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Blog postThe ECG in Figure-1 was obtained from a man in his 60s with known coronary disease — who called EMS for an episode of more severe CP (Chest Pain) that day. The patient describes increasing angina over the previous ~2 months. ECG #1 was recorded when EMS arrived — at which time the patient's CP had totally resolved.In light of this history — HOW would you interpret ECG #1?Would you activate the cath lab?
Figure-1: The initial ECG in today's case. The patient's chest pain had tota -
Blog postHOW would you interpret the ECG in Figure-1 — IF told that this middle-aged woman was having chest discomfort?Should you activate the cath lab?
Figure-1: ECG obtained from a middle-aged woman with chest discomfort.
MY Thoughts on the ECG in Figure-1:The rhythm is sinus at ~90/minute. All intervals (PR, QRS, QTc) and the frontal plane axis are normal. There is no chamber enlargement.
Regarding Q-R-S-T Changes:There are no Q waves.R wave progression is normal. -
Blog postThe patient whose ECG is shown in Figure-1 — is an elderly woman, who was admitted for acute abdominal pain. CT scan revealed splenic infarction. She also complained of an atypical type of chest pain.How would YOU interpret her ECG in Figure-1?Should you activate the cath lab?
Figure-1: The initial ECG in today's case.
MY Thoughts on the ECG in Figure-1:Although there is no long lead rhythm strip — it should be apparent that the rhythm is irregularly irregular — and that -
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Blog postThe ECG in Figure-1 — was obtained from a man in his 50s, who presented to the ED (Emergency Department) with "palpitations".How would YOU interpret the ECG in Figure-1?Doesn't this look like RBBB (Right Bundle Branch Block)?
Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio).
MY Thoughts on the ECG in Figure-1:There is an obviously fast tachycardia in Figure-1. Usually I begin b -
Blog postThe ECG in Figure-1 — is from a 71-year old man who presented to the ED (Emergency Department) with a 1-week history of recurrent severe chest and throat pain. No prior tracing available.In view of this history — How would YOU interpret the ECG in Figure-1?Is there AV block?
Figure-1: The initial ECG in today's case.
MY Thoughts on the ECG in Figure-1:I favor beginning with -
Blog postThe ECG in Figure-1 — was obtained from a previously healthy 17-year old female with palpitations. Serum K+ = 3.9 mEq/L.How would YOU interpret the ECG in Figure-1?Is this a dangerous rhythm? What else would you want to know about this patient?
Figure-1: The initial ECG in the ED.
MY Thoughts on the ECG in Figure-1:It's nice to know at the outset that despite the very tall, narrow and peaked T waves — that serum K+ is normal! This allows us to focus on the rhyt -
Blog postThe patient whose ECG is shown in Figure-1 — is a 68-year old man with risk factors, who presented with severe chest pain lasting ~1 hour — but which resolved by the time he arrived in the ED (Emergency Department). The patient reports that during the previous week — he experienced 2 similar episodes of severe chest pain, lasting about the same amount of time before spontaneously resolving.The patient was pain-free on arrival in the ED — at which time the ECG in Figure-1 was obtained.
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Blog postThe ECG in Figure-1 — was obtained from a 59-year old man who presented to the ED (Emergency Department) with new-onset chest pain.How would YOU interpret the ECG in Figure-1?Why is QRS morphology changing?Should you activate the cath lab?
Figure-1: The initial ECG in the ED.
MY Thoughts on the ECG in Figure-1:The underlying rhythm appears to be sinus — at a rate just under 100/minute. Of note is the observation that QRS morphology changes every-other-beat. This alternat -
Blog postThe ECG in Figure-1 — was obtained from a 65-year old man who was admitted to the hospital for unilateral weakness that began a number of days earlier. No chest pain. Hemodynamically stable. His stroke symptoms had stabilized at the time this ECG was recorded.In view of this clinical history — How would YOU interpret the ECG in Figure-1?
Beyond-the-Core: What is T-QRS-D?
Figure-1: The initial ECG in today's case. (To improve vis -
Blog postThe ECG in Figure-1 — was obtained from an 80-year old man who presented to the ED (Emergency Department) with new-onset chest pain.How would YOU interpret the ECG in Figure-1?Is there a "culprit" artery?
Figure-1: The initial ECG obtained from an 80-year old man with new-onset chest pain.
MY Thoughts on the ECG in Figure-1: Obviously — ECG #1 shows an acute STEMI, based the "eye-catching" ST elevation in leads V5,V6. -
Blog postThe ECG in Figure-1 — was obtained from an older man who presented to the ED (Emergency Department) with new-onset symptoms that began within the past 1-2 hours. The patient had a long history of smoking — but no prior history of heart disease.How would YOU interpret the ECG in Figure-1?Can you identify the “culprit”?Extra Credit: Why is there no ST elevation in lead aVL?
Figure-1: The initial ECG in today's case.
MY Thoughts on ECG #1:The rhythm is sinu -
Blog postThe ECG in Figure-1 — was obtained from a 65-year old woman who presented to the ED (Emergency Department) for abdominal pain. No chest pain. She was hemodynamically stable at the time the ECG in Figure-1 was recorded.How would YOU interpret the ECG in Figure-1?What is the rhythm?
Figure-1: 12-lead ECG and long lead II rhythm strip obtained from a 65-year old woman with abdominal pain. What is the rhythm?
===============================NOTE: The ECG in today's case was rep -
Blog postA 79-year old man presented with palpitations and the ECG shown in Figure-1. The patient had a history of coronary disease. He was hemodynamically stable at the time this tracing was recorded.
