Sudden CP and SOB with Inferior ST Elevation and in STE in V1. Is it inferior and RV OMI?

A 60-something had been having chest " soreness " on and off for one month when she presented with sudden chest discomfort and dyspnea starting about an hour prior to arrival.Here is the triage ECG.It was texted to me along with concern for inferior ST Elevation and STE in V1, possible inferior and right ventricular OMI:There is a negative P-wave in lead II.  You ' ll notice that the P-wave is abnormal everywhere.  This is an ectopic atrial rhythm, and it is low in the atrium such that the atrium is depolarized AWAY from lead II and is inverted.  In any ECG, there might be an atrial repolarization wave, or not.  When there is sinus rhythm, with conduction towards lead II, the atrial repolarization wave is negative, resulting in PR depression and depression of the first part of the ST segment (see schematics below).  This is why we measure the ST segment relative to the QRS onset (PQ junction): both intervals may be depressed by a normal atrial repolarization wave.  In pericarditis, the atrial repolarization wave is exaggerated; hence, we get excessive PR depression.In low atrial rhythms, on the other hand, when the atrial impulse is traveling from inferior to superior, the atrial repolarization wave is positive, and can result in a mimic of ST Elevation.  This is what is happening in inferior leads, but ALSO in V1.Ken Grauer says this is called the" Emery Phenomenon, " but I can ' t find that in any search.Here ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs