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Treating her well
  1. Joris M G Theunissen1,
  2. Heleen lameijer2
  1. 1 Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  2. 2 Department of Emergency Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Heleen lameijer, Department of Emergency Medicine University Medical Centre Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands; h.lameijer{at}


Clinical introduction A 44-year-old woman presents pain free to our ED after experiencing 45 min of tightening of the chest with radiation to her left arm, diaphoresis and nausea. Her vital signs are normal except for her high BP, which is 180/110. She reports recurrent episodes of chest pain in the past 1.5 weeks, unrelated to exercise. She visited a general practitioner who prescribed pain medication and treated her new-onset hypertension. Besides the recently found hypertension, heavy smoking is her only other traditional risk factor for cardiovascular disease.

Question What finding on figure 1 should make you concerned?

  1. The U-wave in the precordial leads

  2. The biphasic P-wave in lead I

  3. The negative T-waves in aVR as well as aVL

  4. The biphasic T-waves in V2 and V3

  • wellens sign
  • coronary artery disease
  • acute myocardial infarction
  • ECG

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.