ECG Case #1 - Question #1

A 55-year-old male with a history of hypertension, dyslipidemia and diabetes presents to the emergency department with substernal chest pain radiating to his left arm. He has diaphoresis and shortness of breath. He has vomited twice and now is intermittently feeling lightheaded.

His temperature is 37.4°C, heart rate is 70 bpm, blood pressure is 110/70 mm Hg and respiratory rate is 24 breaths per minute. His physical exam reveals no jugular venous distention (JVD), mild bibasilar rales on lung exam, his heart sounds are regularly irregular, and an S4 heart sound is present. His ECG is below.

What are the main findings according to the ECG tracing?