Ken Grauer, MD

JUNE 27, 2024

The ECG in Figure-1 — was obtained from an older man with known coronary disease. He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today's case. (

EKG/ECG 404

EKG/ECG Poisoning Resuscitation 404

Ken Grauer, MD

SEPTEMBER 13, 2024

I was sent the ECG shown in Figure-1 — being told only that providers on the case suspected AFib ( A trial Fib rillation ) with RBBB ( R ight B undle B ranch B lock ) aberrancy. Figure-1: The initial ECG in today's case. ( Figure-1: The initial ECG in today's case. ( How certain are YOU of your answer?

EKG/ECG 248

EKG/ECG Wellness 248

Ken Grauer, MD

AUGUST 22, 2024

The ECG shown in Figure-1 — was obtained from an older man with “CP” ( C hest P ain ) for the past 2 days. QUESTIONS: How would YOU interpret this ECG? 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 257

EKG/ECG Wellness 257

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 381

EKG/ECG EMS Hospitals 381

Ken Grauer, MD

JULY 4, 2024

I was sent the ECG in Figure-1 — but 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 ). Take Another LOOK at the ECG in Figure-1. For more on the " Footprints " of Wenckebach — See ECG Blog #164.

EKG/ECG 389

EKG/ECG Wellness 389

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 412

EKG/ECG Hospitals 412

Ken Grauer, MD

APRIL 20, 2024

The ECG in Figure-1 — was obtained from a 70-ish year old man with episodic CP ( C hest P ain ) over the previous 2-3 days , being awakened from sleep now for a more severe CP episode. QUESTIONS: In view of this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case.

EKG/ECG 432

EKG/ECG Wellness 432

Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. ROSC ( R eturn O f S pontaneous C irculation ) was obtained — and ECG #1 was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab?

EKG/ECG 407

EKG/ECG Wellness Hospitals 407

Ken Grauer, MD

SEPTEMBER 21, 2024

The ECG in Figure-1 was obtained from a previously healthy man in his early 20s — who initially presented with GI symptoms, that then evolved into CP ( C hest P ain ). QUESTIONS: Given the above history — How would YOU interpret the initial ECG that is shown in Figure-1 ? Figure-1: The initial ECG in today's case. (

EKG/ECG 393

EKG/ECG Resuscitation Outcomes Hospitals 393

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 395

EKG/ECG Resuscitation EMS Wellness 395

Ken Grauer, MD

AUGUST 8, 2024

I was sent the ECG shown in Figure-1 — told only that that this middle-aged woman noted chest tightness and nausea an hour earlier. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? — IF told that this patient arrested shortly after ECG #1 — Does this change your interpretation? Intervals ( PR-QRS-QTc ) are normal.

EKG/ECG 412

EKG/ECG Resuscitation Wellness 412

Ken Grauer, MD

JUNE 7, 2024

The ECG in Figure-1 was obtained from a previously healthy older man — who presented to the ED ( E mergency D epartment ) with new but atypical CP ( C hest P ain ) for several hours. QUESTIONS: Given this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case. ( Which lead is the most concerning?

EKG/ECG 445

EKG/ECG Wellness 445

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 238

EKG/ECG 238

Ken Grauer, MD

FEBRUARY 23, 2024

The ECG in Figure-1 was obtained from a previously healthy man in his 40s — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ) that awakened him from sleep. ECG #1 was recorded ~90 minutes after the patient was awakened from sleep. Figure-1: The initial ECG in today's case. (

EKG/ECG 423

EKG/ECG Wellness 423

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 441

EKG/ECG Wellness 441

Ken Grauer, MD

JANUARY 13, 2024

The ECG in Figure-1 was obtained from a middle-aged man with known hypertension — who presented to the ED ( E mergency D epartment ) for CP ( C hest P ain ) over the preceding 2-3 days. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? The Initial ECG in Today’s CASE: The rhythm in ECG #1 is sinus at 65-70/minute.

EKG/ECG 400

EKG/ECG Hospitals 400

Dr. Smith's ECG Blog

DECEMBER 19, 2023

It appears EMS obtained two EKGs, but unfortunately these were not saved in the medical record. The EMS crew was only BLS certified, so EKG interpretation is not within their scope of practice. The patient arrived just after 10 AM, and the following EKG was obtained. There are no further EKGs or troponin measurements.

EKG/ECG 121

EKG/ECG EMS Wellness Operations 121

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 363

EKG/ECG Wellness 363

Ken Grauer, MD

APRIL 5, 2024

The ECG in Figure-1 was obtained from a middle-aged woman — who presented with low back pain, shortness of breath and marked hypertension — but no CP ( C hest P ain ). QUESTIONS: In view of this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case. Figure-1: The initial ECG in today's case.

EKG/ECG 238

EKG/ECG EMS Hospitals 238

Ken Grauer, MD

MARCH 15, 2024

What if you were asked to 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 ). By the P s, Q s, 3 R Approach ( which I review in ECG Blog #185 ): Lots of P waves are present — being well seen in the long lead II rhythm strip.

EKG/ECG 403

EKG/ECG Wellness 403

Ken Grauer, MD

AUGUST 26, 2023

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. In view of this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case. (

EKG/ECG 363

EKG/ECG EMS Hospitals 363

Ken Grauer, MD

SEPTEMBER 6, 2024

You are shown the ECG in Figure-1 — told only that the patient had a “continuous" tachycardia. QUESTIONS: 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 differential diagnosis?

EKG/ECG 248

EKG/ECG Administration Wellness Operations 248

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

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

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 109

EKG/ECG Hospitals Wellness 109

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

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

A triage ECG was recorded: Smith : there is widespread artifact, except in lead III. Since lead III is not artifactual, one can deduce that t he artifact is caused by movement of the right arm electrode, so that electrode should be moved and the ECG re-recorded. But, in this patient with CP — ECG #1 needs to be immediately repeated!

EKG/ECG 63

EKG/ECG 63

Ken Grauer, MD

APRIL 29, 2023

The patient whose initial ECG is shown in Figure-1 — is a middle-aged man who presented to the ED ( E mergency D epartment ) for new-onset CP ( C hest P ain ). QUESTIONS: In view of the above history — How would YOU interpret the initial ECG? WHY is it important to correlate severity of this patient’s CP with 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

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

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

JULY 22, 2023

The ECG in Figure-1 was obtained from an elderly man with a history of coronary disease — who contacted EMS for "burning" chest discomfort that woke him at 3am. Some amount of time passed at home — during which his chest discomfort persisted The patient was hemodynamically stable at the time he was seen by EMS, when ECG #1 was recorded.

EKG/ECG 195

EKG/ECG Burns EMS 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

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

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

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