Clinical History 196

Seventy-four year old gentleman who presents to the outpatient clinic with accelerating angina pectoris over the past two months. His past medical history includes coronary artery disease, hypertension and hyperlipidemia. His medications included topical nitroglycerin, amlodipine, metoprolol, digoxin and aspirin. A repeat cardiac catheterization demonstrated compromised blood flow to the left circumflex coronary artery territory.
Comment on this ECG ?