A 54 yo with Chest Pain

A 54 yo male presents with left sided chest pain radiating to his jaw. He has vomited once.
His past medical history includes, Diabetes, Hypertension, an AMI (10 years ago) and Hypercholesterolemia.
His ECG is shown below:
This weeks ECG is contributed and discussed by Prof Louise Cullen, Emergency Physician Royal Brisbane and Women's Hospital and ACS researcher.

Answer the Questions below and then look at the case

• Are there any abnormalities that you notice in the ECG?
• Any evidence of ischaemia?
• How would you manage this patient if he came to your emergency department and would that management differ if you worked in a department without a cath lab?