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

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]
  • Drugs of abuse (cocaine) may cause Wellen's

Differential Diagnosis

  • High voltage
  • PE
  • RBBB
  • Hypokalemia
  • CNS Injury
  • Persistent Juvenile T-wave pattern
  • Digitalis Effect
  • "Normal variant" STE with biphasic T-wave[3][4]
    • Common in young, healthy, black males
    • Differentiate from Wellen's
      • High voltage complexes
      • Notching at J-point ("fishhook")

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 (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

Wellens.jpg

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

Treatment

  • Urgent cardiac catheterization

See Also

Video

References

  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.
  3. Amal Mattu. Mattu ECG Case: April 1 2012. Published Apr 9, 2012. https://www.youtube.com/watch?v=RdnwIWu5HHg.
  4. Wang, et al. ST-segment elevation in conditions other than acute myocardial infarction. NEJM 2003, 349:2128-2135.