ECG of the Week - 26th August 2013

This ECG is from an 85yr old female who presented complaining of worsening dysponea and atypical chest pain. She has known atrial fibrillation and COPD. 
At the time of clinical review we luckily had access to her old ECG's and a recent echo.
You can find the patient's echo result and a bit more information in our interpretation post for this ECG here.