What do you suspect from this ECG in this 40-something with SOB and Chest pain?

I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information:What do you think?The Queen diagnosed " OMI with high confidence " due to the ST Elevation in V1-V3.Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization):The patient is 40 years old and presented to another hospital with chest pain and SOB.  She had been sitting doing work when she experienced " waves of chest tightness " .  Since that moment, she had had shortness of breath as well as pressure-like chest pain. Any kind of exertion made the shortness of breath considerably worse. She also has had some coughing at night. She notes slight bilateral ankle swelling. I do not have the EKG, but it was described as " non-diagnostic " (that probably means that the physician did not know how to diagnose it).  Her troponin I returned at 900 ng/L.  She was diagnosed with a Non-STEMI and kept overnight for a next day angiogram.  On formal echo, she had a normal LV and " right ventricular prominence. "  " Patient was given aspirin, sublingual nitro as well as heparin. Patient did have a considerable relief of pain with the nitro and was placed on a nitro drip. I discussed all results with patient. I di...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs