The rhythm is not clear. It could be sinus with very flat P waves (there are prominent U waves that make it difficult to see P waves) or perhaps nodal rhythm, with most likely ventricular premature complexes. There is a right axis deviation of the QRS and tall R waves in V5 (> 35mm) with wide spread ST changes. The EKG suggest left ventricular hypertrophy with possibly a left posterior fascicular block.