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A 62-year-old man with underlying COPD develops a viral upper respiratory infection and begins taking an over-the-counter decongestant. Shortly thereafter he experiences palpitations and presents to the emergency room, where the following rhythm strip is obtained. What is the most likely diagnosis?
Normal sinus rhythm
Junctional rhythm
Atrial flutter with 4 :1 atrioventricular block
Paroxysmal supraventricular tachycardia (SVT) with 2 :1 atrioventricular block
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