A 79yoM with history of CAD s/p PCI/CABG years ago, Parkinson Disease presents with chest pain. ECG is shown below. Your ECG machine is not malfunctioning, the tech has not made a mistake, and the patient is laying calmly (no shivering or tremor). What is causing this abnormal ECG appearance, what can be done to remedy it.

Answer: This patient has a deep brain stimulator (monopolar setting) causing artifact. The patient usually has a remote for the device and can turn it off.  A magnet can also be used. It is safe to turn off the stimulator for a few minutes to perform an ECG but the neuro symptoms it was placed for (ie tremor, rigidity, etc) may return to cause some artifact. NEVER turn off the GBS if it was placed for dystonia as the patient can have dystonic storm. When in doubt, discuss with neurology.