‘killer’ kheder clobbers ekg conference

cardiology fellow kevin kheder, aka the Jersey heart-attack, aka SCAD-man-du, aka the intercalater-in-chief, aka junctional escape, aka mr wide-complex, put us through our ekg paces! here are a few of the shiniest kheder-nuggets.

If you missed noon conference today (7.25.19) then you missed out big-time. But don’t worry your Chiefs have you covered! First and foremost, you can find the entirety of Dr Kheder’s PowerPoint presentation here (you’re welcome).

Now let’s go over a few key pearls!

Wellens Phenomenon/Syndrome/EKG

refers to an EKG pattern consisting of deeply inverted or biphasic T-waves in V2 and V3. This pattern is HIGHLY SPECIFIC for critical stenosis of the LEFT ANTERIOR DESCENDING ARTERY (LAD) – no bueno.

Patients with this EKG pattern may be chest pain free at the time they’re evqaluated with little to no troponin leak, but this is absolutely a can’t-miss finding as these patients are at EXTREMELY HIGH RISK FOR EXTENSIVE ANTERIOR WALL MI in the near future (days to weeks). Although we didn’t discuss management during NC, it’s important to remember that this is NOT the patient you throw on a treadmill! They get admitted, closely observed, and more-than-likely cathed. Here are some examples of Wellens Syndrome courtesy of Life in the Fastlane.

**Wellens Syndrome (Type A Pattern)**
Biphasic precordial T waves with terminal negativity, most prominent in V2-3.
Minor precordial ST elevation.
Preserved R wave progression (R wave in V3 > 3mm)

**Wellens Syndrome (Type B Pattern)**
There are deep, symmetrical T wave inversions throughout the anterolateral leads (V1-6, I, aVL).

st-elevation morphology – concave? convex?

not all st-elevations are created equal! kk broke it down for us, offering this great illustration of what to look for in STE shape and reminding us that ~~convex~~ … ~~concave~~ … er the scoopy one … is not necessarily the result of ischemia.