Does this ECG represent acute ischemia?

 I was shown this ECG, without any clinical data:What do you think?My answer:" I think it is a baseline ECG, not ischemic. "Why did I say that?  Because of the very high voltage.  Whenever you see voltage like that, ST-T abnormalities which at first appear to be ischemic are probably simply secondary to the abnormal depolarization and due to LVH or some other baseline disease.And so it was indeed the patient ' s baseline ECG:  The patient had presented for nonspecific symptoms and had the ECG recorded.  So they searched for a previous ECG.  Here it is from 20 months prior.  Quite similarIt turns out the patient had had an echocardiogram 22 months prior:Prominent trabeculation is noted in the distal LV segments but not definitive forLeft Ventricular Noncompaction Cardiomyopathy (LVNC).Serial troponins and Serial ECGs were negative.Another ECG was recorded that day:Slightly different, but not significantly so.  No evidence of developing ischemia.The patient was discharged with followup.Noncompaction CardiomyopathyA few pearls on LVNC copied from UpToDate (quotes):Left ventricular noncompaction (LVNC) is a distinct phenotype characterized by prominent LV trabeculae and deep intertrabecular recesses. LVNC was previously also called spongy myocardium or hypertrabeculation syndrome but these terms should not be used interchangeably with LVNC.LVNC is characterized by the following features:●An altered myocardial wall with prom...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs