Evolving myocardial infarction.

Scenario: This electrocardiogram (ECG) was obtained from a 66-year-old male patient being admitted to the coronary care unit (CCU) as a “direct admit.” The patient had gone to an urgent care center 1 hour earlier with complaints of weakness and shortness of breath. Based on the symptoms and ECG (similar to the one below), he was sent via ambulance to the CCU. Past medical history includes hypertension and hypercholesterolemia. The patient stated he has not been feeling well for about 3 weeks, and was especially “sick” this day. He decided to go to work but a coworker urged him to get medical help, and at the end of his shift he went to the urgent care center. A regular feature of the American Journal of Critical Care, the ECG Puzzler addresses electrocardiogram (ECG) interpretation for clinical practice. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click “Respond to This Article” on either the full-text or PDF view of the article. We welcome letters regarding this feature.