EKG Challenge No. 14: Elderly gentleman BIBW (brought in by wife) ....

On a Sunday afternoon, an elderly gentleman is brought into the emergency department by his wife complaining of chest pain that began one hour ago.  He is diaphoretic and appears uncomfortable.  An EKG is obtained:

You have no prior EKGs available for comparison, but the patient denies any prior history of acute MI or CHF.  Interpret the EKG.   What do you think is going on?   What do you do next?

You can read the case conclusion here.