The following ECG is from a 50-year-old man with no past medical history. He has a history of acute onset of palpitations 20 minutes ago with associated chest tightness. There is no history of syncope.

His vital signs are as follows: BP 115/60 RR 20 Sats 99% RA

Interpret the ECG and provided your management.

Thanks to Dr Josh Ho for providing the ECG.