Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

I was reading EKGs on the system and saw this one.....What did I put in as my interpretation?Interpretation: " Acute LAD occlusion until proven otherwise. " There is non-diagnostic ST Elevation in V1-V3, with rather large T-waves but in the context of a deep S-wave (high voltage).  HOWEVER,lead V4 is diagnostic of OMI.  This is massive ST Elevation, huge hyperacute T-wave, and loss of S-wave (which in V4, unlike V2-3,can be normal but should greatly raise suspicion.)  There is ST depression in V5-6.  This alone could be due to LVH, but V4 could NOT be due to LVH.There was an EKG from 5 years prior:I went to check on the history:History: It was the middle of the night.  The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction.  He had been smoking an opiate and suddenly collapsed.  He was ventilated with BVM on arrival.  He awoke with naloxone.  This EKG was recorded as part of a standing order for critical care.  He denied any CP or SOB.An EKG was repeated at 5 minutesThe T-wave is less hyperacute.  Maybe there is some spontaneous reperfusion?" Pathway B " was activated, meaning that there is an immediate consultation with Cardiology.  The cardiologist was worried about the EKG, but did not want to activate the cath lab.   The cardiologist wanted an emergent formal echo first.Another ECG was recorded 25 minutes after first:There is further diminutio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs