Sunday, October 29, 2017

ECG Interpretation Review #143 (ECG Guru - Dawn Altman - Dr. Stephen Smith)

     One of the reasons why I have decreased the frequency of my own ECG Blog posts — is that for the past few years I have actively been commenting on Dawn Altman’s ECG Guru site — as well as on many of the wonderful ECG posts put forth by Dr. Steven Smith on his most excellent blog site. 

For those desirous of additional sources of detailed ECG commentary — I suggest you check out:
I’ve attached below links to some of my earlier posts from both of these sites for which I’ve left detailed commentary. For anyone with a real “passion” for ECG/Arrhythmia interpretation — reading through these posts ought to keep you busy for a good while. Happy reading!
 
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NOTE (10/26/2020) — For an UPDATED version with LINKS to all of my comments on Dr. Smith's ECG Blog and on the ECG Guru site — Please LOOK for the icon in the right-hand column of any page on this web site !!!
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Note: Below the Figure from Dawn’s most recent Instructors’Collection ECG. I’ve added my labels in Figure-1. Detailed commentary by me supplements Dawn’s initial interpretation. Enjoy!
Figure-1: ECG from a 75yo man with new chest pain. How would you interpret this ECG? What is the “culprit” artery? Do you need the bottom ECG to tell? And, WHAT is the rhythm?
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Figure-2: Addition of labels to Figure-1 (Please CLICK HERE for my detailed analysis of this case).
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For My ECG Guru Comments:
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For My Comments on Dr. Steve Smith's Blog:
  • Chest Pain & Flu (STEMI vs Localized Myocarditis) — March 18, 2016 -
  • Acute Prox LAD Occlusion (RBBB/LAHB- Lambda) — March 21, 2016 -
  • A Pathognomonic ECG (long QT, peaked T — Ca++) — March 24, 2016 -
  • Acute LMain Occlusion (ECG recognition) — March 26, 2016 -
  • Acute STEMI despite Permanent Pacing — April 2, 2016 -
  • Resuscitation Pearls / LCx vs RCA "Culprit" — April 17, 2016 -
  • DeWinter-like T waves — Should NOT be Missed! — April 20, 2016 -
  •    10 Examples to TEST Recognition (Ant. T Waves) — April 23, 2016 -
  •    10 Examples of Inferior Hyperacute T Waves — May 1, 2016 -
  • ECG Distinction between Acute PE vs Chronic RVH — May 27, 2016 -
  • Fusion, Capture beats: "2 Wrongs may make a Right" — June 3, 2016 -
  • RBBB and ST Elevation (new STEMI vs LV Aneurysm) — June 6, 2016 -
  • Hyperacute Inferior T Waves or Reciprocal ST Changes — June 10, 2016 -
  • Anterior STEMI vs Benign Early Repolarization? — June 17, 2016 -
  • The Computer Missed WPW (re the Concertina Effect) — June 20, 2016 -
  • Terminal QRS Distortion with Acute LAD Occlusion — June 24, 2016 -
  • Acute Inferior STEMI — or Is It? — July 1, 2016 -
  • Acute Anterior Stemi, Saddleback, Early Repol? — July 8, 2016 -
  • Convex ST Elevation not due to STEMI — July 14, 2016 -
  • WCT in a 12-Year Old — July 20, 2016 -
  • ST Elevation in V1,V2 — RV MI, Brugada or Hyper-K ? — July 24, 2016 -
  • Bifascicular vs Trifascular Block / Acute Changes? — July 30, 2016 -
  • Proportionality of ST-T and the QRS (Ant. STEMI ) — August 5, 2016 -
  • Is this Brugada-1 or a Saddleback? (syncope) — August 10, 2016 -
  • Bidirectional VT vs AVNRT with Alternating RBBB? — August 25, 2016 -
  • RVH vs RBBB vs Both? — Acute PE? (large RV on Echo) — Sept. 1, 2016 -
  • Subtle LCx Occlusion or Not? — Sept. 4, 2016 -
  • LAD Occlusion vs Early Repol (interpolated PVC) — Oct. 18, 2016 -
  • Right Precordial T Wave Inversion (benign) — Dec. 5, 2016 -
  • Changing ST Elevation Distribution (Spasm) — Dec. 7, 2016 -
  • Computer Reads "Non-specific" Abnormalities — Dec. 10, 2016 -
  • Cabrera Format at 50mm/sec (a patient with chest pain) — Dec. 29, 2016 -
  • LVH with Marked ST Depression + Chest Pain — Jan. 6, 2017 - 
  • Wide Tachycardia with Cyanosis (VT vs SVT ...) — Jan. 10, 2017 -
  • LBBB, Chest Pain and Evolving ST-T Changes — Jan. 20, 2017 -
  • A Fast SVT in a Child (rate ~220/minute) — Jan. 22, 2017 -
  • Cocaine Overdose and Brugada ECG Pattern — Jan 25, 2017 - 
  • Group Beating & Hyperkalemia (Brugada Phenocopy) — Jan. 27, 2017 -
  • Use of the ECG with Severe DKA (U waves) — Feb. 2, 2017 -
  • Inferior MI, LVH or Both? (a patient with chest pain) — Feb. 5, 2017 -
  • ST Elevation, Neg Troponin but NOT Early Repol! — Feb. 10, 2017 -
  • Subtle Use of Smith-Sgarbossa Criteria with LBBB — Feb. 20, 2017 -
  • Unstable WCT not responding well to Cardioversion — Feb. 23, 2017 -
  • 40yo Man with Chest Pain and "Funny" ST-T Waves — March 1, 2017 -
  • Another 40yo Man with Chest Pain (recurring "theme" ) — March 3, 2017 -
  • Impending LAD Occlusion (recognizing subtle Wellens) — March 9, 2017 -
  • Do Computerized Interpretations Miss Acute STEMIs? — March 10, 2017 -
  •   — Related Post: EMS 12-Lead (on Triaging ED ECGs) — March 11, 2017 -
  • VT vs SVT with Aberration in a 20yo with DKA - March 17, 2017 -
  • T Peaking and "Pseudo-Infarction" with Dehydration - March 19, 2017 -
  • Alternating Fascicular Block Aberrancy (and LSFB! ) - March 31, 2017 -
  • RBBB with Transient ST Elevation (Rhythm?) - April 2, 2017 -
  • Acute or Recent Anterior MI vs LV Aneurysm? - April 21, 2017 -
  • 16yo Girl with Overdose: LBBB vs WPW? - April 23, 2017 -
  • 40yo Woman with Chest Pain (KEY subtle findings! ) - April 27, 2017 -
  • LVH Pseudo-Infarction Pattern vs Wellens? - May 3, 2017 - 
  • ST Elevation in V1,V2 in a Patient with LVH - May 6, 2017 -
  • TQRSD (Terminal QRS Distortion) - May 13, 2017 - 
  • Dialysis Patient with Bradycardia ... - May 18, 2017 -
  • Acute STEMI in a post-Op Paced Tracing - May 19, 2017 -
  • "Busy at Triage" (subtle-but-real LCx signs ... ) - May 26, 2017 -
  • Chest Pain, GE Reflux and Subtle ST-T Wave Changes - May 29, 2017 -
  • ST Elevation with Reciprocal Change due to ? (MI vs K+?) - June 1, 2017 - 
  • Peaked T Waves in 35yo with DKA/Something Else? - June 17, 2017 -
  • Peaked T waves in a 20yo. Anything Else? - June 21, 2017 - 
  • Pulmonary Edema on Echo + Interesting ECG LVH - July 7, 2017 -
  • Subtle ECG Changes in an 82yo with Syncope - July 12, 2017 -
  • The Computer says, "AFib". Do you agree? - August 11, 2017 - 
  • Effect of Adenosine on this Rhythm? (AFlutter? ) - August 23, 2017 -
  • To Thrombolyse after 15 Hrs of Chest Pain? - Sept. 1, 2017 -
  • DeWinter T Waves / AIVR - Sept. 24, 2017 - 
  • A 30yo Woman with Chest Pain. Is her ECG Normal? - Sept 30, 2017 -
  • VT or Supraventricular with LBBB? - Oct. 14, 2017 -
  • Syncope in an Elderly Man ( ? Wellens ? ) - Oct. 25, 2017 -
  • Chest Pain but a Non-Diagnostic ECG ... - Nov. 1, 2017 -
  • How to Convince the Cardiologist ??? - Nov. 6, 2017 -  
  • Chest Pain & a "Normal ECG" by Computer Report - Nov. 10, 2017 - 
  • 50yo with Chest Pain (Concept of "Competing Conditions") - Nov 15, 2017 - 
  • 30yo with Chest Pain and this ECG (S1Q3T3; IRBBB,ST) - Nov. 22, 2017 - 
  • About the QTc Interval (Using the Rule of Thumb for QTc) - Nov. 24, 2017 - 
  • RBBB, Missed Occlusion on ECG, What is the Rhythm? - Nov 25, 2017 - 
  • Subtle Abnormality in a 54yo with Chest Pain - Nov. 27, 2017 - 
  • Post Cardiac Arrest ECG (Acute MI vs something else?) - Nov. 30, 2017 -   
  • Why the Inf. ST Depression? What's the Rhythm? - Dec. 1, 2017 - 
  • 30yo with Pulmonary Hypertension and this ECG - Dec. 13, 2017 -
  • A Challenging Wide Rhythm (Syncopal patient) - Dec. 16, 2017 -
  • Wellens' ST-T Waves or Something Else? - Dec. 18, 2017 -
  • Serial Tracings tell the Tale (Cancellation Effect) - Dec. 23, 2017 -
  • Not a "STEMI", but NOT Normal! (Ed Burns, LITFL) - Dec. 27, 2017 -
  • Subtle Findings in a Patient with Chest Pain - Dec. 29, 2017 -
  • There is nothing subtle about this ... Right? - Jan. 2, 2018 - 
  • Acute MI or Something Else? - Jan. 5, 2018 -
  • ST Elevation: STEMI vs Early Repol vs Pericarditis? - Jan. 8, 2018 -
  • Use of Terminal QRS Distortion (acute stemi- AIVR) - Jan. 11, 2018 -
  • Chest Pain and ST Elevation (old inf MI? Pericarditis?) - Jan. 17, 2018 -
  • Repolarization Variant? LVH? and/or Acute STEMI? - Jan. 24, 2018 -
  • STEMI? Need for Acute Cath? — or Not? - Jan. 26, 2018 - 
  • The Importance of Comparison Tracings (subtle! ) - Jan. 28, 2018 -
  • Artifact in a Dialysis Patient (Not hyperacute ST-T ! ) - Jan. 30, 2018 -
  • Subtle Changes in a Patient with CP (but no doubts! ) - Feb. 1, 2018 - 
  • Acute LCx Occlusion despite Non-Diagnostic ECG! — Feb. 5, 2018 -
  • Cardiac Trauma — Now ST Elevation (on Pericarditis) — Feb. 7, 2018 -
  • LBBB + CP — Is there Acute Coronary Occlusion? - Feb. 11, 2018 - 
  • Subtle Abnormality (in leads III,T inversion in aVL) - Feb. 15, 2018 -
  • What's the Temperature? (from an unresponsive woman) - Feb. 19, 2018 -
  • Hyperacute ST-T Waves in an evolving STEMI - Feb. 22, 2018 -
  • RBBB with Subtle Ischemic Changes ... - Feb. 24, 2018 -
  • Diffuse ST Depression + ST Elevation in aVR - Feb. 28, 2018 -
  • Anterior ST Elevation: To Activate or Not? - March 5, 2018 -
  • Alcohol Withdrawal + a very Long QTc - March 8, 2018 -
  • Seizure + a somewhat long QTc Interval - March 9, 2018 - 
  • A Pattern To Recognize! ( = Acute PE! ) - March 12, 2018 -
  • LBBB Criteria Redefined? Acute STEMI? - March 14, 2018 -
  • Not Wellens, but V1,V2 Too High on Chest - March 16, 2018 -
  • STEMI vs Pericarditis/Early Repol - May 14, 2011/March 18, 2018 -
  • SVT & Retrograde Atrial Activity (AVNRT vs AVRT?) - March 20, 2018 -
  • You had 2 Hours to Save this Patient (missed STEMI ) - March 24, 2018 -
  • A Tale of 2 STEMIs- Step-by-Step (computer report) - March 27, 2018 -
  • NOT an OMI despite HUGE Anterior S Waves! (Superb! ) - April 4, 2018 -
  • Regular Wide Tachycardia due to HyperKalemia! - April 6, 2018 - 
  • ST Elevation + Hyperthyroidism + LVH + Repol - April 9, 2018 - 
  • U Wave Inversion — Clinical Significance ... - April 14, 2018 -
  • RBBB with HyperKalemia — Anything Else? - April 16, 2018 -
  • Pseudonormalization of ST-T wave and QRS changes - April 20, 2018 -
  • Subtle Hyperkalemia on Serial ECG Findings ... - April 22, 2018 -
  • Isolated ST Elevation in aVL (cardiac spasm) - April 23, 2018 -
  • Cardiac Arrest / "Shark Fin" ST Elevation (Me on ETT ) - April 25, 2018 -
  • Abnormal T (U) Waves in an Alcoholic - May 4, 2018 -
  • Fascicular VT vs Bundle Branch Reentrant VT - May 8, 2018 -
  • AV Dissociation in a Young Man (AV block? ) - May 11, 2018 -
  • Isolated Posterior STEMI (Mirror Test - LCx) - May 19, 2018 -
  • Cardiac Arrest and an Abnormal 12-Lead (RVH/LVH) - May 24, 2018 -
  • Acute Posterior MI despite RBBB (posterior leads Not) - May 26, 2018 -
  • LIST: A Long QT/QU + U Waves (Drugs/Lytes/CNS) - May 27, 2018 -
  • Paced ECG + Primary ST-T Wave Changes! (Acute MI) - May 29, 2018 - 
  • Repost of this 2015 WCT Rhythm: Is the QRS Wide??? - May 30, 2018 -
  • LBBB with LA-LL Lead Reversal + Suble ST Changes - June 4, 2018 -
  • Bradycardia, Wide QRS, Pointed T, Hypotension (artifact) - June 6, 2018 - 
  • Is the QRS really so Wide? (shark fin) - June 11, 2018 - 
  • Inf. STEMI vs Constrictive Pericarditis (Schamroth sign) - June 17, 2018 -
  • WPW or AIVR? Why AIVR? ( = Sinus Brady ...) - June 18, 2018 -
  • What is Terminal QRS Distortion (Pericarditis @ Peril) - June 20, 2018 -
  • LBBB, modified Sgarbossa, Qualitative ST-T Changes - June 22, 2018 -
  • Does this ECG help Manage Insulin Overdose? (low K+) - June 24, 2018 -
  • Early Repol vs OMI vs Pericarditis (AFib/Group Beating) - June 26, 2018 -
  • Wellens' Syndrome + Change in Serial Tracings! - June 28, 2018 -
  • Type 1 MI with a Normal Cath (isolated high lateral MI) - July 1, 2018 - 
  • Use of Terminal QRS Distortion to make the Diagnosis! - July 3, 2018 -
  • Slower-than-Expected AFib + Syncope (about SSS!) - July 5, 2018 -
  • When Should the OMI Dx have Been Made? - July 8, 2018 -
  • Acute Inf. OMI + RV MI (Hyperacute ST-T / Mirror-Image) - July 11, 2018 -
  •    — Also — ischemia-induced J waves (My July 11 Comment)
  • Acute High Lat. OMI (only seen in aVL) - July 13, 2018 -
  • Recognizing LQTS (Long QT Syndrome) on ECG - July 17, 2018 -
  • Sodium-Channel Blockade on ECG (Long QTc) - July 20, 2018 -
  • ECG Findings of Hypokalemia — and — Anything Else? - July 22, 2018 -
  • ECG Findings of Hyperkalemia (Eiffel Tower/Rhabdo) - July 24, 2018 -
  • Is there ST Elevation? (Acute PE/Simultaneous Leads) - July 26, 2018 -
  • Paramedic recognition of subtle OMI (V1,2 malposition) - July 28, 2018 - 
  • Limb Lead and Chest Lead Misplacement (Recognition!) - July 29, 2018 -
  • CP in 30yo Woman (Subtle Abns in 11/12 leads/Compare) - July 31, 2018 -
  • A Regular SVT — How to Diagnose AFlutter? - August 3, 2018 -
  • A Regular WCT with an LBBB-like Pattern ... - August 5, 2018 -
  • A 13yo with SOB (WPW - arrhythmias - localization) - August 7, 2018 -
  • Lots of ST Elevation: Repol vs STEMI? ("mirror-image") - August 9, 2018 -
  • Acute LMain Occlusion! — and a subtle initial tracing ... - August 30, 2018 -
  • 2 Occlusions (Good and less good ECG interpretation ... ) - Sept. 2, 2018 -
  • Reverse Takotsubo and an Unusual ECG - Sept. 4, 2018 -
  • Subtle Post-Lat OMI (LCx) + VT with AV Diss/Capture - Sept. 7, 2018 -
  • 50yo Woman with CP & "Normal" Triage Tracings - Sept. 11, 2018 -
  • Acute PE (ECG & Echo findings) - Sept. 12, 2018 -
  • Idiopathic VT — Fascicular VT (See My Comment) - Sept. 14, 2018 -
  • Subtle Serial ECG Changes in a 30yo with CP - Sept. 15, 2018 -
  • Hyperacute T Waves (The Wrong Question was Asked) - Sept. 20, 2018 -
  • AFlutter with subtle Anterior STEMI (Use calipers! ) - Sept. 24, 2018 -
  • Cabrera Format - 50mm/second speed - Chest Pain ... - Sept. 26, 2018 -
  • Dialysis Patient — "Pseudonormalization" ST-T Waves - Sept. 29, 2018 - 
  • Giant T Waves / Origin of an Atrial Rhythm - October 1, 2018 -  
  • Paced ECG with Acute Anterior STEMI (Sgarbossa) - October 3, 2018 -  
  • Subtle Acute High-Lat STEMI (aVL-mirror image) - October 6, 2018 -  
  • Acute STEMI diagnosed ONLY by PVC Morphology - October 8, 2018 -  
  • Another Invalid Study on Triage ECGs in the ED - October 9, 2018 -  
  • Subtle OMI in a Triage ECG (PR vs TP Baseline) - October 14, 2018 - 
  • Anterior MI + PVCs (Subtle rhythm-junctional escape) - Oct. 19, 2018 - 
  • 80yo man with sudden PEA (no clear "culprit" on ECG) - Oct. 22, 2018 -
  • Normal Troponin & Acute Occlusion (ischemic J waves) - Oct. 24, 2018 - 
  • Inf. ST Elev but No MI! (ST straightened- a "normal" ST) - Oct. 27, 2018 - 
  • Diffuse ST Dep/ST Elev in aVR (Recognize this pattern! ) - Oct. 31, 2018 - 
  • Q waves in V1,V2 = Septal MI? (or V1/V2 Misplacement?) - Nov. 4, 2018 -
  • Recognition of a Long QTc (Assessing the QTc- LIST ) - Nov. 7, 2018 - 
  • A Case-Based Study of Pacer Malfunction (bradycardia) - Nov. 9, 2018 - 
  • 2 ECGs Texted to Dr. Meyers (Acute STEMI or not?) - Nov. 12, 2018 - 
  • Serial ECG Changes over 10 tracings in Acute STEMI - Nov. 15, 2018 - 
  • Hyperacute T waves - new LAHB + Inf. Q waves = OMI - Nov. 18, 2018 -
  • RBBB + Chest Pain: New vs Old? - Nov. 21, 2018 - 
  • Acute STEMI missed by the Computer - Nov. 21, 2018 -
  • Are these Hyperacute T waves? (Computer says stemi) - Nov. 24, 2018 - 
  • Regular SVT at 200/min. + acute STEMI? (Semantics) - Nov. 26, 2018 - 
  • ST Elev. in V1,V2 — STEMI? Brugada-2? (or leads?) - Nov. 28, 2018 - 
  • Shock, LVH and/or Diffuse Subendocardial Ischemia - Nov. 30, 2018 -
  • 2 ECGs without a History: Acute Changes or Not? - Dec. 5, 2018 - 
  • Not Bigeminy — But a Problem with K+ & Ca++ (DKA) - Dec. 11, 2018 - 
  • Can this be Wellens' Syndrome without an Infarct? - Dec. 14, 2018 -
  • A Regular WCT: VT vs AFlutter + Flecainide Toxicity? - Dec. 16, 2018 - 
  • The Computer Called this Normal (Subtle STEMI ) - Dec. 19, 2018 - 
  • Subtle ST-T wave changes (Normal vs Flat ST segment) - Dec. 24, 2018 - 
  • ST Elevation in V1-3: Ant MI vs Strain (ECG Dx of LVH) - Dec. 27, 2018 - 
  • ST Elevation in V3: Is it Normal? (More on ECG Dx LVH) - Dec. 29, 2018 - 
  • Benign T Wave? Hypertrophic CardioMyopathy? - Jan. 2, 2019 - 
  • "Who Done It? = HyperKalemia + HypoCalcemia - Jan. 3, 2019 - Jan 7 -
  • Dynamic ST-T Wave Changes (Myocarditis, LVH) - Jan. 9, 2019 -
  • Isolated RV MI + unusual pointed ischemic T waves - Jan. 11, 2019 -
  • Bradycardia & AV Block from Hyper-K (Rhythm Pearls) - Jan. 13, 2019 - 
  • The Regular WCT: VT vs SVT with Aberrancy? - Jan 24, 2019 - 
  • Junctional vs Low Atrial Rhythm? (neg P  or part QRS?) - Jan. 28, 2019 - 
  • Hyperthermia and ST Elevation in V1,V2 (Brugada-1) - Jan. 30, 2019 - 
  • Diffuse ST Dep/ST Elev in aVR not due to CAD (low K+) - Feb. 2, 2019 - 
  • Subtle OMI diagnosis by ECG Comparison (pos Trop) - Feb. 5, 2019 - 
  • Right-Sided HF and an SVT (Why is this AFlutter?) - Feb. 9, 2019 -
  • RVH - IRBBB: Is Ant T Inversion New or Old? - Feb. 12, 2019 - 
  • How Long Will You Wait for OMI to become STEMI? - Feb. 16, 2019 - 
  • Coved ST Elevation in Chest Leads: Acute or Not? - Feb. 18, 2019 -
  • Cardiac Arrest, ROSC and now RBBB? (very wide! ) - Feb. 28, 2019 - 
  • LVH, diffuse ST dep/ST elev in aVR (Sickle Cell ) - March 2, 2019 - 
  • Monitor Leads for ST Elevation? (Filter Settings! ) - March 4, 2019 -
  • Recognizing abnormal ST elevation in V1,V2 - March 6, 2019 - 
  • Subtle Acute MI (Is complex A or B in aVL correct?) - March 8, 2019 - 
  • Resp. Failure + a "Normal" Computer ECG ("smiley" ) - March 11, 2019 - 
  • What is the Rhythm? (2 Regular WCTs vs 1 Rhythm?) - March 13, 2019 - 
  • The SHAPE in lead V2 — Acute OMI - March 15, 2019 - 
  • Acute OMI Dx'd by Speckle Echo (an unusual IVCD) - March 18, 2019 - 
  • Electrolytes — Pathognomonic ECG (hypoCa/hyperK) - March 19, 2019 - 
  • Junctional Escape (Laddergram)/SubEndo Ischemia - March 26, 2019 -
  • Subtle High-Lat OMI + 3 False Pos (ST elev in aVL) - March 29, 2019 -  
  • 3 ECG shown to Dr. Meyers (To Activate Cath Lab? ) - March 31, 2019 - 
  • Acute LAD Occlusion in an Elderly Patient - April 3, 2019 - 
  • ECG Findings & Clinical Diagnosis of Acute PE - April 5, 2019 - 
  • A Pt with Abdominal Pain and LBBB (qualitatively + ) - April 7, 2019 -
  • Acute OMI missed because it wasn't a "STEMI" - April 12, 2019 - 
  • Type 2 MI + Myocardial Bridging + Tachy/ST Elev - April 15, 2019 - 
  • Acute Pericarditis or a Repolarization Variant ECG? - April 19, 2019 -
  • OMI despite no STEMI ( + V2 lead malposition) - April 20, 2019 - 
  • CP & ST Depression only in leads I and aVL ... - April 22, 2019 -
  • A WCT Rhythm with Alternating Wide-Narrow Beats - April 23, 2019 - 
  • Dx of Acute STEMI despite being a Paced Tracing - April 25, 2019 - 
  • Terminal QRS Distortion (T-QRS-D) - LVH Voltage - April 27, 2019 - 
  • LBBB vs WPW (LBBB criteria- All about WPW) - April 30, 2019 - 
  • Tachyarrhythmias: Use of Monitor vs a 12-Lead ECG - May 1, 2019 -
  • De Winter T Waves (Typical & Atypical Features) - May 2, 2019 - 
  • Brugada ECG Patterns vs Acute Anterior STEMI - May 6, 2019 - 
  • Don't Overlook this OMI (Be Systematic/Computer Use) - May 7, 2019 -
  • Another Anterior OMI/Not Repol (the Visual Picture) - May 11, 2019 - 
  • Chest Pain in a Pt with a Paced Rhythm (2:1 ATach?) - May 13, 2019 - 
  • Peaked T Waves despite serum K+ = 2.4 mEq/L - May 15, 2019 -
  • LVH and/or Acute OMI (Nit-Picking Serial Tracings/LVH) - May 19, 2019 - 
  • LBBB: Recognizing Acute OMI (Smith-Mod-Sgarbossa) - May 24, 2019 - 
  • Acute Ant. OMI (What will Cardiologist do Next Time?) - May 26, 2019 - 
  • A Complex ECG and No Clinical Info (Laddergram) - May 28, 2019 - 
  • Superimposed Changes on Prior Antero-Lat STEMI? - June 2, 2019 - 
  • Cardiologist & Computer said "Normal" (acute OMI) - June 4, 2019 -  
  • Is ST-T wave SHAPE normal? (Cath lab activation? ) - June 7, 2019 -
  • How Not to Miss WPW (Reviews My Approach) - June 8, 2019 - 
  • Hyperacute T Waves (on way down) - Computer - June 9, 2019 - 
  • 20yo with Chest Pain: Early Repol or Something Else?- June 11, 2019 - 
  • A Patient with SOB (Systematic-LVH-QTc-hyper-K+) - June 15, 2019 - 
  • Dr. Smith's 3- and 4-Variable Formula (Ant STEMI? ) - June 17, 2019 - 
  • Repolarization Variants vs LVH-HCM-STEMI? (blacks) - June 20, 2019 - 
  • "Smiley"-shape ST Elevation (Using this Concept! ) - June 22, 2019 - 
  • Very Subtle Inferior Lead ST-T Wave Change - June 23, 2019 -
  • Quick Recognition of Acute Proximal LAD Occlusion - June 26, 2019 -
  • A System needed to pick up all Findings! (Inf OMI ) - June 28, 2019 - 
  • 2 Cases of RBBB (My Approach for ECG Dx of BBB) - July 1, 2019 - 
  • CP Onset 24-48 Hrs Ago (2 Post MIs- Correlate to Hx) - July 5, 2019 - 
  • Subtle-but-definite acute LAD OMI (artifact! ) - July 11, 2019 - 
  • ST Elevation only in V6/Recip in V1 (LCx-Post MI ) - July 15, 2019 - 
  • Doubling Size of Complexes Facilitates OMI Dx! - July 17, 2019 - 
  • Subtle LAD OMI: New vs Old? (Brugada-like) - July 19, 2019 - 
  • Acute Myocarditis vs OMI vs Repol (Serial Tracings) - July 21, 2019 - 
  • The ECG was Correct; the Angiogram was Not! - August 13, 2019 - 
  • 5 Cardiologists say No STEMI — Is in an OMI? - August 15, 2019 - 
  • CP in a 50yo with a "Normal" ECG — Or an OMI? - August 18, 2019 - 
  • Evidence of Acute OMI on this Pacer Tracing? - August 20, 2019 - 
  • Are these Hyperacute T Waves? - August 26, 2019 - 
  • Short QTc Syndrome vs Hyperkalemic T Waves - Sept. 2, 2019 - 
  • Recognize this ECG? (HyperK- Brugada Phenocopy) - Sept. 8, 2019 - 
  • Non-Cardiac Ischemia on ECG (+ a few questions) - Sept. 12, 2019 - 
  • Troponin Trajectory: New Ant MI vs LV Aneurysm? - Sept. 17, 2019 - 
  • When the QRS is Wide — the J-Point will Hide! (VSD) - Sept. 20, 2019 - 
  • Why do beats "A" and "B" look so different? (artifact) - Sept. 22, 2019 - 
  • 7 mm of ST Elevation with LBBB = Acute? What Else? - Sept. 25, 2019 - 
  • Acute MI diagnosis by Chest CT (+ suble ECG/Artifact) - Sept. 27, 2019 - 
  • Subtle Inf. OMI / MAT at normal Rate - Sept. 30, 2019 - 
  • ST Depression in a 30yo (Atrial Repol Wave/Tachycardia) - Oct. 2, 2019 - 
  • Shark Fin Morphology (Don't Forget to look for P waves! ) - Oct. 4, 2019 - 
  • Interplay between Post MI and acute RV MI! - Oct. 9, 2019 - 
  • Do You Understand these T Wave Inversions? - Oct. 10, 2019 - 
  • Regular SVT (AVRT — 30yo with WPW — Mgmt) - Oct. 16, 2019 - 
  • Acute Inf-Lat OMI (QS inf leads-Tall R V1-Silent MI ) - Oct. 20, 2019 - 
  • Causes of ST Depression ("scooped" ST/Dig/LIST ) - Oct. 21, 2019 - 
  • SCAD (Spontaneous Coronary Artery Dissection) - 30f - Oct. 24, 2019 - 
  • Look at All ECGs done Serially! (Subtle clues! ) - Nov. 1, 2019 - 
  • Diffuse Subendocardial Ischemia (not always cardiac! ) - Nov. 3, 2019 - 
  • Vagotonic AFib in 30yo (The RATE of AFib - D.D.) - Nov 5, 2019 - 
  • Subtle Changes = an ECG non-diagnostic of OMI (Lytics?) - Nov. 8, 2019 - 
  • What is this SVT @ 150/min? (AFlutter — MY POST ) - Nov. 12, 2019 -
  • Repolarization Variants vs Acute OMI (T-QRS-D) - Nov. 14, 2019 - 
  • Seizures — Review of HypoKalemia - Nov. 18, 2019 - 
  • CP in a 30yo — Acute OMI? (Serial ECGs) - Nov. 20, 2019 -
  • Cardiac Arrest — Shark Fin/ Osborn Waves/ Low Atrial - Nov. 22, 2019 -  
  • Is there Global ST Depression? — or Atrial Flutter? - Nov. 26, 2019 - 
  • Acute Pancreatitis/LVH and Repol vs Acute OMI? - Nov. 27, 2019 - 
  • Distinguishing New vs Old MI (vs superimposed MI) - Nov. 29, 2019 - 
  • A 30yo woman with Fever-Induced Brugada-1? - Dec. 5, 2019 - 
  • CO Poisoning — Prox LAD Occlusion (T-QRS-D ) - Dec. 9, 2019 - 
  • Acute Myocarditis vs Repol vs OMI (Serial ECGs) - Dec. 10, 2019 - 
  • Acute PERICARDITIS (detailed discussion! ) - Dec. 13, 2019 - 
  • Acute OMI despite LBBB (Smith-Sgarbossa- subtle! ) - Dec. 16, 2019 - 
  • More on HypoKalemia - Dec. 18, 2019 - 
  • A Regular WCT (Wide-Complex Tachycardia) - Dec. 23, 2019 - 
  • Don't Overlook AFlutter! (Regular SVT at ~150/minute) - Dec. 24, 2019 - 
  • Mobitz II in an Asymptomatic 80yo (AV Blocks) - January 1, 2020 -  
  • Hypothermia with Osborn Waves! - Jan. 2, 2020 - 
  • MAT - the Computer - Aberrant Conduction (Ashman) - Jan. 5, 2020 - 
  • Crochetage Sign — Is there an ASD? - Jan. 8, 2020 - 
  • Acute Pericarditis (Myocarditis)? Acute OMI? Repol? - Jan. 10, 2020 - 
  • Acute MI + Post-Infarction Pericarditis (Review) - Jan. 14, 2020 - 
  • Acute LMain Occlusion (ECG Recognition) - Jan. 16, 2020 - 
  • Acute Inf OMI (Complex Rhythms-Ladder-Mobitz I ) - Jan 19, 2020 - 
  • RBBB + 1° ST-T changes/AFib + AV Block (SSS? ) - Jan 22, 2020 - 
  • "Shark Fin" / Myocardial "Stunning" ==> Low Voltage - Jan. 24, 2020 - 
  • Hyperkalemia (Ventricular Escape - ECG Changes) - Jan. 26, 2020 - 
  • 20-ish yo with Chest Pain (distal LAD OMI - subtle) - Jan. 29, 2020 - 
  • Hx of Stents with Chest Pain (RBBB-Fragmentation) - Jan. 31, 2020 - 
  • 7 Tracings: Which 3 have Acute Inferior OMI? - Feb. 2, 2020 - 
  • Cardiology would Not Cath this Patient! (Ant. OMI ) - Feb 4, 2020 -
  • ST Elevation in V1,V2 — due to LVH (not ACS) - Feb. 6, 2020 -
  • ST Elevation in aVR (Coronary Occlusion?/SVT? ) - Feb XXX, 2020 - - -
  • Ischemia vs Lead Misplacement (How to Recognize) - Feb. 11, 2020 - 
  • A 50s Man with "Gas Pain" (Early LAD Occlusion) - Feb. 14, 2020 -
  • HypoThermia — Shark Fin (Causes of Myocarditis) - Feb. 16, 2020 -
  • 32yo with CP — Hyperacute T waves MISSED - Feb. 18, 2020 - 
  • What are these Wide Complexes (AV Diss- AIVR) - Feb. 20, 2020 - 
  • A Man in his 60s with CP (Subtle OMI) - March 2, 2020 -
  • Anterior T Inversion (Not Wellens- PE vs Ischemia) - Feb. 28, 2020 - 
  • Sinus Tach with a VERY Long PR Interval - March 4, 2020 -
  • ATach vs AVNRT of the Fast-Slow Type - March 6, 2020 -
  • ST Elevation in aVR/Diffuse ST Dep (normal cath) - March 9, 2020 -
  • A Scenario to Recognize (Irregular WCT-AFib/WPW) - March 12, 2020 - 
  • Cardiac Arrest/ECMO — Shark Fin (rhythm) - March XXX, 2020 - - - 
  • Differential Diagnosis of a Regular WCT - March XXX, 2020 - - -

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