New ECG Podcasts (March 22, 2024)

  • I recently recorded a series of podcasts regarding KEY concepts in ECG interpretation.
  • Easy LINK —   — 

  • Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS"

My New ECG Podcasts (3/22/2024): 
  • These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ("Making Waves") — hosted by Dr. Anthony Kashou. They are found on the Mayo Clinic Cardiovasciular CME site. 
  • You can adjust the speed of the recording (If the speed is "slow" for you — increasing to 1.25 speed should be optimal for you! ).
  • Note the Timed Contents that I detail below facilitate finding specific material.

ECG Podcast #3 — Computerized ECG Interpretation and AI in 2024 (Is there any computerized ECG program that can reliably help clinicians to better interpret ECGs?) — published by Mayo Clinic CV Podcast Series on 3/19/2024 (28 minutes).
  • 0:00 — Intro by Dr. Anthony Kashou: Welcome to Mayo Clinic’s ECG Segment: “Making Waves” (Today's discussion — About today’s speaker = Ken Grauer, MD).
  • 2:00 — Dr. Kashou to Dr. Grauer: "In 2024 — Where do you see computerized ECG interpretations and AI?" 
Please NOTE: I divided my comments into 2 "Eras, regarding the use of computerized ECG interpretations: i) The initial Era (ie, from the mid-1980s until very recently); — andii) The new QOH (Queen OHearts) Era — in which the QOH application for assessment of acute OMI is so quickly becoming widely available! 

General Overview of this Podcast:
  • From 0:00-to-5:54 = Introductory material.
  • From 5:54-to-16:13 = Review of my experience with computerized ECG interpretation from the mid-1980s until very recently ( = the initial Era).
  • From 16:13-to-27:00 = How the new QOH application may dramatically improve rapid recognition of acute OMI. (For listeners primarily interested in QOH — Feel free to jump to 16:13 in this 28 minute podcast).
  • From 27:00-to-END  SUMMARY by Dr. Anthony Kashou.

More Specific Breakdown of Contents:
  • 2:20 — My "Disclaimer": What follows today reflects my opinion, based on my experience. I have no financial interest in any commercial product related to my comments.
  • I begin by offering some Pros & Cons of AI in our Life "outside" of the ECG World ...
  • 5:54 — So how in 2024, do I think AI is impacting on ECG interpretation? How much "human oversight" is needed? 

  • 7:15 — A number of fundamental errors continue to be made! So — Where are we going with use of AI for ECG interpretations?
  • 8:00 — To answer, it's worth looking at where have we come from? I trace my experience with computerized ECG interpretation, which literally began decades ago, in the 1980s! During these decades (and up to the present) — there continues the tendency for too-many-clinicians to accept without question what the computer says. This needs to change.

  • 10:20 — How the computer can best assist clinicians with ECG interpretation? Realize that clinicians with different levels of experience and different training have different needs (ie, The needs of an experienced cardiologist or emergency physician are different than the needs of clinicians with far less training and experience in ECG interpretation).

  • 11:35 — My views on: Will the computer ever be able to interpret complex arrhythmias?

  • 12:15 — Regarding my experience from the 1980s until ~2010: How I went from hating computer interpretations to loving them (after I finally understood what the computer can and can not do).

  • 14:45 — Using my definition — Are YOU an “expert” ECG interpreter? The computer saves experts time. 
  • For non-experts” ( = 90-95% of clinicianseven though many such clinicians may still be very good interpreters)the computer provides a 2nd opinion.

  • 16:13 — That was then ... What about now? (ie, What can AI offer us in 2024 as a way to improve our ECG interpretation?)
I emphasize these 4 concepts in these last 11 minutes (16:13-27:00)
  • — i) All ECG programs that I am aware of prior to development of QOH — are out-of-date, and of little-to-no use in emergency care! 
  • — ii) Computerized interpretations are not helpful for arrhythmia assessment (The simpler arrhythmias are obvious to capable clinicians — and the computer makes too many mistakes for complex tracings)
  • — iii) The new QOH application is already amazingly accurate in recognizing acute coronary Occlusion in cases when outdated STEMI criteria are not fulfilled (with rapid recognition of acute OMI that prompts early reperfusion saving valuable myocardium!). Future generations of QOH will continue to improve; — and
  • — iv) Optimal clinical diagnosis of acute OMI at an early point in the process is best attained by the combination of a capable ECG interpreter who is open to receiving QOH input.

