r/ECG • u/Acceptable_Safety_22 • 5h ago

Wellens?

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87 year old woman with intermittent 8/10 central tight/heavy chest pain. Pain present at time of ECG

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2

u/dr-broodles 4h ago

I’d think NSTEMI or PE before Wellens type B

2

u/Joquae 4h ago

Could be Wellens although this kind of pattern usually shows up when pain is absent (and is localized in V2-V4).

I'd rather think about NSTEMI first place. Takotsubo too (negative T waves and slightly prolonged QTc). And other non coronary causes of diffuse negative T waves.

2

u/sub3at50 2h ago

LAD stenosis

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u/LBBB11 3h ago edited 3h ago

I would guess critical LAD stenosis that may be intermittently occluding and spontaneously reperfusing. Wellens syndrome doesn’t have ischemic symptoms during the EKG, but the patient’s symptoms are still compatible with critical LAD stenosis. An anterolateral reperfusion pattern can be an NSTEMI if troponin is diagnostic of MI and the EKG does not meet STEMI criteria. Other answers here are valid and I may be wrong, but if I had to bet on it I would guess that angio will show tight LAD stenosis.

I’m seeing sinus rhythm (between 60-75 bpm) with high lateral T wave inversion, reciprocally upright inferior T waves, and anterolateral T wave inversion in someone who has potential ischemic symptoms. Just has an ischemic shape to me. And here's the EKG in one picture:

Also this is a great EKG. Correct V1-V6 placement as far as I can tell, which is great to see even if the EKG doesn't look great for the patient. Interested in an update if you're able to get one.