Case 3

 A 78-year-old man presents to the ED with a three hour history of chest pain and shortness of breath. He had an MI three years previously and has had occasional exertional angina since. His pulse is 110 per minute, BP = 90/60, SaO₂ = 90% on air, and RR is 24 per minute. He appears pale and clammy. On auscultation he has a third heart sound. His chest is clear. He is alert with a GCS of 15/15.

His ECG is shown here.

What is the electrocardiographic diagnosis?

Which one of the following complications has occurred?

You are the duty emergency physician and administer oxygen, aspirin, a careful dose of opiates and are considering what to do next.

Which one of the following statements is most appropriate?