Clinical History 14

Seventy-two year old woman with advanced emphysema referred for possible lung reduction surgery. An echocardiogram performed three years prior to this electrocardiogram demonstrated normal left ventricular systolic function. By history there was no evidence of a prior myocardial infarction. Medications at the time of this electrocardiogram included theophylline and inhaled bronchodilators.
Comment on this ECG ?