Absent P waves and a totally irregular rhythm as well as fibrillary waves (f waves) seen better in lead V1 confirms the diagnosis of atrial fibrillation. R wave amplitude in V5 is 3 mV (30 mm) indicating left ventricular hypertrophy. Prominent T wave inversions are seen in inferior and lateral leads with a prolonged QTc (corrected QT interval) of 510 milliseconds by Bazett’s formula. ST – T changes along with tall R waves would suggest left ventricular hypertrophy with strain pattern. The differential diagnosis for ST – T wave changes have been well discussed by the participants in the quiz. QT prolongation is unlikely in digoxin effect as digoxin is likely to shorten the QT interval.
