Clinical History 101

Forty-five year old gentleman with a history of long-term alcohol use who was admitted to the hospital with hemoptysis. An echocardiogram demonstrated severe global left ventricular systolic dysfunction with an estimated left ventricular ejection fraction of 10%. Moderately severe mitral and tricuspid regurgitation were present. Medications at the time of this tracing included furosemide, potassium, digoxin, amiodarone, warfarin and captopril.
Comment on this ECG ?