ECG Case #33 - Question #1

A 75 year old male with a history of coronary artery disease presents to the emergency room with increasing substernal chest pain. His blood pressure is 110/60, heart rate 100, respirations 20, and oxygen saturation 95% on room air. His physcial examination reveals normal lung sounds, an S4 heart sound, and a paradoxically split S2 heart sound. Review of his old ECG from 1 month prior reveals normal sinus rhythm with a left bundle branch block. His ECG now is below. What are the ECG findings?