Just Ride It Out?

ANSWER

This ECG shows evidence of an acute anterior ST-elevation myocardial infarction (STEMI) and inferolateral ischemia.

STEMI criteria include a new ST-elevation in the anterior chest leads (V₂–V₄) at the J point (the junction of the termination of the QRS complex and the beginning of the ST segment). The American College of Cardiology/American Heart Association guidelines define cut-points for STEMI as follows: in women, 1.5 mm in leads V₂ and V₃ and 1 mm in all other leads; in men, 2 mm (those 40 and older) or 2.5 mm (those younger than 40) in leads V₂ and V₃ and 1 mm in all other leads. In this ECG, the classic “tombstone” pattern can be seen in the T wave in leads V₃ and V₄.

Inferolateral ischemia is evidenced by the ST elevation and T-wave flattening in the inferior leads II, III, and aVF, as well as in lateral chest leads V₅ and V₆.

The patient was transferred via ACLS ambulance to a tertiary care hospital for cardiac intervention.