Rhythm Nation: October 2019

A 50-year-old woman with no significant past medical history is brought to the ED via EMS as a “STEMI notification”. As per family, the patient was at the post office when she developed sudden onset chest pain and then syncopized.

The patient had not seen a doctor recently and does not take any medications. Of note, the patient has a history of depression but has never been hospitalized or taken any medications or supplements. Recently, however, the patient has felt saddened after the tragic passing of her pet chihuahua last month.

Upon arrival to the ED, the patient complains of continued chest pain. The review of systems is otherwise negative.

Vitals: HR 60/min, 75/45 mm Hg, RR 30/min, O2 100% on 15L O2, Temp 98 F

Exam: Alert but confused and mildly agitated, diaphoretic, clear lungs, no cardiac murmur, diminished pulses bilaterally, cool to touch, no focal neurologic deficits.

After reviewing the ECG below, the clinician consults cardiology who decides to take the patient immediately to the cath lab. What do you see in the ECG and where might you expect to find a lesion? (There is no prior ECG for comparison.)