ST Elevation and Biphasic T Waves in a Young Man: Wellens, Anterior STEMI, or Something Else?

ECG Weekly Workout with Dr. Amal Mattu

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HPI

A 38-year-old Kenyan man presents to a Haitian clinic with three days of low sternal and epigastric pain radiating to the neck, plus exertional dyspnea while working in a hot environment. The following ECG is obtained and appears to show a large anterior STEMI. There is no cath lab available.

Before watching this week’s workout, review the arrival ECG carefully and consider:

1. 1. Is this Wellens or a true anterior STEMI?
   2. How should the precordial voltages influence your interpretation?
   3. In a setting without PCI, should this patient receive thrombolytics?