A pain-free patient has recent recurrent rest pain, normal initial high-sensitivity troponin and new deeply symmetric T-wave inversion in V2–V4

Question

A pain-free patient has recent recurrent rest pain, normal initial high-sensitivity troponin and new deeply symmetric T-wave inversion in V2–V4 without Q waves. What is the safest investigation strategy?

Accepted Answer

Admit for urgent coronary angiography and avoid treadmill or pharmacologic stress testing

Answer

Perform immediate exercise treadmill testing because a normal troponin excludes active myocardial injury

Answer

Discharge for ambulatory rhythm monitoring because precordial T-wave inversion indicates intermittent arrhythmia

Answer

Order a D-dimer first because anterior T-wave inversion is specific for pulmonary embolism

Answer

Repeat an ECG in one month because pain resolution makes the current tracing non-diagnostic

Wellens syndrome — RCPSC EM MCQ

A pain-free patient has recent recurrent rest pain, normal initial high-sensitivity troponin and new deeply symmetric T-wave inversion in V2–V4 without Q waves. What is the safest investigation strategy?