Wellens' syndrome
Wellens' syndrome
- ECG pattern of T-waves in precordial leads associated with critical stenosis of LAD
- T-wave changes usually during pain free period
- In 1982 - Wellens reviewed ECG’s of 145 unstable angina patients
- 18% showed ECG pattern (1/2 at presentation, 1/2 within 24 hours), 75% later developed anterior AMI
- Two types ECG pattern
- Biphasic T-waves in V2 (occasionally V3) - 25% of cases
- Deep symmetrically inverted T-waves in V2 and V3, occasionally all V leads - 75% of cases
Criteria
- no cardiac enzyme elevation
- no pathology precordial Q waves
- no ST elevation
- no loss of precordial R-waves
- biphasic T-waves in leads V2 and V3
Please complete brief neurological examination to exclude SAH or focal neurological event. (ECG changes)
In Wellens’ study almost all had critical stenosis of the L.A.D.
Exercise stress testing is contraindicated in cases of suspected
left main stem stenosis
Initial T-wave changes may be transient or persist for many months
after angioplasty.
Differential Dx T-wave inversion
- Non-Q-wave & Q-wave infarcts
- Wolf-Parkinson-White syndrome
- Pulmonary embolism
- Left ventricular hypertrophy
- Myocarditis
- Stroke
- Digitalis
