ECG of the Month: Cough and Chest Tightness

The patient is a 66-year-old male with a history of chronic obstructive pulmonary disease, type II diabetes mellitus, hyperlipidemia, tobacco use and known coronary artery disease, s/p PCI 4 years ago. He presents with cough, exertional chest tightness and right arm pain. He is found to have stage IIIB non-small cell lung cancer. He is undergoing evaluation and staging for chemotherapy. The following ECG is performed:

Figure 1

The ECG shows which of the following?

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