Was the intern correct?

Written by Pendell Meyers, case submitted by Max Macbarb, edits by Steve SmithA 71 year old gentleman with history of CAD and PCI presented with acute chest pain and normal vitals signs.  He was triaged to the general area of the emergency department after an initial review of this ECG by a senior resident or attending physician correctly interpreted " No STEMI. "An intern who has attended my lectures and has begun reading this blog picked up the chart and flipped to the ECG and saw this:Presentation ECG at 6:57 AM. What do you think?I texted this to Dr. Smith with no clinical information and he replied immediately after viewing it on his phone: " Wow, this could be a very subtle LAD occlusion. "The intern was also concerned about LAD occlusion.  So he then looked in the chart and found the patients last ECG on record for comparison:Prior ECG on file. The most important point of this baseline is that you see how the presentation ECG above is diagnostic of LAD occlusion by comparison to this baseline. Going from this baseline to the presentation ECG above, the R wave progression is blunted and the T-waves have massively grown in relative size, height, and area. The increase in the ratio of area under the ST-T waves compared to the size and progression of the QRS is diagnostic.However, this " baseline " ECG turns out not to truly be a " baseline. " It was the last of a series of ECGs recorded years ago during another presentation with chest pain. The next ECG below is...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs