A 45 year old female presents with 2 hour history of left sided chest pain .

You conduct an ECG which is shown below:

1. What are the findings in the ECG?

2. What are the causes of these findings?

3. Which further investigations should be performed next?

4. What are the management options?

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1. ECG Findings:

ST elevation in V1 to V3.

ST depression in V5 - V6.

2. What are the causes of these ECG Findings :

V1 - V3 ST elevation is suggestive of Right ventricular Myocardial infarction.

V5-V6 ST depression is suggestive of severe Coronary artery disease in Left Anterior Descending artery or its diagonal branch.

3 . Further Investigations :

Troponin T levels and Myoglobin levels.

4. Management options:

Load patient with Aspirin and Clopidrogel.

Early Angiography and PCI / Primary Coronary intervention/ Angioplasty +/- stent placement.

Fondaparinux as per ACS protocol.