This ECG, recorded in triage, was shown to me immediately, with no other info.....

This ECG, recorded in triage, was shown to me immediately, with no other info.....What do you think?Computer read is: " Moderate ST depression "I said:" Inferior OMI (Occlusion Myocardial Infarction -see the Manifesto).  Activate the cath lab. "Dr. Laura Schrag also saw this immediately and that is why she showed it to me.Then I asked: " Chest pain?  Is it a good story? "Answer: The patient was a 60-ish woman with 3 risk factors who had had stuttering chest pain for a week, now constant.What makes this diagnostic of OMI when there is less than 0.5 mm of ST Elevation?--ST elevation is large relative to QRS size (the QRS above is very small)-- " Bulky " T-waves--Absence of upward concavity of ST segments (which is what makes the T-wave bulky)--Reciprocal ST depression in aVL--Down-up T-wave in V2 (indicative of posterior MI)A note on specificity of these findings:I post here a lot of subtle OMI ECGs that people show me or send me.  I do not show enough subtly NEGATIVE cases.  The vast majority of cases that are texted to me or showed to me in real time, that physicians are worried about, I tell them: " This is not worrisome.  Do NOT activate the cath lab. "  I always add: " The ECG can be normal in the setting of OMI, so I cannot say that there is no OMI; I can only say that it does not show on the ECG. If you are worried, then get serial ECGs, echo, etc. "But in this case, it definitely shows, and the findings are VERY specific.  In this case...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs