Is it important to recognize LVH Pseudo-infarction patterns?

A middle-aged male called 911 for sudden severe chest pain. The medics were very worried about acute MI and recorded a prehospital ECG. It is unavailable, but looked like this:As with many prehospital ECGs, the R-waves on top,& the S-waves on the bottom, are cut off.There is ST elevation in V2-V4.The medics were very worried about MI and asked to see me at the door to assess the ECG.What do you think?I looked at it and immediately said: " This is LVH. Not MI. " And so we did not place the patient in the critical care area and did not activate the cath lab.What did I see? There is indeed ST elevation, but there is T-wave inversion also, and the TWI is in V4-V6. You might think it is Wellens ' , butWellens ' is a syndrome, not an ECG finding. It is a syndrome in which the pain has resolved (is gone). This patient ' s pain was still present.Furthermore, a true Wellens ' ECG has T-wave inversion in V2-V4, not just V4-V6. And it should not have high voltage. While Wellens ' requires R-wave preservation in the affected leads, high voltage should make you think of what I callPseudo-Wellens pattern due to LVH.Here is a true Wellens ' case, showing evolution over time, in a patient whose pain had resolved:A. First ED ECG: T-wave inversion in V2 only, Pattern A (terminal T-wave inversion)B. At 2 hours, now V2-V4, Pattern A (terminal T-wave inversion)C At 9 hours, V2-V6, Pattern B (deep symmetric)Note there are preserved R-wavesNote there...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs