{"id":562,"date":"2016-06-12T00:04:08","date_gmt":"2016-06-12T00:04:08","guid":{"rendered":"http:\/\/torreyekg.com\/?p=562"},"modified":"2016-05-09T00:24:07","modified_gmt":"2016-05-09T00:24:07","slug":"ekg-of-the-week-34","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2016\/06\/12\/ekg-of-the-week-34\/","title":{"rendered":"EKG of the Week #34"},"content":{"rendered":"

\"341\"<\/a>
\n56-year-old woman with prior chest pain six hours ago.
\nPatient was pain free at the time of this EKG.
\n

Answer & Explanation<\/div>

\nThe most striking finding on this EKG is the deep T-wave inversions in V2-3 and the biphasic T wave in V4. She was pain-free at presentation and an initial troponin was negative. Three hours later the repeat EKG was unchanged and a second troponin was minimally elevated at 0.12. She was heparinized and admitted to telemetry. She went to cardiac cath the next morning \u2013 that revealed 90% proximal LAD stenosis that was successfully stented.\n

Since these anterior T-wave inversions appeared in the pain-free interval following her chest pain episode, I believe they represent Wellens\u2019 syndrome. Wellens\u2019 may present with biphasic T-waves in the anterior leads or with deeply inverted T-waves in the same leads (original reports actually claimed deep T-wave inversion were the more common finding). We can add this form of Wellens\u2019 to the differential list of deeply inverted T waves (remember: spasm, Takotsubo, CNS event, and rarely PE).<\/p>\n

Wellens noted that unstable angina with this EKG pattern frequently (75% of his patient series) developed an extensive anterior MI with days to weeks of presentation. This finding correlates with angiography in the modern era that typically demonstrates a critical lesion in the proximal LAD.<\/p>\n

Rhinehardt J, Brady WJ, Perron AD, et al. Electrocardiographic manifestations of Wellens\u2019 Syndrome. Am J Emerg Med 20:638-643, 2002.<\/p>\n

Tandy TK, Bottomy DP, Lewis JG. Wellens\u2019 Syndrome. Ann Emerg Med 33:347-351, 1999. <\/p>\n

<\/p><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

56-year-old woman with prior chest pain six hours ago. Patient was pain free at the time of this EKG.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-562","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/562","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=562"}],"version-history":[{"count":2,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/562\/revisions"}],"predecessor-version":[{"id":583,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/562\/revisions\/583"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=562"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=562"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=562"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}