Ken Grauer, MD

OCTOBER 6, 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.

Blog 165

Blog Arrhythmia Cardiac Arrest Tachycardia 165

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 145

Blog Chest Pain Ischemia STEMI 145

Ken Grauer, MD

FEBRUARY 23, 2024

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 168

Blog STEMI 168

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 ). ECG Blog #229 — reviews distinction between AFlutter vs ATach.

Blog 155

Blog Arrhythmia Tachycardia 155

Ken Grauer, MD

MAY 28, 2024

Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation.

Blog 143

Blog Arrhythmia Tachycardia CME 143

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.

Blog 148

Blog Arrhythmia Academic 148

Ken Grauer, MD

SEPTEMBER 28, 2024

MY Impression of ECG #1: The above 5 Observations confer ECG features that characterize "the Footprints of Wenckebach!" — which is why within seconds of seeing today's ECG, I was virtually certain there was some form of 2nd-degree AV Wenckebach ( See ECG Blog #164 — ECG Blog #55 — ECG Blog #347 — and ECG Blog #154 ).

Blog 105

Blog Arrhythmia Diabetes 105

Ken Grauer, MD

MAY 11, 2024

To EMPHASIZE: One of my goals in developing this ECG Blog — is to help clinicians to optimize their time efficiency. By the P s, Q s, 3 R Approach ( See ECG Blog #185 ) — the rhythm in the long-lead II of Figure-1 is not R egular. That said, as emphasized in ECG Blog #312 — SA block is rare!

Blog 108

Blog Arrhythmia Download 108

Ken Grauer, MD

JANUARY 26, 2024

By the Ps, Qs, 3R Approach ( which I review in ECG Blog #185 ): P waves are present — and best seen in lead V1. As discussed in detail in ECG Blog #192 — there are 3 Causes of AV Dissociation: i ) By "default"; ii ) By "usurpation"; and , iii ) As a result of AV block. ECG Blog #192 — The 3 Causes of AV Dissociation.

Blog 105

Blog Arrhythmia 105

Ken Grauer, MD

APRIL 5, 2024

For additional examples of this phenomenon whereby automatic truncation of an EMS ECG may mistakenly result in LVH serving to mimi c ischemia — Check out My Comment at the bottom of the page of the following posts in Dr. Smith's ECG Blog — the November 29, 2023 post — June 20, 2020 — March 31, 2019 — March 29, 2019 — and t he December 27, 2018 post.

Blog 94

Blog Ischemia Chest Pain Hypertension 94

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 98

Blog Chest Pain Ischemia STEMI 98

Ken Grauer, MD

OCTOBER 25, 2024

As reviewed in ECG Blog #350 — t he clinical significance of Wellens' Syndrome — is that its recognition tells you that the patient has a high-grade LAD narrowing with presumably "hot" thrombus h avin g high propensity to propagate and/or totally occlude the LAD at any point in time ( including immediately ). What is W ellens’ S yndrome ?

Blog 94

Blog Chest Pain STEMI Cardiogenic Shock 94

Ken Grauer, MD

JULY 18, 2024

It's important to appreciate that we can not rule out the possibility that this rhythm represents Mobitz II 2nd-degree AV block, in which case the patient will need a pacemaker ( See ECG Blog #236 — for review on the ECG diagnosis of the 2nd-degree AV Blocks ). ECG Blog #192 — The 3 Causes of AV Dissociation. STEP-by-STEP.

Blog 86

Blog Arrhythmia Bradycardia Pacemaker 86

Ken Grauer, MD

FEBRUARY 9, 2024

NOTE: As I've commented on in a number of previous blog posts — Wenckebach conduction may occur at more than a single level within the AV Node. 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 #192 — The 3 Causes of AV Dissociation.

Blog 105

Blog Arrhythmia STEMI Bradycardia 105

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

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! IF you scroll down a little on the right-hand column of this blog — You'll see a lot of icons. Figure-1: The initial ECG in today's case.

Blog 78

Blog Pulmonary Hypertension Aortic 78

Ken Grauer, MD

JULY 22, 2023

Although this " Imbalance " of precordial T waves is not see n very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) , most often from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

Blog 78

Blog Chest Pain STEMI 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

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

AUGUST 18, 2023

As always — I like to start by focusing on the long lead rhythm strip — which shows a bigeminal rhythm — in that there are repetitive 2-beat groups ( See ECG Blog #232 for review of the concept of “bigeminy” ). PEARL # 1: As discussed in ECG Blog #232 — it helps to consider the differential diagnosis of a bigeminal rhythm.

Blog 78

Blog Atrial Fibrillation Arrhythmia Atrial Flutter 78

Dr. Smith's ECG Blog

NOVEMBER 27, 2024

In Figure-1 is the ECG from the August 26, 2009 post in Dr. Smith's ECG Blog ( this being one of the 10 Cases of Inferior HATWs that Dr. Smith links to — and the ECG for which he gives a preview of the HATW model that he and Dr. Meyers are working on ). Figure-1: ECG from the August 26, 2009 post in Dr. Smith's ECG Blog.

Blog 133

Blog STEMI Research Outcomes 133

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

APRIL 29, 2023

Although this " Imbalance " of precordial T waves is not seen very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

Blog 78

Blog Chest Pain STEMI Ischemia 78

Dr. Smith's ECG Blog

JANUARY 2, 2025

For more on Torsades de Pointes vs PMVT See My Comment in the October 18, 2023 post and the September 2, 2024 post in Dr. Smith's ECG Blog ). Figure-1: My "correction factor" for QTc estimation when the QRS is not wide ( from My Comment in the March 19, 2019 post in Dr. Smith's ECG Blog ).

Tachycardia 117

Tachycardia Cardiomyopathy Blog Bradycardia 117

ECG Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain.

Chest Pain 131

Chest Pain Blog Embolism Pulmonary 131

ECG Cases

OCTOBER 1, 2024

In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. Can you spot the critical abnormality? Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.]

Blog 111

Blog 111

ECG Cases

SEPTEMBER 12, 2023

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, (..)

Dysrhythmia 128

Dysrhythmia Atrial Fibrillation Embolism Blog 128

Dr. Smith's ECG Blog

SEPTEMBER 15, 2023

More cases can be found on the blog here. Since then ( as we have shown on already many cases of Dr. Smith's ECG Blog ) — this is actually a surprisingly common phenomenon that all-too-often goes unrecognized ( as per the unnecessary cardiac catheterization that was done in today's case ). "Look how bizarre it is."

Chest Pain 137

Chest Pain Diabetes STEMI Blog 137

ECG Cases

FEBRUARY 13, 2024

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false (..)

Cardiac Arrest 121

Cardiac Arrest STEMI Blog 121

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 Technician 126

EKG Technician Chest Pain Blog STEMI 126

Dr. Smith's ECG Blog

JUNE 5, 2024

IMPRESSION: The finding of sinus bradycardia with 1st-degree AV block + marked sinus arrhythmia + the change in PR interval from beat #5-to-beat #6 — suggests a form of vagotonic block ( See My Comment in the October 9, 2020 post in Dr. Smith's ECG Blog ).

Chest Pain 124

Chest Pain Blog Cardiac Arrest Cardiomyopathy 124

Conquering CHD

JANUARY 17, 2025

Watch Zeke and Zanes story *This blog post is sponsored by the Heart Institute at Childrens Hospital Colorado. With every act of kindness and generosity, Childrens Colorado isnt just changing lives, says Kayla, its shaping a future in which my boys can be kids and grow up to pursue their dreams.

Heart Transplant 98

Heart Transplant Transplant Open-Heart Surgery Nursing 98

Dr. Smith's ECG Blog

AUGUST 3, 2023

Each section includes: A brief check list of the OMI ECG criteria Several ECG examples curated from Dr. Smith's ECG Blog The specificity of each criteria with links to relevant literature ? Mark Hellerman — for his excellent work in producing the OMI Pocket Guide , that is the subject of today’s post on Dr. Smith’s ECG Blog.

Blog 92

Blog Myocardial Infarction STEMI Hospital 92

ECG Cases

MARCH 19, 2024

In this Waiting to Be Seen blog Dr. Howard Ovens outlines 4 key learnings from his extensive career in EM leadership: Be a good clinician, get substantial real-world experience, take a long-term view of benefits and risks and get along with your counterparts in the leadership dyad.

Blog 91

Blog 91

Society of Thoracic Surgeons - Early Career

NOVEMBER 19, 2024

Date Nov 7, 2024 Image Blog Giving Credit Matters. Image Blog Managing Relationships with Patients Early career cardiothoracic surgeons have many important relationships that need to be managed and developed. Here's How to Do It.

Cardiothoracic 52

Cardiothoracic Blog Webinar Aortic valve 52

ECG Cases

OCTOBER 17, 2023

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV (..)

Pericarditis 101

Pericarditis AFIB Blog Atrial Fibrillation 101

Dr. Smith's ECG Blog

JUNE 27, 2024

Smith comment: Go here for a comprehensive blog post on syncope and link to the most detailed version of the Canadian Syncope Rule: Emergency Department Syncope Workup. See these blog posts. EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport.

Blog 121

Blog Pacemaker Bradycardia Tachycardia 121