"Abnormal ECG" and Bypass of the Closest Facility

So.. would you call this one and activate the cath lab from the prehospital ECG? The patient is a 72 year old female with severe uncontrolled hypertension. She called 911 for mild shortness of breath. Her blood pressure is over 200 mm Hg systolic. The patient is awake, alert, and oriented. The paramedic is bypassing a local facility in favor of the closest cardiac interventional center.

What's your analysis?

12 Lead ECG

 

12 Lead ECG Interpretation and Discussion

A baseline sinus rhythm is present. There is a significant amount of artifact that interferes with interpretation in the limb leads. A fusion beat is seen in the limb lead tracings. However, there is > 1mm of ST segment elevation in lead III. Lead aVF also has minimal ST segment elevation. Pathologic Q waves are present in contiguous leads (III and aVF). Though an isolated Q wave is common in limb lead III, the presence of Q waves in contiguous inferior leads (III and aVF) suggests ischemia. In addition, ST segment depression is present in the reciprocal leads of I and aVL. This finding further supports the presence of acute injury. ST segment elevations are also seen in leads aVR and V1. As discussed in a previous case, the presence of STE in leads aVR and V1 may predict obstruction of the left main coronary artery. Poor R wave progression is present across the precordial leads V2-V6. This finding  (the loss of R wave amplitude) is consistent with the machine generated diagnosis of "anterior infarct, age undetermined." These findings, when put together, reveal an inferior wall STEMI. This patient is best cared for at a facility capable of percutaneous cardiac intervention.

Final interpretation

Sinus rhythm, inferior wall STEMI. Anterior wall ischemia. Reciprocal changes in the form of ST depression present in the anterior-lateral limb leads.