Wellens' syndrome

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Background

  • T wave abnormality that is associated with critical LAD stenosis
    • Finding can be transient (persists for hours after pain has resolved and then disappears)
    • Preinfarction stage of CAD, and heralds extensive anterior wall MI

Criteria

  1. Biphasic T waves in leads V2-V3 OR symmetric, often deeply inverted T waves in V2-V3
  2. Prior history of chest pain (CP resolved)
  3. Little or no cardiac enzyme elevation
  4. No pathologic precordial Q waves
  5. Little or no ST-segment elevation
  6. No loss of precordial R waves

Two T-wave Characteristics:

  • A: Biphasic pattern - 75% - Deeply inverted and symmetric T-waves
  • B: Inversion pattern - 25% - Biphasic T-waves (initial + deflection and terminal - deflection)

Wellens.jpg

Note Wellens criteria should not be diagnosed in a patetient with LVH. 

Treatment

  1. Urgent cardiac catheterization

Source

Wellens’ Syndrome. Annals of Emergency Medicine, March, 1999

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