Severe Chest Pain on ED Arrival, after Wellens ' waves Seen on Prehospital ECG

A 40-something woman called 911 in the middle of the night for Chest pain that was intermittent.  On arrival, she complained of severe pain.The medics had recorded this ECG and were uncertain whether it was recorded during chest pain:Let ' s get a better image with use of thePM Cardio app:What do you think?There is deep T-wave inversion in proximal LAD territory (V2-V4, I, aVL) that is all but diagnostic of Wellens ' . This is acute ACS, but it almost always seen in a pain free state.  Since the patient has active pain now, if this is indeed Wellens, ' she must be re-occluded at this moment.  An ED ECG, if recorded with pain, should show LAD OMI.So this ECG was immediately recorded: Indeed, as predicted, a patient with previous Wellens ' waves who now definitely has chest pain has acute Occlusion, with new ST elevation in I, aVL, V2-V5.The Cath lab was activated.Repeat ECG while waiting for cath team, t = 56 min after arrival:It is getting worseAngiogram showed 99% acute proximal LAD thrombosis.  It was opened and stented.Initial hs troponin I returned at 48 ng/LPost PCI ECG:This shows huge persistent ST Elevation and suggests that there is "No Reflow" , meaning that there is so much downstream platelet-fibrin aggregates obstructing small vessel flow, that there is poor tissue reperfusion.  This may be seen on angiogram as poor " blush " or a low " TIMI Myocardial Perfusion (TMP) Grade. "  Low TMP grade correlates very well wi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs