A 54-year-old man presents to the emergency department with two episodes of chest pain at rest that have resolved. The pain-free ECG shows deep symmetric T wave inversions in leads V2 and V3 with a preserved R wave progression and no ST segment deviation. Troponin is mildly elevated. Which statement about his condition is correct?
- A It reflects critical stenosis of the proximal LAD and exercise stress testing should be avoided ✓
- B This pattern predicts a large lateral infarct from circumflex occlusion
- C It represents benign repolarization variant requiring only reassurance
- D Immediate thrombolysis is indicated before transfer
Correct answer: A. It reflects critical stenosis of the proximal LAD and exercise stress testing should be avoided
Explanation
Wellens syndrome type B shows biphasic T waves and type A shows deep symmetric inversions in V2-V3 with preserved R waves and an isoelectric ST segment, indicating a critical proximal LAD lesion with hibernating but viable myocardium. Exercise stress testing risks precipitating extensive anterior infarction and is contraindicated; these patients need angiography. The pattern appears when the patient is pain free, distinguishing it from active ischemia.
Reference: Braunwald's Heart Disease, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.