A man in his 70s presented to the emergency department with left-sided hemiparesis, dysarthria, gaze deviation in his right eye, and left-sided hemineglect. His medical history was significant for permanent atrial fibrillation and complete heart block for which he had a pacemaker implanted in the late 1990s that was subsequently upgraded to a biventricular system. His blood pressure was 147/75 mm Hg, heart rate was 84 beats per minute, respiratory rate was 16 breaths per minute, and oxygen saturation was 99% on room air. Computed tomography angiography was consistent with a large middle cerebral artery territory embolic stroke. Embolectomy was advised. An electrocardiogram (Figure 1) was obtained.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Mayfield JJ, Goldschlager N. Alternating QRS Complex Morphology in a Man Presenting With Stroke. JAMA Intern Med. 2020;180(5):778–780. doi:10.1001/jamainternmed.2020.0463
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: