Clinical Picture:
56 year old accountant presented to the Emergency Department at 2pm having developed central chest pain at 1pm after his lunch break at work. He was given aspirin and GTN by the paramedics which resolved his chest pain.
He has borderline type 2 diabetes, but takes no regular medications.
His father and some of his uncles have heart problems.
On examination his observations are within normal limits. He looks well (although the ambulance report notes him to have been sweaty at the scene). His cardiovascular, respiratory and abdominal examinations are unremarkable.
Investigations:
Initial troponin: 6
6h troponin: 8
ECG:
Outcome:
Patient remained chest pain free in A&E and was discharged with advice to present to his GP for a referral to the rapid access chest pain clinic.
Unfortunately the patient sustained a cardiac arrest 2 days later. Despite re-establishing cardiac output he passed away 6 days later on ICU.
What was the mistake?
Initial ECG showed Wellens Syndrome (biphasic T waves in V1-4). This is suggestive of critical stenosis of the left anterior descending artery (LAD). These patients are at very high risk of anterior MI and should be admitted for an inpatient angiogram.
To learn more about Wellens syndrome click here
