ECG of the Week - 6th June 2016 - Interpretation

The following ECG is from a 70 yr old female who presented following an episode of chest pain at home.

Click to enlarge

Rate:

• 54 bpm

Rhythm:

• Sinus arrhythmia

Axis:

• Normal

Intervals:

• PR - Normal (~160-180ms)
• QRS - Normal (100ms)
• QT - 440ms

Segments:

• Nil significant change

Additional:

• Deep T wave inversion leads V1-3 & aVL
• Prominent T waves III, aVF, V6 

Interpretation:

• Wellen's pattern
• Deep T wave inversion leads V1-3
• aVL inversion consistent with ACS

What happened ?

The patient had an angiogram which showed:

• Left main: Normal
• LAD: 80% mid stenosis
• Cx: 40% stenosis
• RCA: 60% proximal & 90% mid stenosis

The LAD lesion was stented and subsequent echo showed only mild LV systolic dysfunction. Medical therapy was maximised and staged further intervention was planned for the RCA lesion.

More on Wellen's

Check out:

Dr Smith's ECG Blog

• Is this Wellen's Syndrome ?
• Wellen's Syndrome No Culprit
• All Wellen's Labelled Posts

Articles

• Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med. 2002 Nov;20(7):638-43. PMID: 12442245 Full text here
• Mead NE, O'Keefe KP. Wellen's syndrome: An ominous EKG pattern. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 206–208.  Full text here.

References / Further Reading

Life in the Fast Lane

• Wellen's Syndrome 

Textbook

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