Compare these two ECGs. Do either, neither, or both show anything important?

One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve SmithTake a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below.Case 1:Case 2: Case 1:What do you think?This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info.  Smith ' s response was: " OMI Mimic. "Later, this info was supplied by Sam:This ECG was recorded in a 23-year-old African American man with a history of psychiatric illness, acute alcohol/drug intoxication, brought in by police officers status post being tazed. He had no symptoms of ACS. This pattern was recognized as an OMI mimic and no further workup was pursued.  The remainder of his Emergency Department stay was uneventful.The Queen of Hearts correctly says:Smith:Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)?  --There is even a convex ST segment in V3!! (when there is ST Elevation, convexity in any one of leads V2-V6 is fairly specific sign of LAD occlusion).  The reasons are: 1) there is too much voltage in the QRS (deep S-wave in V3 especially).  2) The T(volume)/QRS ratio is not large enough for the T-waves to be considered hyperacute.  3) The shape of the T-wave is just " not right " .  This is something that is hard to teach, but with hundreds of such cases, we have taught the ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs