ECG of the Week - 3rd March 2014

This ECG is from a 70 yr old patient with a history of ischaemic heart disease complicated by ischaemic cardiomyopathy (LV ejection fraction of 27%) in has an AICD in situ. 
The patient presented with worsening dysponea without chest pain. 
His intial serial ECGs are below.

ECG 1 - Click to enlarge

ECG 2 - Click to enlarge

VAQ Corner

A 70 yr old patient presentes to your Emergency Department complaining of increased dysponea. The patient has a past medical history of ischaemic heart disease complicated by ischaemic cardiomyopathy (LV ejection fraction 27%) and has an AICD in situ. 
Vital signs: BP 167/84 RR 26 Sats 91% RA Temp 36.7

• Describe & interpret the patient's intial ECG [ECG 1] (50%)
• Outline your indications for NIV in this patient (50%)