ECG of the Week 20th April 2022

The following ECG is from a 52 year old male with a history of bipolar mood disorder and cardiomyopathy. He presents to ED complaining of increasing shortness of breath and leg swelling.  The patient is on antipsychotic medication, bisoprolol, Frusemide and Spironolactone. He has been recently told to decrease his Frusemide dose from 160mg daily to 40mg daily.

  1. Interpret the ECG
  2. How would you manage this patient?