3 days of shoulder and chest pain, and now cardiogenic shock

I was texted these ECGs." Bad chest pressure with severe left shoulder pain 3 nights ago.  Then SOB and nausea the next day.  Now appears to be in cardiogenic shock. "(Later review showed systolic BPs in the range of 55 to 83.  So she was quite hypotensive.)First recorded at time zero:There is sinus rhythm. Rate of only 70 suggests some beta blockade.The QT is very long.There is T-wave inversion in inferior leads, suggestive of reperfused or subacute MI.There is a Q-wave in III, so this may be subacuteThere is ST depression in V2-V4.20 minutes:Again, very long QT.Now, T-waves are upright in inferior leads, inverted in aVL.The QRS is the same, so this is not lead placement.This is highly suggestive of re-occlusion (Pseudonormalization of T-waves).The very long QT is strange.They did a POCUS cardiac echo:Anterior wall is contracting and thickening.Lateral Wall (lower right) is not contracting or thickening.Posterior wall (at bottom of screen) also is not contracting or thickening. Aside:Some insist on calling this posterior wall " lateral, " even though it is clear that it is anatomically posterior.  This is because if you oriented the heart with the RV directly right and the LV directly left, then that wall would indeed be lateral.  But the heart is oriented with the RV more anterior and LV more posterior, so that wall really is closest to the back (posterior).  You also can see that this orientation of the heart also renders the anterior wal...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs