Clinical History 109

Seventy-three year old gentleman admitted acutely to the hospital with profound shortness of breath and a blood pressure of 215/130. The patient was intubated. His past medical history includes an abdominal aortic aneurysm, hypertension and chronic obstructive pulmonary disease. Medications at the time of this electrocardiogram included minoxidil, isosorbide mononitrate, furosemide and inhalers.
Comment on this ECG ?