tag:blogger.com,1999:blog-549949223388475481.post6536574351948972395..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH)Unknownnoreply@blogger.comBlogger12125tag:blogger.com,1999:blog-549949223388475481.post-24938764770251973592021-02-17T11:55:10.910-06:002021-02-17T11:55:10.910-06:00yesyesSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19152360773928001852021-02-17T07:21:41.160-06:002021-02-17T07:21:41.160-06:00Hellow dr smith below is the ecg of patient
https...Hellow dr smith below is the ecg of patient <br />https://photos.app.goo.gl/tKzZVjdCAa8T7N4U8<br />Arm pain 4-5 days before ecg was taken <br />Is it a wellens pattern?<br />Sorry for posting above without the link Kaushik Virivintihttps://www.blogger.com/profile/18060059079952580635noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-41718380133411693622021-02-17T07:19:12.373-06:002021-02-17T07:19:12.373-06:00Dear dr smith I would like you to confirm if the ...Dear dr smith I would like you to confirm if the patient's ecg below has wellens waves <br />History 50 year old female, recent on set of hypertension,diabetic, complained about moderately severe arm pain ecg was taken 4-5 days after the incident <br />My friend says is it wellens pattern , I dont agree with him as it should have progressed to complete inversion of t waves by the time ecg was taken please help us outKaushik Virivintihttps://www.blogger.com/profile/18060059079952580635noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-84708459573051600802020-01-10T17:47:02.349-06:002020-01-10T17:47:02.349-06:00@ Maximillian — I have reviewed your tracing at th...@ Maximillian — I have reviewed your tracing at the above link. I would not call this Wellens or pseudo-Wellens — because I think the ECG appearance is quite different from what I’d expected with true Wellens Syndrome. FIRST — the history (sounds like there is ONGOING chest pressure for ~40 minutes) is not typical (ie, with Wellens Syndrome, as per Dr. Smith — there is typically a history of prior chest discomfort, but none by the time the ECG is obtained). SECOND — we NEED to see the prior ECG, given that this patient has had 2 prior MIs. True Wellens Syndrome entails acute findings — and this wouldn’t be the case if much of what we see on your tracing are longstanding findings. Otherwise — there is MARKED LVH (overlap of a very tall R wave in lead V5 — that to me looks to be at least 23-24mm tall + a R in V6 = 16mm, with ST-T wave changes in these 2 leads perfectly consistent with LV “strain”. There is also a peculiar notching of the T wave in leads V2-V4 (hard to rule out possibility of U waves here …) — which together with clear ST segment flattening, with slight ST depression + biphasic T waves in a number of leads could be: i) electrolyte abnormality (ie, low K+ and/or low Mg++); ii) drug effect; iii) longstanding ischemia; iv) LV “strain” (at least in certain leads). The findings certainly aren’t localized, as I’d expect them to be with Wellens or pseudoWellens. Hope that answers your question. THANKS for your comment! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-30190831161523845662020-01-10T09:24:11.381-06:002020-01-10T09:24:11.381-06:00Dear Dr. Smith,
I would like to ask you if you wou...Dear Dr. Smith,<br />I would like to ask you if you would consider Wellen's syndrome or Pseudo Wellen's syndrome with this ecg:<br /><br />https://photos.app.goo.gl/DzGxKRwF2myNo4DS6<br /><br />Background information: 70 years old, male, no chest pain but chest pressure ongoing for ~40h, 2 former mci, troponin negative?<br /><br />Thank you! <br />Maximilian.karla@gmail.comhttps://www.blogger.com/profile/17438506986217306903noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-67385482305426553592017-12-18T06:17:25.262-06:002017-12-18T06:17:25.262-06:00I didn't use criteria. Just looked at it and ...I didn't use criteria. Just looked at it and knew. But if you do apply the best criteria (recently published), it is LVH.<br /><br />New LVH criteria: sum of the amplitude of the deepest S wave in any lead plus the S wave in lead V4. If the deepest S wave is in V4, then double that value. If the total is greater than 2.3 in women and<br />greater than 2.8 in men then left ventricular hypertrophy is diagnosed. <br /><br />Peguero JG et al. Electrocardiographic criteria for the diagnosis of left ventricular Hypertrophy. JACC 69(23):1694-1703; April 4, 2017Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87971080448108491632017-12-15T17:06:35.728-06:002017-12-15T17:06:35.728-06:00What criteria did you use for LVH in this patientWhat criteria did you use for LVH in this patientAnonymoushttps://www.blogger.com/profile/06978691965510218193noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18867515097498363392017-04-11T12:13:24.799-05:002017-04-11T12:13:24.799-05:00No simple answer. Criteria are not very good for ...No simple answer. Criteria are not very good for LVH. And much LVH does not have repolarization abnormalities, so this does not apply to all LVH. To know this is not Wellens', you need the totality of the presentation: Not chest pain (epigastric), still ongoing, T-wave inversion V3-V6, AND LVH. No one thing will give you the answer. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87961508352688517822017-04-09T22:43:34.483-05:002017-04-09T22:43:34.483-05:00Hello.. If LVH is diagnosed by lead aVL>11mm cr...Hello.. If LVH is diagnosed by lead aVL>11mm criteria n chest leads amplitude being normal, would those wellens waves still be called wallens or pseudo wellens? ThxMGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-33180557567795084182016-02-28T08:48:44.058-06:002016-02-28T08:48:44.058-06:00For me, I simply recognize the pattern. I have se...For me, I simply recognize the pattern. I have seen so many.<br /><br />For others, I just recommend that you think about LVH and, if there is LVH, you must suspect a false positive, as in this case. Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-13556374918733850162016-02-27T08:38:55.774-06:002016-02-27T08:38:55.774-06:00Excuse me please how could you know that the t wav...Excuse me please how could you know that the t wave inversions are not due to NSTEMI ?<br />Anonymoushttps://www.blogger.com/profile/17661984715083294555noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7847136845966177512012-06-20T14:38:03.655-05:002012-06-20T14:38:03.655-05:00Very interesting, thank you so much.Very interesting, thank you so much.hfkarimhttps://www.blogger.com/profile/00135037037153638679noreply@blogger.com