T-wave inversions in inferior ST-elevation myocardial infarction - A case of "inferior Wellens sign".
Am J Emerg Med 2020;
44:478.e1-478.e4. [PMID:
33183921 DOI:
10.1016/j.ajem.2020.10.053]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND
Although T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. "anterior Wellens sign"). Recently tall T-waves in V2-V3 have been reported in association with posterior reperfusion (i.e."posterior Wellens sign"). Less commonly, negative biphasic T-waves or T-wave inversions in the inferior leads have been reported in association with critical stenosis of the right coronary artery (RCA) or left circumflex artery (LCx). We present a case where T wave inversions (i.e. "inferior Wellens sign") and a tall T-wave in V2-V3 (i.e. "posterior Wellens sign") preceded the development of an inferior-posterior ST-elevation myocardial infarction (STEMI).
CASE REPORT
A 37-year-old man presented to the Emergency Department for one day of chest pain. On arrival, his pain had resolved, and his 1st ECG showed inverted/biphasic T-waves in lead III and aVF and a tall T wave in V2-V3. Three- and one-half hours after arrival, his chest pain returned and his ECG showed an inferior-posterior STEMI. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: New, focal T-wave inversions in an anatomic distribution may be an early warning sign of impending myocardial infarction. Careful attention to the T-waves during asymptomatic periods may assist in identifying patients that may have critical stenosis of an underlying coronary artery. In this case, T-wave inversions in the inferior leads, along with a tall T-wave in V2-V3, were seen prior to the development of an inferior-posterior STEMI.
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