Clinical History 18

Seventy-nine year old woman with a history of non-insulin requiring diabetes mellitus who was referred to the emergency room from her private physician's office in the setting of acute onset bilateral shoulder discomfort, shortness of breath and nausea. A cardiac catheterization was performed four days after her hospitalization and demonstrated advanced disease in the right coronary artery which was successfully treated with percutaneous transluminal coronary angioplasty. Medications at the time of this electrocardiogram included aspirin, metoprolol, glyburide, intravenous nitroglycerin and intravenous heparin.
Comment on this ECG ?