<prompt> A 70 year old COPD patients presents with palpitations. ECG rhythm strip shows?Inappropriate sinus TachycardiaJunctional TachycardiaAtrial fibrillationMultifocal Atrial Tachycardia  <response>: ECG strip shows a hea rate of approximately 120min with normal sinus rhythm. However a very peculiar finding is present here with variable P wave morphology. MC arrhythmia in COPD patients is M.A.T Multifocal atrial tachycardia. It originates due to multiple ectopic foci in atria. Choice A has an exaggerated response to emotional stimuli like fear. Choice B has Retrograde P waves with narrow complex QRS. Blue arrows Choice C has absent P waves with irregular RR interval. 