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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).
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?
The patient should be seen immediately because the ECG demonstrates Wellen's sign.
What is Wellen's sign and what is its significance?
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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