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56 year old woman undergoing chemotherapy for bronchio-alveolar carcinoma. Two years previous underwent emergency pericardiocentesis for cardiac tamponade (malignant effusion). Complaining of rapid palpitations.

Click for the patient's ECG when the heart rate is normal

Vent. rate 134 bpm
PR interval 258ms
QSR duration 104ms
QT/QTc 302/450ms
P-R-T axes -10 31 -35

Questions For Thought

1. What is the mechanism of the fast rhythm?
2. Why do you think she has it?

Answer available here