Question 6.1
A 45-year-old man presents to the Emergency Department with worsening shortness of breath. His ECG is shown below
a) Describe the main ECG abnormality?
b) What is the likely lesion?
c) What cardiac management is required?
College Answer
a) Deep symmetrical inverted T waves in V2-V4
b) Critical stenosis of the LAD
c) Coronary angiography + / - stenting
Anti-platelet therapy
Anti-coagulation
Beta-blockade
ACE inhibitor
Statin
Discussion
The image above, depicting the "Wellens WellenSign", was shamelessly stolen from Dr Leonard Gettes' excellent site. Not a great deal more to say there, really. Even a person unfamiliar with the eponymous sign will write "myocardial ischaemia" and receive marks (though less of them).
References
Engelen, Domien J., et al. "Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction." Journal of the American College of Cardiology 34.2 (1999): 389-395.
De Zwaan, Chris, Frits WHM Bär, and Hein JJ Wellens. "Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction." Professor Hein JJ Wellens. Springer Netherlands, 2000. 245-252.