Dr. Smith's ECG Blog

MAY 22, 2024

Written by Sean Trostel MD I returned to my desk after seeing a patient and saw this screening ECG sitting on my desk to be read. ECG #1 @ 15:30 What do you think? QRS is becoming still narrower Note with each ECG there is progressive narrowing of the QRS and dampening of the peaked T-waves.

EKG/ECG 101

EKG/ECG Shock Resuscitation 101

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

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. 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? QUESTIONS: In light of the above clinical history.

EKG/ECG 369

EKG/ECG Resuscitation Documentation/Coding Hospitals 369

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

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. If the rhythm is sinus — ECG Blog #204 reviews how to determine if RBBB, LBBB or IVCD is present ). The talk will be recorded and posted on-line.

EKG/ECG 195

EKG/ECG 195

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 ? The Initial ECG in Today’s CASE: The rhythm in ECG #1 is sinus at 65-70/minute.

EKG/ECG 379

EKG/ECG Hospitals 379

Ken Grauer, MD

MAY 11, 2024

The 12-lead ECG and long lead II rhythms shown in Figure-1 — was obtained from an older man with a recent history of “easy fatiguability” and a presyncopal episode. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case. I outline my approach for doing so below.

EKG/ECG 263

EKG/ECG 263

Dr. Smith's ECG Blog

OCTOBER 21, 2023

Here is a normal LBBB: In LBBB, monophasic wide R-waves should be limited to the lateral leads in left bundle branch block, as in this ECG. In that ECG above, there are monophasic R-waves starting in lead V2 all the way out to V6. From a purely ECG interpretation standpoint — How would you interpret today's rhythm ?

EKG/ECG 124

EKG/ECG COPD 124

ECG Guru

MAY 24, 2024

ECG Number 1, 11:57 a.m.: There is a wide-complex tachycardia at a rate of about 230 bpm. This photo shows an ECG that is not lying flat, so it is difficult to line up the complexes. The T waves are “discordant”, they are in the opposite direction from the QRS complexes, which is typical of LBBB. The QRS is.15

EKG/ECG 98

EKG/ECG Shock Outcomes 98

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

Dr. Smith's ECG Blog

MARCH 19, 2024

The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. This was the ECG obtained at triage. Smith : this ECG cannot represent a normal variant.

EKG/ECG 79

EKG/ECG Hospitals Documentation/Coding Outcomes 79

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

APRIL 2, 2024

Here is the initial ED ECG. Answer : it is irregularly irregular and the initial part of the QRS is fast, so this is atrial fibrillation with Left Bundle Branch Block (LBBB). This meets the Smith Modified Sgarbossa criteria for acute OMI in LBBB and Paced Rhythm. Tachycardia exaggerates ST Elevation in LBBB and Paced rhythm 5.

EKG/ECG 114

EKG/ECG Shock CPR Stroke 114

Dr. Smith's ECG Blog

FEBRUARY 16, 2024

Here is his triage ECG: What do you think? The ECG shows an irregularly irregular polymorphic wide complex rhythm, with some R-R intervals as short as approximately 220 msec or even less. Sedation and cardioversion was then performed: Here is the repeat ECG after conversion: Sinus rhythm with delta waves.

EKG/ECG 112

EKG/ECG Emergency Department Wellness 112

Ken Grauer, MD

FEBRUARY 13, 2023

The ECG in Figure-1 was obtained from an older woman — who presented with chest pain and palpitations over the previous hour. Figure-1: ECG obtained from an older woman with palpitations. To improve visualization — I've digitized the original ECG using PMcardio ). BP = 140/90 mm Hg in association with the rhythm in Figure-1.

EKG/ECG 195

EKG/ECG Poisoning 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”. 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

ECG Guru

JANUARY 16, 2024

For a better overview, the leads aVF and V2-V4 are not shown in this ECG. Faster conduction results in wide QRS complexes with LBBB morphology. This is an example of phase 3 (acceleration dependant) LBBB. The basic rhythm is atrial fibrillation (no P waves or flutter waves visible, but fibrillation waves).

EKG/ECG 75

EKG/ECG 75

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 ). ECG Blog #192 — The 3 Causes of AV Dissociation.

EKG/ECG 195

EKG/ECG 195

ECG Guru

JANUARY 16, 2024

For a better overview, the leads aVL and V2-V4 are not shown in this ECG. Faster conduction results in wide QRS complexes with LBBB morphology. This is an example of phase 3 (acceleration dependant) LBBB. The basic rhythm is atrial fibrillation (no P waves or flutter waves visible, but fibrillation waves).

EKG/ECG 52

EKG/ECG 52

Emergency Medicine Cases

JUNE 6, 2023

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. The post ECG Cases 43 – ECG Interpretation in Shortness of Breath appeared first on Emergency Medicine Cases.

