Which finding helps establish the diagnosis of acute myocardial infarction among the following?

• A. Hypotension with clear chest X-ray
• B. Fever and sweats
• C. Pain relieved by rest
• D. ST-elevation in two contiguous leads with reciprocal changes

Answer: (D)

The key finding tested is an ECG pattern that unmistakably points to a myocardial infarction: ST-segment elevation in two contiguous leads, with reciprocal ST-segment changes in opposite leads. This combination signals transmural myocardial injury from an acute coronary occlusion and is the most specific and time-critical clue for a STEMI, guiding urgent reperfusion therapy.

The other signs don’t fit acute MI as cleanly. Fever and sweats suggest infection or inflammatory conditions; pain relieved by rest is more characteristic of stable angina rather than an acute infarction; and hypotension with a clear chest X-ray could reflect noncardiac causes or cardiogenic shock but isn’t diagnostic of MI.