Cardiology Case Report: Missed Dialysis

In this case report, a man in his 50s with a history of ESRD, alcoholic cirrhosis, and anemia presents to the emergency department for evaluation of generalized weakness after missing his last 2 dialysis appointments. Check out the ECG and determine the most likely cause of the rhythm!

History:

A man in his mid 50’s with a history of ESRD, alcoholic cirrhosis, and anemia presents to the emergency department for evaluation of generalized weakness, vomiting, and diarrhea. He missed his last two dialysis appointments on due to transportation issues. Yesterday he had multiple episodes of non-bloody, non-bilious, yellow emesis as well as non-bloody diarrhea. He reports that he has had generalized weakness that has worsened over the last couple of days but denies any fever, chills, shortness of breath, chest pain, abdominal pain, melena or other complaints.

Exam:

Vital signs are normal. The physical exam is also normal.

An ECG is Performed:

What is the most likely rhythm in this patient?