A 43-year-old man applied for life insurance. He admitted to smoking and chewing tobacco. He operated heavy construction equipment for a living. Positive findings on the insurance exam were a BMI of 41 and an elevated ALT – 57 U/L (normal: 0-45 U/L). His medical records were benign except for a mildly reduced Forced Expiratory Volume in 1 second (FEV1) of 86% of predicted. This EKG was obtained for insurance. What is the major abnormality in this EKG?
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