The ECG shown on page 14 (ECG 15.2) is from a 74-year-old female admitted for monitoring after facial surgery. There is no chest pain.

Wellens-Syndrome-Type-B-Pattern.jpg

 
a)    Describe the abnormalities. (25% marks)

b)    What is the underlying diagnosis? (10% marks)
 


 

[Click here to toggle visibility of the answers]

College answer

a)

  • Deep TWI anterior leads
  • Left axis deviation
  • Moderate voltage criteria for LVH
  • ST abnormalities
  • Prolonged QTc

b)

Critical LAD stenosis (Wellens syndrome) 
 

Discussion

This image was stolen from LITFL, as they all tend to be. According to Rhinehart et al (2002), via that LTFL entry (which is gloriously detailed), the criteria for Wellen's syndrome are:

  • Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6)
  • Isoelectric or minimally-elevated ST segment (< 1mm)
  • No precordial Q waves
  • Preserved precordial R wave progression
  • Recent history of angina
  • ECG pattern present in pain-free state
  • Normal or slightly elevated serum cardiac markers

References

Rhinehardt, Joseph, et al. "Electrocardiographic manifestations of Wellens' syndrome." The American journal of emergency medicine 20.7 (2002): 638-643.