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

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

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

NOVEMBER 25, 2023

For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. Panel B: Mobitz II with QRS widening and a fixed PR interval until sudden loss of conduction with successive nonconducted P waves.

EKG/ECG 421

EKG/ECG 421

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. N OTE : IF the QRS complex is wide — then STOP and find out WHY the QRS is wide before proceding to assessment of Axis, Chamber Enlargement and QRST Changes.

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

MARCH 11, 2024

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 ). PEARL # 2: We only see 2 of the 12 leads of an ECG in Figure-1.

EKG/ECG 370

EKG/ECG 370

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

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

JANUARY 5, 2024

Figure-1: The initial ECG in today's case. KEY Clinical Point: If I was the medical provider charged with the care of the patient whose ECG is shown in Figure-1 — I would approach this tracing in the following sequential stages: I’d first establish that the patient was hemodnamically stable with this ECG and this cardiac rhythm.

EKG/ECG 417

EKG/ECG Wellness 417

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

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

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

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

SEPTEMBER 1, 2023

Why are there so many shapes for the QRS complex in the long lead II rhythm strip? Figure-1: 12-lead ECG and long lead II rhythm strip obtained after Adenosine was given for a regular SVT rhythm. Why are there so many shapes for the QRS complexes? Return for a moment to the 12-lead ECG in Figure-2. second in duration.

EKG/ECG 277

EKG/ECG Administration 277

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

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 ). Figure-1: The initial ECG in today's case — obtained from a 60ish year old man who collapsed in the ED shortly after this tracing was recorded. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Resuscitation Wellness 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

JUNE 2, 2023

QUESTIONS: A total of 9 QRS complexes are seen in the 2 simultaneously-recorded monitoring leads. Why do the QRS complexes of beats #4 and 5 in the bottom lead look different than the other 7 beats? 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

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. The QRS is.15 The QRS frontal plane axis is leftward. This photo shows an ECG that is not lying flat, so it is difficult to line up the complexes. We do not have information about her past medical history.

EKG/ECG 98

EKG/ECG Shock Outcomes 98

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 ). The Q RS complex is wide for all beats on this tracing.

EKG/ECG 195

EKG/ECG Poisoning 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 ). The Q RS complex is obviously wide.

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. Figure-1: The initial ECG in today's case. To do this — I apply the P s, Q s, 3 R Approach ( See ECG Blog #185 — for review of my system ).

EKG/ECG 361

EKG/ECG 361

Ken Grauer, MD

MAY 12, 2023

In between the first 4 sinus-conducted beats and the last sinus-conducted beat — is a wide beat ( = beat #5 ) — which is followed by a run of 5 narrow QRS complexes at a rapid rate ( of ~120/minute ). A short pause is seen after beat #10. Beat #5 is a PVC. What Happens with Beats #6-thru-10? QUESTION: Take another LOOK at Figure-3.

EKG/ECG 195

EKG/ECG 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. What About the Wide Beats in Figure-3? Beats #3 , 6 , 9 and 12 are wide, very different in morphology from sinus-conducted beats — and not preceded by P waves. H OW t o B egin ?

EKG/ECG 239

EKG/ECG Academics Wellness 239

Dr. Smith's ECG Blog

FEBRUARY 20, 2024

Here is the 12-lead ECG: Wide complex tachycardia What do you think? The providers thought that this wide QRS was purely due to (severe) hyperkalemia. What is the diagnosis on the top ECG? Do you think that this was simply hyperkalemia with a wide complex that resolved with bicarb and calcium?

EKG/ECG 109

EKG/ECG EMS Administration 109

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

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

MAY 25, 2024

Here is her ECG: Regular Wide Complex Tachycardia. Regular means it can't be atrial fibrillation --Most regular wide complex tachcardia are VT, especially if the patient has poor LV function, as in this case. She had an ECG done yesterday!! If they are after the QRS and inverted, then it is VT. What do you think?

EKG/ECG 104

EKG/ECG 104

Ken Grauer, MD

APRIL 3, 2023

To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on the Rhythm in Figure-1: Although no history is provided for today's case — I'll presume the patient is hemodynamically stable with the rhythm in Figure-1 , since runs of the wide beats are not sustained. No history was available. (

EKG/ECG 195

EKG/ECG 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. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade. Here is her ECG the next day with normal potassium level: She did well. Also: How did this happen?

EKG/ECG 123

EKG/ECG EMS Shock Wellness 123

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

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

JUNE 6, 2023

== P lease N OTE : After today — No new ECG Blog posts for 2- to -3 weeks. — I will also not be prompt in replying to emails. == All material on this ECG Blog site remains open! So IF you are looking for ECG material — There is plenty on this web site! Figure-1: The initial ECG in today's case. I'll be back! —

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

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. How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. (

EKG/ECG 195

EKG/ECG 195

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. What is it?

EKG/ECG 112

EKG/ECG Emergency Department Wellness 112

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

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."

EKG/ECG 101

EKG/ECG 101