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Short answer question case series: an atypical but dangerous presentation of chest pain
  1. Paul Rohdenberg,
  2. Pranav Shetty,
  3. Timothy B Jang
  1. Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California, USA
  1. Correspondence to Dr Timothy B Jang, Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA,1000 W Carson St, Torrance, CA 90509, USA; tbj{at}ucla.edu

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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).

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, …

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