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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 35 year-old presented with chest pain that resolved by the time the ECG was recorded.
Do you think the troponin will be normal, minimally or significantly elevated, and what do you think the angiogram will show?
Heart rate/rhythm: normal sinus
Electrical conduction: normal intervals
Axis: borderline right
R-wave progression: loss of R waves V2-4
Tall/small voltages: normal
ST/T: convex STE into biphasic T waves V2-4
Mid LAD spontaneous reperfusion after loss of R waves (i.e.not Wellens). Cath 90% mid LAD, troponin 4,000 ng/L.
Wellens syndrome is spontaneous LAD reperfusion before significant infarct (preserved R waves, with minimally elevated troponin), but here the loss of R waves shows there has already been significant infarct (troponin 4000) before spontaneous reperfusion.