  • 27:00 — SUMMARY by Dr. Anthony Kashou. 
NOTE: For more on "My Take" regarding the ECG diagnosis of acute OMI — Please see my ECG Podcast #2 (LINK and detailed Contents below!) 
  • Please also Check Out my new ECG Videos #406407 and 408 on this topic (CLICK HERE)

ECG Podcast #1Common Errors in ECG Interpretation (And How to Easily Correct these Errors!) — published by Mayo Clinic CV Podcast Series on 12/19/2023 (30 minutes).
  • 0:00 — Intro by Dr. Anthony Kashou: Welcome to Mayo Clinic’s ECG Segment: “Making Waves” (Today's discussion — About today’s speaker = Ken Grauer, MD).
  • 2:00 — Dr. Grauer: “How did you get so skilled at ECGs?” 
  • 3:30 — Me introducing today’s topic ( = “Common Errors in ECG Interpretation”) — and why I chose this topic.
  • 4:35 — I’m sent a tracing. The 1st “Error” is either no History (or a History that does not tell me what I need to know).
  • 6:40 — The need for a relevant History (Clinical examples!).
KEY POINT: Be sure to list all antiarrhythmic drugs (Note rate-slowing meds — Herbal products! — and ask about beta-blocker eye drops! ).
  • 13:10 — Next Error = NOT forcing yourself to commit to a diagnosis!
  • 14:10 — Next category of Errors = The need for a Systematic Approach (This will not slow you down! Instead — it speeds you up, improves your accuracy and makes you sound smarter!).
  • 15:50 — My System for Rhythm Interpretation ( = First, look at the patient! — then, “Watch your Ps, Qs & 3Rs” ).
  • 18:15 — The error of premature closure (Thinking there are only 2 answers = “VT or SVT” — because you forget the 3rd Answer = a relative probability statement!).
  • 19:50 — Not appreciating statistical odds! (ie, What are the odds that a regular WCT without P waves will be VT?).
  • 22:25 — What if you have a regular SVT ( = narrow-complex tachycardia) without obvious P waves? (The 4 common causes? — The most commonly overlooked cause?) 
  • 25:10 —  My System for 12-Lead ECG Interpretation (What are the 6 KEY parameters to look for?).
KEY POINT: Rate - Rhythm - Intervals (PR-QRS-QTc) - Axis - Chamber Enlargement - QRST Changes (being SURE to look at Intervals early in the process!).
  • 27:50 — SUMMARY by Dr. Anthony Kashou.

ECG Podcast #2ECG Errors that Lead to Missing Acute Coronary Occlusion (Reviewing the concept of OMI — and why the "STEMI Paradigm" is outdated and misses too many acute coronary occlusions!) — published by Mayo Clinic CV Podcast Series on 1/16/2024 (33 minutes).
  • 0:00 — Intro by Dr. Anthony Kashou: Welcome to Mayo Clinic’s ECG Segment: “Making Waves” (Today's discussion — About today’s speaker = Ken Grauer, MD).
  • 2:25 — Dr. Grauer: “The 1st Error = Too many clinicians in 2024 are still stuck in the outdated millimeter-based STEMI Paradigm”. (What do we really care about in the patient with new CP [Chest Pain]? ).
  • 6:15 — Error #2: Overuse of the term, “NSTEMI — which practically speaking is a useless term. Many (if not most) NSTEMIs are actually OMIs ( = acute coronary Occlusion MIs).
  • 7:42 — Error #3: The ECG criteria for diagnosing an OMI?
  • 9:25 — Are there hyperacute T waves?
  • 11:37 — Can you find a prior tracing on the patient?
  • 12:20 — Look carefully at neighboring leads!
  • 13:10 — The “magical” mirror-image opposite relation! (Use of my Mirror Test to instantly identify posterior OMIs — and inferior OMIs by comparing leads III and aVL).
  • 15:35 — Why posterior leads are not needed!
  • 18:58 — Look for dynamic ST-T wave changes! (How often to repeat the ECG?)
  • 20:25 — The 1st high-sensitivity Troponin may be normal.
  • 21:00 — What to know about the prior tracing?
  • 21:50 — The BIGGEST Error: Not correlating the History to each ECG that is done! (Because the provider does not appreciate the concept of spontaneous reperfusion!).
  • 29:00 — Today's Final Error: Not learning from our cases!
  • 31:28 — SUMMARY by Dr. Anthony Kashou.

ECG Podcast #4 — All About Comparison ECGs for 12-Leads and Arrhythmias (Comparing ECGs seems so "easy" to do — but so often is not done correctly!) — to be published on 5/21/2024.
  • xxxxx

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