This ECG is nearly pathognomonic. What is it? (hint: it ' s not Wellens ' )

I was texted this ECG:What did I say?My response: " takotusubo "Even without a history, this is the likely diagnosis.  Later, I obtained the history: 60-something woman who presented with agitation and had taken a benzodiazepine overdose.  There was no report of chest pain.  She had a respiratory alkalosis, with venous pH of 7.56 (equivalent to an arterial pH of higher than 7.60 and possibly contributing to the long QT and ECG abnormalities).  Electrolytes were normal.  She was also on Duloxetine, which can prolong the QT, and on Lithium (but her level was very low).This is almost certainly takotsubo.  The widespread bizarre T-wave inversion with very prolonged QT interval is classic for takotsubo cardiomyopathy.Most people will say " Wellens? " to this ECG, but the T wave inversions are too big, the QT too long and too bizarre for Wellens ' (which is due to spontaneous reperfusion of OMI).  Moreover, Wellens ' would involve just one territory, and Wellens ' of the LAD would be V2-V4 with possible extension to V5-V6 and to I, aVL if it is a proximal LAD lesion; but it could exend to II, III, aVF if it is an LAD that " wraps around " to the inferior wall ( " wraparound, or Type III, LAD).  By the way, this also resembles the " Spiked Helmet Sign, " which is usually a manifestation of stress cardiomyopathy.  See this case: Spiked Helmet SignA bedside echo was done:This shows apical ballooning consistent with takot...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs