ECG Case 061

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.

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

• Apical hypertrophic cardiomyopathy – suspect if associated LVH
• Raised intracranial pressure – patient will be comatose (see Quiz ECG 012)

Further Reading

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
• Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
• Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.
• Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF