Scenario: This 12-lead electrocardiogram (ECG) is from an 82-year-old man who arrived via ambulance at the emergency department (ED). After a total hip replacement, he had been recovering at a skilled nursing facility when he experienced acute shortness of breath and chest pressure. His oxygen saturation was 83% on room air, so he immediately was given oxygen via nasal cannula and later progressed to bilevel positive airway pressure because his symptoms and desaturation did not improve. He was subsequently transferred to the ED. His history includes heart failure, coronary artery disease, type 2 diabetes, prior surgery for an abdominal aortic aneurysm, and chronic kidney disease. Initial laboratory test results were troponin, 0.71 ng/mL; B-type natriuretic peptide (BNP), 9638 pg/mL; and serum urea nitrogen/creatinine, 48/1.99.

Sinus rhythm with left bundle-branch block (BBB), 2 instances of premature ventricular complex (PVC) triplets with a multifocal pattern, 1 isolated PVC, and 1 premature...

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