ECG Case 181

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ECG Case 181

A 65-year-old man with a history of an ischemic cardiomyopathy presents to the emergency department with a several-hour history of chest discomfort. He states that 2 years before, he had an ICD inserted because of a low ejection fraction (30%), but he has never experienced a shock.

His initial ECG does not show any acute changes and initial cardiac biomarkers are negative. He is admitted to the hospital and placed on telemetry. On the following day, he has an episode of chest discomfort and then loses consciousness.

What is seen on telemetry?