Clinical History 32

Sixty-six year old woman who was scheduled for an elective stress test at which time the above electrocardiogram was obtained. She was admitted to the hospital to exclude acute myocardial injury. Acute myocardial injury was excluded and subsequent stress testing suggested myocardial ischemia. A cardiac catheterization was performed demonstrating normal left ventricular systolic function and normal coronary arteries.
Comment on this ECG ?