ECG of the Week - 11th August 2014 - Interpretation

This ECG is from an 80 yr old male who presented with a 1 weeks worth of chest pain.
Complex past medical history with significant cognitive impairment. Multiple medications but nil sodium channel blocking agents.
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Rate:

• 78

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal (~200ms)
• QRS - Normal (80ms)
• QT - 340ms (QTc Bazette 390 ms)

Segments:

• Up-sloping ST elevation V2-4

Additional:

• Biphasic T wave leads V2-4
• T wave inversion lead I, aVL

Interpretation:

• Wellens' pattern T wave / ST changes

What happened ?

The patient had raised ischemic biomarkers, however given the severity of his co-morbidities nil further intervention was performed.
An ECHO showed concentric left ventricular hypertrophy with posterior wall akinesis.

References / Further Reading

Life in the Fast Lane

• Wellens' Syndrome 

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.