ECG Case 326

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The following ECG is from an 81-year-old female who presented complaining of dizziness, nausea and fatigue. She has a history of pulmonary hypertension and paroxysmal atrial fibrillation.

ECG from an 81-year-old female who presented complaining of dizziness, nausea and fatigue
ECG Case 326

What’s your interpretation ?