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There is a large peaked P-wave in lead II (right atrial enlargement) There is left axis deviation consistent with left anterior fascicular block. There is no evidence of infarction or ischemia. There is atrial activity before every QRS, but that activity has negative polarity, so it is not sinus rhythm.
Evidence of acute ischemia (may be subtle) vii. Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia.
That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. In 2016, I doubled the number of night shifts and suddenly was having 10,000 PVCs per day, very distressingly symptomatic. You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion.
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