A 64 year old male presents to the emergency room with a complaint of substernal chest pressure x 1 hour. He has significant nausea and has vomited once. His blood pressure is 140/90, heart rate 60, respirations 20 and oxygen saturation 95% on room air. Physical examination reveals normal lung sounds, no JVD, and an S4 heart sound. His ECG is below:
What are the ECG findings?