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 ? Is the rhythm Mobitz I or Mobitz II 2nd-degree AV Block? Figure: 1st-degree AV Block — is simply a sinus rhythm with a long PR interval ( ie, more than 1 large box in duration = >0.20

EKG/ECG 239

EKG/ECG 239

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.

EKG/ECG 255

EKG/ECG Operations Wellness 255

Ken Grauer, MD

AUGUST 4, 2023

QUESTIONS: Is there complete AV block? Does this rhythm represent 3rd-degree AV block? PEARL # 2: By definition — 3rd-degree ( = complete ) AV block means that no atrial impulses ( P waves ) are being conducted to the ventricles. HOW then do we determine if one of these 3 degrees of AV block is present?

EKG/ECG 370

EKG/ECG Academics Resuscitation Wellness 370

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? Figure-1: Preoperative ECG from an asymptomatic older woman scheduled for non-cardiac surgery. The 12-lead ECG is very concerning.

EKG/ECG 231

EKG/ECG 231

Ken Grauer, MD

SEPTEMBER 29, 2023

You are asked to interpret the ECG in Figure-1. What is the rhythm in ECG #1 ? 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 239

EKG/ECG 239

Ken Grauer, MD

MARCH 11, 2024

Is there AV block? If so — Is it complete AV block? 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 ). What are YOUR thoughts?

EKG/ECG 370

EKG/ECG 370

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. Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). What are YOUR "Quick Thoughts" about this case?

EKG/ECG 247

EKG/ECG Resuscitation Hospitals Wellness 247

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 ? Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ). M ore P EARLS : Determing IF there is AV Block?

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

DECEMBER 23, 2023

The ECG in Figure-1 — was obtained from a patient with palpitations. 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. Figure-2: I've labeled the initial ECG in today's case. Figure-2 ).

EKG/ECG 430

EKG/ECG Wellness 430

Ken Grauer, MD

APRIL 23, 2023

The 12-lead ECG and long lead rhythm strip in Figure-1 — was obtained from a previously healthy 15-year old male , who presented with fever and diarrhea. How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case — obtained from a 15-year old male with fever and diarrhea. No chest pain.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

Ken Grauer, MD

APRIL 13, 2024

I was sent the ECG in Figure-1 — told only that the patient was 70 years old, and had a history of an ASD ( A trial S eptal D efect ). The patient was hemodynamically stable with ECG #1. Figure-1: The initial ECG in today's case. Serum K+ was normal. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Are there P waves?

EKG/ECG 284

EKG/ECG Wellness 284

Ken Grauer, MD

OCTOBER 6, 2023

The ECG in Figure-1 was obtained from a middle-aged woman who presented with "palpitations". NOTE: Although the most common cause of unexpected pauses in a rhythm is the occurrence of one or more blocked PACs — I do not see distortions in any ST-T wave of this single-lead rhythm strip that might be consistent with blocked PACs.

EKG/ECG 384

EKG/ECG 384

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. Figure-1: The ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). There is no ECG indication of chamber enlargement — ST-T wave changes do not look acute.

EKG/ECG 284

EKG/ECG Research 284

Ken Grauer, MD

MARCH 27, 2024

I was sent the ECG in Figure-1 — with the following history: The patient is a young man in his early 20s — who presents to the ED ( E mergency D epartment ) because of SOB ( S hortness O f B reath ) that had been ongoing for several hours. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1 ?

EKG/ECG 447

EKG/ECG Wellness 447

Ken Grauer, MD

MAY 6, 2023

The ECG in Figure-1 — was obtained from an older woman with chest pain. What kind of AV block is present? — OR — Is there no clear evidence of any AV block? 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 195

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 ? Figure-1: The initial ECG in today's case. Figure-1: The initial ECG in today's case.

EKG/ECG 312

EKG/ECG Wellness 312

Dr. Smith's ECG Blog

MAY 27, 2024

The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. 1] But there are multiple other abnormalities that make this ECG diagnostic of Occlusion MI, localized likely to the right coronary artery: 1. But are there any other signs of Occlusion MI?

EKG/ECG 105

EKG/ECG Documentation/Coding Emergency Department 105

Ken Grauer, MD

FEBRUARY 8, 2023

Is there any evidence of AV block? MY Approach to the Rhythm in Figure-1: As always — I favor a systematic approach to rhythm interpretation — with use of the P s, Q s, 3 R Memory Aid ( See ECG Blog #185 for more on the Ps, Qs, 3Rs ). OR — Is conduction “backward” (ie, retrograde from the AV node, to return to the atria )?

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

Ken Grauer, MD

MARCH 12, 2023

I start today’s case with the ECG shown in Figure-1 — obtained from a 30-something year old man, who presented with palpitations. How would YOU interpret 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 ). What is the rhythm?

EKG/ECG 195

EKG/ECG Administration Wellness 195

Ken Grauer, MD

AUGUST 18, 2023

He was not symptomatic with the ECG shown in Figure-1. How would YOU interpret this ECG? 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

Dr. Smith's ECG Blog

JANUARY 23, 2024

Below is her presentation ECG. How will you interpret the ECG? The ECG above is highly pathological. Thus some form of AV block must be present. If there is a 2:1 AV block with a wide QRS complex — it is more likely that the AV block is second degree AV block type II.

