Although the P waves are few and far between, there must be a sinus mechanism, but the P-P cycle is unclear. The pauses indicate Second Degree AV Block. The shortening R-R intervals between pauses supports Wenckebach AV Block.
The QRS morphology indicates LBBB.
There is concordant ST elevation in Leads II, III and aVF, with reciprocal ST depression in leads I and aVL, consistent with Acute Inferior MI.
ST segment elevation in the right chest leads (V4R,V5R,V6R) provides evidence that the infarction also involves the Right Ventricle.