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Challenges in Clinical Electrocardiography
March 23, 2020

Alternating QRS Complex Morphology in a Man Presenting With Stroke

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco, San Francisco
  • 2Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, California
JAMA Intern Med. 2020;180(5):778-780. doi:10.1001/jamainternmed.2020.0463

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.

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