EKG Challenge

This is a 53 year old man who uses crack cocaine and has hypertension and hepatitis C. He was seen at another hospital seven days prior to this admission with chest pain. His EKG is provided below. He was discharged on indomethacin, colchicine, and ciprofloxacin. He has continued chest pain and malaise. His troponin level is 1.85 ng/mL. He is admitted to the telemetry monitoring and has continued chest pain. His morning EKG is provided below and now his troponin level has gone from 3.58 ng/mL to 6.20 ng/mL.

This is a 65 year old man, presents with dyspnea at rest, recent decline in function, and no change in medications. He is currently taking hydrochlorthiazide, carvedilol, tiotropium, and aspirin.

What does his EKG suggest is the cause of his dyspnea?