64 y.o. Female with CP – “And then I gave her a NTG…”

My apologies for the faded ECGs. Turns out the medic (a recent grad from our hospital’s program) had been carrying them in his work pants for over a week, waiting to catch me in the ED. The  patient had been brought to another hospital, but he wanted to review the ECGs with me. They had been called for a 64 year-old woman at a gym, who had been getting ready for her Zumba class. She described an abrupt onset of precordial chest pressure, 8/10, that radiated to the jaw and left arm. Of note, the Zumba instructor insisted “We hadn’t even started the class!” PMHx: HTN, but no CAD. Meds: ASA daily, Prevacid Vital signs: HR – 70 RR – 20 BP 150/84 SaO2 – 98% RA Aside from mild sweating, the exam was unrevealing. A rhythm strip was obtained: And then a 12-lead: And then a second ECG, with nonstandard lead placement as noted: At this point, the medic gave a sublingual dose of nitroglycerin.   Questions: Clearly, this is a STEMI. What coronary artery is probably involved, and what areas of the heart are likely affected? What do you think happens next?
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research