Alternating QRS Complex Morphology in a Man Presenting With Stroke

Mayfield and Goldschlager present a case report of a man in his 70s presented to the emergency department with left-sided hemiparesis, dysarthria, gaze deviation in his right eye, and left-sided hemineglect. His medical history was significant for permanent atrial fibrillation and complete heart block for which he had a pacemaker implanted in the late 1990s that was subsequently upgraded to a biventricular system. His blood pressure was 147/75 mm Hg, heart rate was 84 beats per minute, respiratory rate was 16 breaths per minute, and oxygen saturation was 99% on room air. Computed tomography angiography was consistent with a large middle cerebral artery territory embolic stroke. Embolectomy was advised. An electrocardiogram was obtained.