You are seeing a 52 year old man who has had an MI 14 years ago secondary to a spontaneous RCA dissection. He presented late (with Q waves seen on ECG) and so was treated medically. 8 years later he required an AICD for secondary dilated cardiomyopathy and a consequent episode of VT . Today he has had an episode of pre-syncope and felt his defibrillator discharge so is presenting for review. He now feels well and his observations are within normal limits. His ECG is as below:

Questions:

1. Describe this ECG.
2. How would you complete your clinical assessment?