A peek behind the curtain

Excerpt

The electrocardiogram (ECG) on admission shows atrial fibrillation with slow ventricular response of 42 beats/min. In some QRS complexes, prominent biphasic T waves are seen in the precordial leads V1–V4 (Fig. 1). This Wellens’ ECG sign is suggestive of critical proximal left anterior descending (LAD) stenosis [1]. The electrocardiographic features are characterised by either biphasic T waves or the more common deep T‑wave inversion in the anteroseptal leads. Furthermore, precordial ST-segment deviation, pathological Q waves and poor R‑wave progression should be absent. These ominous T‑wave inversions mostly occur in patients with a history of angina in a pain-free period, whereas angina can cause “pseudonormalisation” of the T waves [2].

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