An Old Lady with Chest Pain

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Author(s) A.A.M. Wilde
NHJ edition: 2006:04,154
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Figure 1

A 90-year-old lady presented with chest pain which had a sudden onset in the middle of the night. There were no other symptoms. She never had experienced similar pain before. There was no other relevant medical history. She was not on any medication. Physical examination revealed no abnormalities. The first ECG is shown in figure 1 (standard calibration).

What is your diagnosis and what would be the next step?