Ken Grauer, MD

JANUARY 5, 2024

QUESTIONS: What is the rhythm? Figure-1: The initial ECG in today's case. Assuming this patient is at least momentarily stable — I’d then proceed as follows: I’d take a quick look at the long lead rhythm strip. How would YOU interpret the tracing in Figure-1 — that was sent to me without additional information? If so — WHY?

EKG/ECG 417

EKG/ECG Wellness 417

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. What do YOU see?

EKG/ECG 312

EKG/ECG Wellness 312

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-2: I've labeled the sinus P waves with RED arrows.

EKG/ECG 277

EKG/ECG Administration 277

Ken Grauer, MD

JANUARY 26, 2024

I was sent the ECG in Figure-1 — without the benefit of any history. Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). By the Ps, Qs, 3R Approach ( which I review in ECG Blog #185 ): P waves are present — and best seen in lead V1.

EKG/ECG 255

EKG/ECG 255

Ken Grauer, MD

MARCH 11, 2024

I was asked to interpret the 2-lead rhythm strip shown in Figure-1 — without the benefit of any history. Figure-1: You are asked to interpret this 2-lead rhythm strip without the benefit of any history. NOTE: Today's rhythm is challenging — especially if you have not seen this type of rhythm before. Is there AV block?

EKG/ECG 370

EKG/ECG 370

Ken Grauer, MD

MAY 28, 2024

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS".

EKG/ECG 277

EKG/ECG Wellness 277

Ken Grauer, MD

SEPTEMBER 22, 2023

The ECG in Figure-1 — was obtained from a middle-aged man with palpitations and shortness of breath. 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 ). Figure-1: The initial ECG in today's case. (

EKG/ECG 421

EKG/ECG Wellness 421

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? And then I took a c loser LOOK — at the rhythm in Figure-1.

EKG/ECG 386

EKG/ECG Wellness 386

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. QUESTIONS: HOW would you interpret the rhythm in Figure-1 ? Figure-1: The initial ECG in today's case. Is this " high -grade" AV block?

EKG/ECG 361

EKG/ECG 361

Ken Grauer, MD

APRIL 20, 2024

The ECG in Figure-1 — was obtained from a 70-ish year old man with episodic CP ( C hest P ain ) over the previous 2-3 days , being awakened from sleep now for a more severe CP episode. QUESTIONS: In view of this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case.

EKG/ECG 396

EKG/ECG Wellness 396

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 ). That said — LOOK to see if there is an underlying rhythm!

EKG/ECG 247

EKG/ECG Resuscitation Hospitals Wellness 247

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

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 ECG in Figure-1 — was obtained following successful resuscitation.

EKG/ECG 388

EKG/ECG Resuscitation Hospitals Wellness 388

Ken Grauer, MD

APRIL 3, 2023

How would YOU interpret this long lead II rhythm strip? Figure-1: The long lead II rhythm strip for today’s case. 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 ).

EKG/ECG 195

EKG/ECG 195

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. IF there are easier elements of the rhythm to interpret, as well as more difficult elements — Start with the EASIER elements ( and save the more difficult elements for last ).

EKG/ECG 239

EKG/ECG Academics Wellness 239

Ken Grauer, MD

MAY 12, 2023

I was sent the rhythm strip shown in Figure-1 — obtained from telemetry monitoring. Figure-1: Multi-lead rhythm strip obtained from telemetry monitoring. The last beat in Figure-2 is another sinus beat ( = RED arrow before this last beat #11 ). I did not know the history. Can YOU explain what happens after beat #4?

EKG/ECG 195

EKG/ECG Wellness 195

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 ). The QTc appears to be normal. What About Today's ECG? Clinical implications?

