I was sent the ECG in Figure-1 — told only that the patient was 70 years old, and had a history of an ASD (Atrial Septal Defect).  Serum K+ was normal. The patient was hemodynamically stable with ECG #1. QUESTIONS: How would YOU interpret the rhythm in Figure-1? Are there P waves? Figure-1: The initial ECG in today's case. MY Initial Thoughts on Today's CASE: Knowing that today's patient has a history of an ASD (Atrial Septal Defect) — is relevant to the interpretation of today's interesting tracing! There are many variations of ASDs — w ..read more

The ECG in Figure-1 was obtained from a middle-aged woman — who presented with low back pain, shortness of breath and marked hypertension — but no CP (Chest Pain). QUESTIONS: In view of this history — How would YOU interpret this ECG? Are the large, peaked T waves (especially in lead V2) — likely to indicate hyperacute deWinter T waves? Figure-1: The initial ECG in today's case. PEARL #1: Did YOU notice that S wave amplitude is cut off in leads V2 and V3? (and possibly also in lead V1).  As a result — We have&nbs ..read more

I was sent the ECG in Figure-1 with the information that this man in his 60s presented to the ED (Emergency Department) — for flank pain of several days duration (that he thought was from a kidney stone) and an intermittent "heartburn" sensation over the past few weeks. QUESTIONS: Given the above history — How would YOU interpret this patient's initial ECG, that was obtained on arrival in the ED? Should you activate the cath lab?  Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG u ..read more

I was sent the ECG in Figure-1 — with the following history: The patient is a young man in his early 20s — who presents to the ED (Emergency Department) because of SOB (Shortness Of Breath) that had been ongoing for several hours. No chest pain. He reports a number of similar previous episodes over the past few years (although apparently has not been formerly evaluated for this). Physical exam remarkable for tachypnea (respiratory rate ~30/minute) and cyanosis, with clubbing of extremities. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1 ..read more

What if you were asked to interpret the ECG in Figure-1? How would YOU interpret the rhythm? Even without the benefit of any history — Has there been a recent MI? Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing. By the Ps, Qs, 3R Approach (which I review in ECG Blog #185): Lots of P waves are pr ..read more

I was asked to interpret the 2-lead rhythm strip shown in Figure-1 — without the benefit of any history. What are YOUR thoughts? Is there AV block? If so — Is it complete AV block? Figure-1: You are asked to interpret this 2-lead rhythm strip without the benefit of any history. ====================== NOTE: Today's rhythm is challenging — especially if you have not seen this type of rhythm before. That said, attention to the sequential PEARLS I present in my discussion below can greatly facilitate recognizing this rhythm within seconds the next tim ..read more

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1:  ECG #1 is the initial tracing obtained at the scene by the EMS (Emergency Medical Systems) team — in association with an alert but markedly hypotensive patient. ECG #2 was recorded a short while after ECG #1 by the EMS team — but before any treatment other than ASA was given. As might be imagined — the pa ..read more

Imagine the only information provided for the ECG in Figure-1 — is that it was obtained from a 60-year old man with new CP (Chest Pain). QUESTIONS: In view of this brief history — How would YOU interpret this ECG in Figure-1? Is the cardiac rhythm related to the 12-lead ECG? Figure-1: The initial ECG in today’s case. MY Thoughts on the ECG in Figure-1: The goal of practicing clinicians is to interpret both parts of the tracing in Figure-1 ( = the cardiac rhythm and the 12-lead ECG) — in an optimal time-efficient manner. To a ..read more

Today’s patient is an older woman who experienced a number of fainting epiodes over the previous week. No CP (Chest Pain). Shortly after arrival in the ED (Emergency Department) — she suffered a cardiac arrest. The ECG in Figure-1 was obtained following successful resuscitation. Stat Echo — obtained shortly after successful resuscitation revealed anterior wall akinesis. BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1? How can you explain that ..read more

  I was sent the ECG in Figure-1 — without the benefit of any history. QUESTION: What kind of AV block is present in Figure-1?  Figure-1: The initial ECG in today's case. (To improve visualization — I've digitized the original ECG using PMcardio). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing. By the Ps, Qs, 3R Approach (which I review in ECG Blog #185): P waves are present — and best seen in lead V1. The QRS complex is narrow in all 12 leads. The ..read more