51M, called EMS for 6/10 substernal chest tightness radiatin | Figure 1

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51M, called EMS for 6/10 substernal chest tightness radiating to back lasting 45 minutes after smoking cigarette. Took ibuprofen prior to EMS arrival. Pale and diaphoretic. Family hx of heart problems, does not see a PCP, no known hx, no hx of CP before. Initial BP 170/100, HR 64 strong and reg, 98% RA. Prehospital tx: 324 mg ASA, IV, 0.4 mg SL nitro. Pain 4/10 BP 151/101 at hospital, initial pt contact to door in 16 minutes. 7 min transport. 2nd ECG same as the first. No changes of ST elevation in ED, negative troponin, 100% proximal LAD occlusion. Cath'd and CCU for recovery. #STEMI

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A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ECG that would warrant further work-up or is this just a pediatric ECG?