A man in his 40s with chest pain and T wave inversion

Written by Pendell Meyers with edits by SmithA man in his early 40s with history of HTN presented to the ED for feeling lightheadedness and mild " beating " chest pain off and on last night, but resolved at the time of ED presentation. He still felt some lightheadedness during evaluation. He stated that he used ecstasy yesterday prior to the onset of symptoms. Vitals were within normal limits on arrival.Here is his ED ECG on arrival:What do you think?Sinus rhythm. The narrow QRS with relatively high voltage is overall most consistent with a young healthy heart, less likely pathologic LVH (including HOCM). There are no signs of OMI or hyperkalemia. There are terminal T wave inversions present in V3 and V4. Most learners will not be able to distinguish these TWIs from Wellens ' waves. But they are distinctly different and it is difficult to describe why we can tell that they are different. The morphology of the QRS complex itself helps me recognize this overall pattern.First: What is Wellens ' Syndrome?  It is: 1) An episode of anginal chest pain that has resolved, or is resolving. 2) An ECG that has preserved R-waves in V2-V4.  3) The ECG shows terminal T-wave inversion in some or all of V2-V4 ( " Pattern A " ) or deep symmetric T-wave inversion ( " Pattern B " ). But not all T-wave inversions are equal!This case and ECG was sent out to our little group of EKG nerds and all immediately recognized it as a normal variant, NOT as Wellens ' syndrome.Young peopl...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs