There is a regular, broad complex tachycardia at ~187 bpm; All QRS complexes are preceded by P waves with abnormal axis (Negative P in D1). These findings suggest atrial tachycardia. Note that one P wave is dropped in chest leads and made the rhythm irregular.

Other ECG findings:
Left anterior hemiblock
Ventricular conduction delay

#case194 ❤️

65 y female, Known case of Type 2 DM and chronic kidney disease presented with nausea and chest pain

The correct answer is “Hyperkalemia”

This ECG displays many of the features of hyperkalaemia:

• Disappearance of p waves
• ST elevations (best seen in aVR and chest leads)
• Broad, bizarre QRS complexes that merge with subsequent ST segment and T wave.
• Sine waves (best seen in V3)

#case195 ❤️

65 y woman with history of pancreatic cancer presented with chest pain and dyspnea.

The correct answer is “Pulmonary thromboembolism”

The ECG shows “Sinus tachycardia” and “S1Q3T3 pattern”, two most common ECG findings in PTE. These findings are neither sensitive nor specific for PTE, Thus ECG findings only in combination with physical symptoms suggest PTE.

Here are the most common ECG findings in patients with PTE:

• Sinus tachycardia
• S1Q3T3 pattern
• New-onset atrial fibrillation or flutter
• incomplete right bundle branch block
• right axis deviation
• T-wave inversion in leads V1 to V4

#case196 ❤️

55 y man with history of mitral valve replacement presented with palpitation