This is a 68 year old male with long standing HTN, Type II diabetes mellitus and chronic renal failure. He is admitted to the ED with intermittent chest pain of two days duration., He has a BP of 240/120 mm Hg, pulse of 72/min.  There is no past history of known coronary artery disease and an EKG obtained a month previously in the physician's office was within normal limits. An EKG obtained in the ED is shown below.

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