RV infarct

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Posted on 05/10/2010

54 year old male presents to the ED by ambulance. 911 dispatcher sent an ALS crew to a local pharmacy where a the patient was filling a prescription for lansoprazole. He was seen in another ED for epigastric discomfort and occasional shortness of breath 2 days prior. He was discharged with PMD follow up and a prescription for lansoprazole. While filling the script, the patient began to feel the same epigastric pain, with shortness of breath and broke out into a cold sweat. The patient has no medical problems, allergies or surgeries. EMS gave the patient O2, ASA and two sprays of NTG sublingual. Upon presentation, the patient's symptoms worsened, his distal pulses were weak, and was very anxious. His VS were HR:60, BP:80/40, 30, 99% on NRB. Below is his ECG (top image is a right sided ECG and the bottom image is the triage ECG). What is your interpretation?

RV infarct