Acute Coronary Syndrome With Anterior Precordial ST Depression

Abstract

A man in his 60s with no history of diabetes, hypertension, or smoking presented to the emergency department with history of acuteonset left-sided chest pain associated with breathlessness for 16 hours. On examination, the patient was distressed and had a room air oxygen saturation of 88%. Chest auscultation revealed bilateral basal crepitations along with a short systolic murmur at cardiac apex. The Figure, A, shows the electrocardiogram (ECG) taken at the time of presentation.Questions: How do we reconcile the clinical and ECG findings? What is the next step in the management of this case?