Bi-Phasic T waves presenting as acute coronary syndrome
Posted Jan 13 2011 12:43pm
NSTEMI is a common clinical problems in CCU.
When we say NSTEMI it can mean any of the following
NSTEMI with ST depression
NSTEMI with T wave Inversion
NSTEMI with Biphasic T wave
NSTEMI with normal ECG
The irony called STEMI evolving as NSTEMI**
By default most of us think , if it is NSTEMI . . . there must be ST depression. This thinking is not logical but traditional. Still, ST depression may be the common presentation. NSTEMI with ST depression has much worse outcome than other forms.
The following ECG is from a 45 year old man with a vague mid sternal chest pain for 48 hours.
The unusual type of NSTEMI with Bi-phasic T waves
His echo showed wall motion defect in LCX territory .A diagnosis of NSTEMI was made.The predominant finding was biphasic T waves .
**One may wonder why can’t we call this ECG as a Classical STEMI ?
There is a 2mm ST elevation , with a infarct as well ? But , the point here is there is no business for T waves to get bi-phasic or inverted in the early hours of a classical STEMI .
This exactly has happened here. Hence we can not call the above event as STEMI . Instead it is , STEMI evolving into NSTEMI . So a combination of features of STEMI/NSTEMI occur together. The best description for above entity is STEMI in transition to Non Q MI