Wellens' syndrome: Difference between revisions

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**Finding can be transient (persists for hours after pain has resolved and then disappears)
**Finding can be transient (persists for hours after pain has resolved and then disappears)
**Preinfarction stage of CAD, and heralds extensive anterior wall MI
**Preinfarction stage of CAD, and heralds extensive anterior wall MI
==Differential Diagnosis==
*High voltage
*[[PE]]
*[[ECG (Basics)|RBBB]]
*[[Hypokalemia]]
*CNS Injury
*Persistent Juvenile T-wave pattern
*[[Digitalis Effect]]
{{ST elevation DDX}}


== Diagnosis ==
== Diagnosis ==
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''Note Wellens criteria should not be diagnosed in a patetient with LVH. ''
''Note Wellens criteria should not be diagnosed in a patetient with LVH. ''
==Differential Diagnosis==
*High voltage
*[[PE]]
*[[ECG (Basics)|RBBB]]
*[[Hypokalemia]]
*CNS Injury
*Persistent Juvenile T-wave pattern
*[[Digitalis Effect]]
{{ST elevation DDX}}


==Treatment==
==Treatment==
Line 39: Line 39:
*[[STEMI equivalents]]
*[[STEMI equivalents]]


==Source==
==Video==
{{#widget:YouTube|id=SgTJYu8b6dE}}
 
==References==
Wellens’ Syndrome. Annals of Emergency Medicine, March, 1999
Wellens’ Syndrome. Annals of Emergency Medicine, March, 1999


[[Category:Cards]]
[[Category:Cards]]

Revision as of 17:37, 31 October 2015

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

Differential Diagnosis

ST Elevation

Diagnosis

  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:

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

Wellens.jpg

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

Treatment

  1. Urgent cardiac catheterization

Stress testing contraindicated, may prove fatal

See Also

Video

References

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