Understanding this pathognomonic ECG would have greatly benefitted the patient.

 Written by Pendell MeyersInterpret this ECG first without context. You don ' t need context yet because this ECG is nearly pathognomonic.After having learned about benign T wave inversion pattern years ago on this blog, and having seen many cases on this blog and in my practice since then, I instantly recognize this as BTWI, a fairly common normal variant. I see maybe one of these ECGs each month in my practice. There is no ischemia, certainly no concern at all for OMI. It meets basically all of the criteria that Dr. Smith has consistently described over the years, after reviewing a large cohort of patients by Wang et al. (see below for more info on this)1. There is a relatively short QT interval (QTc< 425ms) 2. The leads with T-wave inversion often have very distinct J-waves.3. The T-wave inversion is usually in leads V3-V6 (in contrast to Wellens ' syndrome, in which they are V2-V4)4. The T-wave inversion does not evolve and is generally stable over time (in contrast to Wellens ' , which always evolves).  (you ' ll see that this case does not evolve like Wellens)5. The leads with T-wave inversion (left precordial) usually have some ST elevation 6. Right precordial leads often have ST elevation typical of classic early repolarization7. The T-wave inversion in leads V4-V6 is preceded by minimal S-waves8. The T-wave inversion in leads V4-V6 is preceded by high R-wave amplitude9. II, III, and aVF also frequently have T-wave inver...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs