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 366

EKG/ECG Wellness 366

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 323

EKG/ECG Wellness 323

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 266

EKG/ECG Operations Wellness 266

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 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

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 248

EKG/ECG Shock Wellness 248

Dr. Smith's ECG Blog

OCTOBER 15, 2024

This was sent to me by an undergraduate name Hans Helseth, who is an EKG tech, but who is an expert OMI ECG reader. While an EKG and labs were being obtained on Patient 1, a second announcement came through for another prehospital “STEMI” activation on a 58 year old male ( Patient 2 ) with a history of some substance abuse.

EKG/ECG 106

EKG/ECG Hospitals Wellness 106

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

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

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

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

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

Dr. Smith's ECG Blog

JUNE 19, 2024

This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. An EKG for chest pain was obtained right away: For an 82 year old, this is a good looking EKG, with sinus rhythm at a rate of 70 BPM. Another EKG was obtained: There is now an atrial paced rhythm.

EKG/ECG 60

EKG/ECG Wellness 60

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

Ken Grauer, MD

MAY 12, 2023

As discussed in detail in ECG Blog #240 — the term, “SVT” — refers to any supraventricular rhythm (ie, with origin at or above the AV node ) that manifests a rate of ≥100/minute. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

EKG/ECG 195

EKG/ECG Wellness 195

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

Dr. Smith's ECG Blog

AUGUST 4, 2024

Written by Pendell Meyers Try first to interpret the ECG without any clinical context: What do you think? Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. There was no prior ECG for comparison. To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 94

EKG/ECG Wellness Operations Emergency Department 94

Dr. Smith's ECG Blog

OCTOBER 12, 2024

EKG on arrival to the ED is shown below: What do you think? The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. limb lead reversal is now resolved) Unfortunately, QOH V1 got tricked by this second ECG!

EKG/ECG 97

EKG/ECG Documentation/Coding Emergency Department COPD 97

Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation. For 2 of the 3 patients — the cath lab was activated based on the ECG.

EKG/ECG 85

EKG/ECG Wellness Hospitals EMS 85

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. Here is the initial ECG: A temperature sensing Foley was inserted and reported a core temperature of 26.7 He did well and was discharged.

Hyperthermia / Hypothermia 132

Hyperthermia / Hypothermia EKG/ECG Wellness 132

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ECG below was recorded about 20 minutes after he regained consciousness. ECG #1 The above ECG shows sinus rhythm at about 60 bpm. Figure A It now becomes apparent that there is ST segment depression in almost every lead of the ECG (V1-V6, I, II, aVL and aVF). In the initial ECG (ECG# 1) aVR had ST elevation.

EKG/ECG 125

EKG/ECG Shock Emergency Department Ambulance Services 125

Dr. Smith's ECG Blog

MARCH 4, 2024

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. Shifa Karim and Gabe Keller helped with a project to assess all these ECGs with the Queen of Hearts. The ECG told the story. I wanted to show some of the cases here.

EKG/ECG 109

EKG/ECG Documentation/Coding Wellness Resuscitation 109

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. 1,2 Cardiovascular: Obtain an initial EKG to determine the patient’s baseline and repeat. 1 Class IA (e.g., Juurlink D.

Poisoning 74

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 74

Dr. Smith's ECG Blog

OCTOBER 18, 2023

All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation. 1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes.

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department Outcomes 117

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. An ECG was obtained shortly after arrival: ECG 1 What do you think? The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging.

EKG/ECG 64

EKG/ECG Wellness Point-of-Care Testing Shock 64

EMergucate

NOVEMBER 5, 2019

Following ECG was obtained from a 24 years of age man complaining of a week history of intermittent chest pain. He is clinically well and his haemodynamics are all within normal limits. Describe t…

EKG/ECG 52

EKG/ECG Wellness 52

EMergucate

APRIL 8, 2020

Following is an ECG of a 25 years old man with a four day history of left sided chest pain and its 0400 hours in the morning. He’s in a mild discomfort but looks well from the end of the bed and hi…

EKG/ECG 52

EKG/ECG Wellness 52

Dr. Smith's ECG Blog

APRIL 9, 2024

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. How would you assess this ECG? Note: lead format is Cabrera I was sent this ECG in real time. The above ECG was recorded. The Queen of Hearts AI model for ECG interpretation is still in its early days.

EKG/ECG 91

EKG/ECG Wellness 91

Dr. Smith's ECG Blog

OCTOBER 3, 2024

Smith : "Gestalt, but if I must explain: well formed J-waves and high voltage R waves." Finally, Sam : "Honestly in addition to expert ECG interpretation I think skilled bedside echo can prevent a lot of these activations." 2) You need to be just as expert at echo as I am at the ECG. This usually indicates inferior OMI.

EKG/ECG 110

EKG/ECG Wellness 110

Dr. Smith's ECG Blog

MAY 23, 2023

EMS arrived and recorded this ECG: What do you think? See same ECG below with computer automated interpretation, using the Glasgow ECG algorithm which apparently is used by many different providers and devices Amazing that the computer calls this normal. Next day ECG. And yet it still says "normal". Learning Points: 1.

EKG/ECG 90

EKG/ECG Wellness Emergency Department EMS 90

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Here is his triage ECG: What do you think? What is the most likely cause of the patient’s ECG findings, and what would be your first step in management? What does the ECG show? What does the ECG show? Figure-1: The initial ECG in this case — and a rapid method for estimating the QTc ( See text ). Is it STEMI?

EKG/ECG 112

EKG/ECG Seizures Hospitals Stroke 112

Don't Forget the Bubbles

JULY 26, 2023

Add into this that the majority of children will be in normal sinus rhythm (NSR) by the time of assessment so to truly identify those who have something wrong we have to be confident in identifying arrhythmias where they are present and critical when analysing an ECG in NSR. All were examined and 98% had an ECG. Family history.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The ECG below was recorded and electronically transferred to our PCI center for evaluation. ECG #1 I think many providers might be reassured viewing this ECG. There is slight baseline wander on this ECG which does make the interpretation more challenging. This ECG was recorded roughly 3 minutes after the first ECG.

EKG/ECG 60

EKG/ECG EMS Wellness 60

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

Below is the presentation ECG At the time of recording the ECG the patient was complaining of chest discomfort 4/10. ECG#1 The ECG shows a wide complex QRS with LBBB type morphology. Below the ECG image quality is enhanced using the PM Cardio App. An ECG from three months prior was obtained. If yes, why?

EKG/ECG 101

EKG/ECG Wellness 101

Dr. Smith's ECG Blog

JANUARY 6, 2024

Written by Willy Frick I was reading ECGs in the queue, and the following tracing appeared. Although not necessarily intentional, the first processing that I do when I see an ECG is to categorize as OMI or not. Although not necessarily intentional, the first processing that I do when I see an ECG is to categorize as OMI or not.

EKG/ECG 90

EKG/ECG Wellness 90

Dr. Smith's ECG Blog

JULY 21, 2024

The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. This ECG does not have the typical ST-vector of an LAD occlusion. See below for Ken Grauer Comment on the initial ECG: == On arrival, another ECG was recorded: There appears to have been quite a bit of spontaneous reperfusion!

EKG/ECG 113

EKG/ECG Shock Hospitals Sepsis 113

Dr. Smith's ECG Blog

AUGUST 2, 2024

His ECG is shown below. The LCx and OM branches are not as well seen. How does RCA occlusion fit with the ECG? The answer is that the ECG really shows right ventricular OMI. Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain.

EKG/ECG 109

EKG/ECG Fluid Resuscitation Academics Resuscitation 109

EMergucate

AUGUST 13, 2019

She looked well from the end of the bed and at clinical exami… 61 years of age lady presented with an acute shortness of breath whilst walking her dog. She denied any chest pain nor any pre-syncope.

EKG/ECG 52

EKG/ECG Wellness EMS 52