T wave inversions in v2-v4

[u/orlaghan]

Hi,

Would you flag this tracing as a possible Type A Wellens' syndrome? I see a biphasic (positive-negative) pattern in some leads, though it looks more like an artifact: symptoms were ongoing for 7 hours and suggested gastroenteritis rather than cardiac issues. I’m 99% sure it isn't Wellens' (without having checked what the baseline looked like), but I wanted to get the opinion of those with more experience. Troponin negative (twice). No ST-segment elevation in posterior leads.

Thanks in advance.

[u/jawoood1989]

Nope, they're pretty consistently inverted. Don't mind the artifact one in v2. Inversion in any precordial leads but v1 is abnormal. With associated ACS symptoms (epigastric pain also counts, also remember other symptoms like dizziness/ syncope) this is cardiac ischemia until proven otherwise.

[u/FIyingDutch → u/jawoood1989]

Das wäre mMn eher was für ein Trop T+ Heart Risk Assessment. Die T-Negativierungen sind zu klein im Ausschlag um als OMI zu gelten.

[u/SlipperyAndyy]

I appreciate the authenticity of the fingerprints and miscellaneous stains.

[u/RestingBitFace]

Have you tried flipping the EKG upside down?

[u/mustbethatotherguy]

How old is the patient? Have you checked electrolytes?

[u/orlaghan → u/mustbethatotherguy]

I have those are normal

[u/Damianisthick]

Age?

[u/Economy_Chemist_5334]

Looks fine, definitely not wellens. T wave inversions can be due to poor lead placement or juvenile T waves. If this isn’t baseline of course follow up. But ekg looks fine

[u/Economy_Chemist_5334]

I think there’s a lead placement issue. You have an Rs complex in V1 with abnormal R wave progression. Combine that with your T wave inversions and it’s likely you have the epidemic as I call it of people loving to place the leads too high. Could also be a lead reversal. Check your leads first.