Friday, 4 January 2013

ECG of the Week - 7th January 2013

This is one of the older ECG's I have in my collection, and it didn't come with any clinical information, sorry.

Have a look and see what you think.

Click to enlarge


  1. An unprecedented two consecutive responses before Christopher! I'm on a roll! "Wellens' warning" would definitely be on the short list of differentials.

  2. 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.

  3. Guess I have to set my alarm earlier now ;)

    Rate: ~65 bpm
    Regularity: regular w/o ectopy
    P-waves: sinus
    PRi: 180ms, 1:1 association
    QRSd: 90-100ms

    Rhythm: normal sinus rhythm

    Axis: ~60 deg frontal, late R-wave transition.
    QTc: WNL
    Q-waves: visible in III, but appear to have respiratory variation
    ST/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.

  4. Isn't there STE in III with reciprocal depression in I and aVL and therefore STEMI?

  5. 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.

  6. 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.