HPI:  A 87-year-old man with history of HTN, CKD, CHF (EF 45%), and chronic atrial fibrillation presents with 1-week history of generalized weakness, loss of appetite and intermittent dizziness. He denies chest pain, shortness of breath, or vomiting. On exam, he is found to be hypertensive, bradycardic, and in mild congestive heart failure. The following ECG is obtained and compared to his baseline ECG:

Case ECG



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