High Risk EKGs

Wellens Syndrome

  • deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery (LAD).
  • Patients may be pain free by the time the EKG is taken and have normally or minimally elevated cardiac enzymes; however, they are at extremely high risk for extensive anterior wall MI within the next few days to weeks.


aVR Elevation

  • Widespread horizontal ST depression, most prominent in leads I, II and V4-6
  • ST elevation in aVR ≥ 1mm
  • ST elevation in aVR ≥ V1

Screen Shot 2017-08-25 at 10.29.36 AM

ST elevation is aVR is postulated to result from two possible mechanisms:

  • Diffuse subendocardial ischaemia, with ST depression in the lateral leads producing reciprocal change in aVR due to a process causing generalized coronary ischemia (triple vessel disease, post cardiac arrest)
  • Infarction of the basal septum, i.e. a STEMI involving aVR. aVR records electrical activity from the RVOT and the portion of the septum closest to the base (supplied by a proximal branch of the left main)


VT vs block with tachycardia:
Screen Shot 2017-08-25 at 2.38.45 PM

Screen Shot 2017-08-25 at 3.07.25 PM.png

Anomalous left coronary artery from pulmonary artery syndrome –> SCD

magnet –> converts pacemaker to fixed rate pacing

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