Vignette: Elderly patient with history of chronic smoking, DM, HTN and dyslipidemia was brought in due to weakness and fall. Patient is being worked-up for possible CVA.
What is the rhythm?
This is a regular, wide QRS complex rhythm with left anterior fascicular block (LAFB) and right bundle branch block (RBBB). Our differential are: junctional rhythm or a SR with a long PR interval with P hidden from view as it merges with the T wave.
The rhythm strip revealed the P waves and the long PR interval.
Going back to the 12 lead, if you look closely in lead II you see distortions at the descending portion of the T waves.
For the case, it was found that it was indeed stroke. Managed as that and later sent for rehab and risk factors addressed.
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