Scenario: A 71-year-old white woman with vague complaints of dyspnea while gardening. She is presenting within 4 hours of onset of symptoms to the emergency department and has an unremarkable medical history.

Interpretation: Normal sinus rhythm with inferior posterior ST-elevation myocardial infarction with apical extension.

The most common cause of ST-elevation myocardial infarction is a complete thombotic occlusion in a major coronary artery causing transmural injury. Striking ST-segment elevation is present in leads II, III, and aVF, all of which are inferior leads, suggesting that the right coronary artery is the infarct-related artery. Myocardial ischemia tends to be a regional event. When both ST-segment elevation and depression are observed on the 12-lead ECG, the ST elevation is usually considered primary and the ST depression changes are considered reciprocal. When the distal right coronary artery blood supply is inadequate, the...

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