P-306 In an Asian Population of Patients with Inferior STEMI, Is the Current ECG Diagnostic Criteria of Atrial Infarction Still Applicable?

Abstract

42-year-old female presented with pressure like mid chest pain radiating to the left arm with some difficulty in breathing but described no aggravating or relieving factor. She had no prior personal or family history of cardiovascular disease. She was hemodynamically stable and had normal physical examination relevant to cardiac and pulmonary systems. EKG showed biphasic T-waves in lead V2, V3 on presentation which later progressed to deep and symmetrical T wave inversions in precordial leads. Troponins were mildly elevated. Stress testing was positive. She had a cardiac catheterization revealing 99% stenosis in proximal LAD accompanied with 70% ostial stenosis in D1. Successful PTCA with stent placement in LAD and D1 branch was conducted. Her medication regimen was optimized and she was discharged home in stable condition. Critical high grade occlusion of the proximal LAD (Wellens Syndrome) was first described in 1982 by Dr. Hein J. Wellens. Diagnostic criteria include a recent history of chest pain, normal to slightly elevated serum markers, lack of pathological Q waves or ST-segment elevation. T waves are symmetrically and deeply inverted in the precordial leads or are biphasic in V2 and V3 leads (Wellen’s sign). Appropriate assessment with rapid intervention is paramount in managing these patients as unidentified cases can progress to extensive anterior wall MI and have a worse outcome. It is absolute essential not to rely on computer generated readings in such cases as this can lead to unwarranted noninvasive testing which may have untoward consequences.