An 88-year-old woman with a 10 year history of coronary artery disease is referred to the Emergency Department by her family physician for weakness and dyspnea on mild exertion for the past week:

• Atrial tachycardia with 2:1 AV block 
• Ventricular rate 107/min
• Right axis deviation
• T wave abnormality, consider inferior and septal ischemia