EKG/ECG 284

EKG/ECG Research 284

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

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

JUNE 2, 2023

How would YOU interpret the rhythm in Figure-1 ? Figure-1: The initial 15-second rhythm strip in today’s case. == N OTE : The recording system used in rhythm strips from today’s post may be different from what you are accustomed to. instead of the usual 6-10 second rhythm strips many of us are used to ). second = 9.1

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

MAY 6, 2023

The ECG in Figure-1 — was obtained from an older woman with chest pain. Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ). The PR interval for each of these sinus beats is slightly prolonged ( ie, to slightly more than 1 large box in duration = 0.22

EKG/ECG 195

EKG/ECG 195

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

APRIL 18, 2023

The ECG in Figure-1 was obtained from a 50-year old man — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ). QUESTIONS: There are at least 3 principal findings on this ECG — some of which deal with a possible “culprit” artery and / or the location of whatever is going on. HINT: Is the rhythm sinus ?

EKG/ECG 195

EKG/ECG Wellness 195

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. BP = 140/90 mm Hg in association with the rhythm in Figure-1. How would YOU interpret the rhythm in Figure-1 ? Figure-1: ECG obtained from an older woman with palpitations.

EKG/ECG 195

EKG/ECG Poisoning 195

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 ? A total of 12 beats are seen in the long lead II rhythm strip. He was not hypotensive.

EKG/ECG 195

EKG/ECG Wellness 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

APRIL 9, 2023

The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. Th e patient was hemodynamically stable in association with this rhythm. How would YOU interpret the ECG in Figure-1 ? What is the rhythm ?

EKG/ECG 195

EKG/ECG 195

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

FEBRUARY 8, 2023

Renal function and serum electrolytes were normal — but CK was markedly elevated , leading to a diagnosis of Rhabdomyolysis. Cardiac monitoring revealed a series of interesting ( albeit asymptomatic ) rhythms, 2 of which are shown below in Figure-1. QUESTIONS: How would YOU interpret Rhythms A and B in Figure-1?

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

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

EKG/ECG 412

EKG/ECG Wellness 412

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". Surprisingly — he was hemodynamically stable with minimal discomfort at the time his initial ECG in Figure-1 was recorded. Could the patient have WPW?

EKG/ECG 195

EKG/ECG Shock EMS 195

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 ? What is the cardiac rhythm? What is the rhythm? The Q RS complex is narrow — so the rhythm is supraventricular.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

Ken Grauer, MD

MAY 26, 2023

The ECG in Figure-1 was obtained from a 60-ish year old man with a history of coronary disease ( including prior CABG ) — who presented to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) of 3 hours duration , diaphoresis and nausea/vomiting. The patient was hypotensive at the time his initial ECG in Figure-1 was obtained.

EKG/ECG 195

EKG/ECG Wellness Resuscitation 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. If not — How would YOU interpret this rhythm? To EMPHASIZE: In “real time” — I interpreted this rhythm in less time than it takes to read my intentionally long discussion below.

EKG/ECG 370

EKG/ECG Academics Resuscitation Wellness 370

Dr. Smith's ECG Blog

MARCH 7, 2024

There were times when it would be usurped by sinus tachycardia, then return to this rhythm. I could only conclude that this was an irregular accelerated idioventricular rhythm. It is a stable rhythm. Atropine is ok to improve the sinus rate if the heart rate is too slow. Formal echo was normal.

Shock 99

Shock EKG/ECG Documentation/Coding 99

Dr. Smith's ECG Blog

MARCH 22, 2024

His ECG is shown: What do you think? The history thus far is highly suggestive of OMI, so we must study the ECG very closely to see if we can confirm this. Looking at the rhythm strip, we see there is more going on than simple sinus rhythm, and in fact there are two different morphologies of QRS complexes.

EKG/ECG 99

EKG/ECG Wellness Documentation/Coding 99

Dr. Smith's ECG Blog

OCTOBER 21, 2023

Differential is ventricular tachycardia versus supraventricular tachycardia with aberrancy versus sinus tachycardia with a aberrancy. But these could be an extension of the QRS, so sinus tach is not certain. Given that this QRS looks nothing like any normal kind of a aberrancy, it is reasonable to use electrical cardioversion.

EKG/ECG 124

EKG/ECG COPD 124

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. There was concern that the rhythm might represent ventricular tachycardia, so lidocaine was given and one attempt at cardioversion was performed. Here is her ECG the next day with normal potassium level: She did well.

EKG/ECG 123

EKG/ECG EMS Shock Wellness 123