EKG/ECG 94

EKG/ECG EMS 94

Dr. Smith's ECG Blog

FEBRUARY 20, 2024

Here is the 12-lead ECG: Wide complex tachycardia What do you think? His pulse on the monitor suddenly went down to 140 and another 12-lead ECG was recorded: Sinus tachycardia at a rate of 143 There are peaked T-waves typical of hyperkalemia The K returned at 6.9 What is the diagnosis on the top ECG?

EKG/ECG 109

EKG/ECG EMS Administration 109

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Here's the prior ECG: This confirms thew anterior ST depression is new. The first ECG was labeled “anterior subendocardial ischemia”, but subendocardial ischemia does not localize. So a patient with high pretest probability (prior CABG with new chest pain), had new ECG changes showing posterior OMI. Do you need posterior leads?

EKG/ECG 100

EKG/ECG Outcomes 100

Dr. Smith's ECG Blog

JUNE 11, 2023

Here is his triage ECG: He had several more ECGs taken in the resuscitation bay over the next few minutes: What do you think? The ECGs show a wide complex, irregularly irregular tachycardia. It could easily be mistaken for LBBB, if it were not diagnostic of WPW. 2 hrs later: Still sinus with subtler WPW.

EKG/ECG 76

EKG/ECG Shock Resuscitation EMS 76

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. Here is what the Queen of Hearts says about the Baseline ECG: Active chest pain triage ECG also read as not OMI: She says "not OMI", but she does not have access to the baseline ECG. In the future, we will be able to have her compare with previous and serial ECGs.

EKG/ECG 79

EKG/ECG Shock Documentation/Coding Academics 79

Ken Grauer, MD

FEBRUARY 4, 2023

The ECG in Figure-1 is from a middle-aged man — who had just received thrombolytic therapy for presumed acute infarction. QUESTIONS: How would YOU interpret this ECG? Figure-1: ECG obtained from a middle-aged man following thrombolytic therapy. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG 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. There is a LBBB. The ECG above shows LBBB. In this case (above ECG) ventricular activation depends on the RBB conducting impulses as there is a permanent LBBB.

EKG/ECG 76

EKG/ECG Wellness Pediatrics 76

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. Here is the initial ECG: A temperature sensing Foley was inserted and reported a core temperature of 26.7 C), with Cardiac Echo -- A Pathognomonic ECG.

Hyperthermia / Hypothermia 118

Hyperthermia / Hypothermia EKG/ECG Wellness 118

Dr. Smith's ECG Blog

JANUARY 3, 2024

On arrival, EMS recorded relatively normal vital signs and this EMS ECG: What do you think? Here is the Queen of Hearts interpretation: This ECG was transmitted to the nearest PCI center, where it was simply called "Not STEMI, just follow your protocol." No further ECGs were recorded. So the cath lab was not activated.

EMS 79

EMS EKG/ECG Wellness Outcomes 79

Dr. Smith's ECG Blog

DECEMBER 26, 2023

I was reading ECGs on the system and saw this one, and instantly knew the probable ECG diagnosis: What do you think? This is a very typical ECG for Hypertrophic Cardiomyopathy. Because this is a difficult ECG and she is on the fence, undecided. An unusual form of QRS widening — that just does not look like LBBB.

EKG/ECG 100

EKG/ECG 100

Ken Grauer, MD

JANUARY 26, 2023

The ECG in Figure-1 was obtained from a previously healthy older man — who complained of chest pain and “lightheadedness” while this tracing was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? To improve visualization — I've digitized the original ECG using PMcardio ). He was not hypotensive.

EKG/ECG 195

EKG/ECG Wellness 195

Dr. Smith's ECG Blog

APRIL 18, 2024

What do you think of the ECG, and does it matter? I sent this to the Queen of Hearts So the ECG is both STEMI negative and has no subtle diagnostic signs of occlusion. 2] This is because, contrary to Bayesian reasoning, the STEMI paradigm is named after and defined by one part of one test: ST elevation on ECG. But only 6.4%

EKG/ECG 105

EKG/ECG Documentation/Coding Fractures Emergency Department 105

EMDocs

SEPTEMBER 19, 2023

Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. Cric is not a failure ; it is an integral part of every airway plan.

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

Dr. Smith's ECG Blog

MAY 8, 2023

Triage ECG: What do you think? Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. Queen of Hearts interpretation: The cardiologist initially was not convinced, stating the ECG was not diagnostic or could not be diagnostic because it was paced. Limkakeng AT.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG?

EKG/ECG 68

EKG/ECG Wellness Ultrasounds EMS 68

Dr. Smith's ECG Blog

JANUARY 9, 2024

The ECG below was recorded. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. Said differently, the ECG shows a rather slow ventricular tachycardia with a 2:1 VA conduction. How do you interpret the below ECG?

EKG/ECG 86

EKG/ECG Stroke Hospitals Documentation/Coding 86

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

SEPTEMBER 27, 2023

An ECG was recorded immediately and is shown below. How do you interpret the ECG? ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm. After cardioversion, if successful, you can take a few moments to assess the 12-lead in more detail and assess the post conversion ECG. ECG#2 What do you think?

EKG/ECG 113

EKG/ECG Resuscitation Academics EMS 113