T-wave inversions and dynamic ST elevation

Written by Pendell Meyers, with edits by Steve SmithI received a text message with no clinical information other than the following ECG, with the question " Is this Wellens? No prior ECG available. "What do you think?I responded that this ECG represented benign T-wave inversion (BTWI), not Wellens. I asked for more history.It turns out this was a 25 year old male with no past medical history presenting after he was found " passed out " or laying down on the floor of the nursing home facility where he works. He was reported to be intermittently answering questions and seeming " not himself. " Family reported that he had 2 similar episodes in the past 3 months, which the patient describes as similar to " bad trips, " including increased fatigue, confusion, and vague hallucinations. He had been evaluated last month at an outside hospital by a psychiatrist. He denied any substance use on the day of presentation. There was no history of exertional syncope or sudden death in the family.Apparently a single troponin was ordered on the basis of the perceived ECG findings, which was negative. Three serial ECGs were performed which were all identical (though BTWI is not necessarily always perfectly constant).He was discharged.Two days later he presented again with a similar story. Here is his ECG on arrival from the second visit:This ECG shows sinus rhythm around 65 bpm. The QRS complex has moderately high voltage but otherwise normal morphology. There is STE in V1-V3 of 1.0, 1.5, and 1...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs