Christmas Eve Special Gift!! Prehospital Cath Lab Activation: What do you think?

A 60-something male was sent from Dialysis for several days of SOB.  He did not know his medical history well.The patient was in no distress.The paramedics recorded an ECG:Here I magnify the limb leads and precordial leads:Now of course you see the convex ST elevation in V3 and V4, and the STE in V2 that is preceded by a spike. Is this STEMI?Here is the Computer Interpretation:The medics activated the cath lab.  Do you agree? I was in the ED, and whenever I hear that there has been a prehospital cath lab activation, I like to go take a look because there are many false positive activations, especially in patients without chest pain.First: remember that a heart rate that fast is unusual in acute type 1 MI unless there is cardiogenic shock or impending shock.  But the patient appears well.Second: Look carefully at the limb leads: there are definite flutter waves.You can also see them easily in lead V1 and V2: see the regular spikes at a rate close to 300?Third: Whenever you see abnormal ST-T, look at the QRS.  Here you see QS-waves, highly suggestive of old MI with persistent ST Elevation (LV aneurysm morphology -- LVA).  Other reasons for QS-waves are LVH and cardiolmyopathy, and both can have baseline ST Elevation.----Such baseline STE is often exaggerated by tachycardia.----Flutter waves can also superimpose and exaggerate the ST Elevation.My interpretation at the time I saw this: probably a false positive.  Plan?Let ' s...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs