Scenario: This rhythm strip was obtained on a 45-year-old woman with a medical history of coronary artery disease, prior coronary artery bypass graft, heart failure with reduced ejection fraction, and an implanted left ventricular assist device (LVAD). She arrived at the emergency department with fatigue, weakness, nausea, and vomiting. Her LVAD was operating at a 4.3 L/min flow rate, 5600 rotations per minute (rpm) speed, and 4.2 W of power. Assessment of her vital signs in the emergency department showed low-grade fever, tachypnea (respirations, 20/min), and desaturation (oxygen saturation by pulse oximetry, 92%) on room air. She tested positive for COVID-19 and was admitted to the cardiac LVAD floor. The nurse was concerned about an asystole alarm from the bedside monitor.

Sinus rhythm at a heart rate of 69/min, rS morphology in lead II most likely due to left axis deviation, and low QRS wave amplitude. Additionally, an electrical...

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