Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

By Magnus Nossen, edits by Grauer and SmithThe patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. She ' s had multiple PCI procedures. She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. Just from the medical hx and clinical presentation this patient is very likely to be having an MI. The question is, does she need to go urgently to the cath lab or can she wait. Below is the presentation ECG At the time of recording the ECG the patient was complaining of chest discomfort 4/10. What is your interpretation?ECG#1The ECG shows a wide complex QRS with LBBB type morphology. The rate is very close to but not exactly 60/minute. There seems to be pacing spikes (very small deflections) visible before the QRS complexes in some of the precordial leads. (you need to zoom in on the image). To say that these deflections are definite proof of ventricular pacing would not be correct. It is probably better is to say that these small deflections may represent ventricular pacing spikes.It would help knowing more about the PM and specifically pacing statistics. In this case there had been 100% ventricular pacing since 2016. This makes ventricular pacing almost certain in this ECG even though 100% ventricular pacing in the statisti...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs