Alternating QRS Complex Morphologic Characteristics in a Man Presenting With Scrotal Edema

A man in his 50s with a history of hypertension, New York Heart Association stage III heart failure with reduced ejection fraction (<25%) from polysubstance abuse, and 2 prior strokes presented with bilateral scrotal and lower extremity edema for 10 days. He did not have chest pain, shortness of breath, or dyspnea on exertion but noted scrotal pain. Findings from a heart and lung examination were notable for mild wheezing. A chest radiograph revealed no acute cardiopulmonary processes. The initial electrocardiogram (ECG) is shown in Figure 1.