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 397

EKG/ECG Hospitals 397

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

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 412

EKG/ECG 412

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

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 387

EKG/ECG 387

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 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 262

EKG/ECG Shock Wellness 262

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 262

EKG/ECG Operations Wellness 262

Ken Grauer, MD

MAY 11, 2024

The 12-lead ECG and long lead II rhythms shown in Figure-1 — was obtained from an older man with a recent history of “easy fatiguability” and a presyncopal episode. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case. I outline my approach for doing so below.

EKG/ECG 270

EKG/ECG 270

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 129

EKG/ECG Hospitals Wellness Emergency Department 129

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 236

EKG/ECG Shock Hospitals 236

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 236

EKG/ECG EMS Hospitals 236

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 245

EKG/ECG Shock Wellness 245

Ken Grauer, MD

JANUARY 26, 2024

I was sent the ECG in Figure-1 — 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 ). By the Ps, Qs, 3R Approach ( which I review in ECG Blog #185 ): P waves are present — and best seen in lead V1.

EKG/ECG 262

EKG/ECG 262

American Medical Compliance

DECEMBER 13, 2024

Electrocardiograms (EKGs) are at the top of modern healthcare as indispensable diagnostic tools for identifying arrhythmias, heart attacks, and other cardiac disorders. In this blog, we delve into the power of EKG training, the essential skills healthcare professionals need, and strategies to excel in using this life-saving technology.

EKG/ECG 105

EKG/ECG Outcomes Operations Wellness 105

Ken Grauer, MD

JULY 18, 2024

PEARL # 4: The combination of group beating — with an underlying regular atrial rhythm in which some ( but not all ) P waves are conducting — should immediately suggest the possibility of AV Wenckebach ( especially IF the 12-lead ECG suggests recent or acute inferior and/or infero-postero infarction ). Figure-4: I needed to draw a laddergram.

EKG/ECG 216

EKG/ECG Wellness 216

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

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 89

EKG/ECG 89

Dr. Smith's ECG Blog

MAY 5, 2024

An undergraduate (not yet in medical school) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly arrived at work and happened to glance down and see this previously recorded ECG on a table in the ED. It was recorded at 0530: What do you think?

EKG/ECG 127

EKG/ECG Wellness 127

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 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

JUNE 6, 2023

== P lease N OTE : After today — No new ECG Blog posts for 2- to -3 weeks. — I will also not be prompt in replying to emails. == All material on this ECG Blog site remains open! So IF you are looking for ECG material — There is plenty on this web site! Figure-1: The initial ECG in today's case. I'll be back! —

EKG/ECG 195

EKG/ECG Hospitals Resuscitation 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

JULY 11, 2024

This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. How is it possible that a kid who has not even started medical school can know so much about EKGs and cardiology? He had an EKG taken at the clinic: What do you think? Normal EKG”. Normal ECG.

EKG/ECG 116

EKG/ECG Outcomes Hospitals Wellness 116

Ken Grauer, MD

MAY 26, 2023

The ECG in Figure-1 was obtained from a 60-ish year old man with a history of coronary disease ( including prior CABG ) — who presented to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) of 3 hours duration , diaphoresis and nausea/vomiting. The patient was hypotensive at the time his initial ECG in Figure-1 was obtained.

EKG/ECG 195

EKG/ECG Resuscitation Wellness 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

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

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

Ken Grauer, MD

APRIL 14, 2023

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1 ? Figure-1: The ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Wellness Hospitals 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

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 123

EKG/ECG Hospitals Emergency Department Outcomes 123

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 Operations Wellness Hospitals 195

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 119

EKG/ECG Hospitals Wellness 119

Dr. Smith's ECG Blog

OCTOBER 8, 2024

The first EKG is from 2:30 PM on the day of presentation to the ER. My eyes would bulge within a second of viewing this ECG. I texted this to our group "EKG Nerdz," asking "Do you think that anyone could miss this?" No repeat ECG was recorded. The EKG was not repeated until 7 AM the next morning, about 16 hours later.

EKG/ECG 126

EKG/ECG Documentation/Coding Shock Resuscitation 126

EMDocs

OCTOBER 2, 2024

When you are presented with a tachycardic ECG, there are two major factors we want you to focus on right away. This ECG comes from a 22-year-old female presenting with palpitations. Take a look at her ECG: What do you notice about this ECG? Take a look at his ECG: What do you notice about this ECG?

EKG/ECG 103

EKG/ECG EMS Emergency Department 103

Dr. Smith's ECG Blog

DECEMBER 7, 2023

No EKG arrived with the transfer packet, so I ordered a STAT EKG and went bedside to see her. I walked into the room to see the following EKG before I had the chance to ask any questions. EKG 1 What do you think? We would have taught her "acute reperfused" for this ECG. The angiography fits perfectly with the EKG.

EKG/ECG 127

EKG/ECG Poisoning Hospitals 127