When One Lead Stands Alone: Deciphering Bizarre ECG Abnormalities

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 67-year-old woman with PMHx of HTN, DM, and ESRD presents to the emergency department drowsy and non-cooperative. Her blood sugar is elevated, pH 7.23, and there is concern for DKA or another metabolic process. The following ECG is obtained:

Before watching this week’s workout, closely examine the ECG and ask yourself:

    1. What does it mean when an ECG abnormality coincides with the cardiac cycle but isn’t consistent across all leads?
    2. What is the most likely cause of this bizarre rhythm?