Syncope and Prehospital Cath Lab activation -- What do you think?

A 61 y.o. male with a history of HTN and ETOH developed squeezing epigastric abdominal pain with associated vomiting and diaphoresis, followed by a syncopal episode which lasted about 10 seconds.When medics arrived, he denied any chest pain, shortness of breath, or palpitations prior to the syncopal episode.They recorded a prehospital ECG and diagnosed STEMI and activated the cath lab prehospital.I heard that a prehospital cath lab activation was on its way.The patient arrived and we viewed the prehospital ECG:There is ST elevation in V1 and V2There is ST depression in II, III, aVFThere is ST depression and T-wave inversion in V5 and V6There is T-wave inversion without STD in V3 and V4What do you think?It is worrisome for high lateral OMI (with reciprocal STD in inferior leads), and even for LAD OMI (STE with Q-waves in V1, V2)However, I thought it was likely a false positive.  I always try to go and see these prehospital activations right when they arrive whether he will be my patient or not, in order to view the prehospital ECGs,because they are so often false positives.The combination of ST elevation in V1 and V2, with ST depressionand T-wave inversion in V5, V6 should always make you think of LVH with chronic ST-T abnormalities, even if the voltage does not meet LVH criteria (of which there are many because they are so insensitive and nonspecific).STE in V1 and V2, with ST depression in V5 and V6 is a pattern that occurs in Septal OMI, but it looks different tha...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs