ECG of the Month: Recent Onset of Bradycardia in a Patient with Lightheadedness and Nausea

A 73-year-old woman with a history of remote staphylococcus lugdensis tricuspid valve endocarditis treated medically, end-stage renal disease on intermittent hemodialysis, hypertension, and diabetes presents to the Emergency Department with nausea and lightheadedness for 1 week. She has a heart rate of 30 beats per minute (bpm) and a blood pressure of 160/70 mm Hg. She denies having syncope. Her home medications include clonidine 0.2 mg three times daily, losartan 50 mg daily, and metoprolol 100 mg two times daily. Her potassium is 4.6 mmol/L and magnesium is 2.4 mmol/L. Her electrocardiogram (ECG) is shown in Figure 1.

Figure 1

Figure 1

Which of the following most likely describes the findings on this ECG?

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