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 163

Blog Cardiac Arrest STEMI Plaque 163

Ken Grauer, MD

AUGUST 26, 2023

As discussed in many posts in this ECG Blog — despite not satisfying the millimeter-based definition of a STEMI — in this patient with new chest pain, the ECG findings in Figure-1 merit prompt cath lab activation without any need to wait for serum troponin to return elevated ( See ECG Blog #193 — regarding the new "OMI" paradigm ).

Blog 145

Blog Chest Pain STEMI Ischemia 145

Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. An ICD ( I mplantable C ardiac D efibrillator ) was inserted — and the patient was discharged from the hospital. ECG Blog #185 — Reviews the P s, Q s, 3 R Approach to Rhythm Interpretation.

Blog 148

Blog Cardiac Arrest Cardiomyopathy Hospital 148

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

OCTOBER 27, 2023

My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. Given this patient's older age — if nothing "fixable" is found, she most likely has SSS ( S ick S inus S yndrome ) and will need a pacemaker ( See ECG Blog #342 for more on SSS ).

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

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

SEPTEMBER 21, 2024

The patient arrested outside the hospital. Does the patient's age infuence your interpretation? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). Unfortunately — the cardiologist at that center did not recognize the abnormal ECG findings. He could not be resuscitated.

Chest Pain 120

Chest Pain Blog Thrombosis Tachycardia 120

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

APRIL 14, 2023

The terminology favored to describe these ECG findings is diffuse subendocardial ischemia ( See ECG Blog #271 — for more on diffuse subendocardial ischemia ). The reason for this is simple — Most such patients die quickly , usually before they reach the hospital. Smith’s 8/9/2019 post in his ECG Blog.

Blog 78

Blog Chest Pain Ischemia Tachycardia 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

MARCH 23, 2023

The 12-lead ECG and long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy, elderly woman who collapsed in the hospital parking lot. 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 24, 2023

Hospital evaluation for this patient was negative for an acute coronary syndrome ( ie, CT coronary angiogram was normal — troponin was not elevated — and Echo was negative, with no sign of pericardial effusion ). See ECG Blog #215 — for more on the Cabrera format. = ECG Blog #114 — Reviews another case using the Cabrera format.

Pericarditis 78

Pericarditis Blog Chest Pain Coronary Angiogram 78

Conquering CHD

JULY 17, 2024

News & World Hospital Report rankings , we remind you this is only one of many tools you can use to have a conversation with your care team and should not be used as the sole factor when making decisions about your care. How do hospital rankings fit in? News & World Report ranks and rates hospitals. The post U.S.

Hospital 105

Hospital Congenital Heart Disease Congenital Heart Disease 105

Ken Grauer, MD

APRIL 23, 2023

Assessing the Rhythm: I favor use of the P s , Q s , 3 R Approach for assessing the cardiac rhythm ( See ECG Blog #185 ). As emphasized in ECG Blog #326 ( and as I review in the ADDENDUM below ) — Mobitz I, 2nd-Degree AV Block ( ie, AV Wenckebach ) — is by far (!) ECG Blog #236 — Reviews the 3 Types of 2nd-Degree AV Block.

Blog 78

Blog Chest Pain Arrhythmia Download 78

Conquering CHD

JANUARY 17, 2025

Seeing two brothers have HLHS is extremely rare and even more rare is how differently the condition presented in each child, says Childrens Hospital Colorado cardiothoracic surgeon Max Mitchell, MD, who performed the procedures on Zane and advised on Zekes care. We dont put limitations on them unless its for their safety, says Kayla.

Heart Transplant 98

Heart Transplant Transplant Open-Heart Surgery Nursing 98

Ken Grauer, MD

FEBRUARY 8, 2023

Variations of this “theme” were seen on telemetry over the several days that this boy was in the hospital. 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 ).

Blog 78

Blog Pacemaker Arrhythmia Hospital 78

Cassling

JULY 19, 2024

With only one CT scanner in the hospital to service outpatients and the emergency room, Bonner General saw an urgent need for expansion in order to better serve its patients. Since 2014, Bonner General Health in Sand Point, Idaho, has experienced a staggering 73% increase in the number of CT scans they perform annually.

Hospital 98

Hospital Outpatient Blog 98

Dr. Smith's ECG Blog

OCTOBER 6, 2024

An ECG was recorded immediately at triage and, at this hospital, the Queen of Hearts is routinely used to determine cath lab activation. For more on ECG findings in pulmonary disease — Check out My Comment in the May 31, 2024 post in Dr. Smith's ECG Blog ). This patient had the onset of chest pain 24 hours before arrival to the ED.

Hospital 77

Hospital Chest Pain Blog Pulmonary 77

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He has been following the blog for 4 years. He has now implemented the Queen of Hearts in his hospital. This case was sent by Dr. Jean-christophe Reiters, an interventionalist in Belgium. He wanted to share one of the first cases. A 55 year old with no previous cardiac history presented with 3 hours of chest pain.

Hospital 85

Hospital STEMI Blog Chest Pain 85

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 ? Smith and Meyers ( that are well known to readers of this Blog ). I’ve accessed this hand OMI Pocket Guide on both my ipad and iphone.

