MRCP2-3026

A 24-year-old male presents to the emergency department with a sudden onset headache. The nursing staff are concerned about the appearance of his ECG taken at triage. He denies any chest pain or shortness of breath. On examination, he appears agitated and refuses to open his eyes to light. His blood pressure is 140/80 mmHg and his heart sounds are normal. There is no visible JVP and his lung fields are clear.

What is the most probable reason for the ECG changes observed in leads V4-V6?