A 59-year-old has crushing chest pain. ECG shows 2 mm ST depression in V1-V3 with tall R waves and upright T waves. Initial troponin is pending and

Question

A 59-year-old has crushing chest pain. ECG shows 2 mm ST depression in V1-V3 with tall R waves and upright T waves. Initial troponin is pending and posterior leads have not yet been obtained. What is the most appropriate next step?

Accepted Answer

Obtain posterior leads and activate STEMI-equivalent reperfusion pathway if posterior ST elevation is present

Answer

Delay ECG reassessment until 6-hour troponin returns

Answer

Reassure and discharge if the first troponin is negative

Answer

Give adenosine because tall R waves imply SVT

Answer

Treat as isolated reflux and arrange outpatient endoscopy

Posterior myocardial infarction — RCPSC EM MCQ

A 59-year-old has crushing chest pain. ECG shows 2 mm ST depression in V1-V3 with tall R waves and upright T waves. Initial troponin is pending and posterior leads have not yet been obtained. What is the most appropriate next step?