Chest discomfort, Sinus Tachycardia, Q-waves, ST Elevation, and Intermittent Wide Complex Tachycardia. Activate the Cath Lab?

This ECG was texted to me with no other information:Computer Diagnosis:SINUS TACHYCARDIAINCOMPLETE RIGHT BUNDLE BRANCH BLOCK [90+ ms QRS DURATION,TERMINAL R IN V1/V2, 40+ ms S IN I/aVL/V4/V5/V6]LEFT ANTERIOR FASCICULAR BLOCK [QRS AXIS<= -45, QR IN I, RS IN II]ANTEROSEPTAL MYOCARDIAL INFARCTION , PROBABLY RECENT [40+ ms QWAVE IN V1-V4]***ACUTE MI***What do you think? Below is my response.There is sinus tach.  There is an incomplete RBBB and LAFB.  There are QR-waves in aVL and V2, and a QS-wave in V3.  There is ST elevation in V2 and V3, with upright T-waves in V2 and V3.  There is reciprocal ST depression in inferior leads and also in V5 and V6.This was my response:If it is the right clinical situation, such as acute chest discomfort, it looks like proximal left anterior descending occlusion with right bundle branch block and left anterior fascicular block. Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock.  Alternatively, it is someone who has an old myocardial infarction and is now very sick with something else.Then I looked into the patient ' s chart and found an old EKG:This shows a previous QR-wave in V2, diagnostic of old anterior MI.  It does not show RBBB but does show Left anterior fascicular block.I wrote back:" I am looking at his old EKG. It looks like he has an old anterior lateral MI as well.  This suggests that it is not an acute coronary syndrome. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs