- HPI: 60F presenting with aggitation s/p benzodiazepine overdose
- Key ECG: This is almost certainly takotsubo. The widespread bizarre T-wave inversion with very prolonged QT interval is classic for takotsubo cardiomyopathy. Most people will say “Wellens?” to this ECG, but the T wave inversions are too big, the QT too long and too bizarre for Wellens’ (which is due to spontaneous reperfusion of OMI). Moreover, Wellens’ would involve just one territory, and Wellens’ of the LAD would be V2-V4 with possible extension to V5-V6 and to I, aVL if it is a proximal LAD lesion; but it could exend to II, III, aVF if it is an LAD that “wraps around” to the inferior wall (“wraparound, or Type III, LAD).
- Source: Dr. Smith’s ECG Blog: 2022-09-19