[Sdiver]

Here's the moment you've all been waiting for .... the answer.

In addition to the obvious STEMI, which is indeed an Inferior wall MI (as seen in leads II, III, and aVF, at least 3, possibly 4 mm elevation) this was/is a 2nd degree type I AVB, with 2:1 conduction and periods of 3:2, otherwise known as wenckebach.

Here's the same strip with marks pointing out the P-waves that "march out" with regularity. In lead I, you can see the P waves sitting on the down-ward slope of the T-wave with a dropped QRS. But the next p-wave associated with a QRS is right on time and on target.

Also, look at leads V1-V6. Notice anything "extra" ???
Is that a PVC or a PAC ???
Does it make a difference in your interpretation ???
Should you be concerned about it ???

Yes, the main focus is the STEMI and this person should be in a Cath-Lab ASAP, but as Adel pointed out, this is the kind of strip that one needs to slow down, take your time and hit the basics.

Heart blocks are a bitch to read sometimes. Everyone can pick out a 1st degree, and 3rds are relatively "easy", it's the two different types of 2nd degrees that throw people off.