ECG of the Month: Exertional Chest Discomfort

The patient is an 84-year-old male who presents with chest discomfort on exertion of a more frequent occurrence and increasing shortness of breath. He has had an aortic outflow murmur and a history of "aortic stenosis." A few months ago, he had cardiac catherization with a stent performed at an outside hospital. He is seen in the emergency department and the following ECG was recorded:

Figure 1

The ECG shows which of the following?

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