This is an interesting teaching ECG on many levels.  It is obtained from a man with chest pain. No other history or follow up is available. 

Acute M.I.     Most striking is probably the clearly-seen anterior-septal wall M.I.  There is ST segment elevation in Leads V₁, V₂, and V₃, with ST depression in the low-lateral leads, V₅ and V₆.  There is also ST depression in the inferior Leads II, III, and aVF.  The ST elevations have a coved-upward (frown) shape in V₁ and a straight shape in V₂ and V₃.  Both of these ST shapes are abnormal and reflect injury.  The depressions are presumed to be due to reciprocal changes, since there is no other ST-depression producing condition apparent.  There are abnormal Q waves in V₁, which could herald the onset of pathological Q waves, a sign of necrosis, in the anterior-septal wall.