ECG - Wellens

Question 1

A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.
According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation. She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest. Today she awoke with substernal chest pain that never resolved and continued in the emergency department. She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.
BP 127/89 HR 76 RR 20 O2 sat 100% on 2L NC Temp 99.3
Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
CTA B
2+ pulses in her extremities, no edema
ECG is shown (No prior ECG for comparison)…..

Answer 1

V1-V3: STE

V1-V4: Biphasic T-waves - Type A Wellen’s

Question 2

Why is Wellen’s Sign on 12-Lead

Answer 2

Until proven otherwise, Wellen’s (both Type A & B) are highly specific and sensitive for high LAD occlusion.

Question 3

What is the Wellen’s type seen here?

Answer 3

Type A

Question 4

What is the Wellen’s type seen here?

Answer 4

Type A

Question 5

What is the Wellen’s type seen here?

Answer 5

Type B

Question 6

What is the Wellen’s type seen here?

Answer 6

Type B

Question 7

What must be absent to diangose Wellen’s Syndrome on 12-lead ECG?

Answer 7

Pain (the pt must be pain free)

Question 8

Why is TWI present in Wellen’s Syyndrome?

Answer 8

TWI occurs in individuals who have spontaneous clot lysis in AMI.

Question 9

T/F: R-wave progression remains normal in the Wellen’s Syndrome patient.

Answer 9

True (increasing R-wave sizes in V1-V6)