Wellens' syndrome and clinical significance of T-wave inversion in anterior precordial leads

摘要

To the Editor, We thank Hartman et al for their wonderful article by the title of "The use of a 4-step algorithm in the electrocardio-graphic diagnosis of ST-segment elevation myocardial infarction by novice interpreters." The authors presented the excellent algorithm that helps detect ST-segment elevation myocardial infarction n the prehospital and other nonemergency department (ED) settings. In addition, we would like to emphasize the clinical significance of T-wave inversion in anterior precordial leads is an acute coronary syndrome as well. We recently had a 64-year-old white man who presented to the ED with a chief complaint of substernal chest heaviness that woke him up from sleep. He also reported a 5-month history of shortness of breath on exertion. His medical history was significant for diabetes type 2 and depression. Patient's chest pain had resolved at presentation. His initial electrocardiogram (ECG) and troponin-I were unremarkable. He was admitted for observation. However, his second ECG, which was performed 6 hours later, showed new biphasic T waves in anterior leads without any pathologic Q waves or ST-segment elevations (Fig.).