What does this ECG with significant ST Elevation represent?

These 2 serial ECGs were texted to me recently.  They were recorded 12 minutes apart:" Hey Steve, 30-something with one week of chest pain, mostly right-sided, better with sitting up. " :What do you think?QTc ' s were 330 ms and 373 msThis is what I texted back:These look like they are a very pronounced case ofBenign T-wave Inversion.  I do not think this is acute occlusion myocardial infarction (OMI).  Get an emergent contrast echocardiogram.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica}These are reasons why it does not look like OMI: 1. flat ST segment in V42. huge R-wave in V43. very short QT interval4. J-point notching5. classic early repol in V36. classic features of“Benign T-wave inversion” T-waves in V5, V6.  I would guess the patient is African American.Would I blow it off?  No.  I would get an echo.  I am 99% certain that it is not OMI.An emergent echo was done:Normal left ventricular size, normal wall thickness and mild to moderate systolic dysfunction.The estimated left ventricular ejection fraction is 43%.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px ' Courier New ' } p.p2 {margin: 0.0px 0.0px 0.0px 0.0px; font: 10.0px ' Courier New ' ; background-color: #fefefe} span.s1 {background-color: #fefefe}Global hypokinesis.The first troponin I then returned quite elevated at 9.8 ng/mL.In the absence of a wall motion abnormality, especially with global decreased ejection fracti...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs