The ECG in Figure-1 was obtained from a 60-ish year old man with a history of coronary disease (including prior CABG) — who presented to the ED (Emergency Department) with new CP (Chest Pain) of 3 hours duration, diaphoresis and nausea/vomiting.  The patient was hypotensive at the time his initial ECG in Figure-1 was obtained. The decision was made not to immediately perform cardiac cath — because there is no ST elevation in Figure-1 — and because the initial troponin was negative. Do YOU agree with the decision not to cath at this time? How would you interpret ECG ..read more

The ECG in Figure-1 — was obtained from an older woman with persistent CP (Chest Pain) over the previous day. Her symptoms lessened after Nitroglycerin — so the decision was made not to activate the cath lab. Do YOU agree with this decision? Figure-1: The initial ECG in today's case. MY Thoughts on the ECG in Figure-1: In a patient with CP that had been persistent over the previous day (until Nitroglycerin was given) — the initial ECG shown in Figure-1 is extremely worrisome.  The rhythm is sinus. Intervals (PR, QRS and the QTc) and the frontal plane axi ..read more

I was sent the rhythm strip shown in Figure-1 — obtained from telemetry monitoring. Can YOU explain what happens after beat #4? Figure-1: Multi-lead rhythm strip obtained from telemetry monitoring. MY Thoughts on the Rhythm Strip in Figure-1: The first 4 beats in this 11-beat rhythm strip are sinus — as determined by the presence of regular upright P waves, with a constant PR interval in lead II (RED arrows in Figure-2). The rate of this underlying sinus rhythm is ~57/minute (ie, The R-R interval between these first 4 beats is slightly more than 5 large boxes — t ..read more

The ECG in Figure-1 — was obtained from an older woman with chest pain. How would YOU interpret this tracing? What kind of AV block is present? — OR — Is there no clear evidence of any AV 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: This tracing is challenging to interpret because of the changing QRS morphology — and because of the uncertainty regarding atrial activity. The “good news” — is that although the chief complaint from thi ..read more

The 12-lead ECG and long lead rhythm strip in Figure-1 — was obtained from a previously healthy 15-year old male, who presented with fever and diarrhea. He was hemodynamically stable. No chest pain. How would YOU interpret the ECG in Figure-1? What is the cardiac rhythm? What do you suspect as the clinical diagnosis? Figure-1: The initial ECG in today’s case — obtained from a 15-year old male with fever and diarrhea. What is the rhythm? What is the clinical diagnosis? ===================== NOTE: In the interest of optimizing clinical relevancy and time efficiency for a ..read more

The ECG in Figure-1 was obtained from a 50-year old man — who presented to the ED (Emergency Department) with new-onset CP (Chest Pain). QUESTIONS: There are at least 3 principal findings on this ECG — some of which deal with a possible “culprit” artery and/or the location of whatever is going on. How many of these findings can YOU identify? HINT: Is the rhythm sinus? Figure-1: The initial ECG in today's case — obtained from a 50-year old man with new chest pain. (To improve visualization — I've digitized the original ECG using PMcardio). MY Thoughts ..read more

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1? Is there acute coronary occlusion? If so — What is the "culprit" artery? Figure-1: The 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 significant baseline artifact in a number of leads in ECG #1. That said — the rhythm is sinus, at a rate just under 100/minute. T ..read more

The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED (Emergency Department) with presyncope. No chest pain. The patient was hemodynamically stable in association with this rhythm. How would YOU interpret the ECG in Figure-1? What is the rhythm? Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. (To improve visualization — I've digitized the original ECG using PMcardio). MY Thoughts on the ECG in Figure ..read more

I was asked for my interpretation of this tracing. No history was provided. How would YOU interpret this long lead II rhythm strip? Are the different-looking beats PVCs or supraventricular impulses conducted with aberration? — or — Something else? Figure-1: The long lead II rhythm strip for today’s case. No history was available. (To improve visualization — I've digitized the original ECG using PMcardio). MY Thoughts on the Rhythm in Figure-1: Although no history is provided for today's case — I'll presume the patient is hemodynamically stable with t ..read more

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