An 83-year-old man presents to the emergency department with a 3-week history of right-sided shoulder/scapula pain.
Describe and interpret his initial 12-lead electrocardiogram:
- Sinus rhythm with a ventricular rate of 79 bpm
- PR interval 166 ms
- Normal QRS axis (-29°)
- Normal QRS duration (89 ms)
- Loss of R wave progression
- Convex ST-segment elevation throughout the precordial leads (V1-5) with associated T-wave inversion
- ST-segment depression in high lateral leads (I aVL) and V6 with associated T-wave inversion
- Anterior ST-Elevation Myocardial Infarction
- Patient underwent urgent percutaneous coronary intervention with stenting to his left anterior descending (LAD) coronary artery (99% mid-LAD occlusion). Coronary angiography also revealed a diffusely diseased right coronary artery (RCA) containing a moderately-severe distal lesion and a diffusely diseased left circumflex artery with a proximal chronic total occlusion (CTO) with collateral vessels from the RCA.