This ECG was obtained from a 49-year-old man who was a patient in an Emergency Dept. We do not know his presenting complaint, only that he had a history of insulin-dependent diabetes mellitus (IDDM). It was noted by the donor of the ECG that the patient had no chest pain, no shortness of breath, and no other cardiac symptoms. We do not know his hydration or electrolyte status. There are quite a few interesting abnormalities on this ECG, and the exact interpretation would, of course, depend upon the patient's clinical status.