I performed this 12-lead ECG (Fig. 1) several years ago in the medical intensive care unit (MICU) while standing at the patient's bedside. As I was recording the ECG, I distinctly remember thinking to myself: "this patient looks REALLY sick!" for being as relatively young as he was. Immediately after I printed out the hardcopy, I reviewed the computer's interpretive statements at the top of the page. The computer listed an uncommon pair of findings which I confirmed to be true. I asked the assigned nurse if her patient had the clinical condition that this combination is highly suggestive of. She shrugged her shoulders at me and said she didn't know. I consulted the patient's computerized record and right there listed at the top of their "active problems" was the very condition I suspected the patient of having.
Patient's clinical data: 49-year-old black man with history of Type II diabetes mellitus (DM) and this other clinical condition.
Fig. 1: I performed this ECG exactly 5 months and 5 days before the ECG in Fig. 2.
Fig. 2: This ECG was performed on a outpatient basis during a follow-up appointment with their physician. Have things improved or have they gotten worse?
QUESTIONS: In fig. 1, what rare combination of findings are present and what are those two findings highly suggestive of? What would explain the dramatic changes seen in Fig. 2?
HINT: Figures 1 and 2 both look dissimilar enough (esp. given the sequence in which they were recorded) that one might suspect they're from two completely different patients and technically that assumption would not be entirely wrong. Of what am I hinting towards? To be clear, both of these ECGs were performed on the same 49-year-old black male patient.