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

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

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? Why are there so many shapes for the QRS complexes?

EKG/ECG 277

EKG/ECG Administration 277

Ken Grauer, MD

OCTOBER 6, 2023

The ECG in Figure-1 was obtained from a middle-aged woman who presented with "palpitations". QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Can you explain the atrial activity in this rhythm strip? Figure-1: The initial long lead II rhythm strip in today's case. The rhythm in today's tracing is not R egular.

EKG/ECG 384

EKG/ECG 384

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. What is the rhythm? He was hemodynamically stable at the time this tracing was recorded.

EKG/ECG 351

EKG/ECG Wellness 351

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-1: How would YOU interpret this lead II rhythm strip? Figure: The P s, Q s, 3 R Approach to Rhythm Interpretation.

EKG/ECG 239

EKG/ECG 239

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

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

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 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 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

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

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

APRIL 26, 2024

The ECG in Figure-1 — was obtained on the scene by EMS ( E mergency M edical S ervices ). He was hemodynamically stable — but clearly distressed with a sense of “impending doom” at the time ECG #1 was recorded. QUESTIONS: How would YOU interpret the initial ECG in Figure-1 ? Extra Credit: How many beats are seen on this ECG?

EKG/ECG 348

EKG/ECG Resuscitation EMS Wellness 348

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 ? Is this Ventricular Bigeminy? Is there Ventricular Bigeminy? (

EKG/ECG 195

EKG/ECG Poisoning 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. What is the rhythm? To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Administration Wellness 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 ). What might you suspect clinically?

EKG/ECG 195

EKG/ECG 195

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

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

MARCH 29, 2023

The ECG in Figure-1 is from a man in his 30s — who overall has been healthy, except for a history of "intermittent palpitations" that he has had since childhood. He was hemodynamically stable with ECG #1. QUESTION: What is the rhythm in Figure-1 ? Figure-1: The initial ECG in today's case. But the rhythm is not regular.

EKG/ECG 195

EKG/ECG Wellness Academics 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

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

FEBRUARY 18, 2023

T he ECG in Figure-1 was obtained from a 60ish year old man on arrival to the ED ( E mergency D epartment ). QUESTION: A cardiologist interpreted the rhythm in Figure-1 as VT ( V entricular T achycardia ). To improve visualization — I've digitized the original ECG using PMcardio ). Do YOU agree with this cardiologist ?

EKG/ECG 195

EKG/ECG Resuscitation Wellness 195

Dr. Smith's ECG Blog

APRIL 2, 2024

Medics found him in ventricular fibrillation. Here is the initial ED ECG. Rhythm : Residents asked me why it is not VT. If you use calipers (or equvalent), it is clear that the rhythm is irregularly irregular. This meets the Smith Modified Sgarbossa criteria for acute OMI in LBBB and Paced Rhythm.

EKG/ECG 114

EKG/ECG Shock CPR Stroke 114

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

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

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. Is there OMI?

EKG/ECG 113

EKG/ECG Resuscitation Academics EMS 113

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. Figure-1: The ECG sent to Ken Grauer ( showing some semblance of "group" beating ). But he did get an EKG: What is this?

Shock 99

Shock EKG/ECG Documentation/Coding 99

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

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. She was otherwise very stable during this rhythm. This is a "rhythm control" strategy. Atrial flutter with 2:1 conduction. She did well.

EKG/ECG 112

EKG/ECG Stroke Wellness Administration 112

Ken Grauer, MD

FEBRUARY 28, 2023

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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

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. Shortly after arrival, the patient spontaneously converted to this rhythm (also sent to me, along with the first): What do you think? Smith : the rhythm is irregularly irregular without P-waves.

EKG/ECG 101

EKG/ECG 101

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. But it is not disorganized enough to be polymorphic ventricular tachycardia. And why give adenosine in sinus rhythm? What is it?

EKG/ECG 112

EKG/ECG Emergency Department Wellness 112

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

ECG Guru

DECEMBER 23, 2023

The ECGs: The first ECG , taken at 12:30:05, shows a sinus rhythm with ventricular bigeminy. In some leads, you can see the sinus P waves hidden in the beginnings of the PVCs, so we know the underlying sinus rhythm is about 82 bpm. He states the pain is a 5 on 1-10 scale.

EKG/ECG 105

EKG/ECG 105

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 QRS of sinus beats #3,6,9,12 and 15 looks narrow in this long lead II rhythm strip. How would YOU interpret this tracing?

EKG/ECG 195

EKG/ECG 195