The EKG shows an irregular, narrow complex rhythm with a rate of 85. Lead V1 shows a sawtooth pattern in the baseline, which the cardiology intern (me) incorrectly interpreted as atrial flutter. The cardiology fellow and attending disagreed for the following reasons: the atrial rate is too fast for flutter (about 350/min), the QRS complexes do not follow the previous “flutter” wave with a consistent interval in V1, the morphology of the “flutter” waves changes throughout the tracing, and the R-R intervals are irregular. The diagnosis is coarse atrial fibrillation. CHF decompensation was secondary to poor medication compliance. He refused agressive treatment, requested to be made DNR/DNI, and was discharged to hospice.