A 60 year old man, who speaks little English, is triaged as a category 2 for left sided chest pain after being brought to hospital by ambulance. He has a history of the following:
- CMML under surveillance (he says “no treatment, just blood tests”, but can’t tell you who his haematologist is)
- Kidney Dysfunction (he can’t elaborate further)
- Hypercholesterolaemia (takes a statin)
- Reflux (takes a PPI)
His first ECG is above. He appears pale and diaphoretic, but apart from tachycardia, his observations are within normal limits.
Please describe the ECG and provide differentials for this ECG appearance. Imagine you are his treating clinician, what steps will you next take to manage him further?