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?

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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


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).