The pain is resolved by EMS arrival.
A 12-lead ECG is captured.
History of chronic stable angina.
Your thoughts on the ECG?
*** Update 11/20/2009 ***
Here's an image from Rhinehardt et al. Electrocardiographic Manifestations of Wellens’ Syndrome. Am J Emerg Med 2002;20:638-643.
What do you think? I'm not 100% convinced but it's an interesting possibility!
On the other hand, all the cases of Wellens' Syndrome in the article show the Wellens T-wave in lead V2 (notably absent in this ECG).
What do you think? I'm not 100% convinced but it's an interesting possibility!
On the other hand, all the cases of Wellens' Syndrome in the article show the Wellens T-wave in lead V2 (notably absent in this ECG).
Hey Tom another good post...ok let's get into it.
ReplyDeleteRelative Sinus Bradycardia at 55 BPM, noted a left axis deviation with a possible LAHB, also noted some P-mitrale in leads I, V4, V5, and V6 suggesting some left atrial enlargement. Now about that T-wave inversion, it appears to be Left ventricular strain, which would coincide with the left atrial enlargement suggested by the P-mitrale. This patient probably has some left ventricular enlargement that just has not become significant enough to manifest itself on the ECG...yet. I'm also guessing that this pt has some chronic HTN contributing to the LV strain and LAE. And most likely the HTN is being controlled by beta-blockers which is producing the Sinus relative bradycardia. Most likely a bout of angina. I'm curious, did the patient take any NTG prior to EMS arrival, resulting in the pain relief. Also, what was the hx leading up to the onset of symptoms?
Acase of AF, LA mass
ReplyDeletehttp://www.echojournal.org/video/198/LA-mass
best wishes
chest discomfort maybe related to early signs of ischaemia as ECG indicates T inversion in anterolateral leads.further investigation required as serial ECG and Cardiac Enzyme and Troponin I blood to confirm the diagnosis.
ReplyDeletePossible Wellens syndrome?
ReplyDelete@Batman - I do agree that the ECG resembles LVH with strain in leads I, aVL, V1, and V2. However, the deep T-wave inversions in V3-V6 are not discordant with the QRS complex (since the QRS complexes are equiphasic in these leads). I regret that I don't know anything else about the history.
ReplyDelete@Anonymous - I certainly agree with you with regard to serial ECGs and cardiac biomarkers!
@Jon - My thoughts exactly! :)
Tom