I was handed this ECG at triage with no information

I was at triage when this ECG of a 50-something was handed to me. He speaks no English and I really had no idea what his symptoms were, but someone had pointed to his chest, which is why they recorded an ECG.What do you think?I was pretty alarmed by the ST segments in V4 and V5, and the ST segment of the PVC in V3. V4 and V5 haveQR-waves, in addition to the STE, which suggests:1. Old MI with persistent STE2. Old MI with superimposed new STE, or3. Subacute MI. There is also STE in the normally conducted beats of V2 and V3, but that is in the context of a deep QS-wave, which was less alarming.So I looked for old ECGs, and found these:PreviousThe second beat in each of V4-V6 is a PVC.  The first is normally conducted.The normally conducted beat in V4 has a QR-wave and STE, but not as much STE as the new ECG.  The PVC might fool you into thinking that there was previously anabsence of Q-wave.Another PreviousThis looks a lot like the new one, but the new one has more STE.It is helpful to know thata faster heart rate can exaggerate the ST elevation of LV aneurysm.My suspicion was that this was all old.We did a bedside echo:Apical 4-chamberLarge apical aneurysmParasternal long axisAlso shows the apical aneurysmWe found that he has a history of LAD occlusion and Left Main stent, and ischemic cardiomyopathy, had a v fib arrest and has an ICD and pacer.Previous echo had indeed shown an LV aneurysm.Then the interpreter arrived and confirmed that he does not...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs