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. ECG Blog #205 = The Systematic Approach I favor. Below are slides used in my video presentation.

Blog 142

Blog STEMI Ischemia 142

Ken Grauer, MD

MARCH 1, 2024

PEARL # 2: As described in ECG Blog #394 — QRS widening in the presence of sinus rhythm, in which QRS morphology is consistent with RBBB conduction in the chest leads — but LBBB conduction in the limb leads ( especially with a leftward axis ) — suggests the entity known as MBBB ( M asquerading B undle B ranch B lock ).

Blog 182

Blog Pacemaker Chest Pain Heart Disease 182

Ken Grauer, MD

APRIL 13, 2024

NOTE: For more on ECG recognition of RVH and/or pulmonary hypertension ( re the qR pattern in lead V1 ) — See ECG Blog #234 and Blog #248. This could have been an optimal time to try a Lewis Lead — which sometimes reveals atrial activity not evident with standard lead placement ( See ECG Blog #223 ).

Blog 118

Blog Tachycardia Pulmonary Arrhythmia 118

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 176

Blog Tachycardia Arrhythmia 176

Ken Grauer, MD

APRIL 26, 2024

An example of a case in which the diagnosis of acute OMI was made purely by assessment of ST-T wave morphology in a PVC can be found HERE ( See My Comment at the bottom of this page in the October 8, 2018 post in Dr. Smith's ECG Blog ). = ECG Blog #294 — Reviews how to tell IF the " culprit " artery has reperfused.

Blog 130

Blog STEMI Aneurysm AFIB 130

Ken Grauer, MD

FEBRUARY 3, 2024

As discussed in detail in ECG Blog #228 — this seemingly qualifies as a “ Silent ” MI ( Approximately half of those MIs not accompanied by CP — have some other associated symptom such as syncope, which substitutes as a “chest pain equivalent” ). ECG Blog #218 — Reviews HOW to define a T wave as being H yperacute ? What is T-QRS-D?

Blog 151

Blog Cardiac Arrest STEMI Plaque 151

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 123

Blog STEMI Ischemia Chest Pain 123

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

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

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 148

Blog Cardiac Arrest Ischemia Hospital 148

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 125

Blog Chest Pain Ischemia STEMI 125

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 146

Blog AFIB Tachycardia Arrhythmia 146

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 99

Blog Download Arrhythmia 99

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 99

Blog Chest Pain Ischemia STEMI 99

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 118

Blog Pacemaker Heart Disease Research 118

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 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 99

Blog Download Arrhythmia Pacemaker 99

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 115

Blog Arrhythmia Heart Disease 115

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