"Patient is waiting to be shocked"

 

Patient is a 72 year old white male with a history of hypertension and mild heart failure being treated with lasix 40 mg qd, is found at home with shortness of breath more intense that usual. Several weeks ago he noticed palpatations and saw his cardiologist. He was told that his heart was irregular and he was given some additional medications (Amiodarone and Warfarin) and was told that if his heart rhythm didn't resolve back to normal, he would be admitted and and shocked.

He is Cx and alert in no acute distress. His VS are P-80 and irregular R- 22 BP-110/80 SpO2- 98% on room air. Lungs are clear. He has a grade V/VI systolic MM suggestive of aortic stenosis.

His EKG was aquired:

image

What is this rhythm, why is the QRS wide, how do you explain the narrow QRS, what is the medical procedure in his future if he fails to spontanously convert, and what are the risks of remaining in this arrhythmia? (answers available in one week)

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