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ECG library

Deep anterior T inversion (Wellens pattern)

advanced

A 58-year-old whose chest pain resolved in the ambulance. He feels fine and wants to go home.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • Deep symmetric anterior T inversion
  • Pain-free at the time of the ECG
  • Preserved R waves

Learning points

  • The danger is the reassurance: pain resolved, troponin may be minimally raised, and the LAD is critical.
  • Stress testing this pattern is the classic error; these patients go to angiography.

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