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40 year old male with syncope

How does this ECG explain the symptoms?

Arrhythmogenic Right Ventricular Dysplasia
(ARVD)

A 75-year-old male with a known history of DM and HTN presented to the emergency department complaining of palpitations. Upon examination, his blood pressure was 140/90 mmHg, and O2 saturation was 94%.

The correct answer is “Junctional tachycardia with LBBB and PVCs
”

The ECG shows a repeating pattern of four beat groupings. In the first three beats of each group beat, the QRS complexes are wide and followed by retrograde P waves that come after the QRS, suggesting the beats start near the AV node (junctional tachycardia). The wide QRS complexes are due to underlying Left Bundle Branch Block (LBBB). The fourth beat in each group looks different, comes earlier than expected, and doesn't have a P wave after it, which indicates a Premature Ventricular Contraction (PVC).

65 y old male with a history of opium addiction found unconscious after two days.

The correct answer is “Electrolytes imbalance”

There is a regular rhythm of wide QRS complexes without discernible P waves. Although the T waves are not tall, some have a tented configuration. These findings suggest hyperkalemia, likely due to rhabdomyolysis in the context of a decreased level of consciousness.

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