No acute LAD thrombus here, like the clinical picture might suggest. Notice those Q waves in the anteroseptal leads V1-V3? That is NOT consistent with acute chest pain for 20 minutes! More like an ...

There are Q waves in the inferior leads and in leads V1-V4 (anteroseptal leads). This indicates an infarction, possibly old. What is concerning about this ECG tracing are the ST segments.