QUESTIONS:How would YOU interpret the ECG shown in Figure-1?How certain are you of your diagnosis?
Figure-1: The initial ECG in today's case — obtained from a 79-year old man with palpitations.
MY Approach to the ECG in Figure-1:We are told that the patient whose -
Blog postThe ECG in Figure-1 — was obtained from a 40-year old woman 10 days after a normal vaginal delivery. She presented to the ED (Emergency Department) with a history of progressive dyspnea over the previous 3 days.
QUESTIONS:In view of this history — How would YOU interpret the ECG in Figure-1?Many staff physicians were concerned about an acute MI. Do YOU agree?
Figure-1: Initial ECG from a woman 10 days post-partum — who presented to the ED with progressive dyspnea. (To -
Blog postHow would YOU interpret the lead II rhythm strip shown in Figure-1?
Figure-1: How would you interpret this rhythm strip?
MY Approach to the Rhythm in Figure-1:As always — I favor a systematic approach to every arrhythmia that I encounter, encompassed by the memory aid, "Watch Your Ps, Qs and the 3Rs" (See ECG Blog #185). That said, looking at this rhythm — I could not fail to notice that there is "group beating" in a supraventricular (ie, narrow -
Blog postThe ECG in Figure-1 — was obtained from a middle-aged man who presented with shortness of breath. No chest pain. Assuming the patient was hemodynamically stable:How would YOU interpret the rhythm in Figure-1?What are your diagnostic considerations?NOTE: This is a challenging case! Both the rhythm and the 12-lead ECG manifest complexities without simple solution. My hope is to provide insight by presenting my thought process in the sequence that I used to approach this tracing. Are YOU
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Blog postAn acutely ill man in his 40s was admitted to the hospital. Suffice it to say that the patient was intubated — and that there was multi-organ involvement including effects from severe alcoholism, mental confusion, tenuous fluid balance — and significant ventricular dysfunction on Echo. His initial ECG is shown in Figure-1.How would you interpret this initial tracing?
Figure-1: Initial ECG of an acutely ill man in his 40s with multi-organ involvement (See text).
MY T -
Blog postThe ECG in Figure-1 was obtained from a middle-aged man — who presented to the ED (Emergency Department) with syncope. No other clinical information available.How would YOU interpret this ECG?In view of this history — what are your diagnostic considerations?
Figure-1: ECG obtained from a middle-aged man with syncope.
MY Thoughts on the ECG in Figure-1:The rhythm is sinus at ~65/minute. Regarding Intervals: The PR interval is normal. The QRS complex is -
Blog postThe ECG in Figure-1 was obtained from a 70-year old man with longstanding hypertension. The patient was in for his yearly check-up. He denied symptoms.A preliminary diagnosis of an acute inferior STEMI was made on seeing the ECG in Figure-1. Do you agree?
Figure-1: The initial ECG in today's case.
MY Thoughts on the ECG in Figure-1:Beginning with Rate & Rhythm — the long lead II rhythm strip shows the rhythm to be regular at ~80-85/minute. The QRS complex is narrow. -
Blog postThe ECG in Figure-1 — was obtained from a man in his 40s, who was referred to the ED (Emergency Department) for a "slow rhythm". The patient was asymptomatic at the time this ECG was recorded.How would YOU interpret this rhythm?What are your diagnostic considerations?
Figure-1: 12-lead ECG and long lead rhythm strip recorded on an asymptomatic man in his 40s.
My Thoughts on Figure-1:Intuitively applying the Ps, Qs, 3R Approach for assessment of the rhythm -
Blog postThe ECG in Figure-1 — was obtained from a 60-year old woman, who presented to the ED (Emergency Department) with intermittent shortness of breath over the past week. No chest pain. The patient has a history of diabetes and hypertension.How would YOU interpret the ECG in Figure-1?Why are there "alternating" beats?
Figure-1: 12-lead ECG obtained from a 60-year old woman with intermittent dyspnea (but no chest pain).
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Blog postThe ECG and long lead II rhythm strip in Figure-1 — was obtained from a previously healthy middle-aged woman, with a history of intermittent palpitations over the past few months. No syncope or chest pain. She was hemodynamically stable at the time this ECG was recorded.How would YOU interpret the ECG in Figure-1?What might cause this rhythm? Figure-1: 12-lead ECG and long lead II rhythm strip recorded on a middle-aged woman with palpitations in recent months. Hemodynamically stable.
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Blog postToday's CASE: The 12-lead ECG and long lead I rhythm strip in Figure-1 — was obtained from a 65-year old woman who presented to the ED (Emergency Department) a 1-day history of chest pain. Her chest pain had resolved at the time the ECG in Figure-1 was recorded.
QUESTIONS:
How would YOU interpret the rhythm and the 12-lead?What do you think may have happened?
Extra Credit: Why is interpretation of this tracing so challenging? H -
Blog post=========================================Today’s tracing is another ECG “Quick Case” ( = EQC) — in which I’ll provide a more “time-efficient” account of my thought process (with goal toward expediting your interpretation within seconds rather than minutes)! Relevant links are at the bottom of the page. =========================================
Today's CASE: The 12-lead ECG and long lead II rhythm strip in Figure-1 — was obtained from an older woman who “suddenly fainted”. No -
Blog postNOTE (5/2/2021): I'm adding a feature to my ECG Blog — namely, some ECG "Quick Cases" ( = EQCs) — in which I'll provide "quick answers" to short ECG cases, with my impression of the "essentials" that come to me within the first few seconds that I see the tracing.While I always encourage a systematic approach to ECG assessment — my goal is to help expedite clinical decision-making.I'll add LINKS at the bottom of each case where more detailed discussion can
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