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

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 75

EKG/ECG Operations Ultrasounds Wellness 75

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

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

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 138

EKG/ECG Emergency Department Shock Ultrasounds 138

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

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 113

EKG/ECG Hospitals Emergency Department Outcomes 113

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

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

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 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 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

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

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 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

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

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

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

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 99

EKG/ECG Wellness Operations Emergency Department 99

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

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 127

EKG/ECG EMS Ultrasounds Wellness 127

Ken Grauer, MD

APRIL 23, 2023

The 12-lead ECG and long lead rhythm strip in Figure-1 — was obtained from a previously healthy 15-year old male , who presented with fever and diarrhea. How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case — obtained from a 15-year old male with fever and diarrhea. No chest pain.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 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

Ken Grauer, MD

JUNE 2, 2023

speed that many of us are used to ) — BUT — that the width of each large box on the ECG grid paper has been reduced by 50% ( so that each small rectangular box on this ECG grid paper still represents 200 msec. = 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

Dr. Smith's ECG Blog

JANUARY 27, 2024

Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal? What do you think?

EKG/ECG 107

EKG/ECG Emergency Department Outcomes Documentation/Coding 107

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 90

EKG/ECG Wellness Hospitals EMS 90

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 115

EKG/ECG Documentation/Coding Wellness Resuscitation 115

Dr. Smith's ECG Blog

SEPTEMBER 15, 2023

I said, "Cool, can I see the ECG?' So he showed me the ECG recorded in triage: What did I say? Then he said: "No wonder the next EKG we recorded just before she left for the cath lab was normal." I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" That is not a STEMI. He said: "What?

EKG/ECG 132

EKG/ECG Wellness 132

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 135

Hyperthermia / Hypothermia EKG/ECG Wellness 135

Dr. Smith's ECG Blog

DECEMBER 13, 2023

This is the result for this ECG, from MDcalc.com : The most accurate cutpoint is 18.2. And she learned it well: She is not highly confident, but she does diagnose OMI. Here is a similar case from Pendell: This ECG was handed over at triage. A value above 18.2 (LAD A value above 19 is about 97% specific for LAD OMI.

EKG/ECG 117

EKG/ECG COPD Wellness Outcomes 117

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you manage the patient? The Need for Immediate Transport?

EKG/ECG 129

EKG/ECG Emergency Department Wellness 129

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. He had a previous ECG on file: Proving the findings are new The cath lab was activated. Another ECG was recorded after the nitroglycerine and now without pain: All findings are resolved. No other symptoms.

EKG/ECG 119

EKG/ECG Ultrasounds Documentation/Coding Wellness 119

Dr. Smith's ECG Blog

NOVEMBER 27, 2023

Below is old and then new ECG (old on top; new below). Both ECGs have normal sinus rhythm, normal conduction and normal voltages. Because of the ECG changes in a patient with chest pain, and with inferolateral hypokinesis on POCUS, the cath lab was activated. What do you think? But do they represent acute coronary occlusion?

EKG/ECG 93

EKG/ECG Documentation/Coding Wellness 93

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

An ECG was recorded immediately and is shown below. How do you interpret the ECG? ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm. After cardioversion, if successful, you can take a few moments to assess the 12-lead in more detail and assess the post conversion ECG. ECG#2 What do you think?

EKG/ECG 130

EKG/ECG Resuscitation Academics EMS 130

ALiEM

NOVEMBER 6, 2023

Wolf-Parkison-White Syndrome (WPW) Case Question: What are the characteristic ECG findings of this condition and how is this condition managed? These particular EKG findings define a “Wolff-Parkinson-White Pattern.” WPW Syndrome consists of characteristic EKG findings as well as symptomatic arrhythmias. doi: 10.1111/j.1542-474X.2006.00127.x.

EKG/ECG 78

EKG/ECG Academics Outcomes Wellness 78

Dr. Smith's ECG Blog

JANUARY 5, 2024

The following ECG was obtained. ECG 1 What do you think? The ECG shows sinus bradycardia but is otherwise normal. There is TWI in lead III, but this can be seen in normal ECGs. The following ECG was obtained around midnight. The machine read was "Normal sinus rhythm, normal ECG." ECG 2 What do you think?

EKG/ECG 111

EKG/ECG Burns Urgent Care Documentation/Coding 111

Dr. Smith's ECG Blog

JANUARY 8, 2024

I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information: What do you think? Since that moment, she had had shortness of breath as well as pressure-like chest pain. Patient was given aspirin, sublingual nitro as well as heparin. She also has had some coughing at night.

EKG/ECG 71

EKG/ECG Resuscitation Hospitals EMS 71