ECG of the Month: A 90-Year-Old Woman Presents with Symptoms Consistent with Acute HF Exacerbation

A 90-year-old woman with a past medical history of coronary artery disease with previous coronary artery bypass grafting, heart failure (HF) with preserved ejection fraction, World Health Organization (WHO) grade II pulmonary hypertension, sick sinus syndrome with a dual chamber pacemaker, paroxysmal non-valvular atrial fibrillation, stage 3 chronic kidney disease, hypertension, and hyperlipidemia presents to the hospital with dyspnea and lower extremity edema, consistent with an acute HF exacerbation. She receives intravenous furosemide with improvement in her symptoms. She denies palpitations or syncope.

An electrocardiogram (ECG) is performed on admission (Figure 1).

Figure 1

Figure 1

The ECG shows which of the following?

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