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 ).
Ken Grauer, MD
OCTOBER 10, 2024
QUESTIONS: Is this rhythm too fast to be sinus tachycardia? I say this for the simple reason that to pick any of the above 4 choices — is to imply with 100% certainty that you know the answer ( or, as is implied in the title of today’s Blog post — this would be premature closure). Are flutter waves hidden within the QRS and T waves?
Ken Grauer, MD
JUNE 22, 2024
The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. My THOUGHTS on the ECG in Figure-1: The rhythm is sinus tachycardia at ~105/minute ( ie, The R-R interval is regular — and just under 3 large boxes in duration ).
Ken Grauer, MD
JUNE 27, 2024
IMPRESSION: Given the presence of a wide tachycardia — with 2 distinct QRS morphologies, and no sign of P waves — a presumed diagnosis of B i D irectional Ventricular Tachycardia has to be made. 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. . =
Ken Grauer, MD
MARCH 27, 2024
This leaves us with the usual differential diagnosis for this rhythm presentation ( as per ECG Blog #361 ) ==> We need to consider i ) VT until proven otherwise: ii ) SVT with either preexisting BBB or aberrant conduction; — or , iii ) Something else ( ie, WPW, hyperkalemia, some other toxicity, etc. ). What Kind of Conduction Defect?
Ken Grauer, MD
DECEMBER 23, 2023
By the P s, Q s, 3 R Approach ( See ECG Blog #185 ): The rhythm is fast and QRS complexes are R egular. PEARL # 4: As emphasized in ECG Blog #204 , in which I review derivation of the bundle branch blocks — RBBB is a terminal conduction delay. Figure-2: I've labeled the initial ECG in today's case. And a Final Tracing.
Ken Grauer, MD
MARCH 1, 2024
C linical I MPRESSION: I would interpret ECG #1 as suggestive of near ventricular standstill — with underlying atrial tachycardia, extended pauses, and no reliable ventricular escape focus. 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.
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