A 54-year-old white woman presents to the emergency department with nonradiating, substernal chest pain that started 2 hours earlier. She describes the pain as sharp, achy, constant, and rates it a 7:10 on the pain scale. She denies nausea or diaphoresis. The pain is not affected by anything. She has never had her cholesterol level measured, but has a 25 pack-year smoking history and an extensive family history of coronary artery disease. Her vital signs are: blood pressure, 162/94 mm Hg; pulse 73 beats/min; temperature, 98.2°F; respiratory rate 12 breaths/min. The physical examination is remarkable only for minimally coarse breath sounds bilaterally. An electrocardiogram (ECG) is obtained (Figure).

How Would You Interpret This ECG?