Electrocardiography case presentation - A case of Pseudo Wellens Waves

A 52 years old male presented with epigastric pain, continuing in the emergency department. He had a history of hypertension, and was on Amlodipine thinking that epigastric pain might be an anginal equivalent, the following ECG was recorded. The Emergency Residents were worried about Wellens' syndrome and treated for ACS. He was placed on a nitroglycerine drip and Heparin. Initial troponin was negative. Two follow up serial ECGs were done 3 hours later also showed up the same Electrocardiographic findings. All troponins were normal. A formal echo showed concentric LVH and there was not even a subtle regional wall motion abnormality on echocardiogram suspicious for LAD distribution ischemia. Later, he also underwent a coronary angiogram which was completely normal.