80 y/o male with history of CABG presents with SOB x 24 hours. EKG notes ST elevations in anterior precordial leads. Point of care troponin 0.4 (equivocal). Should the patient be taken for immediate cardiac cath?

No old EKG for comparison.  Click image to enlarge.

No immediate cath.  The patients history and laboratory evaluation are a bit atypical for ST elevation MI.  Additionally, the EKG harbors characteristic findings of a ST elevation MI mimic, prior MI with or without ventricular aneurysm.   EKG features of this ST elevation mimic commonly include:

• ST elevation with QS waves in V1-V4
• T waves flat or inverted 
• ST elevation relatively small relative to QRS amplitude, (less than 1/4 height of QRS) 

Source

Smith, S. and Larson, D.  "Chapter 14: What Pseudoinfarction Patterns Mimic St Elevatioin Myocardial Infarction."  Critical Decisions in Emergency and Acute Care Electrocardiography, 1st ed.   2009.