Which scenario indicates a candidate for immediate coronary reperfusion therapy?

Immediate coronary reperfusion therapy, such as primary percutaneous coronary intervention (PCI) or thrombolysis, is indicated in the presence of ST elevation myocardial infarction (STEMI). The scenario involving a patient with ST elevation in leads V3-V6 is specifically indicative of this condition, which signifies significant myocardial ischemia and a high risk for further cardiac damage.

ST elevation suggests that there is ongoing injury to the heart muscle due to occlusion of a coronary artery, and immediate intervention is required to restore blood flow to minimize myocardial necrosis. Leads V3-V6 correspond to the anterior wall of the heart, which, when showing ST elevation, alerts the clinician to a severe obstruction likely affecting the left anterior descending artery.

This immediate therapy can significantly improve the patient's outcomes, reducing mortality and morbidity associated with myocardial infarction. Other scenarios provided describe conditions that either do not meet the criteria for acute coronary syndrome or indicate less urgent situations that do not necessitate immediate reperfusion therapy.