This post is an answer to the ECG Case 248
- Rate: 72 bpm
- Rhythm:Regular Sinus rhythm
- Axis: Normal
- Intervals:
- PR – Normal (160ms)
- QRS – Normal (100ms)
- QT – 400ms (QTc Bazette 440 ms)
- Segments:
- ST elevation lead V1 (<1mm)
- Additional:
- Biphasic T wave in lead V2
- T wave inversion in leads I, aVL, aVR, V1, V3-6
- Deep inversion in leads V3-5
- Voltage criteria for LVH
Interpretation
The differentials of deep T wave inversion are relatively broad but in a patient with a history of chest pain, a pain free ECG and these ECG features the major concern is Wellen’s syndrome – signifying a critical LAD lesion. The patient’s next ECG, taken whilst having chest pain, highlights the need to recognize the Wellen’s pattern.
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