A 75-year-old woman presents with severe, crushing chest pain, diaphoresis, and nausea. Her ECG shows new Q waves in leads V1-V3. However, her troponin levels are normal. What could be the diagnosis and the next steps?
This patient's symptoms and ECG changes are highly suggestive of an ST-segment elevation myocardial infarction (STEMI). The absence of elevated troponins does not rule out a very early phase of a heart attack. This is a medical emergency, and the patient should receive aspirin and immediate reperfusion therapy, preferably primary percutaneous coronary intervention (PCI), if available and if there are no contraindications.