Acute chest pain: " Activate the Cath Lab!!!!! " Or not?

I was called to the resuscitation room to manage a STEMI patient.I walked into the resuscitation area and was handed this ECG:What did I say?Within 3 seconds, I said: " That is a Fakeout " . (i.e., a STEMI mimic)  Everyone was perplexed.  This patient had presented with chest pain and had ST Elevation and they were certain this was a STEMI and they were going to activate the cath lab.Interestingly, my very smart partner Richard Gray who also reads all my blog posts, was working in triage and had already seen this ECG just as it was recorded, and immediately recognized this as a STEMI mimic. He went to the chart and found old similar ones:6 months priorThere was ST Elevation before, but not as much.Dr. Gray recognized the triage ECG as a STEMI mimic, and had triaged the patient to the Non Resuscitation area, knowing that this was not STEMI or OMI.HistoryI talked to the patient and he stated that he had some mild chest pain now.  Dr. Gray related that that the patient ' s most significant chief complaint was dyspnea, not chest pain.  I went into the chart and saw that the patient had a previous diagnosis of heart failure.  Given that the vast majority of patients with heart failure have had an angiogram, I looked for it and 9 months earlier he had had a negative angiogram ( " no angiographically obstructive coronary disease " ).  He had a non-ischemic cardiomyopathy, suspected to be due to hypertension.  The BP on this day was not very el...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs