The Ions Have It

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Author(s) T.A. Simmers, A.A.M. Wilde
NHJ edition: 2005:11,428
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Figure 1

A 46-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?