Blog 92

Blog Myocardial Infarction STEMI Hospital 92

Cassling

AUGUST 3, 2023

Rural hospitals across the United States are currently grappling with a severe and precarious financial situation. Over the past decade, more than 100 rural hospitals have shut their doors , leaving vulnerable communities without vital healthcare access.

Hospital 52

Hospital Blog 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

He was admitted to the hospital for evaluation of these symptoms — but no ECG was done at that time. The rest of the patient’s hospital stay was uneventful and he was eventually discharged. Regular readers of this ECG Blog will be well familiar with many of these points. An ECG was finally done at 9:17am on the 2nd hospital day.

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

JUNE 23, 2024

He was intubated in the field and sedated upon arrival at the hospital. At his family's request, he was transferred to a hospital closer to his home to continue care. The electrophysiologist is a reader of Dr. Smith's ECG Blog. When EMS arrived the patient was in ventricular fibrillation. He was admitted to cardiology.

Chest Pain 118

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

Conquering CHD

JUNE 21, 2023

News & World Hospital Report rankings , we remind you this is only one of many tools you can use to have a conversation with your care team and should not be used as the sole factor when making decisions about your care. How do hospital rankings fit in? News & World Report ranks and rates hospitals. The post U.S.

Hospital 52

Hospital Congenital Heart Disease Congenital Heart Disease 52

Dr. Smith's ECG Blog

MAY 2, 2019

Written by Pendell Meyers I received this prehospital ECG (we receive prehospital ECGs by telemetry from EMS in a large area around our hospital) and was told that there was a patient in her 50s with chest pain who was headed to an outside hospital (which happens to be a catheterization center). Here is the ECG: What do you think?

STEMI 52

STEMI Hospital Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. As we've often emphasized on Dr. Smith's ECG Blog — it is rare in practice to see LMCA occlusion, because most such patients die before reaching the hospital.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Cassling

JANUARY 31, 2025

Once again, Cassling is teaming up with Bellevue University for a series of webinars that offer current and aspiring leaders with the top-of-license skills they need to make a difference for their teams, their hospitals, and their patients.

Webinar 52

Webinar Hospital Education Blog 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

She presented to an outside hospital after several days of malaise and feeling unwell. Another possible cause of pseudonormalization of T waves mentioned many times on this blog is the pseudonormalization caused by re-occlusion of an infarct related reperfused coronary artery. At the time of admission, her vital signs were normal.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

JULY 25, 2024

For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. As we have often emphasized on Dr. Smith's ECG Blog ( See My Comment in the March 1, 2023 post) — DSI does not indicate acute coronary occlusion! Figure-1: The initial ECG in today's case. —

Cardiac Arrest 124

Cardiac Arrest Ischemia Tachycardia Defibrillator 124

ADN Center of Excellence

NOVEMBER 14, 2024

In this blog, we’ll explore why fellowship programs are invaluable, when you should consider them in your career journey, and the transformative impact they can have on your professional trajectory. Expanded Career Options Fellows often transition into prestigious roles in hospitals, private practices, or academic institutions.

Academic 59

Academic Interventional Cardiology Private Practice Innovation 59

EMS 12-Lead

SEPTEMBER 8, 2024

Complete Heart Block with Altered Mental Status Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the third installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. BVM was continued via NPA and the patient transported to the closest hospital.

Blood Pressure 92

Blood Pressure Bradycardia Hospital Electrophysiology 92

Dr. Smith's ECG Blog

MAY 3, 2024

In fact, most do not make it to the hospital alive, which explains why only a tiny percent of OMI are due to full LM occlusion. Today's patient did make it to the hospital — but was in cardiogenic shock, and despite valiant attempt at treatment, succumbed soon after. Moreover, left main occlusion often presents near death.

Cardiogenic Shock 126

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 126

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

This blog is full of cases in which OMI that did not meet STEMI millimeter criteria were dismissed. Series of Prehospital ECGs Showing Reperfusion == MY Comment by K EN G RAUER, MD ( 9/21/2020 ): == I wish those cardiologists who continue to strictly adhere to STEMI millimeter criteria would begin reading Dr. Smith’s ECG Blog.

STEMI 52

STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

As is often emphasized on Dr. Smith's ECG Blog — the evolution of an acute OMI is not necessarily static — but may be "dynamic". For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ).

Chest Pain 116

Chest Pain Blog Thrombosis Hospital 116

Dr. Smith's ECG Blog

MAY 20, 2024

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. So the patient was admitted to the hospital with no plan for an angiogram. Edited by Smith He also sent me this great case.

Chest Pain 125

Chest Pain Blood Pressure Ischemia STEMI 125

Cassling

JULY 8, 2024

Time is muscle” was the impetus for the new $6 million cardiovascular suite at Methodist Jennie Edmundson Hospital in Council Bluffs, Iowa. The longer you take to stabilize the heart, the higher the risk of long-term damage to the patient’s heart.

Heart attacks 98

Heart attacks Heart Attack Hospital Ultrasound 98