Clinical History 67

Sixty-eight year old gentleman with obstructive coronary artery disease who is status post a remote inferior myocardial infarction and coronary artery bypass graft surgery ten years priorto this electrocardiogram. He returns for a routine follow-up examination. Co-morbidities include hypercholesterolemia and paroxysmal atrial arrhythmias. Medications at the time of this electrocardiogram included aspirin.
Comment on this ECG ?