You MUST recognize this pattern, even if it is not common

Disclaimer: I never state from where I get a case.  They come from all over the world.   Any case may or may not be from my own institution.  Do not make any assumptions.Case: A non-English speaking woman in her 60's with h/o HTN, type II DM, hyperlipidemia, CAD s/p CABG 16 years prior, and end stage renal disease on dialysis  presented to the ED at time 0.  She had awoken 7 hours prior with severe headache followed by upper chest heaviness and vomited x 2.   EMS placed an 18 gauge IV, gave 2 NTG, and aspirin.  She stated the pain was not similar to a previous MI.  BP was 200 systolic.   The patient stated that her chest pain was more of an issue than her headache.Here is her initial ECG:There is sinus rhythm, right axis deviation, and new ST elevation in V1-V3.  What do you think?  See more discussion below.What was not seen is that there is QRS widening (120 ms) and peaked T-waves diagnostic of hyperkalemia and a pathognomonic, though unusual, pseudoSTEMI pattern.  Cardiology was called and the cardiologist activated the cath lab. The angiogram showed no acute disease.  However, following the procedure, during the sheath pull, she experienced VT arrest and was administered multiple shocks for wide complex tachycardia.  3 "amps" of lidocaine, 300 mg amiodarone, Sodium Bicarbonate x 2 "amps", D50 x 1 "amp", and calcium gluconate x 1 "amp" were all given.  She had return to sinus rhythm with narrow...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs