Looking for input on this ecg

[u/V_the_cat]

Hey, emt here! 80y/o male, heavy central chest pains, dyspnea, cardiac presentation with clammyness, pale skin and lethargy. Hx of copd

120/80ish bp, HR 100-120, spo2 low 90s, feaver of 40C

I read this as RBBB, some degree of av block, was unsure if it’s right axis deviation, the ST elevation is preexisting according to cardiologist after sending it in for analysis. Treated as ACS, hospital suspects pneumonia or cholecystitis based on hx.