Anterior wall myocardial infarction

A 52-year-male came to JIPMER hospital with history of acute onset retrosternal chest pain since 4 hours of duration along with palpitation, perspiration, giddiness, dyspnoea. There was no history of orthopnea, PND, syncope. His BP was 140/80 mmhg, Pulse 104 beats per minute, saturation of oxygen was 96%. Patient serial ECG were done which are shown below.

ECG 1

ECG is showing normal sinus rhythm at 100 beats per minute, normal axis, normal PR interval (120 msec), there is mild ST segment depression in lead I,avL (1 mv), there were no other significant ST-T wave changes seen.
Patient was kept under constant observation. His cardiac marker were sent and he was started on antiplatelet therapy along with heparin. But patient chest pain did not improve and suddenly he develop ST elevation acute anterior wall myocardial infarction after 3 hours of presentation.

ECG 2 (3 after presentation)

ECG is showing ST elevation in lead V2-V6 with hyperacute Tall T wave. Also there is mild ST segment elevation in lead I, avL.

ECG 3

ECG is showing ST elevation extensive anterolateral wall myocardial infarction. Patient was immediately started on streptokinase therapy. His post thrombolysis ECG is shown below

ECG 4(Post thrombolysis)

 ECG is showing qRBBB in lead V1, with QS complex in lead V1-V4, ST segment elevation in lead V1-V6, I,avL, also there is ST segment depression in lead II,III,avF.

ECG 5 (Post thrombolysis) 

ECG is showing qRBB with QS complex in lead V1-V5, avL suggestive of failed thrombolysis in this patient.

So the final diagnosis is Acute extensive anterior wall myocardial infarction with failed thrombolysis.

Thank you.