Chest Pain and Ischemic ST Depression — but there is no Cath Lab available. Thrombolytics?

===================================MY Comment by KEN GRAUER, MD (7/14/2020):===================================This middle-aged man with hypertension and hyperlipidemia presented to the ED with 2 hours of new-onset chest pain — and the ECG shown in Figure-1. The patient was hemodynamically stable. No prior tracing was available for comparison.HOW would you interpret the ECG shown in Figure-1?Immediate cath lab activation was not an option in this hospital. Should acute thrombolysis be used?Figure-1: The initial ECG in the ED (See text).My THOUGHTS on ECG #1: I ’ve labeled KEY findings in Figure-2. The rhythm in ECG #1 is sinus tachycardia at ~110-115/minute. The PR interval is normal — but the QRS complex is wide. The QTc appears prolonged — but this is difficult to assess given the rapid rate.QRS morphology is consistent with complete RBBB (ie, widened QRS; qR pattern with predominant positivity in lead V1 — wide terminal S waves in lateral leads I and V6).The initial Q wave, with qR pattern (instead of an rsR ’ complex) in lead V1 is important to note (within the RED circle in lead V1 of Figure-2). This finding may indicate septal infarction of uncertain age.A large and wider-than-it-should-be Q wave is seen in lead III (ie, this Q...
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