ECG of the Week - 10th November 2014

This ECG is from an 89 yr 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)

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Questions for consideration

• What does the ECG show ?
• What is your emergent management of this patient ?
• What are your considerations for the long-term management ?