First beat in the rhythm strip is a sinus and so is the fourth beat as well as the last beat, with upright P waves and a normal PR interval. These are sinus beats. 2nd, 3rd, 5th, 6th and 7th beat have inverted P waves with a shorter PR interval. These beats have inverted P waves in other inferior leads as well V4-V6. These P waves are possibly originating from the left atrium (left atrial rhythm). In addition there prolongation of the QT interval (note the wide and splayed T wave in aVR) and biphasic T waves in anterior leads giving a suggestion of Wellens syndrome. Wellens syndrome is indicative of tight stenosis of proximal left anterior descending coronary artery. Lateral leads show Q waves. QRS axis is a bit leftward, suggesting left anterior hemiblock.