ECG Case #29 - Question #1

A 32 year old female no significant past medical history presents to the emergency room with chest pains and shortness of breath. She just found out her best friend died and is emotionally upset. Her blood pressure is 90/60, heart rate is 90, respirations 24, oxygen saturation 88% on room air. Physical examination reveals pulmonary rales, elevated jugular veins, and an S4 heart sound. Her troponin levels are significantly elevated. Her ECG is below:

What are the ECG findings?