The ECG in Figure-1 was obtained from a man in his mid-60s — who presented with new chest pain. Should the cath lab be activated? Figure-1: The initial ECG in today’s case. Should the cath lab be activated? MY Thoughts on the Initial ECG: The rhythm in ECG #1 — is sinus at ~70/minute. All intervals (PR, QRS, QTc) are normal. There is no chamber enlargement. There is significant LAD (Left Axis Deviation) — as the QRS is predominantly negative not only in lead aVF, but also in lead II. This results in a frontal plane axis of at least -40 degrees — which is consistent w ..read more

I start today’s case with the ECG shown in Figure-1 — obtained from a 30-something year old man, who presented with palpitations. How would YOU interpret the ECG in Figure-1? Treatment? What is unusual about this arrhythmia? ========================= NOTE: The ECG in Figure-1 has been recorded at the usual 25mm/second speed — but with the Cabrera format (Please see my Editorial Note near the top of the page in ECG Blog #365 for review of the basics of this recording system). ========================= Figu ..read more

You are given this ECG to review. No history is provided — except knowing that this patient was seen in the ED (Emergency Department). QUESTION: Is there a potential problem with this ECG? Figure-1: The initial ECG in today's case. =================================== NOTE: Many of us are charged with reviewing ECGs that have been interpreted by other clinicians — often without the benefit of much (or any) history. I did this for 30 years — overseeing (that is "overreading") the ECGs of 35 clinician colleagues.  Given a "pile" of ECGs to review without b ..read more

The ECG in Figure-1 was obtained from a 60ish year old man on arrival to the ED (Emergency Department). The presenting complaint was chest pain — and the patient collapsed soon after arrival in the ED. QUESTION: A cardiologist interpreted the rhythm in Figure-1 as VT (Ventricular Tachycardia).  Do YOU agree with this cardiologist? Figure-1: The initial ECG in today's case — obtained from a 60ish year old man who collapsed in the ED shortly after this tracing was recorded. (To improve visualization — I've digitized the original ECG using PMcardio). M ..read more

The ECG in Figure-1 was obtained from an older woman — who presented with chest pain and palpitations over the previous hour. She had a history of hypertension, and was on medication for this — but she was otherwise healthy. BP = 140/90 mm Hg in association with the rhythm in Figure-1. How would YOU interpret the rhythm in Figure-1? Is this Ventricular Bigeminy? Figure-1: ECG obtained from an older woman with palpitations. Is there Ventricular Bigeminy? (To improve visualization — I've digitized the original ECG using PMcardio). MY Thoughts on the ECG in Figure ..read more

A 14-year old boy was forced to do numerous squats as a “punishment”. He woke up the next day with severe pain in his legs — and presented to the ED (Emergency Department).  Renal function and serum electrolytes were normal — but CK was markedly elevated, leading to a diagnosis of Rhabdomyolysis.  Cardiac monitoring revealed a series of interesting (albeit asymptomatic) rhythms, 2 of which are shown below in Figure-1. QUESTIONS: How would YOU interpret Rhythms A and B in Figure-1? Is there any evidence of AV block? What treatment is indicated? Figure-1: Two o ..read more

The ECG in Figure-1 is from a middle-aged man — who had just received thrombolytic therapy for presumed acute infarction. No other history available. QUESTIONS: How would YOU interpret this ECG? How certain are you of your answer? Figure-1: ECG obtained from a middle-aged man following thrombolytic therapy. (To improve visualization — I've digitized the original ECG using PMcardio). MY Thoughts on the ECG in Figure-1: The ECG in Figure-1 — shows a regular WCT ( = Wide-Complex Tachycardia) at ~140/minute, without clear sign of atri ..read more

The ECG in Figure-1 was obtained from a previously healthy older man — who complained of chest pain and “lightheadedness” while this tracing was recorded. He was not hypotensive. His chest pain had begun the night before. In view of this history — How would YOU interpret the ECG in Figure-1? A total of 12 beats are seen in the long lead II rhythm strip. How many beats are seen in the 12-lead tracing that appears above the rhythm strip? Figure-1: 12-lead ECG and long lead II rhythm strip — obtained from an older man with chest pain and “lightheadedness. (To improve visua ..read more

The ECG in Figure-1 — was obtained from a previously healthy 20-year old man who presented with chest discomfort on inspiration — but no prior history of syncope/presyncope and no sign of heart failure. No prior ECG had been done. Other than a slow pulse — vital signs, oxygen saturation and physical exam were all normal. Screening lab including complete blood count, thyroid function tests and serum electrolytes were unremarkable. QUESTIONS: How would YOU interpret the ECG shown in Figure-1? What is your diagnosis? Does this patient need a pacemaker? Figure-1: The initia ..read more

The ECG in Figure-1 — was obtained from a previously healthy young adult woman who presented with palpitations. How would YOU interpret the rhythm in Figure-1? Is there evidence of AV block?  Figure-1: 12-lead ECG and long lead II rhythm strip — obtained from a previously healthy young woman with palpitations. (To improve visualization — I've digitized the original ECG using PMcardio). MY Thoughts on the Rhythm in Figure-1: As always — I favor beginning with the rhythm by focusing on the long lead II rhythm strip — and assessing the Ps, Qs & 3Rs (See E ..read more