56 year old male with sudden onset of crushing chest pain

What is the EKG intepretation?

A. Acute pericarditis
No. Pericarditis is associated with ST-segment elevations. However the elevated ST-segments in acute pericarditis are typically present in most leads and appear concave so the middle sags downward like a hammock. In this EKG the ST-elevations are bulging upward (convex) and are absent in the inferior leads.
B. Acute inferior myocardial infarction
No. There is no evidence of inferior myocardial infarction as there are no pathological Q waves or ST-segment elevations in the inferior leads (II, III, aVF).
C. Acute anterior myocardial infarction with lateral extention
Yes! ST-segment elevation is present in the precordial leads (V1-V6) extending to the lateral leads (V6, I, aVL). Also there is pathological Q wave formation in V1-V3. The patient history and the EKG should prompt activation of the cardiac catherization lab. ST-segment elevations in the precordial leads suggest an occluded left anterior descending (LAD) artery. See more on extensive anterior myocardial infarction in the library
D. Brugada syndrome
No. The ST-segment elevations in Brugada syndrome are located in the right precordial leads and have a different appearance (downsloping or saddleback pattern).
E. Normal sinus rhythm with no apparent pathologies
No. Sinus rhythm is present. However due to the massive ST-segment elevations this EKG is definitely not normal.

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