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 ejectio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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In this study, we explore the use of low rank and sparse constraints for the noninvasive estimation of epicardial and endocardial extracellular potentials from body-surface electrocardiographic data to locate the focus of premature ventricular contractions (PVCs). The proposed strategy formulates the dynamic spatiotemporal distribution of cardiac potentials by means of low rank and sparse decomposition, where the low rank term represents the smooth background and the anomalous potentials are extracted in the sparse matrix. Compared to the most previous potential-based approaches, the proposed low rank and sparse constraint...
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I was texted this ECG with the words " sudden onset CP in a 20-something " :What do you think?This was my response:" This is abnormal in lateral leads. It probably is a normal variant but I would get a stat echo.It is out of the bounds of the usual with normal variant because the ST Elevation is so focal to the lateral wall. Most normal variant has as much inferior STE as lateral (and of course without ST depression in aVL).  This is myocarditis versus myocardial infarction. He should get an immediate echo.  Problem is, even myocarditis will have a wall motion abnormality. And then the on...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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