A 44-year-old man presents with a history of “crushing” retrosternal chest pain, radiating down both arms, that resolved spontaneously about an hour ago. He is currently pain free.
Describe and interpret his initial 12-lead electrocardiogram:
- Ventricular rate 69 bpm
- Sinus rhythm
- Normal PR interval (150 ms)
- Normal QRS axis (79°)
- QRS duration 96 ms
- QTc 385
- Widespread concave ST elevation → early repolarisation phenomenon versus subtle anterior ST-elevation myocardial infarction
- Tall (possibly hyperacute) T waves in the mid-lateral precordial leads
- Biphasic T wave inversion in lead V2 → ? Type B Wellens’ Syndrome
Highly suspicious for a critical stenosis of the left anterior descending artery (LAD)! Repeat ECG requested in 15 minutes.