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Challenges in Clinical Electrocardiography
January 2017

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

Author Affiliations
  • 1Department of Medicine, University of California San Francisco, San Francisco
  • 2Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco
  • 3Division of Cardiology, Department of Medicine, San Francisco General Hospital, San Francisco, California
JAMA Intern Med. 2017;177(1):120-122. doi:10.1001/jamainternmed.2016.7231

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.

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