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Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.
A previously healthy 55 year old presented with chest pain that resolved
What does the ECG show and what does it predict?
Heart rate/rhythm: normal sinus
Electrical conduction: normal
Axis: normal
R-wave progression: no progression V2 and loss V3
Tall/small voltages: normal
ST/T: biphasic T waves V2-4
LAD spontaneous reperfusion after loss of myocardium.
The first troponin was 8,000 ng/L and at the time of the angiogram the LAD was 100% occluded
Wellens syndrome requires intact R waves signifying reperfusion before myocardial loss, so loss of R waves indicates there has already been myocardial loss.
Spontaneous reperfusion may be transient or from collateral circulation, so the artery may be totally occluded by the time of the angiogram
