Man Shovels Path to Angina

ANSWERThe correct interpretation includes sinus rhythm with blocked premature atrial complexes, left-axis deviation, and serial changes of an evolving anterior MI.

The presence of a P wave without a QRS between the third and fourth QRS complex represents a blocked premature atrial complex. The fifth QRS complex also indicates a premature atrial complex; however, it is not blocked.

Left-axis deviation is evidenced by the R axis of –82°. The loss of an R wave in V₁, the poor R-wave progression in V₂ and V₃, and the ST-T wave changes are all consistent with an evolving anterior MI.