ECG Case 243

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ECG Case 243

This ECG is from an 89-year-old female who presented with a week’s history of feeling generally unwell and episodic pre-syncope over the prior 24 hours. Vital signs: BP 168/67; GCS 15; Sats 96% RA; Temp 36.4 C (97.5 F).

What does the ECG show ?