5 Cardiologists said this is not a STEMI. But was it an OMI?

Written by Pendell MeyersA male in his early 50s presented with waxing and waning chest pain starting at rest. He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS.Here is his initial ECG:What do you think?Sinus rhythm-STE in V1-V5, possibly a tiny amount in V6, and small amount in I and aVL, and II-Reciprocal STD (although perhaps isoelectric at J point, immediate STD after the J point) with very ischemic appearance in lead III (down-up T-wave is strongtly suggestive)-Large T-waves in V2-V4, which may be either a normal variant or hyperacute-Very tiny Q wave in lead V2, as well as V6, I, and aVL, which is not seen in normal variant-STEMI criteria are not formally met; although V2 has sufficient STE (greater than 2.0 mm), neither of it ' s neighbors have enough STE to meet criteria (V1 is close at 0.5 mm of the " required " 1.0 mm)This is all highly diagnostic of acute anterior MI, with the most likely etiology being OMI of the proximal-mid LAD.The formulas would be formally contraindicated because of the Q-wave in V2, but if we use them anyway the results are (using QTc 397 ms):4 Variable formula: 20.323 Variable formula: 24.08Both formulas predict LAD occlusion.The physician called the on-call cardiologist immediately to discuss this ECG, but the cardiologist reportedly said not to activate the cath lab because he/she was not convinced by the ECG. Over the next few hours, four other general cardiologists " signed off on the initial ECG wit...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs