ECG of the month. Complex issues. Myocardial infarction; left bundle branch block

A 64-year-old man came to the hospital complaining of recurrent chest pain and shortness of breath for the previous two days. Diagnoses included diabetes mellitus and hypertension for about six years and documented coronary artery disease. He was not compliant with treatment for any of these disorders. The initial 12-lead ECG and rhythm strip are shown below.