A 50-something male with acute chest pain

A 50 y.o. male was sitting at a work conference when he began having substernal chest pain with diaphoresis.  He had a history of hypertension, but no history of heart problems.  The pain was 7 out of 10 when this ECG was recorded:The QTc = 375What do you think?Computer interpretation:p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px ' Courier New ' ; background-color: #fefefe} span.s1 {font: 11.0px Helvetica}SINUS RHYTHMNON-DIAGNOSTIC ANTEROLATERAL ST ELEVATIONBORDERLINE ECGThe overreading cardiologist confirmed the computer interpretation (did not diagnose OMI or STEMI).To me, it is clearly a STEMI.  But many do not recognize ECGs like this! The ECG in the last post is much more obvious, but not recognized: What happens when you don ' t recognize an OMI? By my visual measurement, STE at the J-point relative to the PQ junction in V2 = 1.5, V3 = 2.0, V4 = 1.5.  Since the threshold for " STEMI " is 2.0 in V2 and V3 for men over age 40, and the threshold in V4 is 1.0 mm, this ECG actually meets STEMI criteria.  (Of course not all ECGs that meet STEMI criteria are STEMI; there are many false positives, but they do NOT look like this one.) Usually, the computer algorithm is accurate in measuring ST elevation at the J-point, so I defer to it for this.  But such measurement simply does not matter!When there is ST elevation in these leads, and all else is normal (normal QRS, upward concavity, no ST depression or T-wave in...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs