EKG of the Week

5-21 EKG_Page_1.jpg

This patient was a man in his early 70s with a history of one week of intermittent chest pain. He was NOT having chest pain when the EKG was done. The only old EKG available is 5 years old and it is a mess (arm leads reversed) but you can see that the precordial (V leads) are quite normal. 

+ EKG Interpretation

Dr. Ohlbaum's Explanation

So, let's look at the current EKG. There are P waves before every QRS, the P waves look normal, but the rate is just under the 60-100 range for "normal" sinus rhythm, so this is sinus bradycardia. Every Pis followed by a QRS. The QRS complexes look normal in duration and size, no pathologic Q waves.

But when we move to the ST/T waves it gets interesting (alarming). There are deep, symmetric, T wave inversions all the way across the anterior leads (and lesser inversions in the inferior and lateral leads too). Deep, nasty, inverted T waves in anterior leads in a patient with episodic chest pain, but NOT having chest pain right now is suggestive of Wellen's syndrome which is strongly predictive of a critical proximal LAD lesion. This is an emergency. When checked, this patient also had a positive troponin though as I said NOT currently having pain.

At cath, this patient had a long proximal-mid 99% LAD lesion. He also had a 99% mid RCA occlusion (back to the T wave inversion in the inferior leads) and a 70% lesion in a big OM (the lateral and high lateral leads), so 3 vessel disease.

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