The ECG shows upslope ST-Depressions and peaked T waves in the anterior leads (best seen in V4) as well as ST-Elevation in lead aVR (>5mm). this pattern is called “De Winter T wave” and seen in ~2% of acute LAD occlusions.
There are P waves with abnormal morphology (negative in lead 2) at a rate of ~220. P waves are variably conducted to the ventricles resulting in irregular RR intervals. other abnormal findings include left anterior hemiblock, poor R wave progression and a PVC.
Is it an atrial flutter? The absence of typical sawtooth pattern and lower atrial rate (<250bpm) makes atrial flutter less likely