ECG Case #4 - Question #1

A 26-year-old woman with a history of HIV infection presents to the emergency room with a complaint of increased dyspnea on exertion and lower extremity edema over the past 6 months. She denies chest pain, paroxysmal nocturnal dyspnea or orthopnea.

Her temperature is 37.1° C, blood pressure is 92/50 mm/Hg, heart rate is 108 beats per minute and respiratory rate is 20 per minute. She has large V waves in her jugular venous pulsations, a III/VI holosystolic murmur at the left lower sternal border that gets louder with inspiration, and a right ventricular S4 heart sound is heard. A pulsatile liver is palpated. Her ECG and chest X-ray are below.

What are the ECG findings?