EKG of the Week
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This tracing was done on a 70 year old man with a history of coronary artery disease with prior Ml and stent. He has a several week history of episodic chest discomfort and shortness of breath, similar to but not as severe as his prior Ml pain. He was NOT having chest pain at the time of the EKG.
+ EKG Interpretation
Dr. Ohlbaum's Explanation
There are regular P waves and there are P waves preceding every QRS and a QRS after every P wave. It is sinus rhythm. Rate is 73 so normal sinus rhythm. His PR is normal. His QRS is normal duration, axis is normal, nothing to suggest LVH. No significant Q waves.
BUT, now we come to the ST and T's. He has very deep, nasty, ischemic looking T waves in the anterior leads. I can imagine a tiny bit of ST elevation in V2 but not enough to be injury. The QT is long.
Very deep T wave inversions in the anterior leads in a patient who has been having chest pain but is NOT having chest pain at the time of the EKG is consistent with Wellen's syndrome (sometimes it is a deep, symmetric T and sometimes like here it looks like the ST starts to go up just a little bit then goes to a very deep inverted T).
Wellen's syndrome is suggestive of significant LAD occlusion. This patient at cath had severe 3 vessel disease including a 95% LAD occlusion...
...He was sent for a CABG.
