65 year old with syncope and a ' normal ' ECG: discharge home?

A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. Vital signs were normal and first ECG was labeled as normal by the computer and confirmed by the treating emergency physician and  cardiology over-read. What do you think? There ’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages with J waves from early repolarization. There ' s inferior down-up ST segments and hyperacute T waves, with reciprocal up-down T wave in aVL. I sent this " normal " ECG without any information to a number of ECG enthusiasts, who were all concerned about possible OMI - whether subtle high lateral OMI with inferior reciprocal change, or subtle inferior OMI with high lateral reciprocal change. First troponin I came back at 2,800 ng/L (normal<16 in females and<26 in males), and a repeat ECG was done:  There ’s wandering baseline that makes it difficult to interpret, but there ' s no longer inferior ST depression and T waves are smaller. There is residual minimal ST elevation from early repolarization. Because of the syncope and troponin elevation the patient was referred to cardiology as cardiac syncope. Repeat troponin declined to 2,500 and repeat ECG ECG was done after another 2 hours, also interpreted as normal. Repeat trop declined to 2,500, and another ECG was done:Similar to prior. The cardiologists were concerne...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs