Evolving MI | Figure 1

Evolving MI

911 for syncopal episode. Patient is playing a sport and has a syncopal episode. EMS called to scene. Patient found sitting on floor but not really complaining of much. He denies any prior medical history. First EKG is from the filed with a BP of 60/40. No medications given in route. Upon arrival to the ED patient BP is 113/80 and the second EKG is obtained. Patient still not really complaining of anything and is hemodynamically stable. Approximately 20 minutes later you notice some slight ST elevation on the monitor and decide to get another 12 lead which is the third one posted.

Thoughts?
Treatment?
Any medication you would not give?

The author made an update to this case

Update 1
100% proximal RCA occlusion
Diagnosis Added
100% proximal RCA occlusion found in cath lab.