Do you understand these T-wave inversions?

Case submitted and written by Alex Bracey, with edits by Pendell MeyersA man in his 50s without prior medical history was sent to the emergency department from an urgent care facility for concern of an " abnormal ECG " after he had complained of chest pain earlier in the day. He was symptom free at the time of arrival.Here is the triage ECG at the Emergency Department (we did not immediately have access to the urgent care ECG just yet):ED ECG#1What do you think? What do you think his urgent care ECG (done during pain) will show?This ECG shows sinus bradycardia with terminal ST depressions in II, III, aVF, V3-V6, with reciprocal changes in aVL and I. These findings indicate reperfusion of the inferior and lateral walls, implying that an ECG during active symptoms would likely show OMI.Note: This is the same pathophysiology and electrophysiology involved in Wellens syndrome, which is simply the name given to reperfusion of anterior wall OMI when the patient is in the pain free state of reperfusion and has not yet lost the anterior wall (requires persistent R-waves to be classic Wellens syndrome). This pattern occurs in any wall of the heart, whichever wall is currently reperfused from a prior occlusion.On this note, " type A " and " type B " Wellens are useless distinctions that arose before we realized that reperfusion is a progression of findings starting with terminal T-wave inversions ( " type A " ) and progressing to full T-wave inversions ( " type B " ). My analogy for th...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs