Case in the Spotlight 3 - answer05 ECG answer

1. This ECG demonstrates
• T wave abnormalities in the anterior leads
• Biphasic t waves
• This is consistent with Wellens syndrome

2. A safe disposition option includes cardiology referral, admission & cardiac monitoring
(a) Discharge
(b) Admit to SSU
(c) Admit to cardiology – non monitored bed
(d) Admit to cardiology – monitored bed = safe option
(e) Admit to CCU = safe option depending on local resources

Potential diagnostic pitfalls with Wellens syndrome include the following:
Failing to recognize Wellens syndrome T-wave changes on electrocardiography (ECG)
Ordering a stress test when one is not required; this may provoke a large anterior wall myocardial infarction (MI)
Underestimating the seriousness of the lesion in a pain-free patient
Failing to properly admit or medicate patients with the characteristic ECG changes

See medscape reference for more details

3. The next invasive test should be coronary angiography

Why do I need to always recognise this ECG?

An exercise stress test can precipitate AMI and VF

References/further reading
http://emedicine.medscape.com/article/1512230-differential

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776372/

http://www.academiclifeinem.com/wellens-syndrome-is-it-on-your-radar/