Chest pressure and T-wave inversions. Not what you might think.

A 40-something male had been in the ED for many hours for altered mental status due to alcohol, when he became more alert and complained of chest pain.They recorded an ECG:What do you think?The clinician called me over due to worry about Wellens ' pattern, and showed this to me.Here was my response: " I do not think this is Wellens.  These are not ischemic T-wave inversions. This is Pseudo-wellens, probably due to LVH.  It is maximal in V3-V6 and there is a lot of QRS voltage.  It is possible that it is Wellens, and so you should order 2 serial high sensitivity troponins, but I think he will rule out. "I would rule him out with our new high sensitivity troponins, or rule him in. But the ECG by itself does not worry me. [This is because it is not a truly ischemic ECG.  One should not apply troponin protocols to patients with truly ischemic ECGs, and our algorithm excludes them.  But our algorithm also says that T-wave inversions have many causes and only patients with truly ischemic ones should be excluded.She said: " I know these are like faces to you and you can recognize them, but to me it looks like Wellens. "I said, " I know, I know.  Does the patient have active chest pain, or was the pain resolved at the time of the ECG? "" It is active. "" Then it is very unlikely to be Wellens.  Wellens is a post-repefusion state, in which the T-waves can be called " reperfusion T-waves, " and the patient is pain free. "Are T-waves ever inverted in A...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs