ST segment and T wave changes

What is the cause of ST changes and T wave inversions in this ECG?

Should the patient be taken to Cath lab for coronary angiography?

These ST segment and T wave changes are secondary to left ventricular hypertrophy.
There are classical features of left ventricular hypertrophy in this ECG which should not be missed.
Hence, if the patient doesn't have any other features which suggest ischemia, then he should undergo evaluation for cause of left ventricular hypertrophy.
The most common cause for left ventricular hypertrophy is hypertension.

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High heart rate

The patient contacts the doctor over phone with this report. Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine. Should he be worried about this and come to emergency department as soon as possible? Correct answer- ECG machine has calculated his heart rate incorrectly. Heart rate is around 100 beats per minute. Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods. Now, should he come to emergency department? Not because of detection of high heart rate. But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist.

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