This ECG shows a polymorphic ventricular tachycardia with a characteristic twisting of the QRS complexes around the isoelectric line.

Key ECG Features:
• Polymorphic wide QRS complexes
• Shifting axis and amplitude of the QRS complexes
• Preceded by prolonged QT interval

What triggered it?
• Patient was on quetiapine (QT-prolonging antipsychotic)
• Started on levofloxacin (another QT-prolonging drug)
• Combo + possible illness-related factors = setup for TdP

Clinical takeaway:
Be cautious when combining QT-prolonging agents, especially in older or critically ill patients. A baseline ECG and electrolytes could make all the difference.