A 40-something with 100 minutes of chest pain

I was reading ECGs on the system, and saw this one:What do you think?I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI.However, it is difficult to recognize for an interpreter who is does not have special expertise in OMI ECG diagnosis. We taught an AI system fromPM Cardio to recognize patterns of subtle OMI (beware: this version of the app is not available to the public yet).  We named the AI app the " Queen of Hearts " This is what the Queen said about this ECG:" OMI with High Confidence "ECG explanation:--There is STE in inferior leads with reciprocal STD and T-wave inversion in aVL.  There is additional ischemic ST depression from V2-V6.  --The STD in V2-V6 might be interpreted as subendocardial ischemia, but with the inferior STE, it is far more likely to represent posterior OMI.Here is the history:A 40-something male had intermittent chest discomfort until 90 minutes prior to presentation, when it became constant.  At 100 minutes, the above ECG was recorded.  In OMI, cath lab activation is indicated.  In subendocardial ischemia, cath lab is indicated if the pain persists in spite of medical therapy (aspirin, anticoagulant, IV nitro).The first hs troponin I returned at 245 ng/L.  This is now further confirmation of ACS.Another ECG was recorded at 160 minutes:There is evolution, with worsen...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs