ECG Case #45 - Question #1

A 62 year old male with a history severe aortic valve regurgitation due to a bicuspid aortic valve underwent aortic valve replacement 2 weeks prior. He was doing well but is now having fevers and chills and feels generally weak. His blood pressure is 160/60, heart rate of 50, respirations of 20, and oxygen saturation 92% on room air. Physical examination reveals normal breath sounds and a II/VI early diastolic murmur at the right upper sternal border. Laboratory studies are normal except on day #2 of admission his blood cultures are positive for methacillin resistant staphylococcus aureus (MRSA). He does not take any beta-blockers or calcium channel blockers. His pre-operative ECG was normal and his current ECG is below. What are the ECG findings?