Ken Grauer, MD

FEBRUARY 18, 2023

The presenting complaint was chest pain — and the patient collapsed soon after arrival in the ED. These findings suggest that instead of VT — the rhythm in Figure-1 is AFib with a fairly rapid ventricular response. Since the rhythm is supraventricular (ie, AFib ) — we can accurately assess QRS morphology.

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Blog AFIB Chest Pain STEMI 78

Dr. Smith's ECG Blog

SEPTEMBER 24, 2023

A 50 something male was seen in the emergency room due to typical chest pain. The pain had started the same day about two hours prior to medical contact. The medical care providers ascribed the patient's chest pain to new onset atrial fibrillation with rapid ventricular response after having viewed the ECG.

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Chest Pain Atrial Fibrillation AFIB Myocardial Infarction 85

DAIC

DECEMBER 8, 2023

Getty Images milla1cf Fri, 12/08/2023 - 08:17 December 8, 2023 — The American College of Cardiology (ACC) and the American Heart Association (AHA), along with several other leading medical associations, have issued a new guideline for preventing and optimally managing atrial fibrillation (AFib).

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Atrial Fibrillation AFIB Strokes Stroke 52

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. I focus my comment on a few additional aspects regarding new AFib. The Importance of History: We are told that today’s patient is an otherwise healthy woman — who presented to the ED for new AFib.

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Diagnosis : Atrial flutter with 1:1 conduction, with fast AV conduction made possible by sympathetic drive of exercise On arrival, we obtained another 12-lead: Unremarkable Further history: One month history of shortness of breath on exertion, denies palpitations, chest pain, orthopnea, leg swelling.

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Atrial Flutter Exercise AFIB Tachycardia 64

Ken Grauer, MD

JANUARY 13, 2024

On the other hand — the ST elevation seen in lead V1 is perfectly consistent with LVH and LV "strain" ( ie, The shape of this ST-T wave in lead V1, in association with the deep S wave in this lead — is a mirror-image opposite picture of the typical expected appearance of LVH with "strain" in a lateral chest lead ).

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Blog Ischemia AFIB Hypertension 158

Ken Grauer, MD

JULY 22, 2023

I see the following: Although there is no long lead rhythm strip — we can see that the rhythm is AFib with a controlled ventricular response ( ie, irregularly irregular rhythm without P waves — and with a heart rate between ~70-110/minute ). Regarding Intervals: There is no PR interval ( since the rhythm is AFib ).

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Blog Chest Pain STEMI AFIB 78

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

AUGUST 13, 2020

9 Hours of Chest Pain and Deep Q-waves: Is it too late for Thrombolytics? As per Dr. Smith — this suggests that despite QRS widening, the rhythm in ECG #3 is AFib with a rapid ventricular response. FINAL PEARL #3: When AFib is fast — the rhythm may at first glance look like it is regular. LV Aneurysm?

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Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. AFib is the irregularly irregular rhythm that is most commonly confused with MAT — and , AFib is much, much, much more common than true MAT. The patient in this case presented with dyspnea and chest pain. GET a 12-lead!

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Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient also has a history of AFib and HFmrEF ( = H eart F ailure with M inimally- R educed E jection F raction ). This patient presented to the ED “after a couple of days of chest discomfort”. For clarity in Figure-1 — I have reproduced and labeled this patient’s initial ECG.

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Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

MAY 26, 2023

And she does not know that this is an overdose; she thinks it is a patient with chest pain!! This meets the Smith Modified Sgarbossa criteria, but the situation is wrong for diagnosing OMI!! By the way, the PM Cardio Bot Queen of Hearts says this is Not OMI with High Confidence. 3 hours later, this was recorded at a K of 2.8

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Cardiogenic Shock Arrhythmia Blog Education 98

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. See this case: what do you think the echocardiogram shows in this case?

