This ECG was texted to me after the fact with no information. What do you think?

This ECG was texted to me with no other information, with this quote: " You will see this in the Queen of Hearts. "  I assumed it was in real time.The Queen said " Not OMI with low confidence "What do you think?The conventional algorithm said: SINUS RHYTHMABNORMAL QRS-T ANGLE [QRS-T AXIS DIFFERENCE> 60]ABNORMAL ECG This was my response: " I am not certain that I agree with the queen on this one. Be careful with it.  Notice that the Queen has low confidence. "Why am I worried?  The T-waves are quite tall.  Although most hyperacute T-waves are bulky, wide, fat and symmetric in proportion to the QRS (due to longer QT + straightening of ST) — some are only extra tall in proportion to the QRS.  I very much doubt that this is the patient ' s baseline ECG.  That said, some patients OMI ECGs look like they are normal and you only know for certain if you can compare to old ones or to serial ones (whether the serial ones are progressing or improving).  There is worrisome T-wave inversion in inferior leads as well, which is another clue to LAD OcclusionIn fact, this ECG meets STEMI criteria!!  There is greater than 1 mm STE in V4 and V5.  Why does the conventional algorithm not diagnose STEMI?Here is a case in which the ECG looks normal but not when compared to the old one.  (In this case, 4 variable formula was positive and the Queen diagnosed OMI with mid confidence).  Transient STEMI, serial ECG...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs