A Text Message in the Middle of the night. Do you give thrombolytics?

I awoke in the morning and discovered a text with this ECG that was sent 6 hours prior by a former resident:" 60 year old with classic chest pain.  The cath lab is occupied for the next 90 minutes.  Cards says " not a STEMI " .  Thinking of giving lytics. "What do you think?What do you do?I texted back: " Sorry for delay!  Was sleeping.  This is OMI!!  Did you give lytics?  Proximal LAD.  Great catch! "There is 0.5 mm of ST Elevation in V3-V6.  The T-wave in V4 is far too large for the QRS.  The LAD occlusion formula would be very high due to the extremely small R-wave in V4 and QRS in V2, but without the QT I cannot calculate it exactly.This ECG is diagnostic of LAD OMI.  Occlusion Myocardial Infarction.I continued:" Cards was right.  It is not a STEMI.  But the new paradigm is OMI.  And that is what is important.  ST Elevation is a very poor way to define myocardial infarction. We have a couple articles, one in press and one in review, that we hope will continue to prompt a change in that inadequate paradigm. "More about the case:History: 60 yo woman w/ history of smoking but no other cardiac risks who presented to triage w/ CP. She had awoken in the morning w/ bilateral arm paresthesias and by evening called a nurse advice line who told her she may be having a heart attack and to go to ED to be evaluated.While in her car she developed central chest pressure radiating to right shoulder about 20 min p...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs