Clinical History 94

Fifty year old woman with a pattern of accelerating angina admitted for a cardiac catheterization. The patient subsequently underwent coronary artery bypass graft surgery. Co-morbidities include hypertension and hyperlipidemia. Medications at the time of this electrocardiogram included topical nitroglycerin, metoprolol, aspirin, premarin and amlodipine.
Comment on this ECG ?