Ken Grauer, MD

NOVEMBER 9, 2024

I was asked to interpret the ECG in Figure-1 — told only that this 30-ish year old man had a history of having undergone a number of operations for CHD ( C ongenital H eart D isease ) as a child. Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 257

EKG/ECG Operations 257

Dr. Smith's ECG Blog

MAY 20, 2024

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. The undergraduate's analysis: This EKG shows J point elevation of about 0.5-1 Edited by Smith He also sent me this great case.

EKG/ECG 122

EKG/ECG Hospitals Wellness Emergency Department 122

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

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

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

OCTOBER 25, 2024

The ECG in Figure-1 was obtained from a middle-aged man who presented with a 2 week history of progressively increasing CP ( C hest P ain ) with exertion. He had his most severe episode of CP the day before he was seen with this ECG. An initial Troponin drawn less than 1 hour after the ECG in Figure-1 was recorded was over 10,000.

EKG/ECG 238

EKG/ECG Shock Hospitals 238

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

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

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

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

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 118

EKG/ECG EMS Wellness Operations 118

Ken Grauer, MD

OCTOBER 19, 2024

The patient whose ECG is shown in Figure-1 — presented with acute dyspnea and hypotension. Figure-1: The initial ECG in today's case. ( I have previously reviewed a number of cases of "Shark Fin" morphology ( Se e ECG Blog #364 — Blog #410 — Blog #265 — among others ). Figure-2: I've labeled the initial ECG in today's case.

EKG/ECG 282

EKG/ECG Shock 282

Ken Grauer, MD

NOVEMBER 1, 2024

I was sent this ECG recording — and asked for my interpretation of the rhythm 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. ( I had little clinical information. r Rhythm Interpretation.

EKG/ECG 248

EKG/ECG 248

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

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 5, 2024

Figure-1: The initial ECG in today's case. KEY Clinical Point: If I was the medical provider charged with the care of the patient whose ECG is shown in Figure-1 — I would approach this tracing in the following sequential stages: I’d first establish that the patient was hemodnamically stable with this ECG and this cardiac rhythm.

EKG/ECG 445

EKG/ECG Wellness 445

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

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

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

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

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 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

American Medical Compliance

AUGUST 15, 2024

Electrocardiography (EKG) is a fundamental skill for healthcare professionals, playing a crucial role in diagnosing and monitoring a wide range of cardiovascular conditions. Mastering EKG interpretation is essential for delivering accurate, timely patient care.

EKG/ECG 52

EKG/ECG 52

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

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

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

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

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

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

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

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 72

EKG/ECG Operations Ultrasounds Wellness 72

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

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

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

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