Ken Grauer, MD

FEBRUARY 3, 2024

The ECG in Figure-1 was obtained following successful resuscitation. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1 ? Is this ECG finding present in today’s initial ECG? Figure-1: The initial ECG in today's case — obtained after successful resuscitation from cardiac arrest. (

EKG/ECG 348

EKG/ECG Resuscitation Hospitals Wellness 348

Ken Grauer, MD

DECEMBER 1, 2023

For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier. Given this history: QUESTIONS: How would YOU interpret the ECG in Figure-1 ?

EKG/ECG 323

EKG/ECG EMS Wellness 323

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 229

EKG/ECG 229

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 372

EKG/ECG Wellness 372

Ken Grauer, MD

NOVEMBER 10, 2023

For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. Figure: 12-lead ECG obtained from an 51-year-old man with palpitations.

EKG/ECG 405

EKG/ECG Emergency Department 405

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 336

EKG/ECG Resuscitation Hospitals Wellness 336

Ken Grauer, MD

DECEMBER 15, 2023

For full discussion of this case — See ECG Blog #392 — == The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms. Figure-1: The initial ECG in today's case. (

EKG/ECG 283

EKG/ECG EMS Hospitals 283

Ken Grauer, MD

DECEMBER 8, 2023

For full discussion of this case — See ECG Blog #292 — == The 2 ECGs shown in Figure-1 were obtained from a man in his 30s — who presented to the ED ( E mergency D epartment ) with chest pain that began several hours earlier. ECG #2 was recorded 1 hour after ECG #1. (22:3 0 min. Initial troponin was negative.

EKG/ECG 306

EKG/ECG Hospitals 306

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. ECG Media Pearl # 8 ( 8:20 minutes Video ) — ECG Blog #191 — Distinguishing between A V D issociation vs Complete AV Block ( 2/6/2021 ).

EKG/ECG 379

EKG/ECG 379

Ken Grauer, MD

NOVEMBER 4, 2023

Figure-1: How would YOU interpret this ECG? MY Thoughts on the ECG in Figure-1: When faced with a challenging cardiac arrhythmia — It is a "luxury" to have access to a long lead rhythm strip containing 3 simultaneously -recorded leads. The repeat ECG after this treatment is shown in Figure-4.

EKG/ECG 334

EKG/ECG Wellness 334

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 281

EKG/ECG Research 281

Ken Grauer, MD

MAY 20, 2023

The ECG in Figure-1 — was obtained from an older woman with persistent CP ( C hest P ain ) over the previous day. Figure-1: The initial ECG in today's case. Voltage for LVH is satisfied — at least by Peguero Criteria ( Sum of deepest S in any chest lead + S in V4 ≥23 mm in a woman — as discussed in ECG Blog #73 ).

EKG/ECG 293

EKG/ECG Wellness 293

Ken Grauer, MD

OCTOBER 21, 2023

The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. QUESTIONS: In view of this history — How would you interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today's case. Troponin is pending.

EKG/ECG 237

EKG/ECG Shock Wellness 237

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 237

EKG/ECG 237

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 ? Section 2F ( 6 pages = the " short " Answer ) from my ECG-2014 Pocket Brain book provides quick written review of the AV Blocks ( This is a free download ). Or — Is it “ something else ”?

EKG/ECG 237

EKG/ECG 237

Ken Grauer, MD

SEPTEMBER 1, 2023

Figure-1: 12-lead ECG and long lead II rhythm strip obtained after Adenosine was given for a regular SVT rhythm. MY Thoughts on the ECG in Figure-1: As per the title of today's Blog post — there are numerous variations in the shape of the QRS complex over the course of the 17 beats seen in the long lead II rhythm strip.

EKG/ECG 274

EKG/ECG Administration 274

Emergency Medicine Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.

EKG/ECG 119

EKG/ECG Emergency Department EMS 119

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

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 110

EKG/ECG Documentation/Coding Fractures Emergency Department 110

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

MARCH 18, 2023

The ECG in Figure-1 was obtained from a man in his mid-60s — who presented with new chest pain. Figure-1: T he initial ECG in today’s case. MY Thoughts on the Initial ECG: The rhythm in ECG #1 — is sinus at ~70/minute. Figure-2: I've labeled significant ST-T wave findings in the limb leads of ECG #1.

EKG/ECG 195

EKG/ECG Wellness 195

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. 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 Wellness Academics 195

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

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

APRIL 22, 2024

EKG from triage: Here is his previous ECG: Normal ST Elevation Resident's interpretation: Reperfusion pattern/Wellens' with biphasic T waves in V2 and V3, and in comparison to an EKG in 2020 this is new. Repeat EKG: Resident interpretation: ST elevation in V2 significantly different than his previous EKG.

EKG/ECG 112

EKG/ECG Outcomes Ultrasounds Hospitals 112

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.

EKG/ECG 97

EKG/ECG Wellness Fractures Hospitals 97

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

Ken Grauer, MD

MARCH 7, 2023

You are given this ECG to review. QUESTION: Is there a potential problem with this ECG? Figure-1: The initial ECG in today's case. == N OTE : Many of us are charged with reviewing ECGs that have been interpreted by other clinicians — often without the benefit of much ( or any ) history. The rhythm in ECG #1 is sinus.

EKG/ECG 195

EKG/ECG Wellness 195

ECG Guru

SEPTEMBER 10, 2023

This EKG shows a sinus rhythm with ventricular bigeminy and retrograde conduction leading to retrograde depolarization of the sinus node, resulting in a longer pause (sinus node reset). The most likely cause of this type of polymorphic ventricular tachycardia during a stress EKG is cardiac ischemia/coronary artery disease.

EKG/ECG 52

EKG/ECG 52

Ken Grauer, MD

JANUARY 31, 2023

The ECG in Figure-1 was obtained from an older woman. QUESTIONS: How would YOU interpret this ECG? Figure-1: ECG obtained from an older woman with shortness of breath. ( To improve visualization — I've digitized the original ECG using PMcardio ). Figure-1: ECG obtained from an older woman with shortness of breath. (

EKG/ECG 195

EKG/ECG 195

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.

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. 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

Dr. Smith's ECG Blog

DECEMBER 7, 2023

No EKG arrived with the transfer packet, so I ordered a STAT EKG and went bedside to see her. I walked into the room to see the following EKG before I had the chance to ask any questions. EKG 1 What do you think? We would have taught her "acute reperfused" for this ECG. The angiography fits perfectly with the EKG.

EKG/ECG 96

EKG/ECG Poisoning Hospitals 96

Ken Grauer, MD

FEBRUARY 24, 2023

The ECG in Figure-1 was obtained from a previously healthy 30-ish year old man — who presented to medical attention for vasovagal syncope. Based on this initial ECG — the patient was transferred to a PCI-capable center: Do YOU agree with the need for transfer? Figure-1: The initial ECG in today's case.

EKG/ECG 195

EKG/ECG Hospitals 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 ). This phenomenon of trying to explain events that are not evident on the surface ECG — is known as " concealed " conduction.

EKG/ECG 195

EKG/ECG 195

Dr. Smith's ECG Blog

OCTOBER 1, 2023

He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think? I sent this ECG, without any text at all, to Dr. Smith, and he replied: "LAD OMI with low certainty. Back to the case: Unfortunately, the ECG was not understood by the provider. V3 is the one that is convincing."

EKG/ECG 119

EKG/ECG EMS Ultrasounds Wellness 119

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