What is the cause of these slurred and downsloping ST segments?

ECG Weekly Workout with Dr. Amal Mattu


A 56-year-old man with PMHx of atrial fibrillation presents to the ED with generalized weakness and near-syncope. He is found to be hypotensive and bradycardic. The following ECG is obtained:

Before watching this week’s video, ask yourself these questions:

  1. What’s the rate and rhythm?
  2. What ST-segment and T wave abnormalities do you notice?
  3. What’s your differential diagnosis?