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

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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

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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.

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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.

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


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

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


  1. Dear Dr Koch, found your site with google, and must say, it looks good! Very good to test my knowledge, I am an IC nurse, and also a teacher at our "Traininginstitute". Look forward to new items on your site.
    Never seen a better relation between EKG and coronary arteries.
    Something I will surely use in my role as a nurse and teacher.
    Best regards.

    Frans Post.
    Erasmus Medisch Centrum.
    The Netherlands.

  2. Dear Dr Koch,
    I too found your site via Google, and am impressed by your interpretation of ECGs. Having both ECG and transcripts open at the same time really helps me in learning to come into grips with this subject. What's more fascinating is the way you present the ECGs in such a concise manner. Thanks for such useful learning points.

    Medical Student

  3. This website is a *life-saver* for medical students like me!

  4. Dear Dr Koch
    I have problem with the audio files, there are not there any longer
    Tank u

  5. Dr Koch i have a problem assessing the diagram of the ECG so i could see it while listening to your lecture on basics of EKG

  6. 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.

  7. Y want you see this portal of cases and images mediques.
    Thank you


  8. As a medical student I didn't really expect to find this kind of simple information...that 1 really helped, thnx alot :)

  9. hey i love this site very much. i've been studying interpreting EKG results for months now. it's very nice. hope to post more EKG results. like AV blocks, and arrythmias.

    thank so much.
    ERlan .

  10. Its interesting that cocaine alone would lead to ST-elevation. Is the rate the reason the heart is possibly becoming damaged, not enough circulation to the tissues? ST-elevation from what i know is due to heart or cardiac tissue damage due to ischemia. The ST elevation doesnt even seem that significant in lead 2, I would of had a difficult time even recognizing this. Thanks I just found this web site I will definitely be back to learn more.


  11. Dr Koch, I have a question about your patient with ST elevation related to cocaine use. I was wondering if the ST elevation would resolve with time and if so how much time would it take?

  12. ECG changes related to cocaine use typically resolve after the drug disappears from the circulation. Unless the patient had a permanent damage to the heart muscle or the conductive system, of course.

  13. thank you! That helped me alot to understand!

  14. Hello Dr. Koch. Your site seems nice... but all audio links are broken. Could you fix it? Thanks.