What happened after the Cath lab was activated for a chest pain patient with this ECG?

Sent by anonymous, written by Pendell MeyersI received a text with this image and no other information:What do you think?I simply texted back: " Definite posterior OMI. " The person I was texting knows implicitly based on our experience together that I mean " Definite posterior OMI, assuming the patient ' s clinical presentation is consistent with ACS. "The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration. The pain was still active at the time of evaluation.Queen of Hearts:You can see that the Queen is most concerned with the ST depression in V2 and V3The physician activated the cath lab and the patient was transported to the cath lab.The interventional cardiologist then canceled the activation and returned the patient to the ED without doing an angiogram ( " Not a STEMI " ).I advised that perhapsposterior leads would help to persuade the interventionalist, since the 2022 ACC recommendations include posterior STEMI as a formal STEMI equivalent, but only officially by 0.5 mm STE in the posterior leads. So here is a posterior ECG (unfortunately, I am not sure where exactly the precordial leads are, but suffice to say that at least some of leads V2-V6 are posterior leads):Limb leads also reversed. Leads V3-V4 are clearly posterior leads and have more than 0.5 mm of STE.Despite the ACC guidelines for posterior STEMI, the cardiologist again refused to take the patient to the cath lab.Only when the first troponin (high sens trop ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs