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

Clinical Features

Refer to Myocardial infarction

  • May be pain free at presentation and time of EKG
  • May have had previous recent episode of angina +/- associated symptoms
  • Initial cardiac enzymes are frequently normal or only slightly elevated[1][2]

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 (at times terms are reversed in the literature or labeled Type I and II):

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


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

  1. Mattingly BB. Wellens Syndrome. eMedicine website. http://emedicine.medscape.com/article/1512239-overview. Accessed October 1, 2014.
  2. Rezaie S. Wellens’ Syndrome: Is it on your radar? Academic Life in Emergency Medicine website. http://www.aliem.com/wellens-syndrome-is-it-on-your-radar. Accessed October 1, 2014.