Antegrade flow into the RPLA is good, however, retrogradely the RPLA is occluded with contrast hang-up indicative of a thrombotic occlusion. The RPLA is supplied by a patent vein graft. RCA: known chronic occlusion, therefore not studied. Lots of change since the prehospital ECG!Ĥ. There is also almost excessively discordant ST elevation in precordial leads, but due to wandering baseline, it is hard to say whether it reaches 25% of the preceding S-wave. Nevertheless, there is a suggestion of proportionally excessively discordant ST elevation in inferior leads, with proportionally excessively discordant reciprocal ST depression in aVL. There is a wandering baseline in the limb leads. It was not relieved with nitroglycerin at home, but decreases from 9/10 to 7/10 after EMS gave NTG. The pain started at rest, was constant, sharp in the sternum and radiating to the jaw and left arm and into the upper back, associated with diaphoresis but no SOB. The medics brought the patient to the critical care area, as they were suspicious of acute MI. V1 has some ST elevation, and V2 has absence of expected discordant ST elevation, with a very flat ST segment. There is some reciprocal ST depression in aVL, but this is normal when there is ST elevation in III that is likely to be due to LBBB, LVH, IVCD, or WPW (in this case, it appears to be due to IVCD) There is some ST elevation discordant to deep wide S-waves in III and aVF, and V3 and V4, appears baseline.
There is sinus rhythm with very long PR interval (about 300 ms).
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