View source for Puzzle 2005 11 428 - Answer

{{NHJ|
|mainauthor= '''T.A. Simmers, A.A.M. Wilde'''
|edition= 2005:11,428
}}
[[Image:Puzzle_2005_11_428_fig1.jpg|Figure 1|thumb]]

A46-year-old male was admitted to our emergency
room with dyspnoea. His medical history included
congestive heart failure with a left ventricular ejection
fraction of under 10%, type II diabetes, gout, hypothyroidism
and morbid obesity. Physical examination
was severely hampered by the patient’s weight (in
excess of 230 kg), but revealed signs of right and left
heart failure. The ECG on admission is shown in
figure 1. 

'''What diagnosis does it suggest, what further information do you need, and how should the patient be treated?'''