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ECG Blog #462 — Why so Slow. ?

Ken Grauer, MD

As always I favor the P s , Q s , 3 R Approach ( See ECG Blog #185 ): Starting with the long lead II ( at the bottom of todays tracing in Figure-1 ) the ventricular rhythm is slow but R egular ( ie, with a constant R-R interval of just over 8 large boxes in duration corresponding to a ventricular R ate just under 40/minute).

Blog 167
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ECG Blog #435 — Did Cath Show Acute Ischemia?

Ken Grauer, MD

And as per ECG Blog #350 — this could represent Wellens ' Syndrome IF this chest lead T wave inversion was new and occurred in a patient who initially had a normal ECG, and then had an episode of transient CP that had resolved at the time this ECG with chest lead T wave inversion was recorded.

Blog 170
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ECG Blog #436 — Bigeminy or Alternans?

Ken Grauer, MD

As discussed in ECG Blog #231 — Bidirectional VT is a special form of VT, in which there is beat-to-beat alternation of the QRS axis. See My Comment in the June 1, 2020 post in Dr. Smith's ECG Blog — for review of Pleomorphic VT. Multifocal vs Polymorphic VT — September 23, 2011 post from Dr. S.

Blog 159
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ECG Blog #411 — Is it Wenckebach?

Ken Grauer, MD

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 174
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ECG Blog #396 — Why the Flat Line?

Ken Grauer, MD

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 175
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ECG Blog #418 — A Single Lead Tells the Tale.

Ken Grauer, MD

Regarding ST-T Wave Changes in Figure-2: As per the title of today's ECG Blog — one KEY lead "tells the tale". 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 #294 — Reviews how to tell IF the " culprit " artery has reperfused.

Blog 167
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ECG Blog #410 — How Tall are the T Waves?

Ken Grauer, MD

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 170