76 year old female, presents with lightheadedness and lethargy. She is complaining of mid-scapular pain & is syncopal at triage.
She has cold hands & clammy skin. Systolic BP 70 mmHg. Crackles to mid-zones of her chest. Distended JVP.
PMHx: AF (on metoprolol) & rheumatic heart disease (?mitral stenosis)
This is her ECG.