The following ECG is from a 40-year-old man who presents overnight with left sided sharp chest pain which has woken him from sleep. He describes the pain as radiating into his left arm. He looks well from the end of the bed and his observations are unremarkable.

He has a past medical history which is significant for hypertension, hypercholesterolaemia and a strong family history of ischaemic heart disease.

What are the key abnormalities and how will you manage this patient?