Typical chest pain and hypotension, Activate the Cath lab?

I was texted this ECG with the info that the patient " clinically looked like he was having a myocardial infarction " :What do you think?There is atrial and ventricular pacing.  Both spikes are best seen in V1 and V2 (as always, if you click on the image, it enlarges).  The QRS is very very wide.  On the image below, I have drawn lines in every lead from the QRS onset (blue) and QRS end (red).  I measure the QRS duration at about 280 ms.  Of course, all ventricular paced rhythm is wide, but not often this wide.  One must always consider hyperkalemia when the QRS is very wide, but the K turned out to not be high.  Here is the EKG with blue lines at the QRS onset and red lines at QRS end:Since this was a photo of the ECG, it was not perfectly square, and so that lines are also not perfect.Beside the pacing and wide QRS, there isno significant concordant ST Elevation, and no excessively discordant ST elevation or depression (in other words, it does not meet the Smith Modified Sgarbossa criteria, even at the 20% ratio).  There is possible trace STE in III and reciprocal STD in aVL.  There is Pseudo ST Depression in V2, but as you can see from my lines, that is QRS, not ST segment.There is alsoQRS fragmentation (see especially leads II, III, aVF).  This is a good sign of ischemic heart disease, and analogous to Q-waves of MI.  In combination with the very long QRS, my reply to the text message was this:There is ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs