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59 yr old man with HTN, CAD and bypass surgery 2 years earlier, complicated by post-operative atrial fibrillation. Presents now with palpitations and pre-syncope.

Vent. rate 73 bpm
PR interval * ms
QRS duration 98 ms
QT/QTc 358/394 ms
P-R-T axes -83 -36 -29

Questions For Thought

1. Is this atrial fibrillation?
2. How do you think the rhythm relates to the symptom of pre-syncope?

Answer available here