• Sylvia Alejandra Piña-Paz and Amandeep Singh.
• Alameda Health System-Highland Hospital, USA. Electronic address: syppaz@alamedahealthsystem.org.
• Am J Emerg Med. 2021 Jun 1; 44: 478.e1-478.e4.

BackgroundAlthough T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. "anterior Wellens sign"). Recently tall T-waves in V2-V3 have been reported in association with posterior reperfusion (i.e."posterior Wellens sign"). Less commonly, negative biphasic T-waves or T-wave inversions in the inferior leads have been reported in association with critical stenosis of the right coronary artery (RCA) or left circumflex artery (LCx). We present a case where T wave inversions (i.e. "inferior Wellens sign") and a tall T-wave in V2-V3 (i.e. "posterior Wellens sign") preceded the development of an inferior-posterior ST-elevation myocardial infarction (STEMI).Case ReportA 37-year-old man presented to the Emergency Department for one day of chest pain. On arrival, his pain had resolved, and his 1st ECG showed inverted/biphasic T-waves in lead III and aVF and a tall T wave in V2-V3. Three- and one-half hours after arrival, his chest pain returned and his ECG showed an inferior-posterior STEMI. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: New, focal T-wave inversions in an anatomic distribution may be an early warning sign of impending myocardial infarction. Careful attention to the T-waves during asymptomatic periods may assist in identifying patients that may have critical stenosis of an underlying coronary artery. In this case, T-wave inversions in the inferior leads, along with a tall T-wave in V2-V3, were seen prior to the development of an inferior-posterior STEMI.Copyright © 2020 Elsevier Inc. All rights reserved.

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