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. Is this " high -grade" AV block? Is this " high -grade" AV block? Figure-1: The initial ECG in today's case. Is a pacemaker needed?

EKG/ECG 361

EKG/ECG 361

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 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. Because of this, it is uncommon to see sinus tachycardia with a prolonged PR interval.

EKG/ECG 284

EKG/ECG Wellness 284

Ken Grauer, MD

MAY 16, 2024

The ECG in Figure-1 — was obtained from an older man who had just completed dialysis — and , is now complaining of abdominal discomfort that radiates to his chest. Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). How would YOU approach this case?

EKG/ECG 374

EKG/ECG Wellness 374

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

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

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

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

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

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

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

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

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

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 ). How would YOU interpret this tracing?

EKG/ECG 195

EKG/ECG 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 ? 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

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

Dr. Smith's ECG Blog

MAY 25, 2024

Here is her ECG: Regular Wide Complex Tachycardia. Did it fail to convert because it is occult sinus tach? Could it be sinus with RBBB and LPFB aberrancy? She had an ECG done yesterday!! Here it is: There is sinus with normal conduction, very different from her tachycardia. Severely decreased LV function.

EKG/ECG 104

EKG/ECG 104

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

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

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

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. These include the following: IF there is more than a single feature in a given arrhythmia ( ie, When the tracing is not a simple sinus rhythm ) — then LOOK to see if there is an underlying rhythm?

EKG/ECG 239

EKG/ECG Academics Wellness 239

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

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 ). QUESTIONS: How would YOU interpret Rhythms A and B in Figure-1? What treatment is indicated?

EKG/ECG 195

EKG/ECG Hospitals 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. 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

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 ). Therefore — there is an underlying sinus rhythm. or — Something else? Figure-1: The long lead II rhythm strip for today’s case.

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

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

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. This QRS is not typical of any kind of bundle branch block, which makes aberrancy much less likely.

EKG/ECG 124

EKG/ECG COPD 124

Ken Grauer, MD

JUNE 2, 2023

speed that many of us are used to ) — BUT — that the width of each large box on the ECG grid paper has been reduced by 50% ( so that each small rectangular box on this ECG grid paper still represents 200 msec. = R-R interval for the first few beats in this tracing ). == H ow M any P - W aves are there in ECG Rhythm #1?

EKG/ECG 195

EKG/ECG Wellness 195

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

An ECG was performed: What do you think? It is unclear what changes happened to the rhythm based on the EMS interventions, but the patient arrived to the ED remaining critically ill and with a very wide complex reported (no ECGs from ED available sadly). Here is her ECG the next day with normal potassium level: She did well.

EKG/ECG 123

EKG/ECG EMS Shock Wellness 123

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

Ken Grauer, MD

APRIL 14, 2023

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1 ? Figure-1: The ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Wellness Hospitals 195

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

ECG Guru

JULY 14, 2023

ECG 1 is from a 57-year-old male with no prior cardiac disease. We see a sinus rhythm with left anterior fascicular block (LAFB) and conspicuous T-wave inversions in the inferior leads and in V1-V6. These are typical ECG changes that may indicate a pulmonary embolism. ECG 2 was taken from the same patient 1 year earlier.

EKG/ECG 98

EKG/ECG 98

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

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 are sinus P-waves throughout the tracing. 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

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