Dialysis Quiz-Wellen's Syndrome

The correct answer to the dialysis quiz from Dec 31, 2011 is A

These are the typical EKG changes of Wellen’s Syndrome

• New precordial T-wave inversions (V2-V5 or V6)
• usually symmetric or biphasic
• often more evident when pain free
• Associated with critical proximal LAD lesion
• Cardiac biomarkers are often normal or mildly elevated
• If treated medically, 75% will develop an anterior MI
• Early cardiac catheterization with revascularization or coronary bypass surgery is recommended

A 57 year old woman with no history of cardiac disease develops substernal chest pressure during her routine hemodialysis session. The episode lasts about 5 minutes and resolves spontaneously before she arrives in the emergency room. Her vital signs are normal and her cardiac biomarkers are not elevated. Her EKG is shown below:

Which of the following treatment plans is most appropriate for this patient?

A. Urgent cardiac catheterization

B. Heparin, plavix, aspirin and cardiac catheterization if cardiac biomarkers become elevated

C. Imaging stress test before considering catheterization

D. Admission for observation and telemetry monitoring

E. Correction of electrolyte abnormalities and reassurance


References

1. Rhinehardt  et al. Ameri J of Emer Med. Vol 20:7. Nov 2002. pp. 638-643.

2.  de Zwaan, Fet al Am Heart J 103 (1982), pp. 730–736.

(Case Courtesy of Drs Rafael Bejar, Tyler Berzin, Rebecca Berman MD, and Chiadi Ndumele, Brigham and Women’s Hospital/Harvard Medical School)