What will you do for this patient transferred to you who is now asymptomatic?

A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath.This ECG was recorded on arrival:What do you think?This is technically a STEMI, with 1.5 mm STE in V1 and 1.5-2.0 mm in V2. The current criteria only require 1mm in V1 and 1.5mm in V2 for a female. However, I think many practitioners might not see this as a clear STEMI, and would instead call this " borderline. " The normal QRS complex with STE and large volume underneath the T-waves in V1-V3 confirm Occlusion MI (OMI). There is not technically STD in V6 and I, however the morphology looks similar to STD.Here is the computer interpretation at the top:Here is the calculation of the formula that differentiates benign anterior ST elevation from subtle LAD occlusion (OMI):The most accurate cutoff is 18.2 (derived and validated).  20.21 is far above 18.2 and should be considered diagnostic of LAD occlusionA baseline was available:Within normal limits. Proof that all STE and hyperacute T-waves in the presentation ECG are new.The practitioner at the outside hospital was concerned and called our cardiologists, who accepted the transfer but stated they would like to evaluate the patient on arrival before activating the cath lab.They collected several repeat ECGs at the outside hospital before transport:None of these three ECGs meet STEMI criteria. There is perhaps a hint of inferior STD (reciprocal). The T-waves, especially in V2, ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs