The auscultatory findings simulated here and the accompanying ECG are from a 54 year old female with exertional dyspnea, 2 pillow orthopnea and leg edema who was being treated with a variety of medications including oral diuretics and digitalis. Her physical examination revealed distended neck veins with a āvā wave, a low pitched rumbling diastolic murmur at the apex and a systolic mumur heard at the apex and at the left sternal border. Occasional rales were heard over the bases of her lungs and she had 2+ pitting edema of her legs. How would you interpret her ECG and what do you think is/are the cause of her murmurs?