Problem: Mr J. lives in a rural area. He is working in his yard and experiences crushing chest pain. His wife immediately puts him in the car and brings him to a free standing emergency room that is 30 minutes away. His ECG demonstrates significant ST changes with elevation in inferior leads. He continues with unresolved chest pain. What does this ECG mean when associated with extended time to care and ongoing symptoms? Myocardial infarction, pre-ischemic conditions, myocardial ischemia, or unstable agina.