Shouldn't need Modified Sgarbossa rule for cath lab here, but it does make the diagnosis certain!

I received this case from a medic (in quotes):"Wanted to know your thoughts on this ECG." "Woman in early 70's with acute chest pain for the past 30 min. Vomited once. Looked sick. Pale and diaphoretic. Had hx of MI with stents one month ago. No old ECG to compare with. I interpreted the ECG as a LBBB with sinus tach but some thought it was VT. We administered Aspirin and transported to hospital."   Here is the prehospital ECG and the only one he sent:Smith comments:There are clear P-waves (see arrows in image below) with a regular rhythm.  The computer interpretation is clearly wrong; it is clearly sinus tachycardia.  However, it does fairly accurately measure ST elevation at the J-point (this was printed out on the tracing!)Notice there is LBBB.  There is subtle concordant ST elevation in leads I and aVL.There is at least 2mm (I doubt 3.03) of STE in V3, with a 6 mm S-wave, for a ratio of 0.33There is 1 mm of STE in V4 with a 1 mm S-wave, for a ratio of 1.0It meets modified Sgarbossa in several leadsIt is diagnostic of a proximal LAD occlusion in the setting of LBBBSame ECG, annotated with arrowsSee clear P-waves (arrows). In V1, the P-waves are negative, as they should be (the later portion of the P-wave represents the left atrium and is normally negative).  This helps to verify they are P-waves.  CommentWhenever there is sinus tachycardia, one must consider whether the tachycardia is secondary to some other acute pathology (GI bleed...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs