This ECG was obtained from a healthy 29-year-old man. It shows "benign early repolarization". It demonstrates the typical pattern of widespread ST elevation with a normal concave upward sloped ST segment. There are also prominent U waves in V2 through V4, and T wave inversions in the inferior wall leads. He was not complaining of any symptoms and, in fact, donated this ECG as an example of known early repolarization pattern. The other changes may represent normal variations for his age and gender. Early repolarization has long been thought to be a completely benign variant, and it is quite common in young people, especially athletic men. But new research suggests a possible link to future serious arrhythmias. For a discussion of research on this topic from the Journal of the American College of Cardiology, see this link. Research reported in the New England Journal of Medicine can be accessed at this link.
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SINCE 2011, the ECG GURU has been devoted to providing resources for ECG teachers and their students. Follow the links above or the search terms to the left to find what you are looking for.
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This is an original photograph by Pam Hamilton. Use of this illustration is FREE in a classroom setting, for presentations or handouts. For any other commercial use, please contact the owner via Dawn.ECGGuru@gmail.com.
Those of you who have followed the ECG Guru for a while are very familiar with the work of Dr. Ken Grauer, M.D. He is a generous contributer to the ECG Guru website, and functions as our official Consulting Expert. He has published many books and e-publications which are (in our opinion) some of the BEST ECG references available, and he has worked hard to keep them low priced to make them available to all of us. He also offers seemingly endless ECG knowledge and insights for FREE, via this website, his own website, and social media.
Dr. Ken Grauer has recently been producing ECG instructional videos. The latest is a three-part series (Videos 10, 11, and 12), which tackle the topic of the BASICS OF ECG RHYTHM INTERPRETATION. These videos cover the basics for those who are just beginning their ECG training, as well as for those who want a refresher. More advanced concepts are included along the way to keep the interest of those who are already experienced. There are also excellent examples of how to teach the basics for those of you who are instructors. It is presumed that the viewer of the videos has a beginning background in health care sciences, and in anatomy and physiology. To facilitate navigating through this 3-part (2 hour) video series, Dr. Grauer has made a LINKED CONTENTS that takes you to the precise place in the video for each given content area. There you will also find links to Dr. Grauer's other publications and free resources.
This is a good teaching strip on many levels. At the BASIC level, we see a strip that clearly meets all the criteria for sinus tachycardia: a regular rhythm over 100/min. with P waves that look normal and all look alike. The rate is 110 per minute. The PR interval is just at the upper limits of normal at .20 second, or 200 ms. The QRS complex is within normal limits, but slightly wide at .10 seconds.
This strip is good for teaching rate determination by several different methods. It is helpful that QRS complexes 1, 5, and 10 fall on the dark lines of the paper.
This is a Lead II rhythm strip, and it is helpful to show students that not ALL Lead II strips produce an upright QRS complex. Of course, correct lead placement should be confirmed. In this particular case, the patient had suffered an anterior - septal wall M.I., and has a left anterior hemiblock, also called left anterior fascicular block. This shifts the frontal plane axis to the left, causing Lead II to have a negative QRS. Axis can't be accurately determined from one lead, but axis shift explains the negative QRS in this strip.
A laddergram is a diagram of conduction through the heart, presented in a minimum of three tiers, one for the atria, one for the AV junction, and one for the ventricles. Laddergrams are very useful for presenting and testing your theory of a dysrhythmia. Instructors often use them to illustrate complex dysrhythmia mechanisms.
If you don't yet have experience in using laddergrams, go to this LINK to find a short PowerPoint presentation that will give you the basics to get started. Be careful - it can be a bit addicting to construct laddergrams, like working a puzzle. If you want to use laddergrams to teach your students, this PowerPoint presentation can help you introduce them to the concept.
Our thanks to Jason Roediger, ECG Guru and dysrhythmia expert, for the laddergram depicted here, and the many LADDERGRAMS featured in his blog posts on this site to see the discussion accompanying this ECG, go to this LINK (Warning: this is an ECG Challenge, which is advanced material)
“For another step-by-step review from Dr. Ken Grauer on How to Draw a Laddergram - Please check out Dr. Ken Grauer’s ECG Blog #69 - GO TO - http://tinyurl.com/KG-Blog-69
In the beginning years of the ECG Guru website, Jason Roediger, CCT, CRAT generously contributed a number of challenging ECGs, helping us get our website off the ground. While his schedule has prevented him from continuing his blog, we want to feature some of his blog posts on the front page from time to time, as they are very valuable. Because of some changes in the website configuration, they don't all come up when you choose "Jason's Blog" on the shortcut links. Unfortunately, Jason will not be able to personally respond to all comments.
From June 10, 2012: As is the case with all practical blogs, I’m encouraging ECG Guru members to engage in active group participation. Share your thoughts, observations, impressions, findings, and interpretations. Feel free to compare notes with one another and pick each other’s brains.
Please post your comments and inquiries and I guarantee I'll respond to them in a timely manner as soon as they are received (usually within a few short hours). All questions will be answered and the interpretation (accompanied by laddergram) will be revealed on Sunday, June 17 2012 at which time I will post a brand new Case of the Week.
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