ECG Guru - Instructor Resources

A gathering place for instructors of ECG and cardiac topics.


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Instructors' Collection ECG of the WEEK, April 15, 2014 __ Acute Inferior Wall M.I.

Tue, 04/15/2014 - 02:08 -- Dawn

Another great ECG donated by Paramedic Eric Testerman.  This ECG is from a 66 year old man who was complaining of feeling dizzy, weak, and of having "minor" chest pain. He was extremely pale/ashen, had moderate cyanosis, and was very clammy and diaphoretic.  His initial heart rate was about 20 bpm.  His initial BP was 131/113 then, just before arrival at the hospital was 127/85. His HR increased to about 50 bpm (not shown). He was given 400 ml I.V. fluid, 324 gr of aspirin, and oxygen.  Transcutaneous defibrillator/pacemaker pads were applied. 

At the hospital, he was successfully treated with angioplasty for a 100% occlusion of the right coronary artery. The time from beginning of treatment to reperfusion of the artery was 47 minutes, which is very good! 

This is a "classic" inferior wall M.I., with ST elevation in leads II, III, and aVF. There are reciprocal ST depressions in I and aVL.  There are also ST depressions in V1 through V5.  This is generally considered to represent reciprocal ST changes in the posterior and lateral walls.There is a quite severe bradycardia, and the patient's skin showed signs of poor perfusion. Amazingly, the patient's BP stayed adequate during transport.  Bradycardia is common in inferior wall M.I. due to ischemic effects on the SA node and vagus nerve (sinus bradycardia) and the AV node (heart block).  In this case, the rhythm is sinus bradycardia.  The heart rate is in the 20's, and the PR interval is around .20 - .22 seconds. 

This patient's unstable condition and close proximity to the hospital prevented the EMS crew from getting a second ECG, but when there is time, a repeat ECG with a V4R lead can be helpful in deciding how much I.V. fluid is safe to give.  This patient's heart rate improved spontaneously during transport, but had it not, the transcutaneous pacemaker could have been used.  In some protocols, a trial of Atropine is advised.  In others, treatment goes straight to the pacemaker or to I.V. epinephrine.  During the angioplasty, a transvenous pacemaker is often inserted into the right ventricle to support the patient's rate if necessary.  

This patient was fortunate to be in an area with advanced paramedics and an interventional cath lab close by.  It is notable that he never developed pathological Q waves, and hopefully had an uneventful recovery.  



Book Review: Dr. Ken Grauer's ECG Pocket Brain 2014, Expanded Version E-PUB

Thu, 03/20/2014 - 13:25 -- Dawn

Want to know more about bundle branch block, IVCD, Wolff-Parkinson-White, Brugada?  Need a systematic approach to evaluating 12-Lead ECGs?  Need to brush up on your arrhythmia interpretation?  How do you explain prolonged QT intervals and Torsades de Pointes to your students?  All this and MUCH, MUCH more in Dr. Grauer's new 2014 ECG Pocket Brain, E-PUB edition.  This is the BEST comprehensive resource out there for ECG instructors and students alike!

Fans of the ECG Guru are very familiar with our Consulting Expert, Dr. Ken Grauer.  His commentary on our content is invaluable, and is especially helpful to instructors who want to know how to present more complex information to their students.  He makes ECG understandable and relevant to patient care situations.  Dr. Grauer has published many  print books and electronic books.  He strives to keep the cost low in order to make his materials accessible to all.  Through E-Publishing, he has been able to add more content and color illustrations to his popular books.  

Dr. Grauer's latest E-book is the electronic version of his 2014 ECG Pocket Brain.  Even if you have the print version of the ECG Pocket Brain, you will want the electronic version, because he was able to include MUCH MORE information, practice, and color illustrations.  The E-Pub looks especially great on iPad, Kindle Fire, and a computer screen.

For more information about the 2014 ECG Pocket Brain E-Pub and Dr. Grauer's other books, go to his website.  His publications can be ordered from Amazon.

ECG Basics: Atrial Fibrillation With Rapid Ventricular Response

Thu, 03/13/2014 - 12:54 -- Dawn

This is a good rhythm strip to use to illustrate how atrial fibrillation can almost look regular when the rate is fast.  Students should be taught how to "march out" the rhythm for regularity.  It is always a good idea with atrial fib to take a longer strip, looking for the inevitable "gaps" in the R-to-R intervals.  Also, as your students progress, a 12-lead ECG is invaluable to really search for P waves.  Even two or three simultaneous leads are better than just one.


Wed, 01/15/2014 - 20:55 -- Dawn


This is not an ordinary tee shirt.  It is made of the smoothest, most comfortable lightweight fabric, which is moisture-wicking and UPF of 30.  And, it is wearable art, featuring the work of ALYSSA BEAN.  If you work in a cath lab, and wear lead aprons all day, you will love the feel of this shirt.   Also great for sports, boating, beach, and layering.

The ECG Guru is committed to providing high-quality resources for ECG instructors and students FREE of CHARGE and FREE of COPYRIGHT.  We do rack up some expenses keeping the website going.  We came up with the idea of fund raising while also providing a product that we know our members and visitors will LOVE. 

Go to the STORE to learn more about this shirt.

Anterior View of Coronary Arteries, Full Color

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Anterior view of coronary arteries.  Free heart illustration

Original illustration by Dawn Altman.  You may use this illustration free of charge and free of copyright in a classroom situation.  Please give credit to the artist and ECG Guru.  For commercial use, please contact the artist at

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1924:  Willem Einthoven wins the Nobel prize for inventing the electrocardiograph.




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