She was 79 and referred for evaluation of an "aortic valve disorder." She was told of a cardiac murmur 6 or 7 years ago, yet had been asymptomatic, without dizziness, shortness of breath, nor loss of conciousness. She did not feel skipped beats and had never had fevers. Her echo one month prior had demonstrated a very mildly stenosed aortic valve with a mean gradient of 12.2 mm Hg and an aortic valve area of 1.64 square centimeters with mild aortic insufficiency and normal left ventricular function. Her only medication at the time of evlauation was hydrochlorothiazide for hypertension.What is demonstrated on the EKG and how should it be treated?
As part of her workup, an EKG was ordered and is shown below:
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