ECG of the Week - 11th November 2013

I'm busy updating my ECG collection so I'm using some of the older ECG's I've collected. Unfortunately many of these, including this week's ECG, don't have any associated clinical information. I will try and track down some information on this case and will update the post if I find any.
Even without any clinical information it's still a nice ECG :-)

Click to enlarge

VAQ Corner

I don't have any clinical information on this case so we'll assume for the question stem it is from a 53 yr old obese male who presents to your Emergency Dept with chest pain and palpitations. 
BP 100/62 RR 22 Sats 98% 10L/min GCS 15

a) Describe and interpret
b) Outline your management plan

For those of you working towards the FACEM Part 2 exam remember to read the question, there is no unnecessary information in the stem. 
Things to watch for are:

• Co-morbidity
• Department type - regional, rural, tertiary
• Patient factors - obesity, pregnant

Address all these factors when planning your answer e.g. do you need to postpone a operation ? will you need to transfer a patient ? is this a complex or difficult situation ?