ECG Case 116 • LITFL • ECG Top 100 Self-Assessment Quiz

These ECGs were taken from a 40 yr old male who presented with a 60 minute history of central chest pain.

On arrival to the Emergency Department he was pain free (ECG 1). Four minutes later he developed further intense chest pain and a repeat ECG was performed (ECG 2).

Describe and interpret ECG 1

ECG Case 116a LITFL Top 100 EKG — **ECG 1**: On arrival

ECG ANSWER and INTERPRETATION

Rate:

72 bpm

Rhythm:

Regular
Sinus rhythm

Axis:

Normal

Intervals:

PR – Normal (160ms)
QRS – Normal (100ms)
QT – 400ms (QTc Bazett 440 ms)

Segments:

ST elevation lead V1 (<1mm)

Additional:

Biphasic T wave lead V2
T wave inversion leads I, aVL, aVR, V1, V3-6
- Deep inversion leads V3-5
Voltage criteria for LVH

Interpretation:

The differentials of deep T wave inversion are relatively broad but in a patient with a history of chest pain, a pain free ECG and these ECG features the major concern is Wellens syndrome – signifying a critical LAD lesion.

The subsequent ECG, taken whilst having chest pain, highlights the need to recognize the Wellens pattern.

Describe and interpret ECG 2

ECG Case 116b LITFL Top 100 EKG — **ECG 2**: Four minutes later