Clinical History 155

Fifty-five year old gentleman recently admitted to the hospital after an acute lateral myocardial infarction. He has a history of a remote anterior myocardial infarction and severe left ventricular systolic dysfunction. This electrocardiogram was obtained as part of the patient's evaluation for possible coronary artery bypass graft surgery. Medications at the time of this electrocardiogram included lisinopril, metoprolol.furosemide and aspirin.
Comment on this ECG ?