to 3 large boxes in duration for most of the tracing ). ECG Blog #229 — reviews distinction between AFlutter vs ATach.

EKG/ECG 370

EKG/ECG 370

Ken Grauer, MD

MAY 11, 2024

To EMPHASIZE: One of my goals in developing this ECG Blog — is to help clinicians to optimize their time efficiency. By the P s, Q s, 3 R Approach ( See ECG Blog #185 ) — the rhythm in the long-lead II of Figure-1 is not R egular. That said, as emphasized in ECG Blog #312 — SA block is rare!

EKG/ECG 263

EKG/ECG 263

Ken Grauer, MD

FEBRUARY 23, 2024

Regarding ST-T Wave Changes in Figure-2: As per the title of today's ECG Blog — one KEY lead "tells the tale". R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #294 — Reviews how to tell IF the " culprit " artery has reperfused.

EKG/ECG 412

EKG/ECG Wellness 412

Ken Grauer, MD

DECEMBER 15, 2023

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. ECG Blog #387 — Dynamic change in 2 minutes.

EKG/ECG 331

EKG/ECG EMS Hospitals 331

Ken Grauer, MD

SEPTEMBER 22, 2023

KEY Point: Although true that patients with longstanding, severe pulmonary disease may manifest a QRST complex in standard lead I with marked overall reduction in QRST amplitude ( See ECG Blog #65 — regarding Schamroth’s Sign ) — you should never normally see a completely flat line in any of the standard limb leads.

EKG/ECG 421

EKG/ECG Wellness 421

Ken Grauer, MD

NOVEMBER 10, 2023

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. Figure: Use of the "3 Simple Rules" for distinction between SVT vs VT ( taken from ECG Blog #196 ).

EKG/ECG 456

EKG/ECG Emergency Department 456

Ken Grauer, MD

NOVEMBER 25, 2023

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. ECG Media Pearl # 8 ( 8:20 minutes Video ) — ECG Blog #191 — Distinguishing between A V D issociation vs Complete AV Block ( 2/6/2021 ).

EKG/ECG 421

EKG/ECG 421

Ken Grauer, MD

DECEMBER 8, 2023

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. Related ECG Blog Posts to Today’s Case: ECG Blog #205 — Reviews my Systematic Approach to 12-lead ECG Interpretation.

EKG/ECG 352

EKG/ECG Hospitals 352

Ken Grauer, MD

DECEMBER 29, 2023

As discussed in ECG Blog #364 and ECG Blog #265 — We are looking at " Shark Fin " ST elevation! Alternatively — the shape of the ST elevation in lead V2 might also be consistent with a component of Brugada Phenocopy ( See ECG Blog #238 ). ECG Blog #265 and ECG Blog #364 — Review cases of Shark-Fin ST Elevation.

EKG/ECG 388

EKG/ECG Resuscitation Hospitals Wellness 388

Ken Grauer, MD

OCTOBER 13, 2023

To do this — I apply the P s, Q s, 3 R Approach ( See ECG Blog #185 — for review of my system ). Explanation of the Laddergram in Figure-4: For those in search of a review on reading and/or drawing Laddergrams — Please check out my ECG Blog #188. ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

EKG/ECG 361

EKG/ECG 361

Ken Grauer, MD

AUGUST 26, 2023

As discussed in many posts in this ECG Blog — despite not satisfying the millimeter-based definition of a STEMI — in this patient with new chest pain, the ECG findings in Figure-1 merit prompt cath lab activation without any need to wait for serum troponin to return elevated ( See ECG Blog #193 — regarding the new "OMI" paradigm ).

EKG/ECG 342

EKG/ECG EMS Hospitals 342

Ken Grauer, MD

JUNE 26, 2023

By the P s, Q s, 3 R Approach ( See ECG Blog #185 ): The rhythm in Figure-1 is fast and R egular. By the Every-Other-Beat ( or in this case Every- 3rd -Beat ) Method ( See ECG Blog #210 ) — the R ate of the rhythm is ~250-260/minute ( ie, As shown in Figure-2 — the R-R interval of every 3rd beat is 3.6 ECG Blog #35 — Review of RVOT VT.

EKG/ECG 351

EKG/ECG Wellness 351

Ken Grauer, MD

OCTOBER 6, 2023

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 of these 5 KEY Parameters is easiest to assess for the tracing in front of me: At least in the single lead II rhythm strip seen in Figure-1 — The Q RS complex appears to be narrow.

EKG/ECG 384

EKG/ECG 384

Ken Grauer, MD

APRIL 5, 2024

For additional examples of this phenomenon whereby automatic truncation of an EMS ECG may mistakenly result in LVH serving to mimi c ischemia — Check out My Comment at the bottom of the page of the following posts in Dr. Smith's ECG Blog — the November 29, 2023 post — June 20, 2020 — March 31, 2019 — March 29, 2019 — and t he December 27, 2018 post.

EKG/ECG 231

EKG/ECG EMS Hospitals 231

Ken Grauer, MD

NOVEMBER 4, 2023

ECG Blog #240 — reviews my approach to the ECG assessment of regular SVT rhythms. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

EKG/ECG 386

EKG/ECG Wellness 386

Ken Grauer, MD

MAY 20, 2023

Voltage for LVH is satisfied — at least by Peguero Criteria ( Sum of deepest S in any chest lead + S in V4 ≥23 mm in a woman — as discussed in ECG Blog #73 ). In the October 15, 2022 post of Dr. Smith's ECG Blog — Drs. I've reviewed my approach to the ECG diagnosis of LVH ofte n ( See ECG Blog #245 — among many other posts ).

EKG/ECG 342

EKG/ECG Wellness 342

Ken Grauer, MD

JANUARY 26, 2024

By the Ps, Qs, 3R Approach ( which I review in ECG Blog #185 ): P waves are present — and best seen in lead V1. As discussed in detail in ECG Blog #192 — there are 3 Causes of AV Dissociation: i ) By "default"; ii ) By "usurpation"; and , iii ) As a result of AV block. ECG Blog #192 — The 3 Causes of AV Dissociation.

EKG/ECG 255

EKG/ECG 255

Ken Grauer, MD

JULY 29, 2023

I fully acknowledge that prior to 2010, when I started my ECG Blog and began my heavy involvement in ECG internet consultation — I had no direct experience with Epsilon waves. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #35 — Review of RVOT VT.

EKG/ECG 369

EKG/ECG Resuscitation Documentation/Coding Hospitals 369

Ken Grauer, MD

FEBRUARY 9, 2024

NOTE: As I've commented on in a number of previous blog posts — Wenckebach conduction may occur at more than a single level within the AV Node. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #192 — The 3 Causes of AV Dissociation.

EKG/ECG 255

EKG/ECG Operations Wellness 255

Ken Grauer, MD

OCTOBER 27, 2023

Given this patient's older age — if nothing "fixable" is found, she most likely has SSS ( S ick S inus S yndrome ) and will need a pacemaker ( See ECG Blog #342 for more on SSS ). See ECG Blog #188 for review on how to read and/or draw Laddergrams ). See ECG Blog #347 for more on dual-level AV Wenckebach ).

EKG/ECG 247

EKG/ECG Resuscitation Hospitals Wellness 247

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

EKG/ECG 239

EKG/ECG Shock Wellness 239

Ken Grauer, MD

SEPTEMBER 8, 2023

I review my user-friendly approach to the ECG diagnosis of the Bundle Branch Blocks in ECG Blog #282 — and to Hemiblocks and Bifascicular Blocks in ECG Blog #203. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. . = What is M BBB? (

EKG/ECG 284

EKG/ECG Research 284

Ken Grauer, MD

SEPTEMBER 1, 2023

MY Thoughts on the ECG in Figure-1: As per the title of today's Blog post — there are numerous variations in the shape of the QRS complex over the course of the 17 beats seen in the long lead II rhythm strip. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

EKG/ECG 277

EKG/ECG Administration 277

Ken Grauer, MD

SEPTEMBER 29, 2023

To do this — I apply the P s, Q s, 3 R Approach ( See ECG Blog #185 — for review of my system ). PEARL # 2: The most common cause of a pause in an otherwise regular rhythm — is a blocked PAC ( See ECG Blog #66 and ECG Blog #147 ). ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

EKG/ECG 239

EKG/ECG 239

Ken Grauer, MD

OCTOBER 29, 2023

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. The talk will be recorded and posted on-line.

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

AUGUST 4, 2023

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 of these 5 KEY Parameters is easiest to assess for the tracing in front of me: At least in the single lead II rhythm strip seen in Figure-1 — The Q RS complex appears to be narrow.

EKG/ECG 370

EKG/ECG Academics Resuscitation Wellness 370

Ken Grauer, MD

NOVEMBER 18, 2023

For full discussion of this case — See ECG Blog #344 — == How would YOU interpret the lead II rhythm strip shown in Figure-1 ? ECG Blog #188 — Reviews how to read and draw L addergrams ( with LINKS to more than 50 laddergram cases — many with step-by-step sequential illustration ). Or — Is it “ something else ”?

EKG/ECG 239

EKG/ECG 239

Ken Grauer, MD

SEPTEMBER 15, 2023

As per the title of today's Blog post — There is no simple explanation for all that is happening in this challenging tracing. Regular followers of my ECG Blog know I routinely emphasize a series of user - friendly points to facilitate the interpretation of any rhythm. The tracing in Figure-1 was sent to me for my interpretation.

EKG/ECG 239

EKG/ECG Academics Wellness 239

Ken Grauer, MD

JULY 22, 2023

Although this " Imbalance " of precordial T waves is not see n very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) , most often from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

Ken Grauer, MD

AUGUST 18, 2023

As always — I like to start by focusing on the long lead rhythm strip — which shows a bigeminal rhythm — in that there are repetitive 2-beat groups ( See ECG Blog #232 for review of the concept of “bigeminy” ). PEARL # 1: As discussed in ECG Blog #232 — it helps to consider the differential diagnosis of a bigeminal rhythm.

EKG/ECG 195

EKG/ECG Dehydration Wellness 195