sClinical History 244

Sixty-eight year old gentleman with recent symptoms of accelerating angina pectoris in the setting of previously diagnosed coronary artery disease. He suffered a myocardial infarction of unknown location twenty-one years priorto this electrocardiogram. A subsequent cardiac catheterization six years priorto this tracing demonstrated an occluded left anterior descending coronary artery with the remainder of the coronary arteries demonstrating diffuse moderate obstruction. The patient was managed medically and at the time of this electrocardiogram was taking aspirin and isosorbide mononitrate.
Comment on this ECG ?