A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
An unprecedented two consecutive responses before Christopher! I'm on a roll! "Wellens' warning" would definitely be on the short list of differentials.
Hi Jason,I agree with your 'warning'.I'm starting to think this is turning into a competition between you and Christopher about who can comment first :-)I did just google the time difference between the USA and Australia to make sure no-one is setting their alarms for the middle of the night to claim first comment honours.
Guess I have to set my alarm earlier now ;)Rate: ~65 bpmRegularity: regular w/o ectopyP-waves: sinusPRi: 180ms, 1:1 associationQRSd: 90-100msRhythm: normal sinus rhythmAxis: ~60 deg frontal, late R-wave transition.QTc: WNLQ-waves: visible in III, but appear to have respiratory variationST/T-waves: 1mm ST-e in V2-V3, minimal ST-e in V1, biphasic T-waves in V2-V4 consistent with Type I Wellen's. T-wave inversions in the high laterals.Given the presence of Wellen's Warning, I'd be concerned about a critical proximal LAD stenosis possibly with recent reperfusion. Patient should receive emergent angiography.
Isn't there STE in III with reciprocal depression in I and aVL and therefore STEMI?
Sebastian,Measured against the TP segment there is no ST-e in III, measured against the PR segment there is maybe a sliver of ST-e, but nothing I'd call a STEMI over. There is some wander in the baseline likely related to the patient's respiratory rate.
Doesn't need a history this one unfortunately.I concur that its likely Mr Wellens paying a visit.Especially with the high lateral ischaemia going on in I and aVL.
PS. South East Asia represent!