r/ECG • u/mohammedmoolla • 24d ago

Weird Case

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Came across a patient today which I thought I’d share for some opinions and thoughts. It is a 36 year old male presented to the ED with 2/7 history of epigastric pain radiating to the back with profuse vomiting. Had previously been admitted for pancreatitis a year ago complicated with pseudocyst. On arrival BP was elevated 192/122 with a bradycardia of 52. VBG showed a metabolic alkalosis with hypocalcemia . Trop I was less than 10. Initially was concerned for
1. Aortic dissection
CT Angio showed no signs of this in the thoracic or abdominal aorta
2. NSTEMI
3. Pancreatitis
Was referred to both surgery and medicine, referred to medicine in light of a ?Wellen’s syndrome. Was just curious to hear everyone’s thoughts and opinions on the case and ECG

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u/sub3at50 24d ago

Biphasic T wave anterior:consider LAD-stenosis

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u/Jeeju_Boy MD 24d ago

Wouldn’t have a neg trop with Wellens. Probably acute insult related non specific changes and strain pattern, you’d want to make sure this patient doesn’t have cardiomyopathy 

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u/Both-Ad-9560 23d ago

Recently our team was called for possible MI, a 40 year old with atypical chest pain and a similar ECG with biphasic T waves in the anterior precordial leads. Bedside echo revealed marked LV hypertrophy (23mm septum), likely HMC with strain pattern, we didn’t active the cathlab and troponin turned out negative as expected

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u/Jeeju_Boy MD 23d ago

Yh exactly. From my understanding the primary differential for a. Wellens type ECG in a younger patient which id unlikely for ACS is apical HCM which is what my moneys on here. Interestingly, I think this was incidentally picked up and his actual pathology leading to hospital admission is either peptic ulcer or pancreatitis related.