Wellens' syndrome

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  • 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


  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


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


  1. Urgent cardiac catheterization

Stress testing contraindicated, may prove fatal

See Also



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