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 26, 2023

and if not — Is the rhythm “irregularly irregular”, as in AFib — or is there a pattern of “regular" irregularity in the form of group beating ? ). This may lead to a series of symptoms similar to “pacemaker syndrome” ( ie, dizziness, fatigue, light-headedness, presyncope/syncope, dyspnea and/or chest pain ). What is the R ate?

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Pacemaker Chest Pain AFIB Blog 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

There was no chest pain — and all troponins were negative. Atrial arrhythmias ( especially AFib or AFlutter ). Smith immediately knew he needed to find out what was going on with this patient! It turned out the patient had cardiac amyloidosis. The presenting complaint was cough and fever from mild Covid pneumonia.

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Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

DAIC

DECEMBER 13, 2023

milla1cf Wed, 12/13/2023 - 10:24 December 13, 2023 — A new artificial intelligence (AI) model designed by Scripps Research scientists could help clinicians better screen patients for atrial fibrillation (or AFib)—an irregular, fast heartbeat that is associated with stroke and heart failure.

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AFIB Blood Clot Heart Rhythm Heart Failure 111

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

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Chest Pain Blog Arrhythmia Critical Care 64

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? Now another, with ultrasound.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. The April 6, 2023 post — excessive baseline artifact misdiagnosed as AFib ( instead of sinus rhythm with AV Wenckebach — as in Figure-4 in this post ). The rhythm terminated before it could be captured on 12-lead.

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Atrial Fibrillation Tachycardia Blog Chest Pain 81

Dr. Smith's ECG Blog

MAY 3, 2024

Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain? Despite the irregularity of QRS complexes — this rhythm is not AFib — because at least some definite P waves are present ( RED arrows that I added at the bottom of ECG #1 ).

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Cardiogenic Shock Cardiac Arrest Hospital Ischemia 126

Dr. Smith's ECG Blog

OCTOBER 28, 2023

There was some dyspnea but no chest pain. Tall R wave in lead V1 and/or early transition in the chest leads ( reflecting increased "septal" forces ). WPW Cardiac arrhythmias ( especially AFib ). A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. Here is his ECG.

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Preserved Ejection Fraction Sudden Cardiac Death Chest Pain Heart Failure 57

Dr. Smith's ECG Blog

NOVEMBER 24, 2017

They measured QTc while patients were in Afib and then again after conversion, when they were in sinus rhythm. They found that Bazetts formula overestimated QTc in Afib while Fridericias formula was the most accurate. The RR interval was also a 10 second average. Other Research: According to this study b y Batchvarov et al. ,

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Bradycardia Article Atrial Fibrillation Chest Pain 52

Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. BP:143/99, Pulse 109, Temp 37.2 °C C (99 °F), Resp (!) 32, SpO2 95% On exam, he was tachypneic and had bibasilar crackles.

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Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. Comment by K EN G RAUER, MD ( 2/11 /2023 ): = Today’s case is from a patient with “many complaints”, including chest pain — and, an ECG that raised concern about acute anterior OMI. Chest pain was just one of these complaints. The ioninzed calcium was 6.5

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

1) Very high initial troponin of 45,000 ng/L 2) A full day of chest pain 3) Q-waves on the ECG, with some T-wave inversion Here is one frame of the CT scan which includes the heart: Can you spot the infarct? SUBACUTE) OMI, that would result in an undesirable delay. But this is clearly a subacute MI, with most of the damage done.

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Blog Chest Pain Myocardial Infarction Critical Care 63

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

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Chest Pain Embolism Pulmonary Tachycardia 112

Dr. Smith's ECG Blog

APRIL 16, 2025

Sent by anonymous, written by Pendell Meyers A woman in her 40s with no known comorbidities presented with acute chest pain radiating to left arm and neck, which started approximately 4 hours prior to arrival. What is the Diagnosis in this 70-something with Chest Pain? 68 minutes with chest compressions, full recovery.

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Chest Pain STEMI Tachycardia Cardiac Arrest 68