55-year old male with chest pain.

The following ECG was taken from a  55-year old male who presented to the ER with 2-hour history of persistent heavy discomfort across the anterior chest with radiation to the neck.

Risk factors: Positive family history (father had MI at age 52); hypertension; dyslipidemia.

Medications: Nifedipine XL 30 mg daily and atorvastatin 10 mg daily.

Physical examination: Heart rate 100 beats per minute, BP 130/85 mmHg,  respiratory rate 22/minute. Jugular veinous pressure is 4 cm above the sternal angle at 45 degrees. Soft S1 and S2 and prominent S4. No murmurs.

Questions:

1)- What is the ECG diagnosis?

a. Acute pericarditis.

b. Acute anterior ST elevation myocardial infarction.

c. Acute infero-posterior-lateral ST elevation myocardial infarction.

d. Acute infero-posterior-lateral with right ventricular myocardial infarction.