Serial EKG and dynamic ST modification

67 yars old male referring chest pain. Symptoms resolved at first medical contact.

During the transport to the local hospital(no PCI capable center) new episode of anterior chest discomfort.

Serial EKG obtained and shown below, revealed dynamic ST changes in precordial anterior leads .

(Click to enlarge)

Immediately diverted to the closest PCI capable center. PCI shown 95% critical LAD occlusion, successfully stented (TIMI flow grade 3)

FMC/balloon time 35 min.

Serial EKG to detect ST dynamic changes must be a standard of care in prehospital chest pain management.