ST elevation in lead I and AVL with ST depression in Lead III V5-6. Anterior MI. Proximal LAD or LCX usually the occluded vessel.

Details history for previous episode and Risk factor DM, HTN.. etc

Serial ECG and cardiac enzymes.

Blood pressure measurement and support.

Antiplatelets + Anticoagulation

Pain control

Urgent Cardiology consultation with high possiblity of urgent C. Angio PCI.