EKGenie November 2017

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

EKG1.jpg

+ Rate

70

+ Rhythm

Sinus, regular

+ Intervals

PR ~120msec QRS complex – ~80msec QT interval – 320msec

+ Pathology

Biphasic T waves in V1-3 with inverted, symmetrical T wave inversion (TWI) V4

+ Diagnosis

Wellen's Syndrome

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

REBEL EM: http://rebelem.com/r-e-b-e-l-ecg-week-wellens-syndrome-stemi/

Amal Mattu: Wellens? Maybe? https://www.youtube.com/watch?v=5UfPqNL2DaY