72 y/o male presenting with chest pain and dizziness. He has history of uncontrolled hypertension and diabetes mellitus.

This ECG shows sinus rhythm with ST elevations in lead II, III, aVF and reciprocal changes in lead I and aVL. There is also prominent R wave( R>s), horizontal ST depression and positive T wave in V2 which denotes posterior myocardial infarction. This patient was transferred to Cath lab immediately for emergent coronary angiography and percutaneous intervention to nearly occluded right coronary artery was performed.