A 50-year old man presents to the ED with nausea, vomiting and generalized weakness. He has no known past medical history, but has not seen a doctor in “years”. He denies chest pain, abdominal pain, change in bowel movements, headache and fever. He has no other complaints.

On exam his vital signs are normal, but he just doesn’t look right. His tongue is a bit dry. There is no JVD. Lung have a few bibasilar rales, but are mostly clear. Heart sounds are normal. The abdomen is non-tender without mass. He has trace bilateral edema.

Below is his EKG. What does it show? What do the second EKG show?

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