History: A 51-year-old man with a history of chronic methamphetamine abuse presents to the emergency department with leg swelling, dyspnea, and near-syncope with exertion, symptoms that have been getting progressively worse for about two weeks. He denies fever, cough, chest pain, or other complaints. He is otherwise healthy.
Exam: Vital signs are normal except for a pulse of 110 beats/min. His lungs are clear and his heart is tachycardic without murmurs. His legs have 1-2+ bilateral symmetric pitting edema. The rest of the physical exam is normal.
Initial concern(s): Congestive heart failure (CHF), pulmonary embolism (PE), pneumonia.
Testing: Chest x-ray, duplex ultrasound of the legs, and CT angiography chest are negative for pneumonia, DVT, and PE; ECG tracing is shown below.
What's your ECG read?