ECG of the Month: Patient Presents with a One-Week Increase in Dyspnea and Orthopnea

A 72-year-old man with history of coronary artery disease, hypertension, cerebrovascular accident, hyperlipidemia, and ischemic cardiomyopathy. His left ventricular ejection fraction is 35%. He is seen because of a one-week increase in dyspnea and orthopnea. An electrocardiogram (ECG) is performed (Figure 1).

Figure 1:

Figure 1

The ECG shows which of the following?

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