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ECG Case 061

Middle-aged patient presenting with an episode of chest pain. Currently asymptomatic. Describe and interpret his ECG


Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

This pattern of deeply inverted T waves in the anterolateral leads V2-6, I and aVL is characteristic of Wellens syndrome.

  • This ECG pattern is highly predictive of a significant occlusive lesion of the LAD.
  • The inverted T waves are a marker of reperfusion and may occur after an aborted anterior STEMI.
  • Despite often being pain free and having normal cardiac enzymes at presentation, these patients are at risk of sudden LAD re-occlusion leading to massive anterior STEMI and are best managed with early angiography and PCI / CABG.

DIFFERENTIAL DIAGNOSIS

A similar pattern of deep anterolateral T-wave inversions may also be seen with:


TOP 100 ECG Series


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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