Clinical History 278

Seventy-five year old gentleman status post a remote anterolateral myocardial infarction and percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery who re-presents with recurrent angina pectoris. Medications at the time of this electrocardiogram included intravenous nitroglycerin, intravenous heparin, metoprolol and aspirin.
Comment on this ECG ?