John, an overweight 49-year-old man with history of diabetes and hypertension is playing soccer. After half an hour of an intense game, he feels severe chest pain that travels to his lower jaw. He is pale, diaphoretic, and short in breath. Upon arrival to the ER, an ECG was taken and the results show the following (note the changes in leads II, III and aVF):

Choose 3 out of the 5 prompts and answer:

1. What could be the possible reason for John’s chest pain? Explain your answer based on the clinical information.
2. How do you know John’s chest pain is heart related? How do you rule out other etiologies of chest pain such as musculoskeletal, pneumonia, and gastric sources?
3. What actions should John’s teammates have taken at the scene to help him?
4. How do you differentiate between heart attack and myocardial infarction?
5. What is TPA? Explain how it relieves the chest pain and how it improves the survival rate in a patient with acute myocardial infarction.

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