Ken Grauer, MD

JUNE 22, 2024

The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. Although CP ( C hest P ain ) was not a prominent symptom — ACS ( A cute C oronary S yndrome ) was suspected from the chest lead T wave inversion seen on this ECG. WHY — or Why Not?

EKG/ECG 433

EKG/ECG Stroke Documentation/Coding Wellness 433

Ken Grauer, MD

MAY 28, 2024

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS".

EKG/ECG 367

EKG/ECG Wellness 367

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

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

AUGUST 29, 2024

The ECG in Figure-1 was obtained from an 80-year old woman — who presented to the ED ( E mergency D epartment ) — with a several hour history of "palpitations" and CP ( C hest P ain ). She was hemodynamically stable at the time ECG #1 was recorded. Figure-1: The initial ECG in today's case. ( How certain are you of your answer?

EKG/ECG 392

EKG/ECG Hospitals Wellness 392

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

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 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 446

EKG/ECG Wellness 446

Ken Grauer, MD

MAY 31, 2024

I was sent the ECG in Figure-1 — without the benefit of any history. Figure-1: I was sent this ECG without any history. MY Thoughts on Today’s CASE: As tempting as it might be to reach for the defibrillator on seeing the ECG shown in Figure-1 — My initial reaction was different. Is this VT? Is this VT? What to do next ?

Shock 414

Shock EKG/ECG Seizures 414

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 483

EKG/ECG Emergency Department 483

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

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

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 418

EKG/ECG EMS Wellness 418

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

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

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 16, 2024

The ECG in Figure-1 was obtained from a man in his 40s — who presented to the ED ( E mergency D epartment ) because of CP ( C hest P ain ) and shortness of breath. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1 ? Based on the history and the patient's initial ECG — the cath lab was activated.

EKG/ECG 394

EKG/ECG Wellness Shock 394

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

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 440

EKG/ECG 440

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 422

EKG/ECG Wellness 422

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 342

EKG/ECG Wellness 342

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

MARCH 11, 2024

By the P s, Q s & 3 R Approach ( which I review on ECG Blog #185 ): The R ate of the rhythm in Figure-1 is somewhat fast — averaging ~100/minute ( ie, with an R-R interval close to 3 large boxes in duration for most of the tracing ). PEARL # 2: We only see 2 of the 12 leads of an ECG in Figure-1.

EKG/ECG 389

EKG/ECG 389

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

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

OCTOBER 6, 2023

The ECG in Figure-1 was obtained from a middle-aged woman who presented with "palpitations". Examples of conditions notorious for producing arrhythmias that "do not obey the rules" include: i ) Hyperkalemia ( See ECG Blog #275 ) ; ii ) Cardiac arrest ; and , iii ) Vagotonic Block ( See ECG Blog #61 ).

EKG/ECG 416

EKG/ECG 416

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

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

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

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

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 317

EKG/ECG Resuscitation Wellness 317

Ken Grauer, MD

APRIL 13, 2024

I was sent the ECG in Figure-1 — told only that the patient was 70 years old, and had a history of an ASD ( A trial S eptal D efect ). The patient was hemodynamically stable with ECG #1. Figure-1: The initial ECG in today's case. Serum K+ was normal. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Are there P waves?

EKG/ECG 296

EKG/ECG Wellness 296

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

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 302

EKG/ECG Resuscitation Outcomes Hospitals 302

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

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 296

EKG/ECG Research 296

Ken Grauer, MD

SEPTEMBER 28, 2024

The ECG in Figure-1 — was obtained from a 45-year old man with diabetes, who was being treated for septic shock. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today's case. What is the rhythm? Why does QRS morphology in the long lead II rhythm strip change every-other-beat?

EKG/ECG 266

EKG/ECG Shock Wellness 266