Clinical History 246

Forty-two year old gentleman who three days priorto this electrocardiogram awoke early in the morning with acute onset chest discomfort. He was accepted in transfer from an outside hospital for cardiac evaluation. Cardiac enzymes confirmed the presence of acute myocardial injury and a subsequent cardiac catheterization demonstrated severe multi-vessel coronary artery disease. Medications at the time of this electrocardiogram included aspirin, atenolol, atorva statin, isosorbide mononitrate and captopril.
Comment on this ECG ?