Country cardiograms case 3 Jim Thompson, MD, CCFP(EM), FCFP Clinical Associate Professor, Department of Family Medicine, University of Calgary, Calgary, Alta. Can J Rural Med 1997; 2 (1): 19 © 1997 Society of Rural Physicians of Canada Case presentation An 83-year-old man presented to the emergency department of a rural hospital with chest pressure and diaphoresis. The initial electrocardiogram (ECG) (not shown) showed acute anterior myocardial infarction, displaying anterior ST elevation with reciprocal ST depression, normal QRS axis and narrow QRS width. The second ECG, see fig. 1, was obtained while the patient was receiving thrombolytic therapy at the rural hospital. It looks quite different from the initial ECG. What is your diagnosis, and how would you manage this patient in your rural setting? See answer and discussion on page 50. "Country cardiograms" is a regular feature of the Canadian Journal of Rural Medicine. In each issue we will present an electrocardiogram and discuss the case in a rural contxSubmit cases to Dr. Jim Thompson, Canadian Journal of Rural Medicine, Bag 5, Sundre AB T0M 1X0 (email jthompso@telusplanet.net). Table of contents: Can J Rural Med vol 2 (1)