Clinical History 145

Sixty-six year old woman with coronary artery disease who is recently status post coronary artery bypass graft surgery. Her comorbidities include non-insulin requiring diabetes mellitus, hypertension, hypothyroidism and moderate restrictive lung disease. Her medications at the time of this electrocardiogram included aspirin, hydralazine, omeprazole, thyroxine, metoprolol and prednisone.
Comment on this ECG ?