I'm sorry the conclusion to this case took so long. Due to a clerical error I received a duplicate case.
Let's take another look at the 12-lead ECG.
The patient was emergently cathed and a partially occlusive thrombotic lesion was identified in the mid-RCA.
Here's what it looked like to the invasive cardiologist.
The balloon is inflated (very short clip).
Here is the RCA after the intervention.
No acute lesions were noted on the left side (LCA and its tributaries, the LAD and LCX).
Finally, here is the post-cath 12-lead ECG.
Diagnosis: Acute ST-elevation myocardial infarction