close
Wellen's Waves + History of Chest Pain
+ Normal/Minimally Elevate Troponin = 86% PPV LAD lesion
心前導極出現雙相 T 波
要高度懷疑是 LAD 阻塞
出現這種心電圖的當下, 病患可能症狀已經改善了, 心臟指數可能正常或稍高
接下來幾天內可能會變成廣泛性 前壁梗塞
通常需要侵入性治療
算是 subacute, 不用急做 cath
- Pattern of deeply inverted or biphasic T waves in V2-3
which is highly specific for a critical stenosis of the LAD
- Biphasic T waves are a marker of reperfusion and
may occur after an aborted anterior STEMI
- May be pain free
- Have normally or minimally elevated cardiac enzymes
- At extremely high risk for extensive anterior wall MI
within the next few days to weeks
- At risk of sudden LAD re-occlusion leading to massive anterior STEMI
and are best managed with early angiography and PCI / CABG
* Rhinehart et al (2002) describe the following
diagnostic criteria for Wellens syndrome :
- Deeply-inverted or biphasic T waves in V2-3 (may extend to V1-6)
- Isoelectric or minimally-elevated ST segment (< 1mm)
- No precordial Q waves
- Preserved precordial R wave progression
- Recent history of angina
- ECG pattern present in pain-free state
- Normal or slightly elevated serum cardiac markers
There are two patterns of T-wave abnormality in Wellen's syndrome :
- Type A = Biphasic, with initial positivity & terminal negativity (25% of cases)
雙向 先正再負
- Type B = Deeply and symmetrically inverted (75% of cases)
對稱倒 T
* A :
* B :
There are no R-waves in V2 and V3, so it is not Wellens.
Furthermore, it can't be Wellens' syndrome even if the ECG is true Wellens' morphology:
Wellens' syndrome requires that the ECG be recorded after an episode of chest pain that is now resolved.
This patient had no pain at any time."
The QS-waves and shallow T-wave inversion are typical of a dense old transmural anterior MI
and may represent an aneurysm of the LV anterior wall.
There could be some acute NonSTEMI superimposed on old MI,
but the ECG does not make me worried for LAD acute coronary syndrome and not for acute coronary occlusion.
If these T-waves are due to acute ischemia, then the troponin will be positive. So just get serial troponins."
文章標籤
全站熱搜
留言列表
CV (7)
