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: Use of the "3 Simple Rules" for distinction between SVT vs VT ( taken from ECG Blog #196 ).

Blog 177

Blog Tachycardia Arrhythmia 177

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. ECG Blog #387 — Dynamic change in 2 minutes.

Blog 126

Blog STEMI Ischemia Chest Pain 126

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 ).

Blog 165

Blog Download Arrhythmia 165

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. Related ECG Blog Posts to Today’s Case: ECG Blog #205 — Reviews my Systematic Approach to 12-lead ECG Interpretation.

Blog 134

Blog Chest Pain STEMI Ischemia 134

Ken Grauer, MD

DECEMBER 29, 2023

As discussed in ECG Blog #364 and ECG Blog #265 — We are looking at " Shark Fin " ST elevation! Alternatively — the shape of the ST elevation in lead V2 might also be consistent with a component of Brugada Phenocopy ( See ECG Blog #238 ). ECG Blog #265 and ECG Blog #364 — Review cases of Shark-Fin ST Elevation.

Blog 149

Blog Cardiac Arrest Ischemia Hospital 149

Ken Grauer, MD

SEPTEMBER 22, 2023

KEY Point: Although true that patients with longstanding, severe pulmonary disease may manifest a QRST complex in standard lead I with marked overall reduction in QRST amplitude ( See ECG Blog #65 — regarding Schamroth’s Sign ) — you should never normally see a completely flat line in any of the standard limb leads.

Blog 163

Blog Chest Pain Bradycardia Physiology 163

Ken Grauer, MD

MAY 20, 2023

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 ). In the October 15, 2022 post of Dr. Smith's ECG Blog — Drs. I've reviewed my approach to the ECG diagnosis of LVH ofte n ( See ECG Blog #245 — among many other posts ).

Blog 131

Blog Chest Pain Ischemia STEMI 131

Ken Grauer, MD

NOVEMBER 4, 2023

ECG Blog #240 — reviews my approach to the ECG assessment of regular SVT rhythms. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

Blog 148

Blog AFIB Tachycardia Arrhythmia 148

Ken Grauer, MD

NOVEMBER 18, 2023

For full discussion of this case — See ECG Blog #344 — == How would YOU interpret the lead II rhythm strip shown in Figure-1 ? ECG Blog #188 — Reviews how to read and draw L addergrams ( with LINKS to more than 50 laddergram cases — many with step-by-step sequential illustration ). Or — Is it “ something else ”?

Blog 95

Blog Download Arrhythmia 95

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

Blog 95

Blog Chest Pain Ischemia STEMI 95

Ken Grauer, MD

OCTOBER 29, 2023

Based on ECG Blog #351 ( www.tinyurl.com/KG-Blog-351 ) LINK to this Page — www. tinyurl.com/KG-MedAll-351 — = = ECG Blog #205 = The Systematic Approach I favor. The "formula" = [link] LINK for Blog #205 = [link] - = Figure: The Systematic Approach that I favor. The talk will be recorded and posted on-line.

Blog 78

Blog Chest Pain STEMI 78

Ken Grauer, MD

SEPTEMBER 8, 2023

I review my user-friendly approach to the ECG diagnosis of the Bundle Branch Blocks in ECG Blog #282 — and to Hemiblocks and Bifascicular Blocks in ECG Blog #203. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. . = What is M BBB? (

Blog 113

Blog Pacemaker Heart Disease Research 113

Ken Grauer, MD

SEPTEMBER 29, 2023

To do this — I apply the P s, Q s, 3 R Approach ( See ECG Blog #185 — for review of my system ). PEARL # 2: The most common cause of a pause in an otherwise regular rhythm — is a blocked PAC ( See ECG Blog #66 and ECG Blog #147 ). ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

Blog 95

Blog Download Arrhythmia Pacemaker 95

Ken Grauer, MD

SEPTEMBER 1, 2023

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. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

Blog 111

Blog Arrhythmia Heart Disease 111

Ken Grauer, MD

FEBRUARY 4, 2023

PEARL # 1: As emphasized in many other blog posts ( ie, ECG Blog #220 and Blog #196 , to name just 2 ) — the differential diagnosis of a regular WCT rhythm without clear sign of atrial activity should be assumed to be VT ( V entricular T achycardia ) until proven otherwise.

