Chest pain, ST Elevation, well-formed Q-waves, and infarction with peak hs troponin I over 1000 ng/L. Is it OMI?

A 60-something male presented stating that he had had chest pain that morning which awoke him from sleep but then resolved after several minutes.  He has had similar pain in the past which he attributed to acid reflux.  He has a history of untreated hypertension.He is pain free now.His systolic BP was 200.The patient is pain free at the time of this ECG:What do you think?The conventional algorithm said:SINUS RHYTHMANTERIOR MYOCARDIAL INFARCTION , PROBABLY RECENT [40+ ms Q WAVE AND/OR ST/T ABNORMALITY IN V3/V4]***ACUTE MI*** There are well-formed Q-waves in precordial leads.  The T-waves are inverted.  Thus, this is either:1) a subacute MI with a significant (large amount) of completed infarction, or 2) old MI with persistent ST Elevation (LV aneurysm).The patient is pain free now, so it is either a reperfused subacute MI or a Non-OMI superimposed on an old MI (aneurysm).If this is subacute MI, then the first troponin should be VERY high, unless the infarct occurred many days or weeks ago.The first troponin returned at 541 ng/L.This is not high enough to be subacute MI unless the infarct happened at least a week ago.  What did the Queen of Hearts say?Version 1 of the Queen states:" OMI with high confidence ".  Although she was taught " Active vs. Reperfused " and " Acute vs. Subacute, " she does not report this in version 1.So if it is a reperfused OMI, she will say " OMI "If it is a subacute OMI, she will say " OMI "YOU TOO CA...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs