You are asked to review the ECG below of an 83 year old man with a 10 day history of shortness of breath and haemoptysis.

Interpretation:

• Rate: 48
• Rhythm: regular narrow complex bradycardia
• Axis: LAD
• Intervals: Retrograde p waves, QRS 120
• Morphology: Poor R wave progression, TWI aVL
• Summary: Escape junctional rhythm
• Clinical relevance: none in this case, XR showed a penumonia and the patient was admitted for an oxygen requirement.