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 119

EKG/ECG EMS Wellness Operations 119

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

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 438

EKG/ECG Resuscitation Hospitals Wellness 438

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

ECG 1 What do you think? Benign T-wave Inversion -- Countless Examples (1) The Queen of Hearts Active OMI model (aOMI) is shown below: Willy : My initial impression looking at this ECG was that it was not ischemic. He concluded by saying that "History and concern should win regardless of EKG." It is imperfect.

EKG/ECG 91

EKG/ECG Operations Ultrasounds Wellness 91

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

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

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 411

EKG/ECG Resuscitation Hospitals Wellness 411

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. If this EKG were handed to you to screen from triage without any clinical information, what would you think? Do you appreciate any dynamic changes compared to the patient’s prior EKG? What do you think? In fact, Kosuge et al.

EKG/ECG 137

EKG/ECG Emergency Department Shock Ultrasounds 137

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

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

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 400

EKG/ECG 400

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

ACEP Now

AUGUST 12, 2024

The patient had an EKG performed within 10 minutes of arrival while in triage (see Figure 1). In the absence of significant ST elevations, the EKG was signed and the patient was placed back in the queue to await a bed. FIGURE 1: First ED EKG. Given his EKG findings and presentation, he was started on heparin and admitted.

EKG/ECG 52

EKG/ECG Emergency Department Hospitals 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. He was admitted to the hospital for evaluation of these symptoms — but no ECG was done at that time. This EKG is very subtle, but it is diagnostic of LAD occlusion. The Queen of Hearts does not see the hyperacute T waves.

EKG/ECG 108

EKG/ECG Hospitals Emergency Department Outcomes 108

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

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

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 289

EKG/ECG Administration 289

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 248

EKG/ECG 248

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

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 257

EKG/ECG Resuscitation Hospitals Wellness 257

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

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

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

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

DECEMBER 11, 2023

Willy is a cardiology fellow with a keen interest in the ECG in OMI. If an immediate EKG was obtained, it was not saved in the medical record. The first available EKG was recorded just after midnight, presumably around the time the result of the troponin came to clinical attention. The patient said, "I just don't feel good."

EKG/ECG 121

EKG/ECG Outcomes Academics Documentation/Coding 121

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

Ken Grauer, MD

AUGUST 4, 2023

MY Approach to the Rhythm in Figure-1: As per ECG Blog #185 — I favor the P s, Q s, 3 R Approach for interpretation of the cardiac rhythm — beginning with whichever of these 5 KEY Parameters is easiest to assess for the tracing in front of me: At least in the single lead II rhythm strip seen in Figure-1 — The Q RS complex appears to be narrow.

EKG/ECG 370

EKG/ECG Academics Resuscitation Wellness 370

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 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 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

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

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

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 126

EKG/ECG EMS Ultrasounds Wellness 126

EMergucate

JANUARY 30, 2023

ECG of the Week 25th January 2023 – Interpretation When examining ECGs, in addition to taking into account the clinical … Continue reading →

EKG/ECG 52

EKG/ECG EMS 52

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