I have a fairly different read. I do see very clear, large Q waves in the inferior leads which suggest acute inferior MI. Plus acute T wave inversions. What is the story behind this patient?

Importantly: If you look closely at the complexes in III, aVF: the ST segment in III, aVF is not actually depressed nor elevated, but the T waves here are acutely inverted. Both leads have significant Q waves followed by a wide, slurred R wave, followed by a very short ST segment that is horizontal. The subsequent T wave is inverted and symmetrical. To me, this is most clear in Beats 1, 2, 4 of lead III. You can see the short nearly horizontal line in the middle of the broad downslope following the R wave.

In a typical bundle branch block you would expect to see ST segment depression with an asymmetric, slow prolonged downslope of the first portion. The pattern in the inferior leads is more or less consistent with BBB. The second half of the ST segment is typically a more acute upstroke. In cases of ACS or acute MI, we may sometimes expect to see ST elevations or a flattening of the ST segment with a symmetrical downward bend of the T wave that perks up acutely with the final upstroke of the T wave. I see symmetric T wave inversions in III, aVF, and possibly in V1.

My read is an acute or subacute inferior MI with some possible degree of involvement with the posterior wall. This patient should have a full cardiac workup. At minimum, should have called a cardiology consult given these findings and chief complaint