Tall, symmetric, narrow “dagger like” pre-cordial t-waves taking off like “rockets” from a depressed (1-3 mm) ST segment.

Different from HATWs because there is no ST-depression in HATWs.

Suggestive of acute high grade LAD occlusion (in contrast to sub-acute occlusion of Wellen’s syndrome). Although no ST-elevation it may represent an unstable lesion for which emergent PCI should be considered. These patients are at high risk for decompensation and may progress to STEMI, therefor you should get serial ECGs.

Case 1 - 33 yo M no PMH with CP that radiates into neck and L arm after a jiu-jitsu match. Patient is sweating and looks awful.