1000: Mr Jefferies is a 59 year old Caucasian male.

1000: Mr Jefferies is a 59 year old Caucasian male. He presents to the ER with c/o substernal chest pain radiating down his left arm, nausea, & shortness of breath.
PMH: Mr Jefferies states that he has a 2 year history of CAD and has been taking S/L nitroglycerine (NTG) for occasional chest pain. He has had controlled HTN for 7 years, Type II diabetes for 3 years, and hyperlipidemia.
History of Present Illness: Prior to arriving in the ER, he began experiencing chest pain at rest. He took 3 NTG tablets with minimal relief. He decided he should go to the ER by personal car.
Social/Personal History: He reports being under a lot of stress, He was divorced 2 years ago and since then been eating out a lot. He has gained a lot of weight and is unable to exercise because of his work schedule. Work has become very stressful and busy. He started smoking at age 16 and reports a 60 pack per year smoking history.
Family History: His father died at age 55 of a heart attack, a brother with HTN, mother died of breast cancer, and sister has no medical history.
Medications:
Glyburide 10 mg po Q AM, 5mg po Q PM
EC ASA 81 mg
Metoprolol 20 mg po twice daily
lisinopril 10 mg po twice daily
Nitroglycerine .4 mg s/l tablets PRN as needed for chest pain
Atorvastatin 20 mg po at night
Q3. The EMT in the ER completes the following 12 – Lead EKG and gives it to you. What does this indicate? What coronary artery could be involved with these changes?