This is the conclusion to our Name that ECG case: 66 year old female, resolved chest pain.
66 year old female, resolved chest pain.
Rhythm:
- Rate: atrial rate of ~55 bpm, ventricular rate of ~55 bpm
- Regularity: regular
- P-waves: sinus (upright in I and II), associated 1:1 with the QRS
- PRi: 140 ms
- QRS duration: 90 ms
Bonus points:
- Axis: -45 degrees, left axis deviation, LAFB
- Bundle Branches: normal conduction
- QTc: normal (<1/2 R-R interval), 420 ms (Bazett's Formula)
- ST/T-waves:
- T-waves: flipped T-waves in aVL, biphasic V2-V5 consistent with Wellen's Syndrome
- ST-elevation: none noted
- ST-depression: none noted
Differentials:
- Normal sinus rhythm in a patient with Wellen's Syndrome
- Possible high-grade stenosis of the LAD with recent reperfusion
Notes:
- Wellen's Syndrome should be regarded with the same importance as a STEMI during assessment and transport.
1 Comment
If you wanted to really push the limits of this ECG I also see inverted inverted U-waves in leads V2-V4, I, and aVL. They're super faint and I wasn't sure if I believed them at first, but measuring from the QRS to the U wave in III and aVF and transposing that interval to the other leads proves that it's really them.
They don't add any information the T-waves don't tell you here, but heck, they're there.
And now I'm really being a pain, but I think calling a LAFB is being a little generous to that LAD. By my eye I put the axis, at most, at around -40 degrees. There's also no well developed rS complexes in II and aVF and the tracing lack the poor R-wave progression I usually see in true LAFB's. There doesn't seem to be an accepted criteria for making the Dx, but this one seems to be pushing it.