Your patient is a 63 yo F with past medical history remarkable for smoking and HTN presenting with chief complaint of chest pain and diaphoresis. Her symptoms began as she was walking up her stairs and resolved upon rest. She chewed 4 aspirins and came straight to your ED for evaluation. She has no symptoms at this time
Vital Signs: Temp 98.6 BP 167/92 HR 90 SpO2 93% RA
Exam: Calm, cooperative; HR regular without murmurs, lungs CTA, extremities and abd unremarkable
PR ~120msec QRS complex – ~80msec QT interval – 320msec
Biphasic T waves in V1-3 with inverted, symmetrical T wave inversion (TWI) V4
2 types of Wellen’s Syndrome EKG Patterns o Type A (more common): Deeply and symmetrically inverted T-waves in V2-3 o Type B: Biphasic T-waves with initially positive and terminal negativity
Usually V2-3, can extend V1-6
+ Why is this important?
This finding is described as a “reperfusion pattern” as it demonstrates restoration of blood flow after a STEMI involving the left anterior descending coronary artery (LAD). Likely from aspirin in this case.
+ What should be your next step in mangement
IV, O2, monitor, advanced airway equipment ready. Call cardiology, as this is a STEMI equivalent!
+ Additional resources
Dr Smith’s EKG Blog: http://hqmeded-ecg.blogspot.com.au/search/label/Wellens%27%20syndrome
Amal Mattu: Wellens? Maybe? https://www.youtube.com/watch?v=5UfPqNL2DaY