EKG/ECG 76

EKG/ECG Wellness Pediatrics 76

Ken Grauer, MD

MARCH 23, 2023

The 12-lead ECG and long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy, elderly woman who collapsed in the hospital parking lot. QUESTIONS: How would YOU interpret this patient’s 12-lead ECG? To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Resuscitation Hospitals 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. How would YOU interpret the ECG in Figure-1 ? Do you see any indication on this ECG of WHY this patient was about to arrest?

EKG/ECG 195

EKG/ECG 195

ECG Guru

OCTOBER 11, 2023

The patient: This ECG was obtained from a 91-year-old woman who was complaining of weakness. The ECG: This ECG has something for your basic students, and even more for the more advanced learners. There are 15 P waves on this ECG – some are buried within QRS complexes (QRS #3) or T waves (QRS #4).

EKG/ECG 98

EKG/ECG 98

Ken Grauer, MD

SEPTEMBER 15, 2023

Regular followers of my ECG Blog know I routinely emphasize a series of user - friendly points to facilitate the interpretation of any rhythm. But at this point, since I could not yet explain all ECG features — I needed to draw a laddergram. See ECG Blog #188 for review on how to read and/or draw Laddergrams ). H OW t o B egin

EKG/ECG 239

EKG/ECG Academics Wellness 239

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”. How would YOU interpret 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 ). What is the rhythm?

EKG/ECG 351

EKG/ECG Wellness 351

Dr. Smith's ECG Blog

MAY 7, 2024

Here is his presenting ECG, which was sent to me real time, along with the 2nd ECG below: Regular Narrow Fast without P-waves. The two ECGs above were texted to me with the text: "Young Guy came in in SVT but now in and out of irregular wide complex tachycardia. -- not sure if polymorphic VT vs. a fib with WPW." Polymorphic 3.

EKG/ECG 101

EKG/ECG 101

Ken Grauer, MD

APRIL 3, 2023

To improve visualization — I've digitized the original ECG using PMcardio ). As always — I favor a systematic approach to rhythm interpretation, using the P s, Q s, 3 R memory aid ( See ECG Blog #185 ). For review of how recognizing AV dissociation proves the presence of PVCs — See ECG Blog #133. or — Something else?

EKG/ECG 195

EKG/ECG 195

Dr. Smith's ECG Blog

DECEMBER 24, 2023

Here is her triage ECG: What do you think? The atrial flutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm. An AV nodal blocker (to prevent the possibility of 1:1 conduction if the flecainide slows the flutter rate enough to be conducted 1:1).

EKG/ECG 112

EKG/ECG Stroke Wellness Administration 112

ECG Guru

FEBRUARY 2, 2022

This two-lead rhythm strip shows a normal sinus rhythm at about 63 bpm. The P waves are regular. After the sixth P-QRS, there is a non-conducted P wave. The normal rhythm then resumes. The two most common reasons for a non-conducted P wave in the midst of a normal sinus rhythm are 1) non-conducted PAC, and 2) Wenckebach conduction.

EKG/ECG 52

EKG/ECG 52

Dr. Smith's ECG Blog

MAY 3, 2024

There were 2 prehospital ECGs: What do you think? There is "shark fin" in I and aVL, which is due to a combination of a large R-wave due to left anterior fascicular block plus downsloping ST elevation due to OMI. Total Left Main Occlusion presents with different ECG findings which are multi-faceted. There is STE in aVR.

Shock 98

Shock EKG/ECG Hospitals EMS 98

Emergency Medicine Cases

OCTOBER 17, 2023

The post ECG Cases 46 ECG in Fever and Infectious Disease appeared first on Emergency Medicine Cases.

Infectious Diseases 90

Infectious Diseases EKG/ECG Sepsis EMS 90

Dr. Smith's ECG Blog

JULY 30, 2023

Here is her triage ECG during active symptoms: What do you think? The rhythm is some form of heart block (see Ken's comments at end of post) with junctional escape. Luckily, 45 minutes later, with ongoing pain and a troponin I that resulted at 136 ng/L, the ECG was repeated: What do you think now? This is wrong on many levels.

EKG/ECG 52

EKG/ECG Operations Resuscitation Wellness 52

Dr. Smith's ECG Blog

APRIL 6, 2023

Medical history: History of Ischemic Heart Disease History of Congestive Heart Failure Diabetes Mellitus requiring treatment with insulin Pre-operative serum creatinine >2 mg/dL He had this ECG recorded: What do you think? They compared to a previous ECG and thought they were identical. Are these ECGs of similar risk?

EKG/ECG 52

EKG/ECG Operations Documentation/Coding Wellness 52

ECG Guru

MAY 27, 2023

This ECG is from an 80-year-old lady who has collapsed or had sycopal episodes several times. The ECG comes from a Holter monitor. The ECG shows a second-degree, Mobitz Type II AV block. She has arterial hypertension and coronary artery disease. In both types of AVB, the PP intervals are usually the same.

EKG/ECG 72

EKG/ECG 72

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Initial high sensitivity troponin I: 3,830 ng/L (URL 20 ng/L for men) 1445: Similar to initial ECG. He was intubated for altered mental status. ST depression.

EKG/ECG 92

EKG/ECG Wellness Fractures Hospitals 92

Dr. Smith's ECG Blog

AUGUST 30, 2023

No prior ECG was available. Here is her triage ECG: What do you think? The ECG was sent to me with no information, and I replied "OMI". I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: V1 and V2 have abnormal STE, and V2 has a hyperacute T wave. Figure-1: The initial ECG in today's case. (

EKG/ECG 68

EKG/ECG Wellness Operations 68