A Middle Aged Male diagnosed with Gastroesophageal Reflux

This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain.  He had been at a clinic that day where he had complained of worsening GERD.  An EKG was recorded and interpreted as normal by the computer, the clinician, and by the overreading cardiologist.He had an ECG recorded in triage (I am not certain whether the patient had active pain at this time; I believe he didnot):What do you think?Here is the patient ' s ECG from several hours ago (which was essentially the same):This shows minimal inferior ST Elevation that is howeverall but diagnostic of inferior ischemia. There is the obligatory ST depression in aVL (very subtle but diagnostic).This was read as " inferior ischemia " without any other information by Dr. Richard Gray and asprobable reperfused inferior-posterior OMI much later by both me and Pendell Meyers, also without any clinical information.The overreading Cardiologist called it only " Sinus Bradycardia " with no other findings.Here is the old ECG from 6 years prior:Notice the inferior T-waves have normal size here.It is quite different, but it has been a long time.The patient was triaged rapidly but no action was taken other than to measure troponins.  It was extremely busy in the ED and things did not get done quickly.  The initial troponin I returned at 1500 ng/L and another ECG was recorded as the patient complained of 9/10 chest pain:Now the T-wave in III is fully upright, suggesting re-occlusion....
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs