A 27-year-old ‘Copa regular presents to the ED with a three-day history of palpitations. The most recent episode occurred earlier today, after using some crack. The patient felt his heart begin to race right after he smoked it. After he rested for approximately half an hour, the racing resolved. At that point, he resumed smoking, and the heart racing promptly returned. He stopped and went to the ED at the urging of his Homeys.
The patient states that this has happened “a couple of times” over the past two days after using meth, but not to this extent. Careful questioning reveals several episodes of palpitations in the past, one of which lasted as long as an hour and all of which have been self-limiting. He has never sought care for these. His past medical history is negative for any prior illnesses,.
An EKG is performed and shows the following values: ventricular rate of 66 beats/min; PR interval, 116 ms; QRS duration, 142 ms; QT/QTc interval, 456/478 ms; P axis, 0°; R axis, –7°; T axis, 105°. What other findings are present, and what is your diagnosis?