A 65-year old man presents to ED at 1am with 90 minutes of central chest pressure that awoke him from sleep.
He is an ex-smoker with a 20 pack-year history.
There is no previous history of IHD, diabetes, hypertension or high cholesterol.
On arrival he looks well, blood pressure (127/86) and oxygen saturations (98% on room air).
Thank you very much for all of your answers
This ECG presented inverted U waves in the lateral leads I, V5 and V6 (and possibly also in leads II and III).
initial troponin I was equivocal (0.05 ng/mL at 2 hours).
The patient ended up spending the night in ED in a monitored bed.
Serial cardiac enzymes confirmed a NSTEMI, with a troponin I of 0.87 ng/mL at 6 hours and 4.0 ng/mL at 12 hours.
In patients presenting with chest pain, inverted U waves:
Are a very specific sign of myocardial ischaemia
May be the earliest marker of unstable angina and evolving myocardial infarction may be observed during attacks of Prinzmetal angina have been associated with LAD or LMCA occlusion and the presence of left ventricular dysfunction.
U wave inversion tends to occur mainly in the lateral leads (I, aVL, V5-6) and may be seen either during ischaemic symptoms or at rest.
Reference: LITFL