Blog 78

Blog Arrhythmia Heart Disease 78

Ken Grauer, MD

JULY 9, 2023

By the P s , Q s , 3 R Approach ( See ECG Blog #185 ): The rhythm in Figure-1 is clearly not R egular. PEARL #2: As cited in ECG Blog #252 — my favorite truism in arrhythmia interpretation is, "The commonest cause of a pause is a blocked PAC". ECG Blog #185 — Review of the P s, Q s, 3 R Approach for systematic rhythm interpretation.

Blog 78

Blog Cardiac Arrest Pulmonary AFIB 78

Ken Grauer, MD

MAY 26, 2023

. = = R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #185 — Review of the P s, Q s, 3 R Approach for systematic rhythm interpretation. ECG Blog #271 — Reviews the concept of diffuse Subendocardial Ischemia. ECG Blog #316 — The patient died.

Blog 78

Blog Ischemia STEMI Cardiac Arrest 78

Ken Grauer, MD

MARCH 29, 2023

M Y T houghts on the ECG in Figure-1: I have presented similar ECGs to the one in today's tracing on several occasions ( most recently in ECG Blog #284 ). Discussion of the pros and cons of these various agents extends beyond the scope of this ECG Blog. I have synthesized what I find the BEST from these programs in my ECG Blog #76.

Blog 78

Blog AFIB Arrhythmia Download 78

Ken Grauer, MD

MARCH 18, 2023

FOR O ther E xamples of Acute RV MI: Discussion of the 12-lead ECG in Blog #187 — See Figure-4 in ECG Blog #80 ( More on the "culprit" artery in this post ) — See ECG Blog #141 — Figure-5 ( together with Figure-6 ): Reviews the ECG Essentials of RV MI ( Excerpted from my ECG-2014-ePub ).

Blog 78

Blog Chest Pain STEMI Ischemia 78

Ken Grauer, MD

AUGUST 11, 2023

To do this — I apply the P s, Q s, 3 R Approach ( See ECG Blog #185 — for review of my system ). R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

Blog 78

Blog Arrhythmia 78

Ken Grauer, MD

APRIL 18, 2023

MY Thoughts on the ECG in Figure-1: As always — I like to start my interpretation of 12-lead ECGs with assessment of the rhythm ( as per my systematic approach in ECG Blog-205 ). R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

Blog 78

Blog STEMI Chest Pain Physiology 78

Ken Grauer, MD

JULY 15, 2023

By the P s, Q s, 3 R Approach ( as reviewed in ECG Blog #185 ): The Q RS complex is obviously wide. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #185 — Systematic P s, Q s, 3 R Approach to Rhythm Interpretation. I do not see P waves.

Blog 78

Blog Coronary Angiogram Cardiomyopathy Ischemia 78

Ken Grauer, MD

MARCH 7, 2023

R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #193 — illustrates use of the M irror T est to facilitate recognition of acute Posterior MI. ECG Blog #294 — How to tell IF the "culprit" artery has reperfused.

Blog 78

Blog Chest Pain STEMI Ischemia 78

Ken Grauer, MD

MARCH 23, 2023

With experience, applying the P s, Q s, 3 R Approach ( See ECG Blog #185 ) — to formulate the above steps in our initial assessment of the rhythm in Figure-1 can ( should ) be completed in less than 30 seconds! These are reviewed in ECG Blog #343. I reviewed the concept of Echo beats in ECG Blog #239.

Blog 78

Blog Tachycardia Arrhythmia Atrial Flutter 78

Ken Grauer, MD

FEBRUARY 28, 2023

By the P s, Q s, 3 R Approach ( See ECG Blog #185 ): Regarding R egularity — the rhythm is irregularly irregular. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #185 — Review of the P s, Q s, 3 R Approach for systematic rhythm interpretation.

Blog 78

Blog COVID-19 AFIB Pulmonary 78

Ken Grauer, MD

JANUARY 31, 2023

There are 2 “eye-catching” features on the ECG in Figure-1 : Diffuse L ow V oltage : As discussed in detail in ECG Blog #272 — a series of clinical conditions have been associated with low voltage on ECG. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

Blog 78

Blog Cancer Tachycardia 78

Ken Grauer, MD

APRIL 9, 2023

The Long Lead II Rhythm Strip: As always — I favor a systematic approach to rhythm interpretation, using the P s, Q s, 3 R memory aid ( See ECG Blog #185 ). As I have often emphasized — it takes a little time to get good at drawing laddergrams ( See ECG Blog #188 ). ECG Blog #108 — Reviews the concept of AIVR.

