ECG of the Week - 19th June 2017

The following ECG's are from a 70 yr old male. He presented to the Emergency Department complaining of palpitations, fatigue, epigastric pain and dizziness. Further history revealed he had malaena for a week prior with no history of significant alcohol consumption. His only past medical history is of ischaemic cardiac disease requiring stenting >10 yrs prior. His medications included aspirin, atorvastatin and metoprolol. His ECG on presentation is below with a further ECG performed when he complained of chest pain during his assessment. His Hb on a venous blood gas is 72 g/L(115 - 155).

ECG on arrival
Pain free
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ECG during episode of chest pain
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Things to think about

• What are the key ECG changes seen ?
• How would you manage this patient ?