Similar-not-Same

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An 80-year-old man presented to the ER with a history of palpitation for several hours. He had no other complaints. No more history was available.

His exam was unremarkable and his vital signs were stable.

His EKG on presentation is shown in Fig.1. His old EKG (baseline) is shown in Fig.2.

Figure 1

Fig.1

Figure 2

Fig.2

Q.1

What is the diagnosis of the rhythm shown on his EKG on presentation (Fig.1)?

a) Supraventricular tachycardia with underlying intraventricular conduction delay
b) Ventricular tachycardia (VT)
c) Supraventricular tachycardia with a pre-existing accessory pathway (WPW syndrome)
d) Atrial flutter with 2:1 AV conduction

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