Scenario: This 12-lead electrocardiogram (ECG) was obtained from a 64-year-old man who was evaluated in the emergency department after a 10-minute episode of chest pain accompanied by diaphoresis and left arm pain while playing with his dog. He had noticed similar episodes in the past couple of weeks. In triage when this ECG was obtained, he had no chest pain. His blood pressure was 110/70 mm Hg, heart rate 92/min, respiratory rate 18/min, and body temperature 36.6°C. He is a smoker and has a history of hypertension and hyperlipidemia for which he takes a calcium channel blocker and a statin. All of his laboratory test results were normal, including the troponin I level.

Sinus rhythm with left ventricular hypertrophy (LVH). The deep T-wave inversions in leads V1 to V3 and biphasic T wave in lead V4 are suggestive of Wellens syndrome. T-wave inversion is commonly associated...

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