An 80-something with weakness, cough, and CP. Should this ECG provoke a Prehospital Cath Lab activation?

An 80-something called 911 for chest pain, generalized weakness, and cough.Here is his prehospital ECG:The medics were worried about this ECG and activated the cath labSmith: As in many prehospital ECGs with large voltage,the tracing goes off the image, making assessment of voltage impossible.  Thus, it is impossible to assess the ST Segments and T-waves, which should always be assessed in proportion to the size of the QRS.  I call this " proportionality " and in a non-ischemic ECG, the repolarization should always be proportional to the depolarization.  Since we can ' t see the true size of the QRS, we cannot assess proportionality.So an ECG like this should not precipitate cath lab activation.On some machines, one can change the settings of millimeters per millivolt and re-record.  Standard measurements are0.1 mVolt = 1mm (as in this case), but it can be changed on most ECGs to" half standard " which means that0.1 mV = 0.5 mm and the QRS complexes then arehalf sized.When the patient arrived, an ED ECG was recorded:Rhythm is uncertain but probably supraventricular at a rate of 100.  There is RBBB and LAFB andMassive LVH.  No ST segments are out of proportion to the QRS.A bedside cardiac POCUS was done, short axis: This shows very hypertrophied myocardium Long axisAgain, very hypertrophied myocardiumThere was no previous ECG on file.Another ECG was recorded shortly thereafter:Now P waves are visible in lead V1&n...
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