ECG Case #12 - Question #1

A 54 year old male with a history of  diabetes mellitus, hypertension, and dyslipidemia presents with substernal chest pressure for 30 minutes. The pain began at rest, is 10/10 in severity, was mild to begin with then increased in intensity, is worse with exertion, radiates to his left arm, is not pleuritic or positional, and is associated with diaphoresis, shortness of breath, and nausea.

His temperature is 37.2, blood pressure 90/50, heart rate 100, respiratory rate is 16. No jugular venous distension is present, he is tachycardic and an S4 heart sound is present. No murmurs are heard. His lungs are clear to auscultation. The rest of his exam is normal.

What are the ECG findings?