A 68-year-old male admitted to ICU for acute exacerbation of COPD develops a sudden onset of palpations. The following ECG changes are seen. What is the most likely diagnosis?
**Core Concept**
The underlying principle in this question is the ECG changes associated with the acute presentation of a life-threatening cardiac condition in a patient with a pre-existing respiratory disease. The ECG changes are a manifestation of the cardiac condition's effect on the electrical activity of the heart.
**Why the Correct Answer is Right**
The most likely diagnosis is Torsades de Pointes (TdP), a type of polymorphic ventricular tachycardia that can occur in patients with a prolonged QT interval. The prolonged QT interval is often seen in patients with electrolyte imbalances, particularly hypokalemia (low potassium levels) or hypomagnesemia (low magnesium levels). In this case, the patient's acute exacerbation of COPD and subsequent ICU admission may have led to electrolyte imbalances. The sudden onset of palpitations and the ECG changes are consistent with TdP.
**Why Each Wrong Option is Incorrect**
* **Option A:** While atrial fibrillation can cause palpitations, it is not typically associated with a prolonged QT interval or the specific ECG changes seen in this patient.
* **Option B:** Ventricular fibrillation is a life-threatening cardiac arrhythmia, but it is not typically associated with a prolonged QT interval or the specific ECG changes seen in this patient.
* **Option D:** Sinus tachycardia can cause palpitations, but it is not typically associated with a prolonged QT interval or the specific ECG changes seen in this patient.
**Clinical Pearl / High-Yield Fact**
The QT interval on an ECG is a measure of the time it takes for the heart to prepare for the next beat. A prolonged QT interval can be a sign of an underlying electrolyte imbalance or a cardiac condition that affects the heart's electrical activity.
**Correct Answer:** C. Torsades de Pointes.