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| t = 0, presentation to ED: Initial ECG of 50 yo woman who had prehospital chest pain, now resolved. There is old inferior MI (and the nonspecific minor T inversion in aVL may be due to this, or may be new) but precoordial leads are unremarkable. |
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| t = 1.83 hours. There are now the beginnings of T-wave inversion in aVL, V4 and V5. |
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| t = 4.75 hours. Now there is the beginning of T-wave inversion in V2, with more in V3, and progressive T-wave inversion in aVL, V4, and V5. |
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| t = 6 hours. Still more T-wave inversion, becoming symmetrical in V4 and V5. |
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| t = 8.5 hours. Still more T-wave inversion and increasing symmetry. |
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| t = 23 hours. Deepening T-waves with increasing symmetry. |
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| t = 27 hours. Diffuse symmetric T-wave inversion. The patient had positive troponins and a tight LAD stenosis that was stented. |
Hi Dr. Smith...
ReplyDeletethank you again for the fascinating post...
during this evolution, there appears to also be a progressive lengthening of the QTc, presumably due to the widened and deepened T waves... is a lengthening QTc a consistent finding with developing Wellens'?
You're paying attention. In fact, in my experience (though I know of no studies addressing this), the QT is prolonged in Wellens'. This is one way to differentiate it from benign T wave inversion (BTWI), which usually has a QTc < 400-425 (as do most forms of early repolarization). I will post an example of BTWI soon. In this series, the computerized QTc's were, respectively: 429, 419, 438, 428, 476, 520, 511.
ReplyDelete