EKGs with Dr. Koch: It's Not Only Educational It's Also Fun!

Author: J. M. Koch, M.D., Cleveland Clinic
Reviewer: V. Dimov, M.D.


J. Michael Koch, MD, FACC; EKG and the schematic distribution of the main coronary arteries.

Note: You probably would like to see the EKG while listening. To do this, first right click on the EKG image and choose "Open in NEW window", then go back to the original window and click the audio player. The cases start with a 30-second presentation by the residents, followed by a discussion by Dr. Koch.

Chest pain, cocaine use and ST elevation: is it myocardial infarction?

This patient wanted to die but was afraid of pain so he decided to use drugs to kill himself. Chest pain was typical for ACS but do not forget to refer to the gold standard -- the EKG. Click to listen to Dr. Koch's discussion of the EKG. A psychiatry consult was obtained. Remember that ST elevation may also be a normal variant, reference: NEJM 2003. Click on the image to enlarge and click on the audio post link to listen.


A cocaine user with ST elevation


powered by ODEO

Bradycardia and hypotension due to cocaine and clonidine

Dr. Akhtar presents a 39 yo AAF who drank 6 beers, used cocaine and was taken to the ED. According to her boyfriend, she was so "high" that he had to give her 2 clonidine pills of his to "slow her down." She came to the ED with SBP in 60s and HR 20-30 bpm


Bradycardia due to clonidine


powered by ODEO

ST elevation-myocardial infarction and the response to PTCA

Dr. Erfan presents a 39 yo AAM with chest pain. The rapid PTCA had a clear effect within minutes. Dr. Koch discusses the EKG and management. Click on the image to enlarge and click on the audio post link to listen.




powered by ODEO

Non-ST elevation anterolateral MI or ST elevation inferior wall MI?

Image 1 is the initial EKG, image 2 is the follow-up EKG.


ST elevation IW MI. Catheterization showed 100% RCA occlusion. Dr. Koch guides us through the EKG.


powered by ODEO

Further reading

Imaging: Electrocardiograms, X-rays, CT scans
A Systematic Approach to Electrocardiogram (ECG, EKG) Interpretation by Using 2 Mnemonics
Medscape ECG of the Week - a large archive of files.
EKG Du Jour: Brugada syndrome. Dr. Wes, 01/2008.
APDIM E-Learning Task Force: Cardiac Auscultation, Chest X-Rays, Electrocardiograms, Patient Images (Dermatology), Pulmonary Function Tests, 2009.

Audio

Audio lecture: Basics of EKG. Dr. Dwight Dishmon. Podcasting Project for the UT Internal Medicine Residency Program, 2006.

Video



ECG Video: For Med Students studying the basics of reading an electrocardiogram, from the University of Wisconsin.

Created: 01/12/2005
Updated: 03/04/2009