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Case vignette
A 53-year-old man with hypertension and diabetes presents with chest pain (CP). The CP has been intermittent for 1 week, non-radiating, non-exertional and not associated with shortness of breath, nausea or diaphoresis. Currently, he is CP free. Vital signs are blood pressure: 150/85 mm Hg, heart rate: 63 beats/min, respiratory rate: 18 breaths/min, pulse oximetry: 96% RA and his physical examination is normal. An electrocardiogram (ECG) is obtained in triage while the patient is CP-free (ECG #1; figure 1).
Question 1
Given the patient's history and ECG, should this patient wait to be seen based on time of presentation (ie, after others who were registered earlier) or be seen immediately?
Answer 1
The patient should be seen immediately because the ECG demonstrates Wellen's sign.
Question 2
What is Wellen's sign and what is its significance?
Answer 2
Wellens' sign consists of T-wave inversions (TWI) in the precordial leads, most commonly in leads V2 and V3. Usually (75% of cases), the TWI are deep and symmetric, …
Footnotes
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
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