Clinical History 183

Seventy-four year old woman with a prior surgical resection of squamous cell esophageal cancer who re-presents to the hospital with increasing shortness of breath and orthopnea. An echocardiogram demonstrated a large pericardial effusion and normal left ventricular wall motion. The patient is not known to have a history of a prior myocardial infarction and no prior cardiac evaluation has been undertaken.
Comment on this ECG ?