This ECG was texted to me: normal variant early repolarization, or LAD Occlusion MI (OMI)?

This ECG was texted to me with no other information.  I assumed the presentation was consistent with acute MI.What did I say?" OMI.  Activate the cath lab. "  The T-waves in V2-V6 are diagnostic.  It does, in fact, the STE meets STEMI criteria since there is 1 mm of in V4 and V5.  There is also some non-diagnostic STE in inferior leads.  There is zero reciprocal ST depression. 50% of LAD OMI have zero reciprocal ST depression!But it looks a lot like normal variant STE (also known as " early repolarization " .Then I sent it to the Queen of Hearts PMCardio AI Bot and she gave this response:The Queen is very good.I also later used the4 variable formula:19.6 is all but diagnostic of LAD occlusion.In spite of a relatively short QTc of 376 ms, the very low R-wave amplitude in V4 and the ST Elevation at 60 ms after the J-point in lead V3 contribute to a high final value.Here is the clinical story:A 40 year old male with no cardiac history presented with acute substernal chest pain that started 40 minutes prior to arrival.  He had been having similar episodes for the past week, lasting no more than 5 minutes.   He reported associated diaphoresis, radiation to the bilateral upper extremities and mild shortness of breath. The first ECG was recorded at 53 minutes after pain onset.He was given NTG sublingual.The pain began to improve and this ECG was recorded:T-waves are not quite as tall, thou...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs