All that wiggles isn’t Wellens’

   This is the discussion for our Snapshot Case involving a 45 year old female complaining of chest pain. Here is the 12 lead for review:                           There is sinus rhythm at about 75 bpm, with a slightly leftward axis. Slight ST elevation in V2. Biphasic T wave inversion in V2, inverted T waves in aVL, V3-V5.  As we recall, the patient had complained of "off and on" chest pain radiating to her left arm. Concerning to be sure! In addition, the patient was "pain free" at about the time of this 12 lead ECG.   Many of you astutely recognized the possiblity that this ECG showed the Wellens' pattern. We know that the Wellens' pattern typically occurs while the patient is pain free.  I was concerned that this was Wellens' also. I did think the R waves were larger than those I've seen in other Wellens' cases, but.. it sure looked like it could be Wellens'. And after all, our chest pain patient was now pain free! Here is an example of Wellens' (second type): Here is V1-V6 from our patient: Sure looked like it could be Wellens'. The receiving doc in the ER was also concerned. Don't you just love catching Wellens! The patient was admitted, and labs drawn. When I followed up to see how critical the LAD lesion was, I got some interesting news: Troponins came back negative. I do not know the discharg...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-topics patient-management Training training-development 12-Lead ECG case study David Baumrind EMS 12-Lead ems12lead.com Paramedic Prehospital 12-Lead ECG blog snapshot case Wellens' Syndrome Source Type: research