A Head Nurse is interpreting a 12-lead ECG of an ICU patient who reports crushing chest pain. She identifies ST elevation geq 2 text mm in leads V1–V4. What is the MOST likely diagnosis and the target time for intervention?

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Nursing QUESTION #9230

Question 1

A Head Nurse is interpreting a 12-lead ECG of an ICU patient who reports crushing chest pain. She identifies ST elevation \(\geq 2 \text{ mm}\) in leads V1–V4. What is the MOST likely diagnosis and the target time for intervention?

Inferior STEMI — PCI within 90 minutes
Anterior STEMI — PCI within 90 minutes (door-to-balloon time)✔️
NSTEMI — medical management for 72 hours before PCI
Pericarditis — ST elevation in all leads, treat with NSAIDs

Correct Answer Explanation

Correct Answer: B — Anterior STEMI, PCI within 90 minutes

ECG Lead Localization of MI:

Leads with ST Elevation	Location	Artery
V1–V4	Anterior	Left Anterior Descending (LAD)
II, III, aVF	Inferior	Right Coronary Artery (RCA)
I, aVL, V5–V6	Lateral	Left Circumflex (LCx)
V1–V2 (tall R waves)	Posterior	RCA or LCx

Time targets (AHA/ACC Guidelines):

Door-to-ECG: \(\leq 10\) minutes
Door-to-balloon (PCI): \(\leq 90\) minutes
Door-to-needle (thrombolysis): \(\leq 30\) minutes (if PCI unavailable)

Anterior STEMI is the most dangerous — large area of myocardium supplied by LAD. The Charge Nurse must activate the cath lab immediately.

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