The following ECG has been taken from an 88 year old man who has presented with intermittent chest pain.

His medications are Amlodipine and Rabeprazole. On examination he is pain free and obs are BP 156/57, RR20, Sats 94%, afebrile and normoglycaemic. He has an irregular heart rate and a soft ejection systolic murmur. His first ECG showed only 1st degree heart block with a pulse of 72 but you have been asked to sign a second ECG taken with his serial troponin. Your handover is that he may go home if that troponin is negative

Interpret the ECG and describe how you will further manage the patient.