Blog 78

Blog Chest Pain Arrhythmia Cardiac Arrest 78

Ken Grauer, MD

FEBRUARY 13, 2023

Contrast today's rhythm with true ventricular bigeminy — that was seen in ECG Blog #343 ). Contrast today's rhythm with true alternating bundle branch block — that was seen in ECG Blog #306 ). R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

Blog 78

Blog Arrhythmia Exercise Chest Pain 78

Ken Grauer, MD

MAY 6, 2023

For those interested in practice reading and/or learning to draw laddergrams — there are more than 80 practice examples on my ECG Blog #188 ). R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. ECG Blog #68 and ECG Blog #359 — Review of interpolated PVCs.

Blog 78

Blog Chest Pain Arrhythmia 78

Ken Grauer, MD

FEBRUARY 24, 2023

See ECG Blog #215 — for more on the Cabrera format. = For more on “My Take” regarding the ECG entity of Repolarization Variants — Please check out My Comment at the bottom of the page in the May 23, 2022 post in Dr. Smith’s ECG Blog. ECG Blog #114 — Reviews another case using the Cabrera format. In contrast, the standard U.S.

Pericarditis 78

Pericarditis Blog Chest Pain Coronary Angiogram 78

Ken Grauer, MD

JUNE 2, 2023

PEARL # 6: As I discuss in my review of SSS ( See ECG Blog #342 for details ) — establishing a diagnosis that sinus bradycardia indicates SSS — will depend on the following: Finding out the age of the patient ( ie, SSS is most common in older individuals ) — and learning whether the patient has been symptomatic? . =

Blog 78

Blog Bradycardia Arrhythmia Tachycardia 78

Ken Grauer, MD

JANUARY 26, 2023

Keeping in mind the P s, Q s & 3 R Approach to rhythm interpretation ( as per ECG Blog #185 ): The overall rhythm in the long lead II rhythm strip shown in Figure-1 is not regular! NOTE: We encountered a similar type of recording system for the case presented in ECG Blog #357 ).

Blog 78

Blog Chest Pain STEMI Arrhythmia 78

Ken Grauer, MD

FEBRUARY 8, 2023

MY Approach to the Rhythm in Figure-1: As always — I favor a systematic approach to rhythm interpretation — with use of the P s, Q s, 3 R Memory Aid ( See ECG Blog #185 for more on the Ps, Qs, 3Rs ). PEARL # 2: As emphasized often in this ECG Blog — there are 3 Causes of AV dissociation. How would YOU interpret these rhythms?

Blog 78

Blog Pacemaker Arrhythmia Hospital 78

Ken Grauer, MD

FEBRUARY 18, 2023

For more on "Shark Fin" ST elevation — See the Audio Pearl in the ADDENDUM below — as well as ECG Blog #265 for an example of a case with even more dramatic "shark fin" ST elevation ). Additional Relevant ECG Blog Posts to Today’s Case: ECG Blog #185 — Reviews my System for Rhythm Interpretation , us ing the P s, Q s & 3 R Approach.

Blog 78

Blog AFIB Chest Pain STEMI 78

ECG Cases

JANUARY 2, 2023

The post Top 10 of 2022 – EM Cases Podcasts & Blogs Highlights of the Year appeared first on Emergency Medicine Cases. Based on a blend of number of listens, feedback from listeners, website visits and my personal faves, here is EM Cases Top 10 of 2022.

Blog 52

Blog Cardiogenic Shock Stroke Strokes 52

Ken Grauer, MD

MARCH 15, 2024

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. This slight variation in sinus P wave regularity tends to be greater when a 2nd- or 3rd-degree AV block is present ( called ventriculophasic sinus arrhythmia — as shown in ECG Blog #344 ).

Blog 153

Blog Arrhythmia STEMI Ischemia 153

Ken Grauer, MD

JANUARY 5, 2024

Regarding the 1 2- L ead E CG: Applying the systematic approach I favor for 12-lead ECG interpretation ( as detailed in ECG Blog #205 ): Rate & Rhythm: As stated above — there is a regular, supraventricular rhythm with some P waves, group beating, and an acceptable overall ventricular rate between ~60-80/minute. I begin with Figure-5.

Blog 161

Blog Chest Pain Arrhythmia 161